Governing Body 13 November 2013

Transcription

1 Paper 07 Governing Body 13 November 2013 Overview of complaints and handling processes Paper Author Lead Executive FOI status Michaela Maloney, Interim Head of Communication and Engagement Brendan Ward, Interim Chief of Corporate Affairs Public report Purpose To provide an overview of the CCG s complaint handling process and progress in developing the way complaints are used to help the CCG learn as a commissioner and understand how complaints and patient insights can be used to help improve services for local people. Paper summary This paper provides an overview of the CWS CCG complaint system and our process for handling and learning from complaints since April Associated papers Appendix A Summary of Local Authority Social Services and NHS Complaints (England) Regulations 2009 Appendix B NHS Constitution Complaint Redress Date paper completed 6 November 2013 CWS Business Domain work associated with: How does this work support the NHS Constitution: Patient and Public engagement to date: Equality and Diversity assessment: 1. Transformation of services and delivery of quality care 2. Patient and Public focus and engagement 3. Promoting Health and Well Being 4. Resource management and financial stewardship 5. High performing and sustainable membership organisation This paper outlines the way the CCG handles and responds to complaints and how it supports Patients and the public your rights and NHS pledges to you. (section 3.a) in particular, the patient rights outlined under complaint and redress. The complaints review process will include consideration as to the mechanisms by which the Patient Reference Panel (PRP) will be kept appraised of progress in this area. No patient engagement around this has been undertaken to date. Full details are available on our website about how to make or raise a complaint. No formal EIA has been undertaken in relation to this service, although effective and appropriate complaints handling will support the narrowing of any equality and diversity gaps across Coastal West Sussex.

2 Overview of complaints and handling processes 1. Background The Governing Body has requested, through its Forward Plan, a summary of complaints handled and lessons learned by Coastal West Sussex Clinical Commissioning Group (CWS CCG) since April 2013 as well as an overview of the CCGs complaint process. This paper is particularly timely in that a national review of complaint handling was published at the end of October 2013 and the CCG support for managing complaints moved from Surrey and Sussex Commissioning Support Unit (CSU) to South CSU on 1 November This paper provides an overview of this work and specifically considers; Where complaints to the CCG come from, what they are about and how we are dealing with them What we are learning from the complaints we handle and how we are using these lessons and insights in our service development plans The CCG s approach to handling complaints Complaint regulations and the impact of recent national inquiries and reviews on the CCG s approach to handling complaints How we intend to improve effectiveness of the system and the steps we are taking to do this 2. Where complaints to the CCG come from, what they are about and how we are dealing with them During the period 1 April - 30 September 2013 the CCG handled 35 new formal complaints and of these, all except one were acknowledged within the required three day acknowledgement time frame 1. (Appendix A - summary of Local Authority Social Services and NHS Complaints (England) Regulations 2009) During the same period the CCG received 45 informal enquiries through the CSU complaints team. These enquiries ranged from requests for information about CCG policies to details of commissioners for a given NHS service. On average, complaints have taken 34 days to respond to, this includes seeking patient consent and liaison with other NHS organisations as required. Two complaints required investigation by other organisations before the CCG could respond and this naturally extended the response time. Whilst there is a defined time period of 12 months, either since the date of an incident or of becoming aware of an incident, within which patients should lodge a complaint, there is no defined timescales for responding to complaints. However, it is understood that all complaints should be handled expediently and in as timely a manner as possible, given that the complexity of each complaint will vary enormously and we specifically track and pursue cases that take more than 30 days to respond to. 1 Local Authority Social Services and NHS Complaints (England) Regulations

3 A summary of complaints received is shown in Table 1. Table 1. Complaints received by the CCG and handled by the complaints team Apr- May- Jun- Jul- Aug- Q Number of new complaints received (formal and informal) Number of new informal enquiries received by CSU Number of complaints received or cc d to the CCG and referred to other organisations Number of formal complaints responded to and closed Number of complaints "upheld" or "partially upheld" Number of new complaints referred to the Ombudsman Sep What the CCG receives complaints about and how they are handled Misdirected complaints In the first six months since becoming a statutory body CWS CCG has received and handled complaints and enquiries from across the local health care system. In the majority of cases complaints have needed to be re-directed as patients and their advocates, including local MPs, become familiar with the new NHS architecture and who is responsible for what. Traditionally, the number of commissioning complaints received has been small, with the majority of complaints received relating to primary care services which are now the responsibility of NHS England. On the whole these re-directions have been handled promptly and efficiently, however in some cases where patient consent has been required this has caused delay and the overall NHS handling and ability to respond in a timely manner has been compromised. Action taken: To specifically address this, and ensure correspondence is accurately directed first time, the CCG webpage was updated on 31 October to reflect not only the new complaints team contact details, but also strengthen details about who to contact about what. Secondly, a briefing note for local MP constituency offices is being prepared to outline the new complaints team contact details and provide details of the new local NHS architecture to enable correspondence. This information will also be able to be shared with their constituents. Consideration is also being given to additional steps that can be taken to reduce the number of required re-directions. Q2 2

4 Continuing Health Care The highest number of complaints handled by the CCG were about the length of time taken to process Continuing Health Care funding requests arising from the national time limits announced in 2011 for individuals to submit a retrospective claim or request a review of an eligibility decision for NHS continuing health care funding, with effect from April Continuing Health Care claims across West Sussex are managed by a pan West Sussex team that is led by Director of Public Health, and hosted by Coastal West Sussex CCG. Action taken: In response to these complaints and the recognised considerable delays being experienced under current resourcing levels, the continuing health care team are currently recruiting three additional Retrospective Nurse Assessors and it is anticipated that this will considerably shorten the length of time it currently takes for reviews to be completed in West Sussex. An overview of what the CCG has received complaints about is shown in Table 2. Table 2. Issues raised in new complaints received (NB more than one issue may be raised in each complaint). Reason for Complaint (based Apr- May- Jun- Jul- Aug- Sep- Q1 on new complaints received) Q2 Funding - treatment not normally provided by the NHS Changes to services commissioned or lack of services commissioned by the CCG Commissioned services provided by other organisations Continuing health care Service Other Lessons learned and actions taken As a CCG we are learning from the complaints we handle and how we can use these lessons and insights in our service development plans. Key lessons learned and services improved Our most significant service change as a CCG in response to complaints since April 2013 has been in our policy for the treatment of cataracts. Complaints about CCG Policy for the eligibility to receive cataract surgery We reviewed our policy for the eligibility to receive cataract surgery and as a result new criteria have been implemented across Coastal West Sussex. Complaints about the NHS 111 Service 3

5 We worked with the ambulance trust that provides the service in Sussex to address this problem. Additional staff were employed by the ambulance trust and this has led to a service improvement including a significant reduction of waiting times for callers even during peak times. Complaints about decisions made by the Individual Funding Review Panel about funding for treatment not normally funded by the NHS In each case a full explanation of the decision was provided, including if appropriate, information about making an appeal. Complaint that funding had stopped for specialist services following changes to the NHS in 2013 We advised the service provider that funding would be taken over by the CCG and the services were resumed. Complaint about the handling of a complaint about patient transport We offered a full apology and ensured that members of staff taking transport bookings fully understood processes for appropriate handling of complaints, including help and support available from the CSU Complaints Team. Concerns regarding the response sent from the ambulance provider were shared with the senior leadership teams at the ambulance trust and processes were reinforced with teams and individual staff. 2.3 Lessons learned from our process The full process for handling complaints by the CCG is currently being reviewed with the new South CSU complaints team, with a view to further improving our existing systems and processes. This review will include consideration of reporting measures and criteria as well as required levels of reporting into the CCE to ensure an appropriate level scrutiny of complaints and lessons learned. Levels of compliance with the three day acknowledgement time frame will be reflected in future reporting together with explanations for any breaches. This will ensure strategic consideration is given to the insights provided through complaints and will be in addition to the existing process where complaints are shared with relevant commissioner and service leads in order to reflect feedback and any system failings into new and improved services. Work to understand any opportunities to improve upon response timescales and how we progress and track complaints within the local health care system when required, particularly where multi-agency complaints are received, is also being explored within this review. 3. CCG approach to handling complaints Within Coastal West Sussex CCG the complaints function is managed by the Communications and Engagement team in close liaison with the Quality team. We currently have an agreed complaints process that is detailed below and supported by the Commissioning Support Unit (CSU). From April October 2013 this service has been provided by Surrey and Sussex CSU and since 1 November has been provided by South CSU. The South CSU Complaints Team is also closely aligned to the South CSU Quality Team which ensures close liaison and handling across the CSU and CCG. 4

6 3.1 Current Coastal West Sussex complaints process Receiving complaints At present, complaints can be received by Coastal West Sussex CCG through a number of mechanisms. Specifically: Information on making a complaint can be found on our website at; , telephone number and postal address details are included on this web page Clear information about the different NHS organisations and contact details for submitting complaints about different services are shown on this web page All CCG member practices and support teams have access to the details about how to make a complaint to the CCG or NHS England as appropriate Complaints triage An initial triage of every complaint received by the CCG is undertaken by the Head of Communications and Engagement in liaison with the Clinical Chief Officer on receipt of each complaint. This triage includes early direction and response around handling of each complaint at a personal and clinical level, with direct contact being made with complainants early on if appropriate. This is managed in parallel to the 3 day acknowledgement process. Commissioner view All complaints are shared with commissioners for the respective services with a view to shaping future services and reflecting service development plans in responses to complaints. Response to complainant After investigation, a draft response to the complainant is agreed by the CSU with a designated person within the CCG and then reviewed by the Head of Communications and Engagement, before being signed by the CCG Clinical Chief Officer or person to whom she has delegated responsibility. It is then sent on CCG headed paper to the complainant and shared with commissioning teams to be reflected in their service development plans. Multi-agency complaints For multi-agency complaints, a lead Complaints Manager is identified, this is usually a commissioner, and therefore the complaint will be handled by the CSU on behalf of the CCG. In these cases the CSU collates responses from service providers and these are developed into a full and appropriate response to the complainant to be sent from the CCG. Reports Since April, Surrey and Sussex CSU has provided quarterly reports to Coastal West Sussex CCG. South CSU will now provide a weekly summary report on the status of all complaints received, and more detailed monthly and quarterly reports highlighting trends, themes and specific issues for comments, complaints, concerns and compliments managed by the CSU on behalf of the CCG. 5

7 Actions and learning South CSU will provide the CCG a summary of any action taken by providers and learning identified as a result of individual complaint investigations. The CCG s Head of Communications and Engagement will review these monthly with the Head of Quality and the CSU Complaints lead to follow up and ensure actions are implemented and learnings are shared appropriately. As a CCG our ambition is to minimise formal complaints throughout the services we commission and the way they work together wherever possible. We want a system where patients can engage with the CCG and provide feedback that we can act upon, without patients feeling the need to place a formal complaint. However, we understand that there will be occasions where things go wrong and don t work as we would want them to. In these cases we need to be able to respond quickly, sensitively and constructively to complainants, saying sorry when we need to and demonstrating how we will, or have, put things right and learn from these complaints in a way that helps to improve the quality of services and manage patient expectations. To do this we need to also consider the national context, in particular the findings of the Francis Inquiry, the revised NHS Constitution from April 2013, and the very recent national review of complaints that was published in October National context and the impact of recent reviews The national context provides a new landscape in terms of the way complaints are handled and used as opportunities for the NHS to learn and improve. A refreshed NHS Constitution and a new NHS architecture came into effect in April 2013, this has meant all NHS organisations, including CCGs, are getting to grips with new systems and processes for the handling of complaints, as well as a much stronger emphasis on patient rights and a new and specific pledge around the duty of candour. New NHS architecture As we have also seen locally, the new NHS architecture is resulting in a national increase in the number of complaints needing to be re-directed around the NHS but it is anticipated that this will subside over the coming months as the new systems are embedded and become established. This includes the role of NHS England in handling primary care complaints as well as the role of Healthwatch teams in handling PALS type enquiries. Revised NHS Constitution The new NHS Constitution (Appendix B), Patients and the public your rights and NHS pledges to you, Section 3a, has been strengthened to reflect a far stronger duty of candour states; To ensure that when mistakes happen or if you are harmed while receiving health care you receive an appropriate explanation and apology, delivered with sensitivity and recognition of the trauma you have experienced, and know that lessons will be learned to help avoid a similar incident occurring again. Francis Inquiry The Francis Inquiry into the failings at Mid Staffordshire NHS Trust highlights a number of failings in NHS complaints systems. These findings and lessons learned must be used to 6

8 consider how we can improve the way complaints are handled by the CCG, of note, the Francis report specifically states; A health service that does not listen to complaints is unlikely to reflect its patients needs. One that does will be more likely to detect the early warning signs that something requires correction, to address such issues and to protect others from harmful treatment. A complaints system that does not respond flexibly, promptly and effectively to the justifiable concerns of complainants not only allows unacceptable practice to persist, it aggravates the grievance and suffering of the patient and those associated with the complaint, and undermines the public s trust in the service. National review of NHS Hospitals Complaints System Putting Patients Back in the Picture The Francis Inquiry led directly to the commissioning of a national review of complaints handling by hospitals, which published its findings on 28 October. The review, commissioned by the Government, was undertaken by the Rt. Hon Ann Clwyd MP for the Cynon Valley and Professor Tricia Hart, Chief Executive, South Tees Hospitals NHS Foundation Trust. The report is focussed on acute hospitals, although they have taken evidence from and about other care providers, and it does state that many of the reflections and comments made could be as relevant to primary care, community services and social care as they are for acute hospitals. The co-chairs were encouraged to make recommendations about: any aspect of the NHS complaints arrangements and other means by which patients make concerns known; the way that organisations receive and act on concerns and complaints; how Boards and managers carry out their functions; and the process by which individual organisations are held to account for the way that they handle concerns and complaints. The report highlights a number of areas for consideration by service providers and commissioners including; Improvements suggested by patients, relatives, friends and carers Points raised by NHS organisations Recommendations for Trusts and Boards, including Board-led scrutiny of complaints Recommendations in relation to improving the way complaints are handled of particular relevance to commissioners it states; Patients want a complaints system to cover all aspects of a patient s care, even if this crosses boundaries within the NHS or between the NHS and social care. They want to be able to make only one complaint about their whole experience within the system. 7

9 Of note, the report highlights the NHS England pledge; Governing Body 13 November 2013 to review the role of commissioners in holding providers to account for a positive attitude towards patient feedback, concerns, complaints and compliments, with specific reference to using the standard contract and quality accounts as relevant existing tools. NHS England will undertake this work by March NHS England is supporting the piloting of the cultural barometer, and in the evaluation, revisions and potential rollout of the barometer, will consider the content and recommendations of the Complaints review. NHS England will undertake this work by March Commissioners are advised that they should therefore be looking at robust contractual levers in the 2014/15 contracts to ensure they are provided with the necessary information and assurances by their providers. The full report can be seen here: omplaints_review_report.pdf 5. Action plan and next steps We can see from the number of complaints received and responded to that our complaints process works within required timescales, but we can and need to do more to develop and strengthen the quality of insights and learnings we gain from this vital area of work, as well as ensure the quality and appropriateness of our responses to complainants fully aligns to our values and those shared in the NHS Constitution. Locally, we need to consider the changes in our local and national landscape to help us identify opportunities to further strengthen our local complaints system and how we can use the insights gained to improve and develop services for the future, as well as retain and rebuild patient trust and confidence in local NHS services if this confidence is damaged. The actions to be taken and reported back to the Governing Body in May 2014 are: Following the recent national review and recommendations about complaint handling, and the transfer of CCG support for its complaints systems to South CSU, the CCG complaints process will be reviewed by the CCG with South CSU, and a proposal for any changes and improvements to existing processes will be taken to the CCG CCE in January Risks to the service and the impact it can have on the CCG in terms of service delivery, reputation, legal challenge and financial risk will be considered and mitigations to manage these will be agreed. In light of the NHS England pledge to review the role of commissioners in the future, this review will include work with the Head of Quality, and contract leads as well as CSU teams, to identify and understand the contractual implications arising from the 8

10 NHS England pledge to ensure commissioners are receiving appropriate information and assurances from providers. The aim being to put the CCG in a strong position to respond to the outcome of the NHS England review that will be completed by March Clear criteria and reporting timescales to ensure CCG are able to undertake appropriate level scrutiny of complaints will be defined and developed. A clear understanding of the role of any formal committees in the complaints process will be developed, particularly any role for the Quality Committee or the newly formed Public Reference Panel. Clarity around how the service is defined and promoted to patients and the public in terms of its role around handling comments, complaints, concerns and compliments A review of our approach to communicating our complaints process will be undertaken and any further work required based on current information provided will be implemented. 6. Forward look The Governing Body will be informed in May 2014 of the outcome of the CCG review of its complaints handling service and updated on the strengthened complaint handling process and systems in place in light of this local review with the new teams and the national complaints review. From this paper the Governing Body is asked: To note activity to date and lessons learned in relation to the CCG complaints process To note the current local and national landscape for NHS Complaints and the implications of this for the CCG and resulting action plans To receive an update on this service at its May 2014 meeting 9

11 , Appendix A Summary of the Local Authority Social Services and NHS Complaints (England) Regulations 2009 Since April 2009, the NHS complaints process has had two stages: 1) The patient or their representative can make a complaint to the provider of the service involved OR to the commissioner of the service. They cannot do both, if the patient or their representative has made a complaint to the provider or commissioner organisation and is unhappy with or has not received a response, they should in the first instance, explore further local resolution. It should be noted that once a complaint has been opened by either a provider or commissioner of a service, another NHS organisation cannot open a complaint on the same matter. 2) If the patient or their representative remains unhappy with the response they have received from the provider or commissioner of the service, despite further local resolution, they can refer the matter to the Parliamentary and Health Service Ombudsman (PHSO) and contact details are given in all formal complaint responses and on the NHS Choices website. If a patient or their representative wishes to make a complaint regarding primary care services including dentistry, or specialised commissioning they must be directed to NHS England. A complaint may be made by: a person who receives or has received services from a responsible body; or a person who is affected, or likely to be affected, by the action, omission or decision by the responsible body which is the subject of the complaint. A complaint may be made by a person (in this regulation referred to as a representative) acting on behalf of a person mentioned above who: (a) has died (b) is a child (c) is unable to make the complaint themselves because of: (i) physical incapacity or (ii) lack of capacity within the meaning of the Mental Capacity Act 2005 or (d) has requested the representative to act on their behalf. 10

12 , Appendix A Consent If the patient has requested the representative to act on their behalf, written confirmation of this is requested. If the patient is unable to make the complaint themselves due to lack of capacity under the mental capacity act then confirmation of appropriate authority is requested. Re-opening Complaints Complaints that have been previously investigated under the 2009 regulations and local resolution exhausted should only be re-opened if the complainant can demonstrate that they have new evidence that needs to be considered. Timescales There is a time limit of 12 months after the date of the incident that caused the complaint, or 12 months from the date on which the matter came to the attention of the complainant. The time limit can, and should be, waived if it is still practical and possible to investigate the complaint (the records still exist and the individuals concerned are still available to be questioned) and the complainant can demonstrate reasonable cause for delay in making the complaint. It will be the decision of the Complaints Manager if the time limit can be set aside. A complaint must be acknowledged within three working days. A formal response should be received by the complainant within a timescale agreed with them at the outset. It should be noted that timescales for responding to complaints were removed by the EXPLANATORY MEMORANDUM TO THE LOCAL AUTHORITY SOCIAL SERVICES AND NATIONAL HEALTH SERVICE COMPLAINTS (ENGLAND) REGULATIONS 2009 No It states: These regulations align adult social care and health complaints processes into a single set of arrangements. They require the complainant to be involved in the way in which the complaint is handled, by requiring the body dealing with the complaint to offer to discuss this with the complainant. They also remove prescription around the timescale to be followed in terms of investigating a complaint. Less prescription around timescales allows organisations to assess and deal appropriately with all complaints, allowing these arrangements to meet the needs of the individual case and for proper consideration of learning and service development issues. 11

13 NHS Constitution Complaint and Redress Governing Body 13 November 2013, Appendix B The NHS Constitution was updated in April 2013 in relation to a number of key areas, including providing feedback and making complaints. The revised NHS Constitution now more robustly reflects what patients have the right to expect in respect of the way complaints are handled. Section 3a. Patients and the public your rights and NHS pledges to you, specifically states; Complaint and redress: You have the right to have any complaint you make about NHS services acknowledged within three working days and to have it properly investigated. You have the right to discuss the manner in which the complaint is to be handled, and to know the period within which the investigation is likely to be completed and the response sent. You have the right to be kept informed of progress and to know the outcome of any investigation into your complaint, including an explanation of the conclusions and confirmation that any action needed in consequence of the complaint has been taken or is proposed to be taken. You have the right to take your complaint to the independent Parliamentary and Health Service Ombudsman or Local Government Ombudsman, if you are not satisfied with the way your complaint has been dealt with by the NHS. You have the right to make a claim for judicial review if you think you have been directly affected by an unlawful act or decision of an NHS body or local authority. You have the right to compensation where you have been harmed by negligent treatment. The NHS also commits: to ensure that you are treated with courtesy and you receive appropriate support throughout the handling of a complaint; and that the fact that you have complained will not adversely affect your future treatment (pledge); to ensure that when mistakes happen or if you are harmed while receiving health care you receive an appropriate explanation and apology, delivered with sensitivity and recognition of the trauma you have experienced, and know that lessons will be learned to help avoid a similar incident occurring again (pledge); and to ensure that the organisation learns lessons from complaints and claims and uses these to improve NHS services (pledge). The full revised constitution can be seen here 12