HEALTHWATCH AND NHS COMPLAINTS ADVOCACY AN UPDATE ON THE IMPLEMENTATION OF SERVICES IN BEXLEY

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1 HEALTH OVERVIEW AND SCRUTINY COMMITTEE 7 APRIL 2014 HEALTHWATCH AND NHS COMPLAINTS ADVOCACY AN UPDATE ON THE IMPLEMENTATION OF SERVICES IN BEXLEY 1. INTRODUCTION The Health & Social Care Act 2012 transferred the duty to commission independent advocacy services from the Secretary of State to individual local authorities and also placed a duty on local authorities to commission a local Healthwatch. In Bexley, the local authority embraced the localism agenda fully by opting to directly commission each service rather than carrying out a joint procurement pan- London. The result of which has been that from 1 April 2013, both services have been delivered by local voluntary sector organisations. MIND Bexley and Age UK Bexley formed a joint independent body which has become local Healthwatch. Advocacy for All has been delivering independent advocacy services for NHS Complaints to Bexley residents. This report provides an update on the implementation of each these services respectively, focussing on their activity and outcomes achieved in first three quarters of delivery. It is split into two parts: Section 2 relates to NHS complaints advocacy and is set out on pages 21 to 28, with appendices i) and ii) on pages 29 to 60. Section 3 relates to Healthwatch Bexley and is set out on pages 61 to 66, with appendix x) on pages 67 to NHS COMPLAINTS ADVOCACY 2.1 Background Independent advocacy services are services assisting persons making or intending to make complaints in relation to the provision of NHS services or the exercise of functions of certain NHS bodies. The purpose of this service is to ensure that all individuals are adequately supported in navigating the NHS complaints system and seeking a resolution to their complaint. This is particularly important for vulnerable individuals. Until 1st April 2013 the regional service had been delivered by POhWER. Many London boroughs sought a shared service solution (now provided by Voiceability). Bexley, however, commissioned Advocacy for All.

2 Advocacy for All s experience means the organisation is well placed to deliver a locally commissioned NHS complaints advocacy service for Bexley residents. Based in Sidcup, it has provided independent advocacy services in Bexley since The organisation has a good knowledge of local demographics and has built up an excellent network of individuals, groups and organisations within the Borough particularly those working with vulnerable people. 2.2 Partnership Working with Healthwatch, CCG and Local Authority We, as advocates, give patients the confidence to take their complaints forward and we chase progress on their behalf. In our meetings with service providers we emphasise the vital role of complaints in driving up standards and improving services. In order for our work to do this and impact on the wider health economy - we have built a strong relationship with Healthwatch, CCG and Council. We have explored with them the best ways of identifying complaint trends between us, particularly where service providers straddle borough boundaries. We ensure that each partner is sharing their part of the picture with one another to triangulate our experiences. 2.3 Service Activity Advocacy for All s NHS Complaints Service Team are made up of both paid staff and volunteers. We are proud of how we have incorporated volunteers into service and the impact they have had Publicising the New Service Advocacy for All s initial objective was to publicise the new service throughout the Borough. We found that the even the previous service, provided by POhWER was not well known among services users or service providers. Therefore we had an immediate challenge to raise the profile of the service in the borough. We did so by: Producing information material - leaflet/poster/information pack/website page which has been disseminated widely. Our leaflet and poster are at appendices (i) and (ii). Publicity articles in the Bexley Magazine, Oxleas Exchange newsletter, Spotlight (BVSC s newsletter). Contacting service providers we have contacted and, in most cases, visited the various NHS Trusts complaints teams, and GPs practices servicing Bexley residents. We are currently working on contacting all other service providers in the Bexley area such as opticians, pharmacies and dentists. Contacting social care, voluntary and community groups to advise them of our service and encourage them to pass information about our service on to their clients. Networking and attending public meetings to ensure the widest possible publicity for the project.

3 With the South London Healthcare Trust being dissolved in October 2013, this has meant a major change in the demographics of health provision for Bexley residents. We have attended stakeholder events around this, and have provided information about the change to the public where required Face to Face Support Face to face support is the key activity strand to this service; it provides robust outcomes for the client, but is also time consuming. Within the first three quarters of the service, we have opened 32 face to face cases. This is already more than the indicative caseload for the whole year of 30 (as set by the Council and is based on the previous provider s annual caseload). Number of Face to Face Cases Supported Monthly complaints Complaints year to date April (carried Jun Aug Oct Dec Clients and patients by gender Male Female

4 Clients and patients by age < It is worth highlighting the period of time that the average case can take. Our cases will only be closed once there is an NHS resolution to the complaint and this can depend on the complexity of the complaint, how quickly the NHS provider acts and which stage the complaint finally reaches. During this initial 9 month period, only two complaints have reached resolution both of these cases were inherited from the previous provider Self Help Support We want to encourage those who can to help themselves. So we see it as our role to empower residents to feel confident enough to take forward complaints themselves. Our website provides guidance and has self-help packs that include template letters, a useful contacts list and a guide on how to write a letter of complaint (copy at Appendix (iii)) all of which can be downloaded. We also provide telephone advice assisting a number of people, either by providing information about the NHS complaints system, talking through options with them or referring them to other more appropriate services.

5 Number cases supported in addition to complaints Ist Quarter 2nd Quarter 3rd Quarter Number of cases supported quarterly Number of cases supported year to date An NHS advocacy page on Advocacy for All s website was operational from June Since then, the page has had a monthly average of 287 hits and 36 downloads of our documents. We are confident that the literature we have produced will have helped residents to navigate through the NHS complaints process. 2.4 Service Outcomes Types of issues, trends, where complaints come from We have had a diverse range of issues and providers complained about as set out in Appendix (iv). Some complaints are against more than one provider or involve multiple issues. Breakdown of complaints by type of service provider NHS Hospital Trusts NHS Mental Health Trusts GPs NHS England Pharmacies Dentists CCGs Bexley PCT (pre April 2013) Non NHS Hospitals

6 The majority of complaints we have opened have been against NHS Hospital Trusts. They cover a number of different Trusts and a number of different departments within those Trusts. The largest number of hospital complaints were initially made against South London Healthcare Trust, and with three being about their orthopaedic services which is the highest number of complaints we have had about any one specific service. Whilst such a low number could not be said to amount to a definite trend, we will continue to monitor this as well as any other potential trends that might emerge over time. With the CCG and Healthwatch we are monitoring what effect the dissolution of South London Healthcare Trust might have, if any, on the number and types of complaints we receive. We are also closely monitoring complaints about NHS England and its commissioned services. - NHS England was initially taking a very long time to deal with complaints made to it about its services. In some instances that delay then became the basis for a further complaint against NHS England itself. - We have also dealt with complaints about the perceived lack of objectivity and thoroughness employed by NHS England in its complaint handling. The problem with delays seems to be improving, but we are aware that there are still problems. We are aware it is a new body and inevitably will have had teething problems. However, we hope that it will use its recent experience from complaints to shape and improve services on a national basis Quotes, feedback from clients: The following quotes are taken from feedback given by our clients. They are evidence of the value we add to their experience of making an NHS complaint. They also show that not only is advocacy vital for clients who have difficulty expressing themselves, it is also invaluable for individuals who just need a hand to hold as they navigate the complaints system. I am so grateful to you for your valuable help today. You have helped me to focus and for the first time since my dear Mother died I have felt more supported in bringing this daunting case Your support is much appreciated. I am glad you are with me

7 Having someone to put me on the right road to sort the problem. Having been told there was no point in complaining by the Consultant I am daunted by the prospect of the meeting on Friday but feel more confident now with all the preparation you have helped me with Each time we have spoken I feel more confident, less apprehensive and clearer in thought about what I have to face Impact We feel that Bexley Advocacy for NHS Complaints has already made some significant impacts during the first nine months, despite only having two cases close formally. We have been requested to feed into CQC reports on South London Healthcare Trust. We hope that our relationship with the CQC puts us in a good position to do likewise with other reports in the future. Our intervention as part of local resolution for a client resulted in a change of literature regarding an orthopaedic operation. The client was involved in the design of the new leaflet, and the content of letters being sent to patients as well as the GP after seeing a Consultant. An addendum was attached to the client s medical file that a consultant had not examined the client, when it had been recorded originally the client had been examined. A Client who had wanted support after the death of her brother, found our advert in the Bexley Times and as a result the Ombudsman is now investigating the issues. The client feels finally that they have been listened to. Another case has also resulted in a Bexley GP Practice better publicising their complaints and appointment procedures.

8 2.5 Next Steps for the Service We would like to develop ways of working with: younger people to enable greater understanding of NHS complaints advocacy. Dentists within the Borough. Adults with an Autistic Spectrum disorder and their friends, families and carers. We are looking at setting up a small information surgery to meet this identified need. We are looking to extend our volunteering offer. As the level of case work has increased more cases are being handled by Volunteers allowing the team time to continue engaging with the community. Volunteers are still at an early stage of development and require good support, which we are providing. We will be looking to demonstrate a number of robust outcomes for our clients and the wider health economy so that the Council continue to fund the service from April 2015 and beyond. 2.6 National Context The NHS is under constant review and there are many reports available to the public including Francis, Keogh and Ann Clywd MP, many of which have come out of the Mid Staffordshire failings. Each of these reports has much to say about how complaints are handled in the NHS and how complaints inform learning and service development. We have attached a summary of what these reports say about NHS Complaints advocacy. Attached appendices: i) Leaflet for our Project ii) Poster for our Project iii) Our guide to writing a letter of complaint iv) Statistics for the types of complaints received up to December 2013 v) Statistics for types of client by age, gender and ethnicity up to December vi) Communications Plan updated to end of December 2013 vii) from Parliamentary and Health Service Ombudsman into University Hospitals of Morecambe Bay NHS Foundation Trust viii) Francis Report Executive Summary (not attached but available below: ix) Government Reports and NHS Complaints Advocacy