CONTENTS PAGE. Page CHAPTER 1 INTRODUCTION 4

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1 COMPLAINTS & PATIENT ADVICE AND LIAISON SERVICE ANNUAL REPORT 1 April 2012 to 31 March 2013

2 CONTENTS PAGE Page CHAPTER 1 INTRODUCTION 4 CHAPTER 2 COMPLAINTS & COMPLIMENTS 5 1 Background 5 2 Numbers of complaints received by service areas 5 3 Analysis of complaints 6 4 Complaints categories Learning from Complaints Performance in responding to complaints Parliamentary and Health Service Ombudsman cases 15 (PHSO) 8 Compliments 16 9 Advice, assistance and information 17 CHAPTER 3 PATIENT ADVICE & LIAISON SERVICE (PALS) 18 1 Background 18 2 Overview of PALS Contacts 18 3 Analysis of contacts Trust Overview PALS contacts received in Operations Directorate by 3 20 Divisions 3.3 PALS contacts received in Children s and Families 20 Services by area or speciality 3.4 PALS contacts received in Community Services by area or 22 speciality 3.5 PALS contacts received in Community Hospitals and 23 Outpatients Services by area or speciality 3.6 PALS contacts by subject PALS contacts by subject divided into directorates PALS contacts received for 2011/12 and 2012/13 by 28 method of contact 3.8 Changes and improvements Examples of changes, improvements and lessons learnt Some specific examples of change within Community 31 Hospitals 3.9 Adding Value What have we done to listen and engage? Have we responded? How have we learnt? Patient Opinion 33 4 Conclusion 33 2

3 CHAPTER 4 COMMON AREAS - COMPLAINTS AND PALS 35 CHAPTER 5 CONCLUSION 36 APPENDIX 1 GLOSSARY 37 3

4 CHAPTER 1 INTRODUCTION Each year, as required under the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009, all NHS organisations are required to publish an annual report in relation to complaints. Shropshire Community Health NHS Trust is delighted to present its second Complaints and Patient Advice and Liaison Service (PALS) annual report covering the period from 01 April 2012 to 31 March The report provides an analysis of the complaints received, and the concerns raised with the Trust s PALS. The purpose of this report is to provide information about the perceived patient experience provided by our services from the perspective of patients/service users and carers and to demonstrate how the learning from this feedback is being used to implement service improvements. The report is presented in three parts, chapter two looks at Complaints and Compliments data, chapter three focuses on PALS data, and chapter four describes the common themes raised across complaints and PALS. A glossary of the abbreviations used throughout this report is provided at Appendix 1. 4

5 CHAPTER 2 COMPLAINTS & COMPLIMENTS 1. BACKGROUND The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009, which came into effect on 1 April 2009, lay out the statutory requirements for handling complaints in the NHS. The regulations in turn informs the Trust s approach to dealing with complaints flexibly and effectively which encourages a culture that seeks and then uses people s experiences to make services more effective, personal and safe. The Trust s Complaints and Compliments Policy and Procedure describes in detail the Trust s process for dealing with and responding to complaints and defines the key roles of the Complaints Manager and the Heads of Service/Senior Managers. As part of good practice, all complainants receive a tailored reply from the Chief Executive to their complaint, alongside the detailed response from the investigating manager. A copy of the Trust s Complaints and Compliments Policy and Procedure is available on the Trust website, and there is a public information leaflet about how to make a complaint or contact the Patient Advice and Liaison Service. 2. NUMBERS OF COMPLAINTS RECEIVED BY SERVICE AREAS The Trust has received 76 complaints during the year, with most being received in patient facing services as depicted in Chart complaints were received in Community Hospitals and Outpatient Services, 20 in Children s and Families Services and 16 in Community Services. The number of complaints represented 0.013% of the total 559,508 outpatient contacts during the period 1 April 2012 to 31 March

6 Chart 1: Complaints received Community Hospitals and Outpatient Services Children's and Families Services 37 Community Services Workforce 20 Finance & Performance Management 3. ANALYSIS OF COMPLAINTS Analysis of the complaints has included a detailed breakdown of the individual areas where issues have been raised to enable monitoring for trends during six monthly reporting periods, as shown in Tables 1, 2, 3, 4 and 5: Table 1: Community Hospitals and Outpatient Services Service area Quarters 1 & 2 01/04/12 30/09/12 Quarters 3 & 4 01/10/12 31/03/13 Oswestry MIU 1 1 Ludlow MIU 1 1 Whitchurch MIU 1 1 Bridgnorth MIU 2 2 Bridgnorth Hospital Ludlow Hospital 3 3 Whitchurch Hospital 1 1 Prison Healthcare Advanced Primary Care Service (APCS) Podiatry Total: Total number of complaints 6

7 Table 2: Children s and Families Services Service area Quarters 1 & 2 01/04/12 30/09/12 Table 3: Community Services Table 4: Workforce Quarters 3 & 4 01/10/12 31/03/13 Child and Adolescent Mental Health Services (CAMHS) Dental Service School Nursing Health Visiting 1 1 Health Promotion 1 1 Occupational Therapy 2 2 Child Development Centre 1 1 Total: Service area Quarters 1 & 2 01/04/12 30/09/12 Quarters 3 & 4 01/10/12 31/03/13 District Nursing Continence Service 2 2 Diabetes Nursing Service 1 1 Shropshire Wheelchair and Posture Service (SWPS) Palliative Care (Nursing 1 1 Macmillan) Administration 1 1 Total: Service area Quarters 1 & 2 01/04/12 30/09/12 Quarters 3 & 4 01/10/12 31/03/13 Occupational Health Total: Total number of complaints Total number of complaints Total number of complaints 7

8 Table 5: Finance and Performance Management Service area Quarters 1 & 2 01/04/12 30/09/12 Quarters 3 & 4 01/10/12 31/03/13 Counter Fraud Service 1 1 Total: Chart 2 shows the four service areas (CAMHS, Interdisciplinary Team Nursing, Bridgnorth Hospital, and Prison Healthcare) that received the most complaints. These services received 35 (46%) out of the total of 76 complaints received during the year. Total number of complaints 8 10 CAMHS District Nursing Bridgnorth Hospital 8 Prison Healthcare 9 Chart 2: Service areas with highest number of complaints The following summaries assist in understanding further detail of the issues raised in relation to these services: Child and Adolescent Mental Health Service (CAMHS) Ten complaints. Similar to last year CAMHS received the most complaints across the Trust s service areas. Six of the complaints contained elements relating to communication issues. The following provide a summary of the action taken in respect of the 4 investigations that were completed at the end of the year. Provision of contact details for the service following its change of location and concerns about a member of staff s attitude in dealing with an enquiry. It was acknowledged that it had been assumed that the child was under a shared care agreement with a GP for the prescribing of medication. The service introduced a system of labelling records to avoid recurrence and the complaint was partly upheld. 8

9 The accuracy of information conveyed to the clinician and the way that a referral was subsequently made by the clinician to Social Services. Reassurance was given about how the information had been conveyed and that the clinician had acted appropriately. The complaint was not upheld. Concern about how a diagnosis was made, the accuracy of address details held on the system, and difficulty in receiving a timely response to telephone messages. As the patient declined to give consent for the complainant to pursue the complaint on their behalf the Trust was limited in its ability to reply. Reassurance was given that the complainant s address details had been updated on the system and an apology was given that telephone calls had not been replied to promptly. The complaint was partly upheld. A complaint was received about the level of service provided by a practitioner including attendance at meetings, non receipt of questionnaires, and their view with regards to the child s condition. Details of the meetings that the practitioner had attended were given together with confirmation that the questionnaires relating to the child had been received. The information received about the child had been appropriately considered and the complaint was not upheld. Interdisciplinary Team Nursing Nine complaints. Four of the complaints contained elements relating to quality of treatment and four related to communication/staff attitude and behaviour issues. The following provide a summary of the action taken in respect of the 7 investigations that were completed at the end of the year. A complaint spanning several organisations about catheterisation problems experienced by the patient was received. A detailed reply was sent explaining the sequence of events from initial contact with the District Nursing Service through to the patient s treatment at hospital. The complaint was not upheld in relation to the service provided by the District Nursing Service. Three complaints about the level of service provided by the District Nursing Service were not upheld. The standard of care provided by District Nurses in dressing a post-operation wound. Reassurance was given about the nursing care provided though it was acknowledged that the patient s file was not taken into the patient s home initially. The complaint was partly upheld. Reassurance was given about the appropriateness of the treatment provided by a District Nurse though the complainant s perception of the nurse s communication and her interpersonal skills during the visit was accepted. A period of supervision was arranged to support the nurse s continuing professional development and the complaint was partly upheld. 9

10 An apology was given in relation to how a nurse s manner and attitude had been construed by the patient together with reassurance that the nurse would be undertaking a clinical supervision session and reflective practice. The complaint was upheld. Bridgnorth Hospital Eight complaints. Four of the complaints contained elements relating to quality of treatment and three related to communication/staff attitude and behaviour issues. The following provide a summary of the action taken in respect of the 8 investigations that were completed at the end of the year. Two complex complaints were received about the level of care provided for two patients by two hospitals including Bridgnorth Hospital. Both complaints were partly upheld. The action taken included reiterating to staff the importance of establishing with patients individually how they wished to be addressed, communication of information about how a piece of equipment should be used during a patient s transfer, care rounds for all patients were introduced, Community Hospital documentation was updated, and all Community Hospitals have introduced information boards at each patient s bed which assist with identifying risk factors such as falls risk and nutrition status. Four complaints about the level of care provided for patients were not upheld. Concern about the accuracy of information in an appointment letter for a scan, waiting time for an appointment, difficulty in contacting the hospital by telephone, and the attitude of a member of staff. An apology was given that information contained in the appointment letter was inaccurate. Reassurance was given that a review of the appointment letters would be undertaken in order to prevent errors. The complaint was partly upheld. Issues relating to the process of discharge of a patient including planning and communication issues. The complaint was upheld. The action taken included the Ward Manager reviewing the discharge paperwork with the Discharge Liaison Nurse in order to address communication issues and documentation, the Discharge Liaison Nurse attended the Ward Staff meetings to ensure that staff are updated on assessment processes, and the failure to notify the patient s next of kin with regards to the patient s discharge has been addressed with the staff member concerned. Prison Healthcare Eight Complaints. Six of the complaints contained elements relating to quality of treatment and two related to communication/staff attitude and behaviour issues. Six of the complaints included issues relating to the provision of medication. The following provide a 10

11 summary of the action taken in respect of the 8 investigations that were completed at the end of the year. Five of the complaints received, three of which related to the provision of medication were not upheld. Concern about the length of wait for a hospital appointment and the provision of medication. It was established that the complainant had recently attended hospital and an apology was given that an item of medication had not been provided. The complaint was partly upheld. Concern about the provision of medication, arrangements for a blood test, and the provision of an item. The complaint was partly upheld in relation to the blood test as the GP had not fully understood the appointments process. Concern about the provision of medication. An apology was given for the delay in the provision of one of the items of medication. This was due to a flaw in the computerised system which was being addressed as a wider concern at national level. The complaint was partly upheld. 4. COMPLAINTS CATEGORIES The top three categories of issues are communication/staff attitude and behaviour, quality of care/treatment and other, as shown in Table 3. The information has been used to help focus training with staff as described in section 5 below. Table 3: Top three complaints categories Category Number of complaints Communication/staff attitude and behaviour 35 Quality of care/treatment 31 Other 10 Totals LEARNING FROM COMPLAINTS To ensure that learning from complaints is shared throughout the Trust, regular reports are received by the Operations Directorate, the Quality and Safety Committee, and the Quality and Safety Operational Group. Key actions taken this year include: 11

12 You said (issue raised) We did (action taken) I rang to order my son s prescription, only to be told that I should be going through the GP. CAMHS The child had mistakenly been identified as being under a shared care agreement during the telephone conversation with the parent. CAMHS introduced a system for labelling records to ensure that it was clear where a shared care agreement was in place with GPs to take over the prescribing of medication. You have the incorrect address on your system for me yet despite several phone calls requesting the letter to be forwarded to myself this has not happened to date. I would like to put in a complaint and feel strongly that a receptionist is needed at the centre. It was agreed that xxxxxx would go alone to the meetings which she was happy to do but it all falls apart when there is no one there to greet them upon their arrival. Difficulties were experienced by the complainant in trying to contact the service. I would like to know when there will be any contact from CAMHS? After doing a xxxxxx test we waited a Reassurance was given that the complainant s address details had been updated on the system and an apology was given that telephone calls from the complainant had not been replied to promptly. The stress that the young person attending for the appointment had experienced was acknowledged. There is now an administrative presence at the location which should prevent a similar situation from reoccurring. An apology was given for the difficulties that had been experienced in trying to contact the service together with reassurance that additional resources had been allocated. The CAMHS worker had been unable to make contact with the parent and the child s school due to other caseload commitments. An apology was given for this and contact was made between the CAMHS worker and the parent. It was acknowledged that at the time 12

13 very long time before getting a diagnosis during that time I had 3 wasted trips to see Dr xxxxxx as a meeting with herself and colleagues had not taken place to discuss my son s diagnosis. there was a delay between completing the assessment and diagnosis this has now been changed in order to eliminate delay in the process. We want to know in detail what procedures you are going to put in place to ensure that others do not suffer. Community Hospitals Care rounds have been introduced in Community Hospitals for all patients in accordance with patients needs and level of risks. All Community Hospitals have introduced information boards at each patient s bed which assist with identifying risk factors e.g. falls risk, nutrition status. Staff attended training on dementia and there is an identified Dementia Link Nurse. Community Hospitals documentation has been updated. I was very rarely called by my name as requested, but sweetheart, my little soldier and others, which I found demeaning and disrespectful. What care plan was agreed and signed off with the Nursing Home regarding my mother s ongoing health care needs? I assume that a full assessment would inform this. The importance of establishing with patients individually the way in which they wished to be addressed was reiterated to staff. An apology was given that a full assessment had not been undertaken prior to the patient being discharged. The Ward Manager reviewed the discharge paperwork with the Discharge Liaison Nurse in order to address communication issues and documentation. Staff were also updated on assessment processes. On each visit we have had a long wait, sometimes over an hour and never an apology. Dental Service An apology was given for the delay and staff were reminded of the need to keep patients informed of any appointment delays. 13

14 He also made an entry in my nursing notes saying that I had been abusive to staff earlier in the day, which I find offensive. I was informed that there had been an error made with xxxxx vaccination and she hadn t been injected with that, in fact she had been injected with saline solution. I was taken by surprise and shocked. An inappropriate term was used by a staff member to describe the impact of the patient s illness. District Nursing Health Visiting Occupational Health It was acknowledged that the incident should not have been recorded in the patient s records and the staff member concerned was advised about how this may be resolved in line with record keeping standards. An apology was given that the vaccine had not been administered correctly together with reassurance that staff would in future follow routine processes during immunisation clinics. An apology was given for the term used by the staff member. Staff were reminded to use appropriate language when conveying information about patient illness. I am writing to you to make a complaint about the way my son xxxxxx had his gait plates fitted. Podiatry An apology was given for the experience that the parent had throughout the child s treatment at the clinic. A patient advice leaflet was produced for issuing with gait plates to ensure patients receive written advice in support of any verbal advice given. In addition to this, complaints information was also cascaded to Service Managers on a weekly basis ensuring that any lessons learned or trends were shared on a timely basis. 6. PERFORMANCE IN RESPONDING TO COMPLAINTS The Trust aims to respond to 85% of complaints within 25 working days for single service complaints and 60 working days for complex complaints. Last year (1 July 2011 to 31 March 2012) the Trust responded to 59% of complaints within these timescales, this year we responded to 82.8% complaints within these timescales showing an improvement of 23.8%. 14

15 Out of the 64 complaints that were due for response during the year a total of 25 (39%) were either upheld or partly upheld. Upheld complaints are defined as those where all the elements in the complaint are considered to be well-founded, partly upheld complaints are those where one or more elements but not all in the complaint are considered to be well-founded. 7. PARLIAMENTARY AND HEALTH SERVICE OMBUDSMAN CASES (PHSO) The PHSO s role is to consider complaints that government departments, a range of other public bodies in the UK, and the NHS in England, have not acted properly or fairly or have provided a poor service. The PHSO aims to provide an independent, high quality complaint handling service that rights individual wrongs, drives improvement in public services and informs public policy. On concluding the investigation of complaints, the Trust informs complainants of their right to complain to the PHSO if they remain dissatisfied and we also invite them to contact the Trust if they feel there is anything further that the Trust can do to help resolve their complaint. During the year the Trust was informed by the PHSO s Office of five complaints where the complainants remained dissatisfied following the Trust s investigations. In the case of three of these complaints the PHSO decided not to investigate and a decision is awaited on one complaint. The PHSO has decided to investigate one complaint relating to Health Visiting and the outcome of this investigation is awaited. In March 2013 the PHSO announced that having listened to NHS organisations in response to its public consultation the PHSO will begin investigating and sharing reports on more of the complaints they receive from April From April 2013 the PHSO will be investigating thousands rather than hundreds of complaints each year. The PHSO estimates that changing their criteria for launching an investigation will mean they investigate around 5,000 complaints each year across the NHS and other public organisations. If a complaint meets the three basic tests below, the PHSO will now usually conduct an investigation: Is the issue in their remit and is the organisation one they are allowed to investigate? Is the complaint within their usual time limit, or is there a good reason to extend it? Are they satisfied that it is not reasonable to expect the person to resort to any alternative legal remedy? 15

16 8. COMPLIMENTS The Trust recognises the importance of recording the compliments received from patients, relatives and carers about services. Compliments can be received in various ways for example through letters/cards of thanks, donations, and gifts. A total of 610 compliments were reported as being received by services during the year. Quotes from some of the compliments received included: I would like to say a big thank you to all your staff for making what could have been a very traumatic experience a very pleasant one, from the moment we booked in everyone treated her in a very sympathetic and reassuring way The staff there cared for her really well, building up her strength physically, and dealing sensitively and gently with her developing mental decline during this period. You are such a lovely team and your empathy, sensitivity, brilliant nursing and humour makes you a credit to your profession. I brought my daughter here, who was initially nervous, but was put at ease and very happy. I am extremely grateful for the very professional and thorough help that I received. 16

17 Out of all the professionals we met, he spoke so highly of you and I know he was so very grateful for everything you did for him. It was a difficult time for us as. family but made it easier leaving him in your loving care. 9. ADVICE, ASSISTANCE AND INFORMATION People who wish to complain about NHS services in Shropshire are able to access free support and advice from POhWER. POhWER can be contacted on and information is available on their website at Further information about the Trust s Complaints and Compliments Policy and Procedure is available on our website at or by contacting the Complaints Manager on , via to complaints@shropcom.nhs.uk, or by writing to the Complaints Manager at Shropshire Community Health NHS Trust, William Farr House, Mytton Oak Road, Shrewsbury, SY3 8XL. The Trust s Complaints and Compliments Policy and Procedure reflect the guidance contained in the Parliamentary and Health Service Ombudsman s Principles of Good Complaints Handling and Principles for Remedy. 17

18 CHAPTER 3 PATIENT ADVICE & LIAISON SERVICE (PALS) 1. BACKGROUND The Patient Advice & Liaison Service (PALS) is a service which offers support, information and help to patients, their families, carers and friends by listening to concerns and feed-back about their experience of NHS and focussing on improving the services by learning from our mistakes. The Trust is committed to continually reviewing and improving its services and the information provided from PALS contacts give the Trust useful intelligence on areas and issues of concern. The management and learning from PALS helps to show that the Trust is listening to their patients and making effective changes to improve quality in care. 2. OVERVIEW OF PALS CONTACTS The total number of PALS cases received in this financial year, from 1 April 2012 to 31 March 2013 was 272 in comparison to 179 received in the previous financial year during 1 July 2011 to 31 March Most of these were about services that are directly provided by the Trust, for example community nursing, podiatry, children s and specialist services or about our community hospitals. By listening to people about their experiences of health we are able to resolve mistakes faster, learn new ways to improve and prevent the same problems from happening in the future. In short, by dealing with concerns more effectively, services can get better, which will improve things for the people who use them as well as for the staff working in them. This is exactly what we have been doing in PALS for the last two years. The PALS service has focussed on achieving 3 things: to be a listening organisation to be a responding organisation to be a learning organisation When service-users contact the PALS service, it s because they are upset or anxious about some aspect of their health care. PALS promote a swift investigation and personal feedback to enquirers, which is a highly effective and an appreciated method of resolution to concerns and, for the majority of service users, is the first choice to register their feedback about our services and getting their concerns addressed. As well as resolving individual concerns, wherever possible, a number of improvements have been made through PALS as a direct result of patient feedback. Some examples of these changes are summarised at the end of this report. 18

19 3. ANALYSIS OF CONTACTS During this time the Trust has also received a number of enquiries and concerns relating to GPs and dentists which fall outside the Community Trust and these have been successfully referred to the appropriate organisation along with clear explanation to the service-user about the changes in the NHS Trust Overview Graph 1 (below) shows the number of enquiries received from 1 April 2012 to 31 March 2013 presented into quarters. PALS dealt with a total of 272 enquiries during this period, all of which are recorded in Datix. Quarter 4 received the largest number of contacts this year, 80 in total and the same was noted in the last financial year with 70 contacts logged in the last quarter, 1 January 2012 to 31 March No particular reason can be attributed to this except the need to find out answers to questions and flag up unresolved issues before the end of the financial year. Graph 1 All PALS Enquiries data in Quarters 19

20 3.2. PALS CONTACTS RECEIVED IN OPERATIONS DIRECTORATE BY 3 DIVISIONS A total of 175 enquiries were received and logged under Operations Directorate and 97 on other Directorates either requesting information about our services, local NHS information, advice on local and national support organisations, concern about other Trusts, advice on different policies and how to access services and others. All PALS contacts received under the Operations Directorate have been broken into the 3 Divisions which are Children s and Families Services, Community Hospitals & Out Patient Services and Community Services. The break-down of enquiries in each Division is as follows: Community Hospitals and Out Patient Services 84 Community Services 52 Children s and Families Services 39 compared to 24 in the last financial year Due to the restructuring of the Operations Directorate leading to the creation of the 3 Divisions, it has not been possible to provide a direct comparison to data from previous financial year for Community Hospitals and Out Patient Services and Community Services as they are now structured PALS CONTACTS RECEIVED IN CHILDREN S AND FAMILIES SERVICES BY AREA OR SPECIALITY Graph 2 (below) shows the number of PALS enquiries received from 1 April 2012 to 31 March 2013 related to Children s and Families Services broken down into the top ten Areas or Speciality. The total number of enquiries received in this speciality is 39. The highest number of issues was on Child and Adolescent Mental Heath Services (CAMHS) - 15, some directly received by or telephone while others received via We Want Your Views forms which is available for service users and their family for providing feedback. Though delay in getting an appointment for an assessment is the commonly raised concern by most parents, there is a lack of understanding of the role of CAMHS, its parameter and what the service entails, both by parents and professionals, such as GPs. Some examples received through We Want Your Views at Ringway House, Telford CAMHS are: No blinds in the doorway for privacy Lack of enough disabled spaces No receptionist The second highest area under this Directorate is Shropshire Dental Services where 7 enquiries were received. Some examples are: 20

21 Advice on domiciliary visit/treatment Advice on reimbursement for travel for an emergency dental assessment and policy on patient transport Concern over quality of treatment Attitude of staff All concerns have been raised with appropriate Managers and PALS have worked alongside staff to resolve these issues and provide a quick response. Whilst all feedback/comments/suggestions and concerns are taken seriously it may not be possible to implement or put them into action immediately as they need to go through the right Committee for discussion and approval before any action takes place. Therefore, changes in practice, systems or services may not be noticed immediately. Graph 2 Children s and Families Services Enquiries data divided into Speciality 21

22 3.4. PALS CONTACTS RECEIVED IN COMMUNITY SERVICES BY AREA OR SPECIALITY Graph 3 (below) provides a breakdown of PALS enquiries received from 1 April 2012 to 31 March 2013 relating to Community Services broken down into Areas or Speciality. The total number of enquiries received is 52. The top three areas are: Shrewsbury Interdisciplinary team 13 One particular service where we received a significantly high number of enquiries (11) in the first quarter was the Community Matrons. All enquiries on this area were related to the proposed changes to this service. Reassurance was given that this service will not be cut and was being realigned to provide a more flexible and consistent service across GP practices. As part of this expansion, the Community Matrons have been integrated into the wider multidisciplinary teams and, as a result, we are now able to care for more patients by drawing on the skills of a wider group of staff including District Nurses, Physiotherapists and Occupational Therapists. Community Matrons will continue to assess all new patients referred to their service and will work with these patients for up to 12 weeks to develop a care plan to actively manage their long term conditions. Following this, most patients will then be managed by the wider multidisciplinary team who will work with the patient and will follow the care plan as prescribed by the Community Matrons. Continence Nursing 8 This mainly relates to change of product where there were communication issues between community nursing teams where information relating to patient assessment was not conveyed sufficiently resulting in patients receiving incorrect products. This led to a range of actions including all patients being notified of the change in product and Community Nurses reminded to inform Continence Service teams of individual needs, particularly if they need to continue the product they have been using due to specific needs and are not suitable to change to new products. Wheelchair Services 7 The issues are mainly related to difficulty in accessing the service, poor communication, staff attitude and long delays in getting an assessment. Staff have been made aware of the need to demonstrate a professional attitude by being helpful, polite and courteous to all patients, their family members and carers. It has been noted that there is a very high volume of referrals to this service resulting in delays in getting an assessment causing frustration and anxiety to service-users who are desperately waiting to be assessed or are waiting for a wheel-chair. Due to the long waiting list and delays, patients and families contact the service repeatedly to find out where they are on the list and the response they get back may fall short of their expectation causing them to be upset. One of the actions is to confirm discussions with patients with a letter from the Manager following a phone call. The letter outlines the advice provided by staff and also provides an update on present status, for example, waiting time. 22

23 Staff have been advised to sign-post patients to PALS if they remain dissatisfied with the service they have received or staff members are busy with other patients or on visits and are not able to deal with their concerns or enquiries promptly. This will help to address the concerns about communication and may reduce the pressure on the service, leading to a quicker access and speedier response. Graph 3 Community Service Enquiries data divided into Speciality 3.5. PALS CONTACTS RECEIVED IN COMMUNITY HOSPITALS AND OUT PATIENTS SERVICES BY AREA OR SPECIALITY Graph 4 (below) provides a breakdown of PALS enquiries received from 1 April 2012 to 31 March 2013 related to Community Hospitals and Out Patient Services broken down into Areas or Speciality. The highest number of issues was on Podiatry (32), mostly related to toe-nail cutting service but a few on staff attitude, access and communication which have all been resolved. The other biggest area was Ludlow Hospital followed by Whitchurch Hospital and the enquiries include a whole range of issues starting from food choice to quality of service and treatment received. Some examples from Ludlow Hospital are: 23

24 Lack of privacy Concern over clinical care Staff attitude and delay in attending patient Compassion and care Examples from Whitchurch Hospital are: Request for a vicar Lost medical notes Delay in transfer from Acute to Community Concern over physiotherapy support We received a number of issues on Oswestry Minor Injuries Unit (MIU) through our Have Your Say forms where we ask patients/carers to provide their feedback about the services received either through PALS or through Patient Opinion. PALS have worked with other Service Managers too and have requested the use of a similar mechanism for recording service user feedback. Some other services such as CAMHS, Podiatry, and School Nursing are using it too. For Oswestry MIU, though most service-users have fed back how good the service is, some issues that were flagged up are as follows: More sign-posting including road signs, service users did not realise that there is a MIU some improvements have been made on this front Front door hard to open, no automatic door assistance, difficulty for service-users with prams and in wheelchairs a building meeting took place and the Estates Manager will be undertaking a review of access into and security within MIU Confidential information could be overheard outside clinic while waiting for physiotherapy appointment at Ludlow hospital chairs removed from the corridor by the physiotherapy department and have been placed in the main out patient waiting area by the MIU entrance. Request for increased hours at MIU, to be kept open late on weekends Manager to take this up with Commissioners following greater demand Parking the Trust is currently looking at a car park management system called parking-eye. The Estates Manger is also looking at other options to control the parking situation, e.g. a barrier system Patient consultation could be overheard in the waiting room at MIU use of radio which is played now helps to address this issue and also creates a relaxing environment. PALS leaflets and posters have been circulated to all departments and displayed across all Community Hospital sites and wards and staff advised to sign-post patients to PALS if they remain dissatisfied with the service. 24

25 Graph 4: Community Hospitals and Out Patient Enquiries data divided into Speciality 3.6. PALS CONTACTS BY SUBJECT Graph 5 (below) provides a breakdown of PALS enquiries received from 1 April 2012 to 31 March 2013 broken down into top 10 Subjects. The top 5 Subjects are as follows: Information/concerns related to other organisations 50 Example advice, concern or information related to Clinical Commissioning Groups (CCG) and PCTs (until 31 March 2013) Access to Services/Appointments 34 Examples of Services - Wheelchair Services and CAMHS Information for patients 29 Quality of clinical/medical care 17 Example - Ludlow Hospital Service Provision 17 Example - Podiatry and Community Matrons 25

26 Graph 5 All Enquiries divided into Subjects Top PALS contacts by Subjects divided into Directorates Table 1 (below) shows some of the other primary reasons (Subjects) for patients or carers to make contact with the Trust including the top ten Subjects broken down into Areas. All Directorates 88 Appointments 2 Access to Services 2 Patient Transport 1 Charges/funding issues 2 Confidentiality 2 Support needs 6 Complaints 2 Consent 1 Personal records/patient information 5 Information for patients 10 Information related to other organisations 49 26

27 Other 3 Quality of clinical/medical care/practice/treatment 2 Self care 1 Chief Executives Office 2 Support needs 1 Information for patients 1 Children s and Families 39 Appointments 3 Access to Services 9 Parking 1 Patient Transport 1 Hotel services/environment 4 Staff attitude/behaviour 3 Confidentiality 1 Dignity, respect and privacy 1 Support needs 2 Human Resource issue 1 Communication 3 Information for patients 4 Aids, appliances and equipment 1 Quality of clinical/medical care/practice/treatment 5 Community Hospitals &Out Patient Services 84 Appointments 7 Access to Services 12 Admission Transfer and Discharge 3 Referrals 2 Way finding/signage 3 Service Provision/PCT Commissioning 6 Waiting Times 1 Hotel services/environment 1 Charges/funding issues 1 Staff attitude/behaviour 7 Confidentiality 3 Support needs 2 Communication 6 Personal records/patient information 3 Information for patients 10 Information related to other organisations 1 Compliments 2 Other 1 Medication/prescription issues 1 Patients property and expenses 1 Quality of clinical/medical 9 27

28 care/practice/treatment Unknown 2 Community Services 52 Appointments 1 Access to Services 11 Service Provision/PCT Commissioning 11 Waiting Times 1 Supplies and equipment 8 Charges/funding issues 1 Staff attitude/behaviour 3 Dignity. respect and privacy 1 Support needs 2 Communication 5 Personal records/patient information 1 Information for patients 2 Compliments 1 Aids, appliances and equipment 3 Quality of clinical/medical care/practice/treatment 1 Governance and Strategy 1 Information for patients 1 Organisational Development and Workforce 6 Human Resource issue 3 Communication 1 Information for patients 1 Other 1 Totals: PALS CONTACTS RECEIVED FOR 2011/12 AND 2012/13 BY METHOD OF CONTACT Graph 6 (below) shows the method used for accessing the PALS service. Though phone contact appears to be the most preferred form of communication, it is evident that many patients/relatives are choosing to access the service by compared to the more traditional system of phone-calls. This is an indication that greater emphasis is required on more up-to-date information on the Trust web-site for easier access and transparency. 28

29 Graph 6: Method of Contacting PALS 3.8. CHANGES AND IMPROVEMENTS In Shropshire Community Health NHS Trust we continually review our services with the intention that there is flexibility to accommodate the various differences that patients present so that our services are based on need and those policies and plans address the needs of people across the range. The aim of PALS is to ensure that there is a learning outcome so that small changes could be put into practice to make a big difference to patient care and improve the overall patient experience Examples of changes, improvements and lessons learnt: Improved process for facial dermatological surgery conducted under Advanced Primary Care Service (APCS). Surgical sites are marked with pens prior to surgery. The provision of a mirror for showing the patient the extent of the planned surgery is now used for areas which the patient cannot see directly. A work plan devised by Podiatry Manager to visit all clinics to ensure standardisation in practice across all sites. 29

30 A matrix with risk classification devised by the Podiatry team and shared with all clinicians to ensure consistency in decision making. Self referral assessment (SRA) forms handed to patients on the day and clinical reasons explained when podiatrist makes a decision to transfer patient on self referral. All Podiatrists demonstrate basic foot care to patients/carers/family during appointment when a decision about self referral and self care has been made. An information pack which contains diabetic foot care and basic toe-nail cutting/filing advice leaflets specifically relating to carers and family advice is now issued routinely by all podiatrists. This is now used as a discharge aid where appropriate. Podiatrists and all administrative staff add reasons for rescheduling patient appointments on the system. This helps to identify any problems in the service and also indicates whether patients have not attended several times. An update was provided to Telford & Wrekin PCT s Telford Referral and Quality Service (TRAQS) on the services that the Community Trust provides to prevent TRAQS from making inappropriate referrals in future and causing delay in patients seeing a podiatrist. Amended wording in a Podiatry appointment letter which caused anxiety and concern to a patient. Awareness raised that all appointments for Podiatry need to be booked via the central podiatry team and podiatrists not to provide their direct telephone number to patients which caused delay in getting an appointment. Community Equipment Service now stores a small stock of non-standard items which they used to purchase when requested by an assessor causing needless delays. Referral criteria have been drawn up for district nurses referring patients to see a tissue viability nurse. This ensures greater accessibility and prevents district nurses booking patients for tissue viability without having access to their diary resulting in cancellation of appointments. Clear information provided to all patients on what the proposed changes to Community Matrons Service meant. This helped to resolve anxiety and provided assurance to patients which were unclear at the beginning. Letters providing an update of their current status, i.e. waiting time sent to patients who have had several contacts with the Wheelchair service and feel that they have not been listened to. This has enhanced clarity in communication. Awareness raised with community nursing teams to assess and reassess patients thoroughly on their continence need and share results with continence team so that appropriate products are prescribed and patients products are not changed without consultation. A new form developed and guidance circulated to staff on the disclosure of a deceased person s record which falls under the Access to Health Records Act 1990 and not as a Subject Access Request. 30

31 Some specific examples of change within Community Hospitals: Management of pain relief Medication training programme for staff with particular focus on management of pain relief Weekly multi-disciplinary meeting within community hospitals as an education forum as well as one which communicates to develop and both challenge care planning. Transfer of care information Improve sharing of information with a new transfer of care document, which has been agreed for use across the Shropshire partnership. Strategically work is being undertaken to improve patient flow and the information required to support the patients. Datix forms completed and submitted when information is insufficient, enabling trends to be identified and raised formally with other organisations. Documentation of Nutritional Care Currently introducing a new format for documentation and a new early warning scoring system for escalation in accordance with NICE guidance. This began in June 2013 and is being reviewed over a three month period which will enable us to enhance the training we are providing and continue to amend paperwork to support the clinicians in their documentation. All paperwork will be kept at the patients bedside apart from medical notes and anything deemed particularly sensitive. Further training to be provided to staff by dietetics and speech and language therapists and anonymous patient stories to be shared which will help increase staff knowledge of clinical conditions. A named nurse to be responsible to review and amend handover with the team to enhance communication with all clinicians, including the doctors. Learning will be shared with the other ward in the hospital and shared at the monthly sister s meeting for community hospitals. Improved Communication and Accessibility Customer care training undergone by staff Considering a patient/ relative/carer diary which may also enhance communication Posters on the ward to encourage greater conversation with staff. Staff to make positive effort to make themselves more accessible to families and carers, particularly at visiting times to encourage sharing of information or any concerns. 31

32 3.9. ADDING VALUE We are always looking for ways to improve the way we do things and try out new approaches to listen to our patients and service users. The focus is on getting the best outcome for both individuals and services. Therefore every concern, feedback or suggestion is seen as an opportunity to help make care better. We now have a much more proactive approach and, if we know that something may have gone wrong, we get in contact, say sorry and find out what we need to do to prevent the issue recurring. People s needs, not the process, drive our work and this has already made a difference What have we done to listen and engage? A thriving PALS service based at William Farr House with easy access for patients and service users PALS leaflets and posters displayed across all sites Regular PALS visits to Community hospitals, chatting to patients and their family to pick up any issues early and address concerns to improve patient experience Discussion with staff to identify any gaps and sort them before it escalates PALS talk and presentation to various groups, for example Senior Citizens Forum, Care and Health Issue Group and others Have your Say and We Want Your Views comment cards for service users to give their feedback and raise concerns about the services received Trust registered with Patient Opinion, an online feedback platform for service users to leave their suggestion and feedback about the Trust and an opportunity for the Trust to respond to patient stories and improve services where appropriate Have we responded? All issues acknowledged and responded to as promptly as possible Work closely with staff and Managers to provide a prompt resolution All feedback and suggestions received through various methods taken seriously and ways to improve services discussed with Managers and identified if possible Closed the loop by providing a response to the person raising the issue Proactively identified any gaps in service provision, policy and service delivery to improve patient experience and quality in care How have we learnt? Learnt through PALS feedback/concerns which provide a vital source of insight about people s experiences of health and social care services, and how those services can improve Learnt through patient stories and feedback about our services posted on Patient Opinion website 32

33 Patient Opinion Patient Opinion is an independent organisation where members of the public can share their comments, concerns and compliments about services on line and the Trust can then respond back to the service user via the Patient Opinion site. As the Trust is committed towards improving patient experience, we are using different methods to capture patient feedback, including Patient Opinion. Existing resources and systems that are already in place have been used to promote Patient Opinion to service users. Some examples are: Patient Opinion is added to the bottom of all appointment letters that are sent to patients for Podiatry appointment. Patient Opinion is added at the bottom of all letters that are sent to parents whose children attend the enuresis clinic Patient Opinion on Have Your Say comment card at MIU Through Patient Opinion leaflets/posters A standing item on the Children s Service news-letter which is sent to all parents whose children use the services The Trust received 22 postings for the period 1 April 2012 to 31 March 2013 in the following areas: 8 positive comments on Bridgnorth Hospital, only 1 issue about unmanned reception which has been resolved 3 positive comments on Paediatric Community Physiotherapy Service related to quality of care, staff attitude and compassion 1 negative comment on CAMHS diagnosis 1 positive comment on Physiotherapy outpatient 1 positive comment about Whitchurch Hospital 2 positive comments on APCS Dermatology Service 1 positive comment about care received at Dinham ward, Ludlow Hospital 1 positive comment about Minor Injuries Unit, Oswestry except that the patient s phone number was not updated. 1 unclear whether MIU or A&E 1 unclear whether Foot clinic at the hospital or Podiatry Service 2 related to Telford Referral & Quality Service (TRAQS) but the appointments were for Podiatry service 4. CONCLUSION Shropshire Community Health NHS Trust has been very open and welcoming of any feedback from our service-users. We strive to ensure that constructive and wellstructured changes are initiated as a result of direct feed-back from our patients, for the benefit of those who are and will be using our services in the future. PALS will 33