Report to: Public Trust Board Agenda item: 11 Date of Meeting: 18 December 2013

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1 Report to: Public Trust Board Agenda item: 11 Date of Meeting: 18 December 2013 Title of Report: Status: Board Sponsor: Authors: Appendices Complaints Report For Approval Helen Blanchard, Director of Nursing Theresa Hegarty, Head of Patient Experience Mary Lewis, Associate Director of Nursing, Quality and Patient Safety None 1. Purpose of Report Work To inform the Board and promote discussion on the complaints process for the NHS with reference to recent national reports and the delivery of the Patient and Carer Experience Strategy for RUH Summary of Key Issues for Discussion This report provides: A summary of the key findings from two recent national complaints system reviews and their subsequent recommendations A summary of the current status of complaints against the Trust that have escalated to the Parliamentary Health Service Ombudsman Key recommendations from the Trust Whole System Complaints service review. 3. Recommendations (Note, Approve, and Discuss) To note and discuss the analysis, national guidance and findings of the reviews in relation to further improvement of patient and family experience at the RUH. To support the proposed next steps. 4. Care Quality Commission Outcomes (which apply) Outcome 1: Respecting and involving people who use services Outcome 4: Care & Welfare of people who use services. Outcome 16: Assessing and monitoring the quality of service provision Outcome 17: Complaints 5. Legal / Regulatory Implications (NHSLA / Value for Money Conclusion etc.) Care Quality Commission (CQC) Registration 2013/14 NHLSA Standard 2: Learning from Experience. 6. NHS Constitution This report demonstrates compliance with the following areas from the NHS Constitution: Agenda Item: 11 Page 1 of 13

2 1. Principles that guide the NHS 2. 2a. Patients and the public your rights and NHS pledges to you 3. 3b Staff your responsibilities NHS values 7. Risk (Threats or opportunities link to risk on register etc.) Risk to reputation of the RUH. 8. Resources Implications (Financial / staffing) None. 9. Equality and Diversity Ensures compliance with the Equality Delivery System (EDS). 10. Communication None at this stage. 11. References to previous reports Monthly Quality Reports. 12. Freedom of Information Public. Agenda Item: 11 Page 2 of 13

3 Complaints Report 1. Purpose The purpose of this report is to provide Trust Board with: a) A summary of the key findings from a recent national complaints review and the complaints section of the Governments response to the Mid Staffordshire Public Enquiry: A Review of the NHS Hospitals Complaints System; Putting Patients Back in the Picture; Final report (October 2013) by Right Honourable Ann Clwyd MP and Professor Tricia Hart Hard Truths; The Journey to Putting Patients First (DOH; November 2013). b) An update on complaints that have been escalated to the Parliamentary Health Service Ombudsman (PHSO) Ombudsman from 2009 November c) An Executive summary of the Complaints review that has recently been undertaken by the Trust. 2. The following provides a précis for Trust Board of two important national documents that have been written following the Francis Inquiry: A Review of the NHS Hospitals Complaints System; Putting Patients Back in the Picture; Final report by Right Honourable Ann Clwyd MP and Professor Tricia Hart, CEO South Tees Hospitals NHS Foundation Trust Hard Truths; The Journey to Putting Patients First (DoH 2013), Robert Francis Public Inquiry into Mid Staffordshire NHS Foundation Trust emphasises the importance of complaints. Francis 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. The two reports detail a number of areas of good practice and recommendations which, alongside the recommendations from the RUH Trust s Complaints Review, will form the basis of an improvement work programme and action plan in relation to the Trust s complaints and PaLs service. Agenda Item: 11 Page 3 of 13

4 2.1 A Review of the NHS Hospitals Complaints System; Putting Patients Back in the Picture; Final report This review was co-chaired by the Rt. Hon Ann Clwyd MP for the Cynon Valley and Professor Tricia Hart, Chief Executive, South Tees Hospitals NHS Foundation Trust. The Review was instigated by the Prime Minister to consider the handling of concerns and complaints in NHS hospital care in England and focused on 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 recommendations from this report are presented in four areas for change: Improving the quality of care Improving the way complaints are handled Ensuring independence in the complaints procedure Whistle-blowing Recommendations: Improving the quality of care All staff providing care should be well trained, supported and supervised, with annual appraisals linked to the process of medical revalidation with a focus on communication skills for clinical staff and dealing with patient concerns positively. Trusts will ensure that there is increased information and support available on the ward for patients, such as a description of who is who on the ward and what they do; meal times and visiting times; and who is in charge of care for the patient. Information must be available in various ways to provide for differences in language, culture and vulnerability. Patients need to better understand their care and treatment, revisiting topics already addressed and their family, friends or carers should also be included in discussions, as appropriate. Trusts should provide patients with a way of feeding back comments and concerns about their care on the ward. Hospitals should actively encourage and train volunteers to support patients who wish to express concerns or complaints. Agenda Item: 11 Page 4 of 13

5 Trust Chief Executives and Board members should have the necessary skills in effective communication, seeking and using patient feedback, routinely throughout their organisation to ensure their organisation learns from that feedback. PALS should be re-branded and reviewed so it is clearer what the service offers to patients and it should be adequately resourced in every hospital Recommendations: Improvements in the way complaints are handled There should be NHS accredited training for staff to investigate and respond to complaints, to develop specific skills and professional behaviour in this process, including an immediate willingness to listen to the complainant, to understand and work with them to rectify the problem as a priority. Every Trust has a legislative duty to offer complainants the option of a conversation at the start of the complaints process to agree on the way in which the complaint is to be handled and the timescales involved. Staff will record complaints and the action that has been taken and check with the patient that it meets with their expectation. Complaints should be welcomed as necessary for continuous service improvement. Every Chief Executive should take personal responsibility for the complaints procedure. All Boards and Chief Executives should receive monthly reports on complaints and the action taken, including an evaluation of the effectiveness of the action; these reports should be available to the Chief Inspector of Hospitals. There should be a new duty on all Trusts to publicise an annual complaints report, in plain English, stating what complaints have been made and what changes have taken place. Where complaints span organisational boundaries, the Trusts involved adhere to their statutory duty to cooperate. Further work should be done to explore how we look for the right skills in the recruitment of Chief Executives and Board members to ensure they are capable of ensuring that their Trust is a learning organisation with a Duty of Candour. Agenda Item: 11 Page 5 of 13

6 2.1.3 Recommendations: Ensuring independence in the complaints process. Hospitals should offer a truly independent investigation when serious incidents have occurred. Trusts must ensure the true independence of the clinical and lay advice and advocacy support offered to the complainant. Patients, patient representatives and local communities and local Healthwatch organisations should be fully involved in the development and monitoring of complaints systems in all hospitals. Board level scrutiny of complaints should involve lay representatives Recommendations: Whistle-blowing The report highlights that more needs to be done to avoid the need for whistle-blowing and to protect those who, with justification, speak out. Hospitals should have in place the following: Clear guidance for staff on how they should report concerns, including access to the Chief Executive on request. A board member with responsibility for whistle-blowing should be accessible to staff on a regular basis. A legal obligation to consider concerns raised by staff, and to act on them if confirmed to be true. 2.2 Hard Truths; The Journey to Putting Patients First Hard Truths details the Government s response to the Mid Staffordshire Public Inquiry. Annex D of the report - A Review of the NHS Hospitals Complaints System: Putting patients back in the picture draws on previous reports and their recommendations. The key findings are: Vulnerable people find the complaints system complicated and hard to navigate. There is a low level of public awareness of the NHS Complaints Advocacy Service. People are reluctant to complain and staff can be defensive and reluctant to listen to or address concerns. Organisations do not always deliver their legislative responsibilities on complaints handling. There is a need for quality, trained staff to deal with complaints effectively and appropriately. Agenda Item: 11 Page 6 of 13

7 2.2.1 Hard Truths complaints review key recommendations are as follows: Every Chief Executive should take personal responsibility for the complaints procedure, including signing off letters responding to complaints, particularly when they relate to serious care failings. There should be Board-led scrutiny of complaints. All Boards and Chief Executives should receive monthly reports on complaints and the action taken, including an evaluation of the effectiveness of the action. These reports should be available to the Chief Inspector of Hospitals. There should be a new duty on all Trusts to publicise an annual complaints report, in plain English, which should state what complaints have been made and what changes have taken place. Trusts should provide patients with a way of feeding back comments and concerns about their care on the ward including simple steps such as putting pen and paper by the bedside and making sure patients know who to speak to if they have a concern it could be a nurse or a doctor, or a volunteer on the ward to help people. PALS should be re-branded and reviewed so it is clearer what the service offers to patients and it should be adequately resourced in every hospital. The Care Quality Commission should include complaints in their hospital inspection process and analyse evidence about what the Trust has done to learn from their mistakes. Trusts should actively encourage both positive and negative feedback about their services. Complaints should be seen as essential and helpful information and welcomed as necessary for continuous service improvement. 2.3 RUH actions in response to the recommendations The RUH complaints practice follows a number of the recommendations but there is recognition that improvements to strengthen practice are required. The key areas for development will be to: Welcome complaints as valuable feedback to enable improvements to be made. Train and support staff at all levels of the organisation to work responsively and proactively with complainants. Re-brand and review the current complaints service. Report on sustained changes to practice and services as a result of feedback and complaints. Agenda Item: 11 Page 7 of 13

8 3. Parliamentary Health Service Ombudsman Complaints Work has recently been undertaken and completed to improve the system for tracking and following complaints that are currently active with the Parliamentary Health Service Ombudsman (PHSO). The PHSO can investigate any complaint made against the Trust that is escalated to them by a complainant, who still remains dissatisfied after the local complaints process has been completed. All avenues of local resolution must have been exhausted before the PHSO will consider investigation. During the period 2009 to November 2013, the PHSO received a total of 39 complaints about the Trust s services and response. Table 1 shows the number of complaints escalated to the PHSO about the Trust between 2009 and The date reflects the date of the original complaint made to the Trust. Number of Complaints regarding the Trust escalated to the PHSO between 2009 and 2013 Year of Complaint received by the Trust Total Grand Total 39 Table 1 Summary of the 39 cases: Of the 39 files received during this period from the PHSO, 24 are now formally closed. 6 of the 24 closed cases were upheld by the Ombudsman; this means that following investigation the Ombudsman had concluded there were issues that the complainant had raised with the Trust that had not been adequately addressed or that showed a service deficiency. Investigations into the remaining 18 closed cases were discontinued by the PHSO after the initial review phase. 3.1 Upheld Complaints Between 2009 and November 2013 the PHSO upheld 7 complaints made against the Trust. Three of the complaints required a further apology from the Trust as well as an action plan to remedy the concerns. These actions were then monitored by the PHSO to ensure compliance. Agenda Item: 11 Page 8 of 13

9 One complaint required a further apology and an addendum to the patient s notes. Three of the complaints resulted in financial restitution to an overall total of Current Status of cases with the Ombudsman There are currently 15 complaint files from the Trust that are classed as currently active with the PHSO. 7 of these date from between 2009 and 2012 and can be classed as pending. In each of these cases the PHSO has requested the file, or has asked if local resolution has been exhausted but no further communication has been received from the Ombudsman. One case has been passed back to the Trust to reconsider awarding compensation. Seven files therefore remain open and are confirmed as the PHSO actively investigating these are: 1 from from from 2012 Of the seven active cases: One of these cases will be ruled on imminently Three are still in the investigation phase. Three are being considered by the PHSO to see if a full investigation will be commissioned. 3.3 Next steps The system for tracking and reviewing cases that the PHSO are investigating has been strengthened and future complaints reports to the Board will include updates on this activity and any issues arising from it when relevant. 4. RUH Whole System Complaints Service Review In recognition of the rising trend in the number of complaints, the need to improve internal processes and to ensure the Trust is following best practice in relation to complaints and patient experience feedback a complaints review was commissioned by the Trust in September Robust complaints management systems in health services help safeguard the rights of people who receive a service and are a fundamental feature of modern health laws and guidance. They also provide an opportunity for organisations to improve the quality of services, reduce the risk of externally reported complaints and support patient and carer- engagement and participation. Effective complaints management systems demonstrate a commitment to listening to, and inclusion of the voices of patients and carers in the review and improvement of the service delivery. It is within this context that the review was commissioned Agenda Item: 11 Page 9 of 13

10 The scope of the review was to undertake a diagnostic review of the current service resulting in a report to the Trust detailing recommendations for improvement. A full assessment of the current situation within the Trust was undertaken, including consideration of the views of relevant parties, understanding the culture of the organisation and experiences of people using the service. A series of face to face interviews and focus groups were held with key stakeholders. The complaints system review has now been completed and a report detailing the findings and recommendations will be considered in full by the Trust Board in a seminar in December 2013 and by Management Board in January The context of the review recognises and embraces the principles and requirements within key NHS legislation and best practice guidance, including the NHS Constitution, the Francis report(s), The Berwick report and more recently Anne Clwyd s report, the Parliamentary Health Ombudsman reports, Care Quality Commission requirements and the standards for complaints handling by the Patients Association. The report recognises that complaints are a useful way of stimulating innovation and a powerful form of knowledge. Work by the Institute of Customer Service has shown how complaints are useful early warning signs that something has gone wrong, which uncover problems and enable engagement with people that use the service. Trust Boards need to receive valuable, relevant and timely complaints information to help to: identify and prioritise need highlight opportunities to change challenge established wisdom co-create and co-produce solutions uncover system failures The following details a number of key recommendations from the review: 4.1 Recommendations 1. The Trust are recommended to review the resources, structure, roles, responsibilities and training needs of the staff within the patient experience services in light of this report and its recommendations to: o Ensure that the PALS structure is fit for purpose and offers a service during peak day and evening visiting times over a 7 day period. The Agenda Item: 11 Page 10 of 13

11 Trust may wish to explore the use of volunteers, nursing and medical students in supporting the service. o Enable the service offered by PALS to have a degree of independence from the formal complaints process. o Ensure the Complaints structure is fit for purpose and offers a fully supportive service to people wishing to complain and to staff handling/receiving complaint information. 2. To enable an improved tracking and monitoring of complaints, comments and compliments (CCC), it is recommended that the Trust fully implement the Datix complaints module for all aspects of CCC handling. 3. The Trust are recommended to consult with their patient experience group and other local health related community/advocacy groups, to look at ways of ensuring that people who are vulnerable or seldom heard are able to access the complaints, comments, compliments process. The Trust are recommended to engage with local community groups for younger people and people with learning and/or physical disabilities or mental health issues to consider the ways that they may wish to make their views known to them by using advocacy, modern technology and online resources. 4. It is recommended that complainants are appropriately supported during the complaints process through a well-publicised advocacy and mediation service. The Trust needs a clear contractual arrangement with their advocacy and mediation service(s) that ensures that the most vulnerable patients are assisted. Staff should be made aware of support available to complainants and encouraged to promote the service as a matter of course to people. 5. The Trust should continue to build on their current good practice for promoting the praise and positive feedback to staff and the public by developing a clear internal and external communications framework that highlights and promotes the work well done and areas that have improved following patient feedback. This framework should also include how complaints outcomes are published and shared with relevant regulatory organisations such as CQC and Local Health Watch and Clinical Commissioning Group(s). 6. The Trust is recommended to simplify the system for identifying lead people to investigate complaints. 7. It is recommended that that the process for acknowledgement, dissemination and tracking of complaints is streamlined and maintained by staff within the complaints team. Agenda Item: 11 Page 11 of 13

12 8. It is recommended that the Trust develop a more robust procedure and package of complaint handling formats/guidance for the investigation process that includes; A checklist of best practice standards as devised by the Patients Association should be adopted and used by investigation officers. This should form part of the information placed within the Datix complaints module for quality delivery and assurance purposes. A robust process for grading the severity of complaints that is standardised across the Trust and monitored by relevant and nominated Clinical Leads. A standardised template for taking statements that is dated and signed or stamped. Clear investigative training and guidance be provided for investigation staff to include production of tangible and relevant action plans and good practice examples of response letters. The standards should be publicised widely and explained when people raise a complaint. 9. It is recommended that the Trust devise and implement a governance reporting framework for complaints, comments and compliments. Governance leads should be consulted and involved in the development of the framework. 10. All complaints that are investigated should record where applicable whether they are substantiated or not with clear reasons when unable to make a finding. Utilising the Parliamentary Health Ombudsman style of outcome is strongly recommended. 11. All investigated complaints must provide a clear action plan. These action plans need to be placed on the Datix system and made available to the complaints team and complainant as evidence of lessons learnt and actions taken. Actions must be reported and monitored by sound governance arrangements and made available to the Board. 12. A system of sharing lessons learned across services is recommended to be built- in to key information sharing mechanisms that are already in place. 13. The current good practice of using complaint case scenarios and experiential learning from people who have had a poor experience is recommended to continue. These should also be included as part of action planning and feedback to staff in services where complaints have been made. 14. The use of examples of complaint and compliment scenarios (made anonymous) are also recommended to be published on internal and external Trust website as well as reporting issues to the Board. Agenda Item: 11 Page 12 of 13

13 15. The Trust are recommended to engage with their Patient Experience Group, Local Health Watch and other organisations such as Patients Association to develop and introduce a system of Quality Assurance reviews regarding the complaints system and to check areas where improvements and actions have been identified from complaints made 16. It is recommended that clear criteria be produced for triggering a deeper look at a service. A team of designated staff should be trained and made available to undertake a speedy review where concerns dictate. 17. Staff development and appraisal systems are recommended to have a set of values and behaviours that reflect the Trusts commitment to the patient experience and complaints handling. Complaint investigations should identify shortfalls of acceptable standards. 18. It is strongly recommended that a lead Non-Executive Director has designated overview for Patient Experience. This lead could also encourage and monitor collaboration with best practice Trusts and organisations. 19. A robust staff training matrix should be produced around the whole patient experience that starts at Induction and includes aspects of customer care, complaints procedures, complaint handling, investigation and lessons learned. 4.2 Next Steps The Trust will use the recommendations from the independent whole system complaints review, alongside best practice as detailed in the national reports outlined above, to form the basis of an action plan and improvement programme in relation to complaints, compliments and PALS. These will be reported to Trust Board, including governance arrangements to provide assurance about delivery of the improvements. 5. Recommendation To note and discuss the analysis, national guidance and findings of the reviews in relation to further improvement of patient and family experience at the RUH. To support the proposed next steps. Agenda Item: 11 Page 13 of 13

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