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National Patient Safety Agency Patient Safety Division
National Patient Safety Agency - Patient Safety Division



What does PEAT assess?
A Patient Environment Action Team (PEAT) assessment examines standards in three main areas at each site:

  • Environment: Cleanliness, decoration, linen, furniture and state of repair;
  • Food: Quality of food and its nutritional value;
  • Privacy and Dignity: The quality of sleeping accommodation as well as toilet/bathroom facilities.
How often is PEAT conducted?

PEAT is conducted annually. In 2009 trusts were asked to conduct the assessment between 5 January and 17 April 2009.

Where did PEAT originate?

PEAT was established and developed by NHS Estates as a benchmarking tool to ensure improvement in non-clinical aspects of patient healthcare experience.  The NPSA took over management of PEAT in 2006 after the closure of NHS Estates.  PEAT was established following the publication of the NHS Plan in 2000.

What do the scores say about individual hospitals?

The scores tell us how well individual healthcare providers believe sites are performing in the key areas including cleanliness, food and nutrition, infection control, hand hygiene and design of buildings.  

Why is PEAT necessary?

Hospital food and cleanliness are at the heart of patient confidence in healthcare. PEAT assesses these standards every year and highlights areas for improvement and facilitates the sharing of best practice across the NHS.

How are the scores achieved?

NHS organisations are each given scores from 1 (unacceptable) to 5 (excellent) for standards of environment, food and dignity and privacy within their buildings.  The NPSA publishes these results every year.

Is PEAT self assessed?

Yes.  Assessments are conducted by trusts and they are free to choose which members of their staff conduct the assessment. NPSA recommend involving patients as well as staff from estates and facilities, domestic, catering, nursing and dietetic departments. Some trusts also involve patient forum representatives. Results are fed back to  NPSA and shared amongst the NHS, Care Quality Commission, Monitor and Department of Health.

How reliable are the scores if they are self assessed?

This method of self assessment follows methods used for regulation by the Care Quality Commission and Monitor.  The NPSA provide independent validation for a number of trusts each year, ensuring the assessment is conducted fairly.

Should I worry if my local hospital has received a low score?

There are a variety of factors that can affect the score awarded to an individual hospital site. NPSA recommend that sites with a low score produce individual action plan for improvement.  Any member of the public who has concerns about the scores awarded to their local hospital should contact the hospital directly for advice or help.

Why do trusts with high levels of hospital acquired infections have scored relatively well in PEAT?

PEAT does not directly measure a sites performance in preventing and controlling infection. The environment score includes, amongst other things, a measurement of cleanliness and hand hygiene.  However, it is well established that infection rates are affected by other variables that PEAT does not measure.
The PEAT scores also reflect the findings on the day the assessment was performed.

What happens to sites that do not score very well in PEAT?

The performance management of individual sites is a matter for primary care trusts, strategic health authorities, Monitor and the Care Quality Commission.  These organisations regulate and manage the performance of local NHS healthcare providers and these organisations should determine what, if any, action should be taken.

What does a PEAT assessment team do/ check for?

The aim of the PEAT assessment is to review the key areas from a patient perspective. The team assess NHS healthcare facilities in England with ten or more inpatient beds. Teams look at the quality of the environment, food and privacy and dignity before giving their final score.

Are patients involved in the assessment process?

The NPSA recommends PEAT assessment teams include a patient or patient representative.  In addition teams are encouraged to seek the opinions of patients during their assessment. Some trusts across England actively involve their patient forum or LINKS representatives, something the NPSA would recommend.

Have there been changes in how PEAT is assessed over recent years?

The questions are adapted annually to reflect current key priority areas of the NHS and requirements of patients and their carers/ relatives. The three areas of environment, food and privacy and dignity have remained the same.

What type of trust does PEAT assess?

PEAT assesses all trusts with ten or more inpatient beds. These include acute, mental health and primary care trusts.  It does not assess ambulance trusts or strategic health authorities.

How does PEAT affect a trust’s overall Care Quality Commission (CQC) rating?

The PEAT results are shared with the CQC. The CQC would then compare the PEAT scores with other performance information gathered relating to an individual trust before making an overall assessment.  PEAT scores would not be used in isolation to make decisions about an organisation’s performance