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Hospital assessment: first results published from new patient led programme

September 18, 2013: Highest national average marks for cleanliness compared to food, building maintenance and privacy

HSCIC must be credited as the source of the figures in this release
Regional information to site level available from this report

Hospitals score on average around eight out of 10 for their non-clinical services like catering and the condition of buildings, fixtures and fittings according to the first ever results from a new patient-led assessment programme.

Self-assessments of more than 1,300 health premises in England, each led by a team comprising at least 50 per cent patients, point to high average scores across four different category areas - with the highest national average mark for cleanliness and the lowest for food and hydration.

Today's Health and Social Care Information Centre (HSCIC) report considers the new Patient-Led Assessments of the Care Environment (PLACE) programme, a voluntary initiative covering both the NHS and the independent sector.

PLACE gives prominence to the role of the public (known as patient assessors), who must make up at least 50 per cent of each assessment team, with two patient assessors as a minimum. There were more than 5,800 patient involvements in the 2013 programme.5

All 1,140 eligible NHS sites (including hospitals, hospices and treatment centres) carried out self-assessments in spring 2013 along with 218 independent/voluntary sector sites (the exact number of eligible sites in this sector is not known). Key findings include:

Cleanliness (including assessment of bathrooms, furniture, fixtures and fittings) 6:

  • The national average score was 96 per cent
  • 90 per cent of hospital sites scored more than 80 per cent of which 144 sites scored 100 per cent
  • One site scored less than 40 per cent

Condition, appearance and maintenance (including assessment of decoration, signage, linen and car-parking access) 6:

  • The national average score was 89 per cent
  • 68 per cent of hospital sites scored more than 80 per cent, of which two sites scored 100 per cent
  • Two sites scored less than 40 per cent

Privacy, dignity and wellbeing (including assessment of changing and waiting facilities, appropriate separation of single sex facilities, telephone access and appropriate patient clothing) 6:

  • The national average score was 89 per cent
  • 65 per cent of hospital sites scored more than 80 per cent, of which eighteen sites scored 100 per cent
  • No sites scored less than 40 per cent.

Food and hydration (including assessment of choice, taste, temperature and availability over 24 hours6):

  • The national average score was 85 per cent
  • 70 per cent of hospital sites scored more than 80 per cent, of which four sites scored 100 per cent
  • One site scored less than 40 per cent

There are no set achievement targets for PLACE, but the criteria within the assessments do represent aspects of care which patients and the public have identified as important.

In April 2013 PLACE replaced Patient Environment Action Team (PEAT) assessments that had been undertaken from 2000 - 2012 inclusive.

The report can be accessed at:

All guidance and assessment forms issued in relation to the programme can be found on the NHS England website:


Notes to editors

1. The Health and Social Care Information Centre (HSCIC) was established on April 1 2013 as an Executive Non Departmental Public Body (ENDPB). It is England's trusted data source, delivering high quality information and IT systems to drive better patient services, care and outcomes. Its work includes publishing more than 130 statistical publications annually; providing a range of specialist data services; managing informatics projects and programmes and developing and assuring national systems against appropriate contractual, clinical safety and information standards.

2. The aim of PLACE assessments is to provide a snapshot of how an organisation is performing against a range of non-clinical activities which impact on the patient experience of care - cleanliness; the condition, appearance and maintenance of healthcare premises; the extent to which the environment supports the delivery of care with privacy and dignity; and the quality and availability of food and drink. The criteria included in PLACE assessments are not standards, but they do represent both those aspects of care which patients and the public have identified as important, and good practice as identified by professional organisations whose members are responsible for the delivery of these services, including but not limited to the Healthcare Estates Facilities Managers Association, the Association of Healthcare Cleaning Professionals and the Hospital Caterers Association

The week in which assessments are to be undertaken is determined by HSCIC and individual organisations are given 6 weeks' notice. Thereafter it is for them to arrange the precise date(s) of the assessment. The criteria for the inclusion of hospitals/units in the programme are: all hospitals/units with 10 or more in-patient beds; hospitals/units with fewer than 10 beds where the services provided and the environment in which they are provided clearly are, or are analogous to, a hospital. For example, a small eye hospital or birthing centre would meet the eligibility criteria whereas a small community-based residential home would not. However in the latter case any organisation is free to include such units as they wish regardless of whether they meet the eligibility criteria, and some choose to do so.

3. Hospitals should assess whichever is the greater; up to 10 wards, or 25% of wards. Therefore a hospital with two wards would assess both; a hospital with 10 wards would assess all; a hospital with 30 wards would assess 10; and a hospital with 60 wards would assess 15 (25%). The following should also be assessed: all emergency departments; a minimum of 25% of out-patient departments; a representative sample of 25% of 'common' areas (e.g. corridors); external areas. Although the basic assessment process is common to all, the precise areas undertaken in any particular hospital will vary according to size, services provision, and the precise services on offer.

4. It is a matter for each organisation to recruit their patient assessors, although they have been urged to always approach their local Healthwatch to offer them the opportunity to provide patient assessors. Whether local Healthwatch choose to do so is entirely a matter for them to determine. Anyone can act as a patient assessor except: existing members of staff from the hospital/organisation being assessed; ex-staff from the hospital/organisation who have left within the last two years (this allowing for a common sense approach so that someone who is within a few weeks of having left for two years may be deemed eligible). A total of 5,869 members of the public (whether as patients or former patients, individuals or representatives of other organisations (e.g. local Healthwatch: were involved in assessments during the 2013 programme This number relates to the number of involvements, not the number of individuals since some may have been involved in more than one assessment or on more than one day of a single assessment.

5. The assessment of cleanliness covers all items commonly found in healthcare premises including patient equipment; baths, toilets and showers; furniture; floors and other fixtures and fittings. The assessment of condition, appearance and maintenance includes the above items as well as a range of other aspects of the general environment including décor, tidiness, signage, lighting (including access to natural light), linen, access to car parking (excluding the costs of car parking), waste management and the external appearance of buildings and the tidiness and maintenance of the grounds. The assessment of privacy, dignity and wellbeing includes infrastructural/organisational aspects such as provision of outdoor/recreation areas, changing and waiting facilities, access to television, radio, computers and telephones; and practical aspects such as appropriate separation of sleeping and bathroom/toilet facilities for single sex use, bedside curtains being sufficient in size to create a private space around beds and ensuring patients are appropriately dressed to protect their dignity. The assessment of food and hydration includes a range of questions relating to the organisational aspects of the catering service (e.g. choice, 24-hour availability, meal times, access to menus) as well as an assessment of the food service at ward level and the taste and temperature of food. Food assessment, should be undertaken on one to five wards depending on the number of wards in the hospital according to the following: Up to six wards, one food assessment; Seven to 12 wards, two food assessments; 13 to 18 wards, three food assessments; 19 to 24 wards, four food assessments; 25 or more wards, five food assessments. Treatment Centres without in-patient facilities complete a substantially different and reduced assessment of food to recognise that they do not need to provide a full catering service. The lowest scores in the food category are all from Treatment Centres.

6. PLACE differs from PEAT (other than assessment teams) as follows: areas - for example wards and out-patient departments are scored individually within the PLACE process whereas previously a single score was agreed to reflect all such areas assessed; the food assessment is now split into two sections: the first is for the Trust/organisation to complete in respect of services offered and the second is for the assessment team to complete in respect of service on the ward and the food itself. This assessment may now also take place on more than one ward depending on the size of the site.

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