Patient experiences of Outpatient clinics in Hereford Hospital

Healthwatch Herefordshire conducted  Enter and View visits of outpatient services at Hereford County Hospital between 11 and 22 March 2019. The study involved interviews with 165 patients attending Ophthalmology, Ear Nose and Throat (ENT), Trauma and Orthopaedic/Fracture Clinic and Radiology, Urology and Rheumatology clinics. The aim was to understand patients' experiences of appointments, communication, waiting times, staffing, clinic environments and access to care. 

Overall, patients were positive about the quality of care they received. Across all clinics, patients consistently described staff as friendly, professional, knowledgeable and caring. Most patients felt safe, treated with dignity and respect, listened to, involved in decisions about their care and given privacy during appointments. Communication from doctors and nurses was generally well regarded, with the majority reporting that information was explained in a way they could understand. 

Patients were broadly satisfied with appointment booking systems, although experiences varied between specialties. Most accepted waiting times for appointments of up to several weeks, but many felt that waits of four to six months were excessive and unreasonable. Patients generally preferred appointment notifications by letter, although some expressed interest in greater use of email, text messages and online booking systems.

Communication was an important theme throughout the report. Patients appreciated receiving clear information but wanted more details about appointment purposes, expected appointment duration, treatments, delays and self-care between visits. Some patients also highlighted difficulties contacting departments by telephone and suggested greater use of electronic communication methods. 

Waiting times after arrival at clinics were generally viewed as acceptable when they remained below 30 minutes. Most patients felt that waits of 15 to 30 minutes were reasonable. Satisfaction fell when waits exceeded 45 minutes, particularly when patients were not informed about delays. Parking concerns often amplified frustration about waiting times because patients worried about parking charges and time limits.

Opinions on automated check-in systems were mixed. Patients in some clinics supported the idea, while others preferred personal interaction with reception staff. Concerns included difficulties for older people, people with visual impairments and those less confident using technology. Many patients stressed that reception staff should remain available even if electronic check-in systems were introduced.

The physical environment of clinics was generally seen as satisfactory, clean and functional, but patients identified several areas for improvement. Common concerns included cramped waiting areas, uncomfortable seating, limited space for wheelchairs and mobility aids, poor signage, outdated notices and a lack of child-friendly facilities. Parking emerged as one of the most frequently raised issues, with patients describing parking charges, shortages of disabled spaces and difficulties accessing spaces close to clinic entrances. 

In Ophthalmology, patients were particularly positive about staff and the quality of care, but some wanted more information about tests, procedures and what to expect at appointments. Concerns included long waits for some appointments, difficulties contacting the department by phone, split appointments across different locations and the cramped layout of the clinic. Awareness of the Eye Care Liaison Officer service was low. 

ENT patients were generally very satisfied with the quality of care and communication. However, some reported confusion after the removal of the department's reception desk and felt clearer signage and instructions were needed. Patients also suggested improvements to clinic décor, seating and information about treatment and delays.

Patients attending Trauma and Orthopaedic, Fracture Clinic and Radiology services gave highly positive feedback about staff and clinical care. Nevertheless, they highlighted concerns about parking, waiting times, overcrowding, wheelchair access, communication between hospital and GP services, and delays in receiving appointment letters. Some patients with mobility problems also found travelling between departments challenging.

Feedback from Urology and Rheumatology clinics was similarly positive regarding staff and care, although some patients reported long waits for initial appointments and concerns about continuity of care when seeing different clinicians. Patients welcomed the concept of the new one-stop clinic but wanted further development of services that reduced the need for multiple visits.

Twenty-two patients had reached outpatient services following attendance at Accident and Emergency (A&E). Experiences were mixed. While many praised staff and the quality of treatment received, over half felt they had not been seen within a reasonable time. Patients reported concerns about long waits, overcrowding, communication, access to information and delays in receiving pain relief. 

Overall, the report concluded that outpatient services at Hereford County Hospital were highly valued and that staff across departments provided compassionate, professional care. However, improvements were recommended in areas including appointment booking, communication, waiting times, parking, clinic environments, family carer involvement, access to information, use of technology and patient support services. The hospital accepted the findings positively and stated that many of the recommendations would be incorporated into ongoing service improvement programmes.