National Cancer Patient Experience Programme National Survey. South Tees Hospitals NHS Foundation Trust. Published September 2014

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1 National Cancer Patient Experience Programme 2014 National Survey South Tees Hospitals NHS Foundation Trust Published September 2014 The National Cancer Patient Experience Survey Programme is undertaken by Quality Health on behalf of NHS England

2 Introduction The Cancer Patient Experience Survey 2014 (CPES) follows on from the successful implementation of the 2010, 2012 and 2013 surveys, designed to monitor national progress on cancer care. The 2014 survey is congruent with the National Operating Framework (NOF) for the NHS 2014, which defines quality as those indicators of safety, effectiveness and patient experience that indicate that standards are being maintained or improved; with the NHS England Business Plan ; and "Everyone Counts", Planning for Patients The CPES provides information that can be used to drive local quality improvements, both by Trusts and Commissioners, and is consistent with the objectives of NHS policy. Participating Trusts 153 acute hospital NHS Trusts providing cancer services took part in the survey, accounting for every Trust that provides adult cancer care in England. Some specialist hospital Trusts were excluded because of very low numbers of patients being treated for cancer in the data capture period. The number of Trusts has fallen from 160 in 2010 because of Trust amalgamations, especially this year the disbandment of South London Healthcare in 2013 and the reallocation of cancer activity to Lewisham, Kings, and Dartford and Gravesham. Patients selected to take part The survey included all adult patients (aged 16 and over) with a primary diagnosis of cancer who had been admitted to an NHS hospital as an inpatient or as a day case patient, and had been discharged between 1st September and 30th November The three month eligibility period for data capture is identical to that for the 2010, 2012 and 2013 CPES. The Health Research Authority supported the CPES by granting Section 251 approval. Patients eligible for the survey were taken from Trust patient administration systems; the inclusion criteria were that the patient had an International Classification of Disease (ICD10) code of C00-99 (excluding C44 and C84) or D05. As in the 2010, 2012 and 2013 surveys, the types of cancer patients included significant numbers with rarer cancers as well as patients in the Big 4 cancer groups i.e. breast, prostate, lung, and colorectal/lower GI. Trust samples were checked rigorously for duplicates and patient lists were also de-duplicated nationally to ensure that patients did not receive multiple copies of the questionnaire. Deceased checks on Trust samples through the DBS system were carried out on at least three occasions during the fieldwork, to ensure that the numbers of deceased patients in samples was reduced to an absolute minimum. This process was undertaken by Quality Health and was highly effective. 2

3 Survey method Postal surveys were sent to patients home addresses following their discharge. Up to two reminders were sent to non-responders. A freepost envelope was included for their replies. Patients could call a free telephone line to ask questions, complete the questionnaire verbally, or to access an interpreting service. Response rate A total of 118,081 patients who had received treatment for cancer during September to November 2013 were included in the national sample for the Cancer Patient Experience Survey. These patients were allocated to 13 different cancer groups. The numbers of patients in active treatment is rising by about 1.5% each year. 1,143 eligible patients from this Trust were sent a survey, and 707 questionnaires were returned completed. This represents a response rate of 66% once deceased patients and questionnaires returned undelivered had been accounted for. The national response rate was 64% (70,141 respondents). In 2013 the national response rate was 64%. Percentage scores The questions in the cancer survey have been summarised as the percentage of patients who reported a positive experience. For example, the percentage of patients who were given a complete explanation of their diagnostic tests or the percentage of patients who said that nurses did NOT talk in front of them as if they were not there. Neutral responses, such as Don t know and I did not need an explanation are not included in the denominator when computing the score. The higher the score the better the Trust s performance. Some scores represent performance across a pathway involving primary and community care in addition to acute care but represent important parts of the patient experience along the pathway of care. Most of the questions in the 2014 Cancer Patient Experience Survey are in the same format and have the same wording as in the 2013 CPES, and the scoring system for them is unchanged. Low numbers of respondents and data not reported Some Trusts have relatively small numbers of cancer patients, so the total number of respondents to the survey may be low despite the high response rate. Reports for these Trusts have been completed in the normal way, but the results for these Trusts need to be treated with caution. It is important to recognise however, that the low numbers of respondents in these Trusts is simply the result of low numbers of cancer patients being treated. 3

4 Patients were asked to complete the questionnaire in respect of the Trust named on the covering letter. In those Trusts without a radiotherapy or chemotherapy unit, where patients reported receiving these treatments despite these instructions, responses have been suppressed. In almost all Trusts, there were tumour groups where the number of respondents was less than 20; this is particularly true of tumour groups representing rarer cancers. Where numbers of respondents in a particular tumour group is less than 20, we have used the convention of leaving the relevant cell blank. This is further explained in the introduction to the tumour group tables in this report. Benchmark charts Percentage scores are displayed on benchmark bar charts in the following section. Each bar represents the range of results across all Trusts that took part in the survey for one question. The bar is divided into: a red section: scores for the lowest-scoring 2 of Trusts in 2014 a green section: scores for the highest-scoring 2 of Trusts in 2014 an amber section: scores for the remaining of Trusts in 2014 The black circle represents the score for this Trust. For example, if the circle is in the green section of the bar, it means that the Trust is among the top 2 of Trusts in England for that question. The line on either side of the circle shows the 95% confidence interval (the amount of uncertainty surrounding the Trust s score). The table below each benchmarking chart shows the following: Column 1 the Trust score for that question in 2014; Column 2 shows the lower confidence interval at 95% for the 2014 data; Column 3 shows the upper confidence interval at 95% for the 2014 data (the scores in columns three and four are the outer limits of the horizontal black line on the RAG chart); Columns 4 and 5 show the upper threshold for the lowest scoring 2 of Trusts on that question and the lower threshold for the highest scoring 2 of Trusts on that question in 2014 (i.e. the end of the red section, and the beginning of the green section, on the chart); Column 6 shows the highest Trust s score for this question in 2014; Column 7 shows the number of respondents who answered this question at this Trust in 2014; Column 8 shows where the Trust's score for that question in 2014 falls within the highest 2 (cell coloured green) or lowest 2 (cell coloured red) of Trust scores. Where no Trust data or confidence interval is displayed on the RAG chart or in the tables for a particular question, there is insufficient data (below 20 respondents) to allow this to be displayed. 4

5 Following the RAG charts are tables which show the scores for each question for each of the 13 tumour groups at this Trust, with a comparative score for that tumour group for all Trusts. Where the number of responses is lower than 20 for a tumour group at this Trust, the score is suppressed. Charts showing performance over time are incorporated in this report, showing, for the first time in 2014, the scores for each comparable question for this Trust in 2010, 2012, 2013 and 2014, with the national mean score for 2014 shown as a horizontal red line. If a score in 2012, 2013 or 2014 is statistically significantly different from the previous year, this is indicated by the value being either green for positive changes or red for negative changes. Any statistically significant difference between scores in 2010 compared to 2014 is indicated by an asterisk * on top of the bar representing the score for Further information Full details of the survey method are in the National Report of the Cancer Patient Experience Survey 2014, which will be available at from August 2014; further details of survey development, nationally agreed methodology, and cognitive testing are also available at Copies of the questionnaire, covering letters, and a master spreadsheet showing all results for every Trust in England in 2014 and previous years, both at "all cancers" level and at individual tumour group level, can also be viewed at 5

6 Who responded to the survey at this Trust? 707 patients responded to the survey from the Trust. The tables below show the numbers of patients from each tumour group and the age and sex distribution of these patients. Respondents by tumour group Tumour Group Breast Colorectal / Lower Gastrointestinal Lung Prostate Brain/Central Nervous System Gynaecological Haematological Head and Neck Sarcoma Skin Upper Gastrointestinal Urological Other Number of respondents* * These figures will not match the numerator for all questions in the comparisons by tumour group section of this report because not all questions were answered by all responders. Age and sex The survey asked respondents to give their year of birth. This information has been amalgamated into 6 age bands. The age and gender distribution for the Trust was as follows: Missing Total Men Women Missing Total

7 Scored % in highest/lowest 2 of Trusts 2014 Number of responders for this Trust Highest Trust's percentage score Threshold for highest scoring 2 of all Trusts Threshold for lowest scoring 2 of all Trusts Upper 95% confidence interval Lower 95% confidence interval 2014 Percentage for this Trust National Cancer Patient Experience Survey 2014 Trust results Seeing your GP Q1 Saw GP once/twice before being told had to go to hospital Q2 Patient thought they were seen as soon as necessary Q4 Patient's health got better or remained about the same while waiting < worse Percentage score better > RTR Question Q1 Saw GP once/twice before being told had to go to hospital 74% 71% 78% 72% 79% 94% 579 Q2 Patient thought they were seen as soon as necessary 83% 86% 81% 86% 91% 692 Q4 Patient's health got better or remained about the same while waiting 77% 73% 77% 83% 95% 689 7

8 Scored % in highest/lowest 2 of Trusts 2014 Number of responders for this Trust Highest Trust's percentage score Threshold for highest scoring 2 of all Trusts Threshold for lowest scoring 2 of all Trusts Upper 95% confidence interval Lower 95% confidence interval 2014 Percentage for this Trust National Cancer Patient Experience Survey 2014 Diagnostic tests Q6 Staff gave complete explanation of purpose of test(s) Q7 Staff explained completely what would be done during test Q8 Given easy to understand written information about test Q9 Given complete explanation of test results in understandable way < worse Percentage score better > RTR Question Q6 Staff gave complete explanation of purpose of test(s) 89% 86% 92% 81% 86% 92% 583 Q7 Staff explained completely what would be done during test 88% 92% 85% 89% 95% 595 Q8 Given easy to understand written information about test 89% 86% 92% 83% 95% 457 Q9 Given complete explanation of test results in understandable way 82% 79% 85% 75% 82% 91% 605 8

9 Scored % in highest/lowest 2 of Trusts 2014 Number of responders for this Trust Highest Trust's percentage score Threshold for highest scoring 2 of all Trusts Threshold for lowest scoring 2 of all Trusts Upper 95% confidence interval Lower 95% confidence interval 2014 Percentage for this Trust National Cancer Patient Experience Survey 2014 Finding out what was wrong with you Q11 Patient told they could bring a friend when first told they had cancer Q12 Patient felt they were told sensitively that they had cancer Q13 Patient completely understood the explanation of what was wrong Q14 Patient given written information about the type of cancer they had < worse Percentage score better > RTR Question Q11 Patient told they could bring a friend when first told they had cancer 77% 84% 71% 79% 88% 587 Q12 Patient felt they were told sensitively that they had cancer 88% 86% 82% 87% 97% 697 Q13 Patient completely understood the explanation of what was wrong 76% 73% 79% 71% 76% 86% 694 Q14 Patient given written information about the type of cancer they had 73% 69% 77% 68% 76% 84% 585 9

10 Scored % in highest/lowest 2 of Trusts 2014 Number of responders for this Trust Highest Trust's percentage score Threshold for highest scoring 2 of all Trusts Threshold for lowest scoring 2 of all Trusts Upper 95% confidence interval Lower 95% confidence interval 2014 Percentage for this Trust National Cancer Patient Experience Survey 2014 Deciding the best treatment for you Q15 Patient given a choice of different types of treatment Q16 Patient s views definitely taken into account by doctors and nurses discussing treatment Q17 Possible side effects explained in an understandable way Q18 Patient given written information about side effects Q19 Patient definitely told about treatment side effects that could affect them in the future Q20 Patient definitely involved in decisions about care and treatment < worse Percentage score better > RTR Question Q15 Patient given a choice of different types of treatment 89% 85% 93% 82% Patient s views definitely taken into Q16 account by doctors and nurses 74% 71% 78% 69% 74% 85% 626 discussing treatment Q17 Possible side effects explained in an understandable way 79% 76% 83% 72% 78% 85% 648 Q18 Patient given written information about side effects 85% 82% 88% 78% 85% 647 Patient definitely told about treatment Q19 side effects that could affect them in the 59% 55% 62% 52% 59% 69% 598 future Q20 Patient definitely involved in decisions about care and treatment 76% 73% 79% 69% 76% 85%

11 Scored % in highest/lowest 2 of Trusts 2014 Number of responders for this Trust Highest Trust's percentage score Threshold for highest scoring 2 of all Trusts Threshold for lowest scoring 2 of all Trusts Upper 95% confidence interval Lower 95% confidence interval 2014 Percentage for this Trust National Cancer Patient Experience Survey 2014 Clinical Nurse Specialist Q21 Patient given the name of the CNS in charge of their care Q22 Patient finds it easy to contact their CNS Q23 CNS definitely listened carefully the last time spoken to Q24 Get understandable answers to important questions all/most of the time < worse Percentage score better > RTR Question Patient given the name of the CNS in Q21 88% 86% 91% 86% 92% 97% 668 charge of their care Q22 Patient finds it easy to contact their CNS 77% 83% 69% 92% 526 Q23 CNS definitely listened carefully the last time spoken to 93% 91% 95% 93% 98% 580 Q24 Get understandable answers to important questions all/most of the time 92% 95% 88% 93% 97%

12 Scored % in highest/lowest 2 of Trusts 2014 Number of responders for this Trust Highest Trust's percentage score Threshold for highest scoring 2 of all Trusts Threshold for lowest scoring 2 of all Trusts Upper 95% confidence interval Lower 95% confidence interval 2014 Percentage for this Trust National Cancer Patient Experience Survey 2014 Support for people with cancer Q25 Hospital staff gave information about support groups Q26 Hospital staff gave information about impact cancer could have on work/education Q27 Hospital staff gave information on getting financial help Q28 Hospital staff told patient they could get free prescriptions < worse Percentage score better > RTR Question Q25 Hospital staff gave information about support groups 84% 81% 87% 79% 86% 96% 493 Hospital staff gave information about Q26 impact cancer could have on 76% 71% 81% 72% 78% 91% 334 work/education Q27 Hospital staff gave information on getting financial help 49% 44% 54% 48% 61% 84% 372 Q28 Hospital staff told patient they could get free prescriptions 73% 68% 78% 73% 82% 93%

13 Scored % in highest/lowest 2 of Trusts 2014 Number of responders for this Trust Highest Trust's percentage score Threshold for highest scoring 2 of all Trusts Threshold for lowest scoring 2 of all Trusts Upper 95% confidence interval Lower 95% confidence interval 2014 Percentage for this Trust National Cancer Patient Experience Survey 2014 Cancer research Q29 Patient has seen information about cancer research in the hospital Q30 Taking part in cancer research discussed with patient Q31 Patient has taken part in cancer research < worse Percentage score better > RTR Question Q29 Patient has seen information about cancer research in the hospital 91% 89% 93% 82% 88% 96% 693 Q30 Taking part in cancer research discussed with patient 25% 22% 29% 21% 35% 61% 643 Q31 Patient has taken part in cancer research 61% 53% 68% 55% 68%

14 Scored % in highest/lowest 2 of Trusts 2014 Number of responders for this Trust Highest Trust's percentage score Threshold for highest scoring 2 of all Trusts Threshold for lowest scoring 2 of all Trusts Upper 95% confidence interval Lower 95% confidence interval 2014 Percentage for this Trust National Cancer Patient Experience Survey 2014 Operations Q33 Staff gave complete explanation of what would be done Q34 Patient given written information about the operation Q35 Staff explained how operation had gone in understandable way < worse Percentage score better > RTR Question Q33 Staff gave complete explanation of what would be done 87% 93% 85% 94% 380 Q34 Patient given written information about the operation 77% 73% 82% 71% 89% 351 Q35 Staff explained how operation had gone in understandable way 81% 77% 85% 74% 81% 92%

15 Scored % in highest/lowest 2 of Trusts 2014 Number of responders for this Trust Highest Trust's percentage score Threshold for highest scoring 2 of all Trusts Threshold for lowest scoring 2 of all Trusts Upper 95% confidence interval Lower 95% confidence interval 2014 Percentage for this Trust National Cancer Patient Experience Survey 2014 Hospital doctors Q37 Got understandable answers to important questions all/most of the time Q38 Patient had confidence and trust in all doctors treating them Q39 Doctors did not talk in front of patient as if they were not there Q40 Patient s family definitely had opportunity to talk to doctor < worse Percentage score better > RTR Question Q37 Got understandable answers to important questions all/most of the time 87% 84% 91% 79% 86% 95% 421 Q38 Patient had confidence and trust in all doctors treating them 86% 83% 89% 82% 88% 94% 466 Q39 Doctors did not talk in front of patient as if they were not there 85% 82% 88% 81% 87% 94% 464 Q40 Patient s family definitely had opportunity to talk to doctor 75% 71% 79% 64% 71% 89%

16 Scored % in highest/lowest 2 of Trusts 2014 Number of responders for this Trust Highest Trust's percentage score Threshold for highest scoring 2 of all Trusts Threshold for lowest scoring 2 of all Trusts Upper 95% confidence interval Lower 95% confidence interval 2014 Percentage for this Trust National Cancer Patient Experience Survey 2014 Ward nurses Q41 Got understandable answers to important questions all/most of the time Q42 Patient had confidence and trust in all ward nurses Q43 Nurses did not talk in front of patient as if they were not there Q44 Always / nearly always enough nurses on duty < worse Percentage score better > RTR Question Q41 Got understandable answers to important questions all/most of the time 82% 78% 85% 71% 409 Q42 Patient had confidence and trust in all ward nurses 78% 75% 82% 66% 75% 88% 467 Q43 Nurses did not talk in front of patient as if they were not there 87% 84% 81% 89% 93% 461 Q44 Always / nearly always enough nurses on duty 66% 74% 56% 69% 89%

17 Scored % in highest/lowest 2 of Trusts 2014 Number of responders for this Trust Highest Trust's percentage score Threshold for highest scoring 2 of all Trusts Threshold for lowest scoring 2 of all Trusts Upper 95% confidence interval Lower 95% confidence interval 2014 Percentage for this Trust National Cancer Patient Experience Survey 2014 Hospital care and treatment (part 1 of 2) Q45 Patient did not think hospital staff deliberately misinformed them Q46 Patient never thought they were given conflicting information Q47 All staff asked patient what name they preferred to be called by Q48 Always given enough privacy when discussing condition/treatment < worse Percentage score better > RTR Question Q45 Patient did not think hospital staff deliberately misinformed them 92% 95% 86% 91% 95% 460 Q46 Patient never thought they were given conflicting information 81% 78% 85% 77% 83% 94% 461 Q47 All staff asked patient what name they preferred to be called by 67% 63% 72% 67% 85% 459 Q48 Always given enough privacy when discussing condition/treatment 88% 85% 91% 83% 89% 96%

18 Scored % in highest/lowest 2 of Trusts 2014 Number of responders for this Trust Highest Trust's percentage score Threshold for highest scoring 2 of all Trusts Threshold for lowest scoring 2 of all Trusts Upper 95% confidence interval Lower 95% confidence interval 2014 Percentage for this Trust National Cancer Patient Experience Survey 2014 Hospital care and treatment (part 2 of 2) Q49 Always given enough privacy when being examined or treated Q50 Patient was able to discuss worries or fears with staff during visit Q51 Hospital staff did everything to help control pain all of the time Q52 Always treated with respect and dignity by staff < worse Percentage score better > RTR Question Q49 Always given enough privacy when being examined or treated 97% 95% 99% 93% 96% Q50 Patient was able to discuss worries or fears with staff during visit 72% 67% 76% 406 Q51 Hospital staff did everything to help control pain all of the time 89% 86% 92% 83% 88% 95% 405 Q52 Always treated with respect and dignity by staff 87% 93% 81% 88% 94%

19 Scored % in highest/lowest 2 of Trusts 2014 Number of responders for this Trust Highest Trust's percentage score Threshold for highest scoring 2 of all Trusts Threshold for lowest scoring 2 of all Trusts Upper 95% confidence interval Lower 95% confidence interval 2014 Percentage for this Trust National Cancer Patient Experience Survey 2014 Information given to you before leaving hospital and home support Q53 Given clear written information about what should / should not do post discharge Q54 Staff told patient who to contact if worried post discharge Q55 Family definitely given all information needed to help care at home Q56 Patient definitely given enough care from health or social services < worse Percentage score better > RTR Question Given clear written information about Q53 what should / should not do post 86% 83% 82% 88% discharge Q54 Staff told patient who to contact if worried post discharge 96% 95% 98% 92% 96% Q55 Family definitely given all information needed to help care at home 68% 63% 72% 56% 65% 398 Q56 Patient definitely given enough care from health or social services 66% 71% 52% 65% 85%

20 Scored % in highest/lowest 2 of Trusts 2014 Number of responders for this Trust Highest Trust's percentage score Threshold for highest scoring 2 of all Trusts Threshold for lowest scoring 2 of all Trusts Upper 95% confidence interval Lower 95% confidence interval 2014 Percentage for this Trust National Cancer Patient Experience Survey 2014 Hospital care as a day patient / outpatient Q57 Staff definitely did everything to control side effects of radiotherapy Q58 Staff definitely did everything to control side effects of chemotherapy Q59 Staff definitely did everything they could to help control pain Q60 Hospital staff definitely gave patient enough emotional support Q62 Doctor had the right notes and other documentation with them < worse Percentage score better > RTR Question Q57 Staff definitely did everything to control side effects of radiotherapy 86% 81% 91% 75% 83% 91% 222 Q58 Staff definitely did everything to control side effects of chemotherapy 76% 84% 78% 85% 98% 443 Q59 Staff definitely did everything they could to help control pain 86% 83% 79% 86% 93% 407 Q60 Hospital staff definitely gave patient enough emotional support 72% 68% 76% 66% 76% 86% 494 Q62 Doctor had the right notes and other documentation with them 97% 96% 99% 95% 98%

21 Scored % in highest/lowest 2 of Trusts 2014 Number of responders for this Trust Highest Trust's percentage score Threshold for highest scoring 2 of all Trusts Threshold for lowest scoring 2 of all Trusts Upper 95% confidence interval Lower 95% confidence interval 2014 Percentage for this Trust National Cancer Patient Experience Survey 2014 Care from your general practice Q63 GP given enough information about patient`s condition and treatment Q64 Practice staff definitely did everything they could to support patient < worse Percentage score better > RTR Question Q63 GP given enough information about patient`s condition and treatment 97% 96% 99% 93% 97% Q64 Practice staff definitely did everything they could to support patient 71% 67% 75% 62% 71% 83%

22 Scored % in highest/lowest 2 of Trusts 2014 Number of responders for this Trust Highest Trust's percentage score Threshold for highest scoring 2 of all Trusts Threshold for lowest scoring 2 of all Trusts Upper 95% confidence interval Lower 95% confidence interval 2014 Percentage for this Trust National Cancer Patient Experience Survey 2014 Your overall NHS care Q65 Hospital and community staff always worked well together Q67 Given the right amount of information about condition and treatment Q68 Patient offered written assessment and care plan Q69 Patient did not feel that they were treated as a `set of cancer symptoms` Q70 Patient`s rating of care `excellent`/ `very good` < worse Percentage score better > RTR Question Q65 Hospital and community staff always worked well together 71% 68% 75% 69% 83% 662 Q67 Given the right amount of information about condition and treatment 92% 89% 94% 86% 98% 662 Q68 Patient offered written assessment and care plan 23% 2 27% 18% 27% 45% 549 Q69 Patient did not feel that they were treated as a `set of cancer symptoms` 84% 82% 87% 78% 84% 93% 677 Q70 Patient`s rating of care `excellent`/ `very good` 88% 93% 86% 92% 97%

23 Comparisons by tumour group for this Trust The following tables show the Trust and the national percentage scores for each question broken down by tumour group. Where a cell in the table is blank this indicates that the number of patients in that group was below 20 and too small to display. Seeing your GP Q1. Saw GP once/twice before being told had to go to hospital Q2. Patient thought they were seen as soon as necessary Q4. Patient's health got better or remained about the same while waiting Cancer type This Trust National This Trust National This Trust National Breast 98% 92% 95% 91% 94% 93% Colorectal / Lower Gastro 69% 72% 75% Lung 67% 68% 96% 82% 81% 76% Prostate 76% 77% 77% 86% 82% 89% Brain / CNS 61% 78% 64% Gynaecological 77% 73% 85% 69% 72% Haematological 64% 64% 82% 65% 68% Head and Neck 76% 75% 77% 77% 71% 79% Sarcoma 59% 63% Skin 87% 88% 85% 10 94% Upper Gastro 78% 68% 79% 78% 73% 68% Urological 72% 79% 84% 87% 86% Other Cancers 56% 68% 79% 78% 67% 73% All Cancers 74% 75% 83% 83% 77% 23

24 Diagnostic tests Q6. Staff gave complete explanation of purpose of test(s) Q7. Staff explained completely what would be done during test Q8. Given easy to understand written information about test Q9. Given complete explanation of test results in an understandable way Cancer type This Trust National This Trust National This Trust National This Trust National Breast 91% 87% 88% 88% 89% 88% 83% 82% Colorectal / Lower Gastro 88% 84% 88% 91% 89% 85% Lung 87% 84% 91% 88% 95% 87% 85% 77% Prostate 86% 94% 88% 92% 89% 93% 79% Brain / CNS 85% 82% 73% Gynaecological 94% 81% 93% 85% 93% 86% 84% 75% Haematological 83% 94% 87% 79% 84% 72% 75% Head and Neck 83% 93% 86% 84% 93% 77% Sarcoma 82% 86% 84% 75% Skin 91% 88% 92% 88% 88% 92% 83% Upper Gastro 93% 83% 87% 96% 87% 82% 77% Urological 77% 82% 86% 83% 87% 76% 78% Other Cancers 83% 81% 85% 85% 88% 87% 82% 75% All Cancers 89% 84% 87% 89% 87% 82% 78% 24

25 Finding out what was wrong with you Q11. Patient told they could bring a friend when first told they had cancer Q12. Patient felt they were told sensitively that they had cancer Q13. Patient completely understood the explanation of what was wrong Q14. Patient given written information about the type of cancer they had Cancer type This Trust National This Trust National This Trust National This Trust National Breast 91% 82% 92% 88% 87% 79% 76% 77% Colorectal / Lower Gastro 85% 89% 85% 76% 78% 73% 71% Lung 87% 76% 86% 82% 84% 75% 73% 64% Prostate 73% 76% 85% 84% 84% 78% 76% Brain / CNS 83% 81% 64% 61% Gynaecological 88% 88% 81% 72% 63% 67% Haematological 67% 69% 87% 83% 58% 76% 74% Head and Neck 81% 71% 94% 86% 71% 75% 79% 64% Sarcoma 71% 79% 62% 58% Skin 73% 64% 94% 87% 88% 79% 93% 81% Upper Gastro 81% 75% 88% 81% 77% 72% 66% Urological 71% 85% 81% 76% 69% 69% Other Cancers 79% 71% 82% 81% 71% 54% 59% All Cancers 75% 88% 84% 76% 73% 73% 72% 25

26 Deciding the best treatment for you Q15. Patient given a choice of different types of treatment Q16. Patient s views definitely taken into account by doctors and nurses discussing treatment Q17. Possible side effects explained in an understandable way Q18. Patient given written information about side effects Cancer type This Trust National This Trust National This Trust National This Trust National Breast 94% 89% 75% 73% 83% 79% 93% Colorectal / Lower Gastro 87% 84% 76% 73% 78% 78% 83% 83% Lung 85% 84% 79% 71% 76% 84% 82% Prostate 96% 91% 65% 73% 78% 74% 89% 83% Brain / CNS 88% 67% 75% 79% Gynaecological 10 82% 83% 77% 89% 84% Haematological 82% 84% 71% 71% 72% 78% 81% Head and Neck 88% 85% 82% 72% 73% 86% 76% Sarcoma 78% 66% 76% 75% Skin 10 86% 83% 77% 86% 73% 83% 69% Upper Gastro 86% 83% 75% 86% 76% 93% 83% Urological 88% 81% 74% 68% 66% 66% 73% Other Cancers 85% 79% 62% 65% 84% 72% 95% 78% All Cancers 89% 86% 74% 71% 79% 75% 85% 82% Q19. Patient definitely told about treatment side effects that could affect them in the future Q20. Patient definitely involved in decisions about care and treatment Cancer type This Trust National This Trust National Breast 64% 71% 74% Colorectal / Lower Gastro 57% 74% 74% Lung 61% 54% 81% 72% Prostate 64% 66% 73% 75% Brain / CNS 58% 71% Gynaecological 47% 53% 72% Haematological 46% 51% 72% Head and Neck 83% 93% 72% Sarcoma 53% Skin 68% 58% 87% 78% Upper Gastro 71% 54% 81% 71% Urological 51% 48% 82% 68% Other Cancers 54% 62% 68% All Cancers 59% 56% 76% 72% 26

27 Clinical Nurse Specialist Q21. Patient given the name of the CNS in charge of their care Q22. Patient finds it easy to contact their CNS Q23. CNS definitely listened carefully the last time spoken to Q24. Get understandable answers to important questions all/most of the time Cancer type This Trust National This Trust National This Trust National This Trust National Breast 99% 93% 85% 71% 93% 91% 98% 91% Colorectal / Lower Gastro 89% 91% 75% 77% 88% 92% 85% 91% Lung 96% 92% 74% 75% 91% 91% 88% 89% Prostate 97% 88% 85% 72% 94% 91% 94% Brain / CNS 91% 71% 89% Gynaecological 95% 93% 81% 71% 95% 94% 89% Haematological 77% 87% 79% 75% 94% 92% 91% Head and Neck 94% 86% 96% 73% 10 91% 10 Sarcoma 85% 73% 91% 89% Skin 97% 85% 85% 96% 92% 10 92% Upper Gastro 84% 91% 73% 74% 93% 91% 94% 91% Urological 77% 79% 75% 72% 85% 91% 93% Other Cancers 74% 83% 73% 93% 78% All Cancers 88% 89% 73% 93% 91% 92% 91% 27

28 Support for people with cancer Q25. Hospital staff gave information about support groups Q26. Hospital staff gave information about impact cancer could have on work/education Q27. Hospital staff gave information on getting financial help Q28. Hospital staff told patient they could get free prescriptions Cancer type This Trust National This Trust National This Trust National This Trust National Breast 92% 89% 77% 78% 42% 58% 62% 77% Colorectal / Lower Gastro 86% 83% 87% 76% 54% 52% 85% 81% Lung 82% 84% 85% 74% 69% 86% 83% Prostate 96% 85% 78% 65% 41% 69% 74% Brain / CNS 82% 74% 65% 75% Gynaecological 84% 83% 65% 72% 45% 56% 74% Haematological 82% 67% 77% 43% 55% 73% 82% Head and Neck 96% 84% 88% 76% 67% 55% 92% 81% Sarcoma 75% 53% 74% Skin 83% 84% 72% 49% 71% 56% Upper Gastro 85% 83% 78% 75% 49% 55% 84% Urological 76% 69% 76% 63% 38% 33% 64% 65% Other Cancers 79% 79% 77% 66% 48% 52% 52% 76% All Cancers 84% 83% 76% 75% 49% 54% 73% 78% 28

29 Cancer research Q29. Patient has seen information about cancer research in the hospital Q30. Taking part in cancer research discussed with patient Q31. Patient has taken part in cancer research Cancer type This Trust National This Trust National This Trust National Breast 95% 88% 26% 35% 61% 59% Colorectal / Lower Gastro 92% 86% 7% 29% 61% Lung 88% 15% 3 58% Prostate 84% 85% 39% 34% 58% Brain / CNS 85% 37% 75% Gynaecological 94% 86% 43% 29% 48% 64% Haematological 88% 3 37% 83% 71% Head and Neck 97% 88% 67% 34% 69% Sarcoma 86% 35% 64% Skin 91% 1 17% 59% Upper Gastro 93% 88% 18% 34% 63% Urological 78% 2% 14% 58% Other Cancers 95% 88% 3 35% 63% All Cancers 91% 86% 25% 31% 61% 63% 29

30 Operations Q33. Staff gave complete explanation of what would be done Q34. Patient given written information about the operation Q35. Staff explained how operation had gone in understandable way Cancer type This Trust National This Trust National This Trust National Breast 88% 81% 84% 71% 78% Colorectal / Lower Gastro 85% 87% 65% 73% 81% 82% Lung 89% 68% 75% Prostate 96% 88% 92% 84% 84% 75% Brain / CNS 83% 61% 71% Gynaecological 93% 87% 82% 77% 87% 79% Haematological 81% 84% 77% 64% 76% 75% Head and Neck 96% 86% 81% 65% 88% 77% Sarcoma 84% 56% 78% Skin 96% 89% 81% 88% 79% Upper Gastro 10 89% 75% 87% 79% Urological 79% 86% 64% 73% 78% 74% Other Cancers 85% 65% 75% All Cancers 88% 77% 76% 81% 78% 30

31 Hospital Doctors Q37. Got understandable answers to important questions all/most of the time Q38. Patient had confidence and trust in all doctors treating them Q39. Doctors did not talk in front of patient as if they were not there Q40. Patient's family definitely had opportunity to talk to doctor Cancer type This Trust National This Trust National This Trust National This Trust National Breast 87% 85% 84% 86% 83% 65% 71% Colorectal / Lower Gastro 94% 84% 93% 86% 91% 81% 77% 67% Lung 78% 88% 82% 88% 88% 66% Prostate 83% 84% 87% 87% 86% 68% 69% Brain / CNS 77% 81% 79% Gynaecological 98% 84% 96% 86% 94% 86% 85% 67% Haematological 68% 82% 73% 82% 76% 82% 68% Head and Neck 88% 83% 96% 85% 89% 82% 92% Sarcoma 82% 84% 81% 68% Skin 89% 89% 85% 72% Upper Gastro 91% 81% 86% 83% 81% 78% 74% 65% Urological 84% 79% 81% 85% 78% 81% 69% 61% Other Cancers 79% 79% 83% 65% All Cancers 87% 83% 86% 85% 85% 84% 75% 67% 31

32 Ward Nurses Q41. Got understandable answers to important questions all/most of the time Q42. Patient had confidence and trust in all ward nurses Q43. Nurses did not talk in front of patient as if they were not there Q44. Always / nearly always enough nurses on duty Cancer type This Trust National This Trust National This Trust National This Trust National Breast 86% 78% 83% 73% 91% 89% 72% 66% Colorectal / Lower Gastro 72% 75% 67% 67% 82% 82% 74% 56% Lung 89% 75% 87% 82% 74% 61% Prostate 87% 79% 81% 74% 83% 87% 65% 68% Brain / CNS 66% 69% 78% 61% Gynaecological 89% 76% 88% 69% 96% 85% 61% Haematological 75% 78% 81% 72% 88% 85% 74% 59% Head and Neck 69% 73% 75% 67% 86% 82% 75% Sarcoma 79% 69% 83% 63% Skin 79% 87% 76% Upper Gastro 82% 73% 67% 83% 82% 55% 57% Urological 89% 74% 77% 72% 87% 85% 62% Other Cancers 71% 66% 84% 56% All Cancers 82% 76% 78% 71% 87% 85% 62% 32

33 Hospital care and treatment Q45. Patient did not think hospital staff deliberately misinformed them Q46. Patient never thought they were given conflicting information Q47. All staff asked patient what name they preferred to be called by Q48. Always given enough privacy when discussing condition or treatment Cancer type This Trust National This Trust National This Trust National This Trust National Breast 94% 91% 81% 82% 52% 54% 89% 87% Colorectal / Lower Gastro 96% 87% 78% 61% 64% 86% 84% Lung 82% 85% 82% 77% 83% 65% 82% 82% Prostate 97% 91% 87% 84% 77% 57% 87% 86% Brain / CNS 82% 74% 59% Gynaecological 96% 88% 85% 79% 73% 58% 89% 83% Haematological 86% 87% 72% 76% 72% 62% 84% 86% Head and Neck 96% 88% 82% 79% 52% 93% 86% Sarcoma 87% 74% 86% Skin 93% 86% 53% Upper Gastro 85% 84% 73% 69% 84% Urological 93% 88% 82% 77% 64% 83% 84% Other Cancers 85% 73% 81% All Cancers 92% 88% 81% 79% 67% 88% 85% Q49. Always given enough privacy when being examined or treated Q50. Patient was able to discuss worries or fears with staff during visit Q51. Hospital staff did everything to help control pain all of the time Q52. Always treated with respect and dignity by staff Cancer type This Trust National This Trust National This Trust National This Trust National Breast 96% 95% 72% 66% 93% 88% 88% 86% Colorectal / Lower Gastro 10 94% 68% 64% 87% 85% 86% 82% Lung 10 94% 64% 62% 86% 84% 96% 84% Prostate 94% 94% 85% 67% 88% 86% Brain / CNS 92% 58% 84% 82% Gynaecological 10 94% 68% 64% 95% 85% 96% 84% Haematological 95% 94% 75% 67% 94% 86% 92% 86% Head and Neck 10 94% 77% 63% 92% 83% 93% 84% Sarcoma 94% 65% 86% 85% Skin 95% 72% 86% 88% Upper Gastro 96% 95% 75% 65% 88% 84% 86% 83% Urological 94% 94% 58% 63% 83% 82% 91% 84% Other Cancers 94% 84% 83% All Cancers 97% 95% 72% 65% 89% 86% 84% 33

34 Information given to you before you left hospital and home support Q53. Given clear written information about what should / should not do post discharge Q54. Staff told patient who to contact if worried post discharge Q55. Family definitely given all information needed to help care at home Q56. Patient definitely given enough care from health or social services Cancer type This Trust National This Trust National This Trust National This Trust National Breast 91% 98% 97% 58% 61% 67% 59% Colorectal / Lower Gastro 83% 84% 98% 95% 65% 62% 59% 67% Lung 81% 10 93% 85% 59% 69% 59% Prostate 86% 94% 94% 78% 62% 53% Brain / CNS 82% 91% 62% 54% Gynaecological 96% 86% 10 95% 81% 58% 67% 55% Haematological 85% 82% 96% 96% 79% 63% 64% 59% Head and Neck 96% 85% 96% 93% 76% 63% 82% 53% Sarcoma 79% 93% 58% 57% Skin 87% 94% 64% 59% Upper Gastro 78% 79% 91% 94% 57% 74% Urological 77% 82% 91% 89% 55% 58% 51% Other Cancers 92% 55% 59% All Cancers 86% 85% 96% 94% 68% 66% 59% 34

35 Hospital care as a day patient / outpatient Q57. Staff definitely did everything to control side effects of radiotherapy Q58. Staff definitely did everything to control side effects of chemotherapy Q59. Staff definitely did everything they could to help control pain Q60. Hospital staff definitely gave patient enough emotional support Cancer type This Trust National This Trust National This Trust National This Trust National Breast 86% 86% 82% 83% 67% 67% Colorectal / Lower Gastro 86% 78% 72% 81% 84% 82% 77% 71% Lung 77% 93% 83% 85% 82% 81% 71% Prostate 67% 81% 64% 81% 67% 58% 71% Brain / CNS 78% 76% 83% 64% Gynaecological 81% 89% 83% 10 82% 79% 69% Haematological 83% 79% 73% 82% 86% 84% 71% 72% Head and Neck 95% 79% 10 82% 92% 84% 71% Sarcoma 78% 81% 83% Skin 77% 79% 67% 78% 79% 74% Upper Gastro 92% 78% 96% 82% 75% 69% Urological 10 76% 83% 77% 76% 69% 69% Other Cancers 79% 74% 84% 79% 52% 65% All Cancers 86% 79% 81% 86% 82% 72% Q62. Doctor had the right notes and other documentation with them Cancer type This Trust National Breast 98% 96% Colorectal / Lower Gastro 97% 96% Lung 96% 96% Prostate 95% 96% Brain / CNS 94% Gynaecological 10 96% Haematological 97% 97% Head and Neck 97% 96% Sarcoma 94% Skin 96% 95% Upper Gastro 99% 95% Urological 10 96% Other Cancers 10 95% All Cancers 97% 96% 35

36 Care from your general practice Q63. GP given enough information about patient's condition and treatment Q64. Practice staff definitely did everything they could to support patient Cancer type This Trust National This Trust National Breast 96% 96% 74% 66% Colorectal / Lower Gastro 10 95% 59% 66% Lung 98% 95% 78% 68% Prostate 10 95% 61% 72% Brain / CNS 89% 55% Gynaecological 10 94% 65% Haematological 94% 96% 63% 64% Head and Neck 10 94% 83% 64% Sarcoma 95% Skin 10 95% 81% 71% Upper Gastro 93% 94% 73% 69% Urological 98% 94% 71% 68% Other Cancers 10 94% 63% 64% All Cancers 97% 95% 71% 66% 36

37 Your overall NHS care Q65. Hospital and community staff always worked well together Q67. Given the right amount of information about condition and treatment Q68. Patient offered written assessment and care plan Q69. Patient did not feel that they were treated as 'a set of cancer symptoms' Cancer type This Trust National This Trust National This Trust National This Trust National Breast 74% 63% 93% 88% 22% 22% 84% 79% Colorectal / Lower Gastro 69% 62% 94% 89% 25% 25% 83% 83% Lung 69% 65% 89% 87% 21% 21% 81% 79% Prostate 68% 66% 97% 89% 24% 2 78% 83% Brain / CNS 51% 83% 21% 76% Gynaecological 77% 61% 93% 86% 18% 2 81% Haematological 69% 66% 25% 24% 83% 83% Head and Neck 87% 63% 87% 87% 29% 24% 94% 81% Sarcoma 57% 86% 21% 79% Skin 68% 97% 91% 21% 21% 89% Upper Gastro 68% 61% 93% 87% 32% 23% 79% Urological 69% 64% 87% 88% 25% 19% 83% Other Cancers 68% 57% 89% 85% 15% 18% 67% 76% All Cancers 71% 63% 92% 88% 23% 22% 84% 81% Q70. Patient s rating of care excellent / very good Cancer type This Trust National Breast 92% Colorectal / Lower Gastro 92% 89% Lung 92% 88% Prostate 92% 87% Brain / CNS 86% Gynaecological 96% 88% Haematological 88% 92% Head and Neck 97% 89% Sarcoma 89% Skin 88% 89% Upper Gastro 87% 87% Urological 89% 86% Other Cancers 82% 86% All Cancers 89% 37

38 YEAR ON YEAR SCORES FOR COMPARABLE QUESTIONS Set out below are scores for each comparable question in the Cancer Patient Experience Surveys between 2010 and 2014 for this Trust. The scoring system is the same each year for most questions. If a score in a year is statistically significantly different from the previous year, then it is indicated as such by a green colouring of the percentage on top of the bar if the score is higher, or a red percentage if the score is lower than the previous year. If the score in 2014 is significantly higher or lower than in 2010 for the Trust, then an asterisk has been placed on top of the bar for Some questions in the survey are not scored as they are indicator questions showing what happened to a patient. These are: Q3 (time elapsed before seeing hospital Dr); Q5 (had tests); Q10 (who told you that you had cancer); Q32 (had an operation); Q36 (had an op or stayed overnight in last year); Q61 (had an outpatient appointment in last year); and Q66 (had treatment by one of these professionals). These questions are reported in the year on year charts below but no significance tests have been used to measure change from one year to the next, as they are indicators of volume of activity or time which are not direct measures of Trust performance. Some questions have no values for some earlier years as they were introduced in to the survey after

39 Q1 Saw GP once/twice before being told had to go to hospital % 74% 74% 74% Q2 Patient thought they were seen as soon as necessary % 84% 85% 83% 39

40 Q3 Patient seen by hospital doctor within 3 months (indicator question) 10 96% 96% 96% Q4 Patient's health got better or remained about the same while waiting % 78% 79% 77% 40

41 Q5 Had diagnostic test(s) for cancer in the last 12 months (indicator question) % 86% 89% Q6 Staff gave complete explanation of purpose of test(s) % 83% 85% 89% * 41

42 Q7 Staff explained completely what would be done during test % 89% 87% Q8 Given easy to understand written information about test % 87% 88% 89% 42

43 10 Q9 Given complete explanation of test results in understandable way % 79% 81% 82% Q10 Patient first told they had cancer by a hospital doctor (indicator question) 10 97% 98% 98%

44 10 Q11 Patient told they could bring a friend when first told they had cancer % 79% 82% Q12 Patient felt they were told sensitively that they had cancer % 83% 86% 88% 44

45 Q13 Patient completely understood the explanation of what was wrong % 75% 72% 76% * Q14 Patient given written information about the type of cancer they had % 71% 71% 73% * 45

46 Q15 Patient given a choice of different types of treatment % 89% 88% 79% Q16 Patient s views definitely taken into account by doctors and nurses discussing treatment % 71% 74% 46

47 Q17 Possible side effects explained in an understandable way % 78% 79% 79% Q18 Patient given written information about side effects % 82% 85% * 47

48 10 Q19 Patient definitely told about treatment side effects that could affect them in the future % 59% Q20 Patient definitely involved in decisions about care and treatment % 72% 76% 48

49 Q21 Patient given the name of the CNS in charge of their care % 88% 89% 88% * Q22 Patient finds it easy to contact their CNS % 81% 82% * 49

50 Q23 CNS definitely listened carefully the last time spoken to % 94% 93% 93% Q24 Get understandable answers to important questions all/most of the time % 94% 92% 92% 50

51 Q25 Hospital staff gave information about support groups % 84% 83% 84% Q26 Hospital staff gave information about impact cancer could have on work/education % 76% 51

52 Q27 Hospital staff gave information on getting financial help % 54% 53% 49% Q28 Hospital staff told patient they could get free prescriptions % 74% 75% 73% 52

53 Q29 Patient has seen information about cancer research in the hospital % 91% Q30 Taking part in cancer research discussed with patient % 26% 25% 53

54 Q31 Patient has taken part in cancer research % 61% Q32 Had an operation during the last 12 months (indicator question) % 57% 56% 54

55 Q33 Staff gave complete explanation of what would be done % 89% Q34 Patient given written information about the operation % 77% 72% 77% 55

56 Q35 Staff explained how operation had gone in understandable way % 79% 81% Q36 Had an operation or overnight hospital stay during the last 12 months % 68% 67% 56

57 Q37 Got understandable answers from Drs. to important questions all/most of the time % 84% 84% 87% Q38 Patient had confidence and trust in all doctors treating them % 84% 87% 86% 57

58 Q39 Doctors did not talk in front of patient as if they were not there % 84% 86% 85% Q40 Patient s family definitely had opportunity to talk to doctor % 71% 67% 58

59 10 Q41 Got understandable answers from Ward nurses to important questions all/most of the time % 78% 79% 82% Q42 Patient had confidence and trust in all ward nurses % 71% 73% 78% * 59

60 Q43 Nurses did not talk in front of patient as if they were not there % 88% 87% 84% Q44 Always / nearly always enough nurses on duty % 65% 60

61 Q45 Patient did not think hospital staff deliberately misinformed them % 89% 92% Q46 Patient never thought they were given conflicting information % 81% 86% 81% 61

62 Q47 All staff asked patient what name they preferred to be called by % 61% 64% Q48 Always given enough privacy when discussing condition/treatment 86% 85% 86% 88% 62

63 Q49 Always given enough privacy when being examined or treated 94% 92% 95% * 97% Q50 Patient was able to discuss worries or fears with staff during visit % 71% 72% 63

64 Q51 Hospital staff did everything to help control pain all of the time % 84% 85% 89% Q52 Always treated with respect and dignity by staff % 81% * 87% 64

65 Q53 Given clear written information about what should / should not do post discharge % 84% 84% 86% Q54 Staff told patient who to contact if worried post discharge 93% * 96% 96% 96% 65

66 10 Q55 Family definitely given all information needed to help care at home % 64% 68% * Q56 Patient definitely given enough care from health or social services % 62% 66% 66% 66

67 Q57 Staff definitely did everything to control side effects of radiotherapy % 86% 81% 81% Q58 Staff definitely did everything to control side effects of chemotherapy % 81% 84% 67

68 Q59 Staff definitely did everything they could to help control pain % 82% 83% 86% Q60 Hospital staff definitely gave patient enough emotional support % 71% 72% 68

69 Q61 Had an outpatients appointment in the last 12 months 10 96% 96% 95% Q62 Doctor had the right notes and other documentation with them 96% 96% 97% 97% * 69

70 Q63 GP given enough information about patient`s condition and treatment 94% 96% 96% 97% * Q64 Practice staff definitely did everything they could to support patient % 74% 71% 70

71 Q65 Hospital and community staff always worked well together % 69% 71% 63% Q67 Given the right amount of information about condition and treatment % 91% 92% 71

72 Q68 Patient offered written assessment and care plan % 24% 23% Q69 Patient did not feel that they were treated as a `set of cancer symptoms` % 79% 83% 84% 72

73 Q70 Patient`s rating of care `excellent`/ `very good` % 73

74 The National Cancer Patient Experience Survey was undertaken by Quality Health, which specialises in measuring patients experiences of hospital, primary care and mental health services, using this information to improve the quality of health care and the responsiveness of health services to patients and service users needs. Quality Health works with all acute hospitals in England, all independent providers of hospital care, all Health Boards in Scotland, Wales and Northern Ireland using rigorous survey methods to evaluate the quality of services to patients, the outcomes of operative procedures and health gain, and establish the views of NHS staff. Quality Health also works for international healthcare Providers on 5 continents. Quality Health is an approved contractor for the Care Quality Commission survey programmes of patients and staff in the NHS and also undertakes data collection and survey systems for the National Patient Reported Outcomes programme on behalf of NHS England. Quality Health has headquarters in North Derbyshire. Further information on the National Cancer Patient Experience Survey programme and the 2013/14 survey can be obtained at Crown Copyright Produced by NHS England The text of this document may be reproduced without formal permission or charge for personal or in-house use. Published September info@quality-health.co.uk 74