Complaints Annual Report Author: Sarah Housham, Senior Complaints and PALS Officer

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1 Complaints Annual Report Author: Sarah Housham, Senior Complaints and PALS Officer 1

2 Rnoh Complaints Annual Report 2014 / 2015 Complaints Handling & the Principles of Remedy Introduction Complaints are considered a vital source for identifying where services and care require improvement to their quality. Formal complaints are investigated thoroughly following the Trust s Complaint Policy. All staff are encouraged to manage complaints raised in an effective and timely manner rather than letting them escalate to a formal complaint. Complaints data is reported to the Clinical Quality Governance Committee (CQGC), Patient Experience Improvement Committee (PEIC) and the divisions monthly, inclusive of numbers, category, subcategory, department and risk rank. Statistics are recorded on the Trust Balanced Scorecard and subsequently shared with the Trust Board. Complaints and their responses are seen by the Director of Nursing and the Chief Executive. A Patient Experience Story (based on a formal complaint) is presented to the Trust Board on a monthly basis. Examples of complaints, the outcomes and changes made as a result of the complaint are published regularly on the Trust website. The aim of this report is to: Provide assurance that the Trust follows its Complaints Policy and procedures when investigating and responding to formal complaints addressed to the Trust. Show examples in which data from complaints and lessons learned from complaint investigations have been used to improve the quality of patient care during the year. Set out recommendations and an action plan for 2015/16 for areas of non-compliance and ways in which further improvements could be made to both the complaints process and the use that the Trust makes of formal complaints received from patients and their representatives. This report is limited to a review of formal complaints received up until April 2015 and is produced in order to meet NHS Complaints regulations to ensure the Board of directors and our patients are aware of all complaints related work. The Trust s complaints service is easily accessible through , writing to the CEO or Complaints Department, telephone contact and face to face interaction. An acknowledgement of the received complaint is made within 2 working days, which acknowledges the complainant s concerns and conveys that we aim to complete the complaint investigation within 25 working days. The complaints legislation indicates that the Trust must investigate the complaint in a manner appropriate to resolve it speedily and efficiently and keep the complainant informed. When a response is not possible within the agreed timescale, a new completion date should be agreed with the complainant, who, in addition, must be kept informed of progress throughout the investigation. We work with the notion of being flexible in resolving complaints. RNOH aims to provide a response in as timely a manner as possible setting an internal benchmark of 25 days. The Trust aims to remedy complaints locally through investigation and meetings if appropriate, 2

3 however if the complainant remains dissatisfied they have the right to refer their complaint to the Parliamentary and Health Service Ombudsman (PHSO) as the second stage. The Trust works with the PHSO s Principles of Remedy. Principles being: encompassing fairness; taking responsibility; acknowledging failures and apologising for them; making amends and to using the opportunity to improve our services. Following the Clwyd-Hart Report A Review of the NHS Hospitals Complaints System Putting Patients Back in the Picture and the Patients Association - Good Practice Standards for NHS Complaints Handling, an action plan was produced. Of the 50 recommendations, there are 38 which the Trust identified with. 28 of these are now complete. The remaining actions are due for completion within April Audit Findings There were several actions recommended by an internal audit of the complaints process made in 2015 for action in 2015/16. Action Status 1 Complaints Policy Adequate 2 Communication of Complaints Procedure Adequate 3 Complaints Handling Improvements required on timeliness of investigations and on updating complainants as to delays 4 Complaint Action Plans Reminders to be sent to investigators weekly for production of late action plans. Owners of action plans to provide evidence of completed actions. Trust to share learning from complaints across the Trust. 5 Complaints Process Feedback The Trust to formalise a process of gathering feedback from complainants 6 Complaints Trend Analysis Adequate 7 Reporting Adequate Table 1. Internal audit action plan Analysis of complaints received The Complaints Department provided monthly updates to the CQGC on the number of new formal complaints received, key themes and the number of responses that are sent to the complainant within the guidelines of 25 working days. The Trust performance target is 25 working days for completion of formal complaint investigations unless otherwise discussed with the complainant. Complaints reporting is shared with the PEIC quarterly. No. of formal complaints No. referred to PHSO* No. of re-opened complaints received % (17) Table 2. Representation of unsatisfied complaints *Parliamentary Healthcare Service Ombudsman (PHSO) During 2014/15 the Trust has received 92 formal complaints, compared to 91 in 2013/14 which is an increase of approx. 2%. One complaint was reviewed by the PHSO which was not upheld. 3

4 14 Complaints per Month / / Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Chart 1. Number of complaints/month and annual trends There is a trend of peaks in May, November and January when the volume of complaints received is greater. Traditionally summer months are quieter with the number of complaints received. The number of complaints received has ranged from 3 13 with an average of 8 per month. This is the same finding as 2013/14. The Trust receives a small number of complaints with consideration to the number of patient contacts across the Trust. Years Period No. of Complaints Number of Patient Contacts * 2014/15 Q Q Q Q Table 3. Number of complaints and number by patient contacts *Patient contacts includes inpatient admissions, day cases and outpatient appointments Complaints per 1000 patient contacts Benchmarking against other organisations It is hoped that this aspect will be strengthened in the coming year. Connections are being made with UCLH and Royal Orthopaedic Hospital, Birmingham. Complaint Categories The numbers of complaints by category are displayed in the chart 2, below: Please note complaints can span more than 1 category which is why the numbers displayed below exceed the total number of complaints received. Patients most frequently complained about clinical treatment, appointments, poor communication across the disciplines, along with attitude of staff across the disciplines. The Trust received very few complaints about transport, patient property and documents & records. 4

5 Chart 2: Complaints categories received from to The top three complaint categories are divided into subcategories and illustrated in the following charts 3, 4, and Complaints Concerning Clinical Treatment and Diagnosis Concerns raised about the competency of medical staff attributed to 32% (13) of clinical treatment & diagnosis complaints. Whilst 22% (9) complaints referred to adverse outcomes of treatment. 9% (4) were concerned with diagnosis issues. Chart 3: Subcategories of complaints concerning clinical treatment and diagnosis

6 2. Complaints Concerning Appointments, Admission and Discharge Over recent months there has been an increase in dissatisfaction from patients having to contact the Trust to find out when their appointments are. Some patients are then discovering that appointments have not been made and they have slipped through the net. Issues concerning referrals, delays at appointments, and rescheduled/cancelled appointments each represent 14% (5) of this category. These complaints were concerned with referrals not being actioned in a timely manner, appointments frequently cancelled and rescheduled - one of which meant the patient was not going to be seen for over a year. There has been an increase in formal complaints and informal complaints (managed through PALS) reporting dissatisfaction in rescheduled and cancelled appointments. This relates particularly to one clinic. As a result this clinic s list has been reviewed and managed to better accommodate capacity and demand. Chart 4: Subcategories of complaints concerning appointments, admissions and discharges Complaints Concerning Staff Attitude Complaints raised about staff attitude have remained at a frequent rate throughout the year. No repeat pattern is noted concerning individual staff members. Staff attitude complaints are managed by the investigator and discussed with the individuals mentioned by either the investigator or line manager and managed accordingly. Upheld nursing complaints have been managed in the following ways: customer care training; Human Resources disciplinary process; temporary staff member stopped from working until appropriate customer care training is complete with forward monitoring. Complaints about medical staff s attitude have received limited feedback on the actions taken as a result. One medical complaint was managed with support from the Medical Director and workload reduced to assist in supporting the staff member and their levels of stress. Chart 5: Staff attitude breakdown by profession

7 Complaints by Department Spinal Surgery received 2 of complaints in 2014/15. Many of these complaints are related to patients having expectations of surgery which were not reached. This is a recognised trend across all surgical departments. Related to this, our Consent Policy and process is currently being reviewed. Complaints by Department SSU JRU Nursing Imaging/Radiology F&A Physio PNI Estates Rheumatology Sarcoma Upper Limb Pain Service Prosthetics Transport ISS Urology Commissioning CBO Anaesthetics Paediatric Service Pharmacy Occ Therapy Plaster Theatre Rehab Service 2% 1% 2% 2% 1% 1% 1% 1% 1% 2 12% 4% 4% 5% 5% 5% 12% Chart 6: Breakdown of complaints per department from

8 Complaint Outcomes Chart 7. Outcomes of complaints 2014/15 58% of complaints received were upheld. 20% (18) of complaints were found not to be upheld. At the end of the financial year, 11% (10) of complaints received in 2014/15 remained under investigation. 10% (9) were withdrawn either by the complainant or the Trust for a variety of reasons. 2 complaints remain under Root Cause Analysis investigation. Department Statistics The top 3 departments that received complaints and their statistics are as follows in table 4 Department No. of Upheld Partially Not Upheld Withdrawn Ongoing complaints Upheld Spinal Surgical 24 9 (37.) 4 (17%) 5 (21%) 2 3 Unit Joint (25%) 2 (17%) 3 4 Reconstruction Unit Nursing 12 6 (50%) 4 (3) Table 4. Top three department and complaint outcomes Number of Complaints Resolved and Agreed Timescales Of the complaints received within 2014/15, 39% of these were answered within our guidelines of 25 working days. Other cases over the 25 working days, we closed within an agreed timeframe specific to the complainant. The majority of the complaints closed outside of the 25 day timescale were either complex ones which involved multiple services, complaints involving great depth of investigative methods or those which raised additional issues during the course of the investigation. Long delays were also caused during the investigative period due to investigator s work capacity and the other demands of their role. This aspect has deteriorated during the year resulting in complaints being open for longer and also dissatisfied complainants. Such concerns were raised by the complaints manager with the management structure of the relevant department. 8

9 One of our aims for 2015/16 is to build on the considerable work already undertaken to improve timely responses. Number of Complaints Referred to the Parliamentary & Health Service Ombudsman (PHSO) If the complainant remains dissatisfied with the response they receive, they can request the Ombudsman independently reviews their complaint. The Ombudsman may: Refer the complainant back to the Trust to complete local resolution Ask the Trust to consider if further local resolution is an option Request the case file for screening assessment Having assessed the case file, decide not to investigate further Having assessed the case file, appoint an Investigating Officer to carry out a review on paper During 2014/15 a total of 1 complaint was referred to the Parliamentary & Health Service Ombudsman and no further actions or recommendations were made for these. To date, there are no active cases with the PHSO. The table below illustrates the area which the complaints referred to. Department No Complaints referred to Comments PHSO Spinal Surgery 1 Not upheld Actions taken to Improve Services as a Result of Complaints Received The Trust recognises the value of complaints and the importance they hold in improving services. To ensure organisational learning from complaints, any recommendations made following investigation of a complaint are now being recorded and monitored. An action log is kept to ensure that any recommendations from complaint investigations are implemented. As a means of monitoring this, a summary is presented to individual directorates of the Trust. The table below highlights a selection of some of the lessons learned from complaints over the past year. What Our Patients Said Complainant unable to book outpatient appointments in a timely manner What We Did New Service Manager in the Central Booking Office is ensuring all the schedulers are following the ABC processes. In addition, the partial booking service will ensure that patients are not missed for their follow-ups. Pathway Co-ordinators have been alerted to the need to be aware of the failings when no appointments are available and how to escalate this. Completion of ICE requests for admission Medical staff to use the current procedure 9

10 codes and not DATX (generic code) when completing ICE request and to also be reiterated at Induction. Nutritional needs of patients not being met Housekeeper to inform the nurse in charge if patient has not received or eaten their meal, Alternatives to be offered, introduction of the all-day menu, core staff to attend relevant study days and feedback at Ward Meetings by Link Nurse. Improvement in discharge information e.g. change of dressing Close monitoring by Ward Manager and Matron to spot check discharge documentation, additional support from the Tissue Viability Service. Patient experience and convenience of appointment times Ensure any special requests or considerations are taken into account when appointments are being booked. Communication with patients when carrying out care Senior nurse daily to monitor daily handover Hello my name is embedded into everyday care on the ward Delays in clinic due to archived imaging X-Ray Dept Manager to review the processes within the department to ensure that all images for outpatients are un-archived in preparation for clinics. We continue to review the lessons learned process and are introducing improved systems of robust trend analysis in order to enable the Trust to monitor and act upon any recurring themes. Key Achievements in 2014/15 Reporting complaints details and statistics to departments and directorates has become more streamlined and relevant Complaints Action Plans are in place Development of Complaints Team knowledge of complaints handling, complaints legislation and local and national complaints networks Recommendations by Robert Francis QC in respect of complaint handling are adopted by the Trust Complaints data published on RNOH website 10

11 Increase in the number of complaints resolved at a local resolution level Aims for RNOH 2015/16 Continue to be open and transparent in complaint responses Development of a more proactive complaints process Ensure that lessons learned from complaints are embedded into service delivery Improved monitoring of complaint action plans post-investigation Complaint management training for RNOH staff will be introduced Improve and implement the current Ulysses database system and tailor to maximum effect for reporting and trend analysis Re-build on the work already undertaken to improve response timescales aiming for 25 day turnaround Provide training for staff investigating complaints 11

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