MANAGEMENT OF COMPLAINTS, CONCERNS, COMMENTS AND COMPLIMENTS POLICY. Documentation Control

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1 MANAGEMENT OF COMPLAINTS, CONCERNS, COMMENTS AND COMPLIMENTS POLICY Documentation Control Reference GG/CM/002 Date approved Approving Body Trust Board Implementation date Supersedes Patient and Carer Feedback Policy /NUH version 2 Consultation undertaken PPI Steering Group Organisational Risk and Patient Partnership Committee Target audience Distribution: Policy and Procedure(s) Supporting Procedure(s) All Trust Staff All staff Management of incidents [including near misses] Policy Review Date March 2010 Lead Executive Director of Nursing, Midwifery, Service Improvement and Operations Author/Lead Manager Complaints Lead Further Guidance/Information Complaints Lead Ext

2 CONTENTS Section Title Page 1. Policy Statement 5 2. Introduction 6 3. What is Patient Feedback? 8 4. Who Can Give Feedback? 9 5. Process for giving feedback to the Trust Processes for giving feedback 5.2 Processed for handling feedback 5.3 Complaint Process 5.4 Parliamentary and Health Service Review 5.5 Unreasonably persistent complainants 6 Reporting Feedback Learning From Patient Feedback Training Roles and Responsibilities Equality and Diversity Monitoring Associated Guidelines References 31 Appendices Appendix 1 Handling NHS Choices feedback 33 Appendix 2 Compliment Log 34 2

3 Appendix 3 Compliment handling process 35 Appendix 4 Comment log 36 Appendix 5 Comment handling process 37 Appendix 6 Process for handling of concerns and 38 enquiries relating to the Nottingham NHS Treatment Centre Appendix 7 Concern report form 39 Appendix 8 Complaint Severity Assessment 40 Appendix 9 Triage criteria for establishing a concern 41 or complaint Appendix 10 Concern handling process 42 Appendix 11 Complaint Management Plan 43 Appendix 12 Template Acknowledgement letter 49 Appendix 13 Process for handling multi-organisational 51 complaints Appendix 14 Process for handling of complaints 52 received by NUH that relate to another organisation Appendix 15 Process for handling of complaints 53 Appendix 16 Template letter to transfer complaint to 54 other organisation Appendix 17 Consent request form 55 Appendix 18 Complaint file content 56 Appendix 19 Template letter to confirm extension to 57 complaint timescale Appendix 20 Complaint statement proforma 58 Appendix 21 Staff support mechanisms 59 Appendix 22 Complaint action plan 60 Appendix 23 Template directorate complaint response letter 61 3

4 Appendix 24 Template Chief Executive complaint 62 response cover letter Appendix 25 Template Chief Executive complaint 63 response to MP Appendix 26 Complaint Service Evaluation 64 Appendix 27 Training Processes 66 Appendix 28 Complaint Handling Toolkit 68 Appendix 29 Key Performance Indicators 83 4

5 Management of Complaints, Concerns, Compliments and Comments Policy 1. Policy Statement To enable the Trust to provide a responsive quality public service it is essential to actively seek the views of those people who use our services. Listening, Responding, Improving A Guide to Better Customer Care (DOH, 2009) outlines the government s plan to ensuring a single health and adult social care service approach to the handling of feedback. The Trust has a statutory obligation to involve and consult the public about services (DOH, 2008). The Trust is held accountable for the actions taken as a result of public participation and feedback. The Trust is required to report to the Local Involvement Networks (LiNKs) and the Overview and Scrutiny Committee (OSC). The Health and Social Care Act (DOH, 2008) sets out to sustain public confidence in the regulation of Healthcare Professionals. This incorporates the need for effective handling of concerns about healthcare professionals. The NHS Constitution (DOH, 2009) outlines to the public their rights when making a complaint. Experience demonstrates that the wealth of information gained from listening to service users will add considerable value to the quality of patient care we provide. Ensuring that all patients and carers have access and opportunity to feed back their views and experiences of care is an essential part of how we ensure people have a say in public services. At the Nottingham University Hospitals NHS Trust this will be achieved by establishing robust mechanisms to facilitate feedback about the service and ensuring lessons have been learned as a result. 5

6 2. Introduction Patients and carers have a right to have their views heard and acted upon. From April 2009 the NHS complaints legislation (DOH, 2009) requires a single approach for handling of complaints across health and social care. In preparation for the new legislation the Department of Health undertook a consultation process entitled Making Experiences Count and supported early adopter sites to pilot person centered approaches to obtaining and handling patient feedback in relation to complaints, concerns, comments and compliments (the 4C s). Every member of staff is responsible for supporting people who wish to provide feedback or raise concerns. The Trust s Patient Experience Team will provide a comprehensive service incorporating the 4C s. Team members will support patients and public throughout, regardless of whether their feedback is handled as a complaint, concern, compliment or comment. The Trust will ensure that information gained is acted upon to improve, plan, develop and evaluate the services delivered. The Patient Advice and Liaison Service (PALS) is a key source of patient/carer feedback for the Trust and is an avenue for the public to gain help, support, information and advice. Patient Experience Coordinators will provide this service. The Patient and Carer Feedback Policy aims to ensure that: Staff have access to relevant information to support patients, their relatives and carers in giving feedback via access to this policy, leaflets/posters displayed at the Trust and via information accessible on the Trusts internet and intranet sites. The information received as a result of complaints, concerns, compliments and comments and other forms of feedback is used to improve services provided to patients and carers. The Trust response to complaints and concerns is fair and equitable to both the complainant and staff involved. 6

7 Investigations of complaints and concerns are performed in a thorough and timely manner, facilitating resolution in an open and conciliatory way. The information gained forms an essential element of the Trust s approach to Governance. The Trust takes all patient feedback seriously. Every effort will be made by staff to act on feedback at the time if possible and try to resolve the concerns of patients and carers promptly. Care must be taken to ensure that no clinical details are disclosed without the written permission of the patient. The Trust will assure patients, relatives and their carers who give feedback regarding service or raise a concern or complaint, that they will continue to be treated according to their clinical needs and care will not be compromised. Equally, the relatives / carers will not be treated any differently. This assurance will be offered by the Trust through relevant communications, included in Trust feedback leaflets, complaints leaflet and outlined in acknowledgement letters for all complaint. Complainants who may be concerned that discrimination may occur will be offered the support of PALS. If a complainant reports a concern that they have been treated differently this will be reported to the Directorate Clinical Lead who will ensure corrective actions are implemented. All concerns regarding actual or potential discrimination will be recorded by the Patient Experience Team on DATIX, and reported in the quarterly trust board reports. This policy has been written to comply with the Local Authority Social Services and National Health Service Complaints (England) Regulations

8 3. What is Patient Feedback? 3.1 Compliment Positive feedback in writing (often in the form of a thank-you card) or verbally regarding the service received by patients, their relatives and carers. 3.2 Comment Comments may be made either verbally or in writing to any member of staff within the Trust. 3.3 Concern An issue that is raised in writing or verbally to any member of staff within the Trust, identifying concerns about the service or proposing ways of improving the service for patients, their relatives and carers. 3.4 Complaint An expression of dissatisfaction about services provided which requires a formal response. 3.5 Other forms of feedback A range of approaches are in place across the Trust to obtain feedback from people who use our services. The methods used include surveys, focus groups, workshops and NHS Choices. In addition each year the Trust is required to undertake National Patient Surveys as prescribed by the Department of Health which captures information on a range of factors related to the patient experience. All of these methods give the Trust valuable information about the individual and collective needs of patients and carers. 8

9 4. Who Can Give Feedback Any individual can give feedback to any Trust employee or the Patient Experience Team. Feedback can be made by; Service users, those affected by service provision or acting as a representative of a service user A Member of Parliament, councilor or solicitor may write on behalf of the service users. 5. Process for Giving Feedback to the Trust Information regarding the 4C s processes for patients, their relatives and carers to provide feedback to the Trust are available via the following means: Leaflets and posters displayed in areas across Trust campuses. Members of staff and volunteers. Trust Internet site (and Intranet site to support staff when assisting patients, their relatives and carers in providing feedback). Patient Experience Team incorporating the Patient Advice and Liaison Service (PALS). External to the Trust patients and the public can also feedback through the NHS Choices website. Staff have access to the above materials and services thus enabling them to deal effectively with patient feedback. In addition to this, the policy is available to staff in hard copy and via the intranet. 9

10 5.1 The processes by which the Trust receives feedback are as follows: Verbally to any member of staff Staff are encouraged and expected to discuss any comment, concern or complaint raised to facilitate immediate action and fast resolution of any problems. In the event that the staff member cannot resolve issues immediately or answer questions, the member of staff and the person giving feedback can jointly decide to either involve a more senior member of staff or the Trust PALS. Your Views are important to us leaflets The Your views are important to us leaflets will be available in all patient areas to ensure patients have a method of providing written comments. Patient Advice and Liaison Service (PALS) Feedback can be given via the Trust PALS service using any of the following methods - in person, by telephone, text phone, fax, or referral by a member of staff. When a complaint is made, the patient experience coordinator will support the patient/visitor thought the complaints process and provide any support the complainant requires. In writing to the relevant ward or Department or Chief Executive Compliments, comments and concerns will be responded to by the manager (or senior member of staff) of the ward or Department by telephone and/or in writing (whichever is identified as most appropriate) to the patient/visitor with a response if contact details are supplied in the letter. Electronically via the Patient Feedback page offered on the Trust internet site in the give us your feedback section of the home page Service user feedback received electronically will be received at the trust by the Communications Team who filters the s to the patient experience team. The patient experience coordinator will forward the feedback to the appropriate Department or into the complaints process as relevant. The Department will provide a response 10

11 directly to the service user who has raised comments and concerns. NHS Choices Patients and the public can submit feedback about the service they receive from the Trust on the NHS choices website. All feedback is reported to the Trust communications team. The Trust should review the feedback and provide a response to the patient or member of public on the NHS Choices website. On receipt of feedback on the website the communication team will receive an alert which will be forwarded to the Patient Experience Administrator. The Patient Experience Team Leaders will assess the feedback and request review and response from the relevant Directorate Clinical Lead. The feedback will be categorized and recorded on DATIX under the appropriate 4C category (Appendix 1). 5.2 Process for Handling Feedback Compliments Compliments can be provided to any member of staff by any member of the public. If a compliment is provided in writing to the relevant ward/department the manager will respond by telephone and/or in writing. Thank you letters received by the Chief Executive will be responded to in writing to the person providing the feedback. A copy of the letter will then be sent to the appropriate Department, ward or manager. Each ward/department is responsible for ensuring all compliments are logged (Appendix 2) and the logs are submitted to the Patient Experience Team on a monthly basis (Appendix 3). 11

12 5.2.2 Comments Comments can be made in writing using the Your views are important to us leaflet that is available in all public areas of the trust. The feedback leaflets can be placed in the collection box within the wards and Departments. Alternatively they can be returned to the trust via the FREEPOST address quoted on the leaflet. All feedback submitted by post is received by the Patient Experience Team. The Patient Experience Coordinator will send the feedback to the appropriate Department, ward, manager or into the complaints process if relevant. Each area is responsible for ensuring comments they receive are reviewed and actioned accordingly. The relevant Department will provide a response directly to the service user who has made comments on the service. All completed comment leaflets should then be sent to the Patient Experience Team, ensuring the ward or Department details are clearly specified. (Appendix 4) Each ward/department is responsible for ensuring all comments are logged (Appendix 5) and the logs are submitted to the Patient Experience Team on a monthly basis Concerns and Complaints The PALS team may receive enquiries or concerns in relation to the Nottingham NHS Treatment Centre. If the enquiry or concern relates wholly to the Treatment Centre this should be passed to the Treatment Centre s Governance Team for handling, in accordance with Appendix 6. 12

13 Verbal Response to concerns and complaints should be on the spot when possible and a concern report form completed (Appendix 7). If it is not possible for the member of staff to resolve the concern or complaint assistance should be sought from line management. If the concern or complaint is raised verbally and can be resolved within one working day the response does not need to be in writing. However, the nature of the concern or complaint and resolution should be documented by the member of staff responsible for resolution using the concern reporting form. The Patient Experience Team may be accessed for assistance as required. The concern will be triage assessed using the complaint severity grading assessment (Appendix 8) and triage criteria for establishing a concern or complaint assessment form (Appendix 9) to aid the decision as to whether at this point the concern needs to be handled through the complaint process. If the decision is to handle the resolution as a concern corrective action and a response should be provided to the person raising the concern within ten working days (Appendix 10). In Writing All written concerns and complaints will be triage assessed by the Patient Experience Team Leader (or deputy) to aid the decision as to the handling plan. Written concerns will be investigated, responded to either verbally or in writing and activity logged on DATIX. If a written in writing the response should be signed by the relevant Directorate Clinical Lead of Head of Service. Written complaints will always require a formal investigation and written response. The NHS Complaint Procedure encompasses complaints made by: 13

14 A person who receives or has received services from the Trust. A person who is affected, or likely to be affected, by the action, omission or decision of the Trust. A person who is acting on behalf of a person who has died, is a child, is unable to make the complaint themselves because of physical incapacity or lack of mental capacity (Mental Capacity Act, 2005) or if the person has requested the representative to act on their behalf. Complaints should be made within twelve months of the incident or becoming aware of the incident that has caused concern. However, this timescale can be extended if the Complaint Head is satisfied that there is good reason for the time delay and that it is possible to investigate the complaint effectively. When a complaint is made by a representative the trust Complaints Lead must be satisfied that there are reasonable grounds for a complaint to be made by a third party on behalf of another person. Consent should be obtained where there does not appear to be reasonable grounds. Complainants will be informed about the Independent Complaints Advocacy Service (ICAS). Complainants also have the option to apply to the Parliamentary and Health Service Ombudsman if they remain dissatisfied with the trusts complaint management. This policy does not apply to:- Private patients being treated at NUH who wish to complain about the competence or conduct of a privately paid practitioner. Patients should be advised to address such complaints directly to the consultant. However, the policy does apply where a private patient wants to complain about any other aspect of their care / treatment at NUH. 14

15 Staff who wish to voice concerns or grievances. These should be raised through appropriate line management processes. The complaint process is supported by:- The Patient Experience Team Leaders and Coordinators The Patient Experience Team Leader will ensure that the concern or complaint is severity graded and triaged before contacting the complainant to discuss the handling of the concern/complaint. The complaint management plan will be developed to include the complainants concerns, resolution expectation and agreed timescale for the investigation (Appendix 11). The complaint will be acknowledged in writing within 3 working days (Appendix 12). The Patient Experience Team Leader (or deputy) will liaise with relevant Clinical Leads, matrons or managers and other organisations to facilitate responses within the agreed timescale. Where more than one directorate or organisation (health or social care) is involved, the Patient Experience Team Leader (or deputy) will ensure all appropriate consent from the complainant and involvement or stakeholders in conjunction with the Directorate team[s], agree an appropriate lead person to coordinate the enquiries and response (Appendix 13). If it becomes apparent that the complaint relates to another organisation and has not involvement of the Trust the complaint will be handled according to Appendix

16 Directorate Clinical Leads, Matrons, Heads of Service and Department Managers This group of staff will receive all complaints for their respective areas of responsibility. They will ensure that all relevant information to respond to a complaint is collated from appropriate sources and provided to the lead investigator who will draft the response to provide to the complainant. The Directorate Clinical Lead (or Clinical Director) will sign the final complaint response before this is presented to the Chief Executive for final sign-off. Each directorate will have established processes for demonstrating learning from individual complaints and complaint trends. The Chief Executive The Chief Executive (or nominated deputy) will sign all final responses to complainants after checking that the responses addresses all points raised in the complaint management plan. 5.3 Complaint Procedure (Local Resolution) All complaint investigations are to follow the pathway for complaint management (Appendix 15) All complaint responses should adhere with the negotiated time-scale All complaints should be sent to the Chief Executive. It is the responsibility of the Patient Experience Team to collect new complaints daily from the Chief Executive s office All complaints will be stamped and dated with the Trust stamp on the day of arrival to the Trust by the staff in the Chief Executive s office (CEO). All complaints that are delivered to other locations in the Trust should be delivered to the CEO immediately. 16

17 5.3.5 Complaints that span two or more directorates will be managed and coordinated by one directorate clinical lead or matron. This will normally be the directorate lead that has the majority of issues to investigate from the complaint. If this situation arises, the directorate clinical lead or matron must discuss and agree who will take the lead as soon as possible Complaints that span two or more organisations will be managed and coordinated by the organisation that has the majority of issues, or the highest risk issues. The lead organisation will coordinate a single comprehensive investigation and response to the complainant If the complaint relates to another organisation consent must be obtained from the complainant to forward the complaint to the relevant organisation (Appendix 16) Every effort must be made to support people who wish to make a complaint. This could include obtaining interpreters, assisting in putting the complaint into writing, signposting to the Independent Complaint Advisory Service (ICAS) or providing mediation If a complaint is received electronically, the Patient Experience Team member must obtain the complainants official mailing address and telephone number. It should then be explained to the complainant that due to issues of confidentially the final response to the complaint will be sent in hard copy via the postal system, unless the complainant specifically requests the response to be sent electronically, in this situation evidence of this must be documented in the complaint file All complaints will be coded and logged onto the DATIX database / linked to any concern records, incident or claims files at the point of receipt within the directorates. Records on DATIX about the complaint will be kept up to date at all times; this is the responsibility of the Patient Experience Administrator. 17

18 Demographic data about the complainant will be recorded onto DATIX this will include, address, age, gender, and ethnic origin. The relationship of the complainant and the source of the complaint will also be collated The Patient Experience Team Leader (or deputy) will commence the complaint management plan, this will include triage and severity grading assessment, contacting the complainant to identify the complainants concerns, resolution expectation and agreed timescale for the investigation If the complainant requires access to medical records/patient information, in accordance with the Data Protection Act or the Access to Health Records Act, an application form can be forwarded to them by contacting the Administrator, Patient Records Services, B Floor, QMC Campus. Ext If the complaint includes a request for information under the Freedom of Information (FOI) Act the request should be passed immediately to the FOI Lead for action If a complaint makes reference to a claim for compensation this will not automatically exclude the issues from being investigated through the complaint process. However, the Complaints Lead must be informed to ensure due consideration and collaboration with relevant senior colleagues. If there is no indication that a complaint investigation will prejudice any legal proceedings the complaint will be registered through the complaint process. If necessary, advice from the Claims Manager can be sought An acknowledgement letter from the Complaints Lead informing the complainant who will be investigating the complaint, outlining the complaint management plan and providing a copy of the Trusts information leaflet about the complaint process will be sent to the complainant within three working days. If the complaint has been made by a third party they must be asked to provide written consent from the patient before confidential information is released (Appendix 17). However, as the Trust welcomes all feedback as an opportunity to learn and develop its services the investigation 18

19 into the complaint and subsequent response will be commenced whilst consent is awaited. Consent is not required if the complainant can demonstrate they have sufficient interest in the welfare of the patient, for example, next of kin or main carer The Patient Experience Coordinator and Administrator will record the progress of the complaint investigation onto the DATIX database and the paper complaint file. This includes copies of any correspondence to the complainant or staff, telephone calls, face-to-face conversations and electronic correspondence The complaint management plan must be maintained, including documentation of each contact made in the complaint investigation. This is the responsibility of any members of the team who has input into the complaint investigation All records relating to complaint investigations are confidential and must be kept in one master complaint file separate, from any medical records (Appendix 18). Care should be taken with accuracy, legibility and language used. In accordance with the Data Protection Act (1998) a complainant has the right to access all correspondence within the complaint file All complaint records must be kept by the Trust in a secure environment for 10 years If a response is not available within the pre-agreed timescale, the Patient Experience Team Leader (or deputy) must contact the complainant to re-negotiate an extension. This should be confirmed in writing by the Patient Experience Coordinator to the complainant (Appendix 19) To minimize any delays related to the complaint investigation process, information relating to the complaint investigation will, when possible, be transmitted electronically within the organisation. 19

20 The Directorate Clinical Lead/Matron will review every complaint and make a decision as to the complaint complexity and seriousness taking into account the severity grading assessment. The following needs to be considered: If the complaint involves issues that could potentially compromise public or patient safety the Directorate Clinical Lead for the relevant directorate and the Medical Director / Director of Nursing, Midwifery, Service Improvement and Operations should be informed immediately. Complaints that could fall into the Serious Untoward Incident category (SUI) must be referred for advice to the Clinical Risk Lead. Complaints about members of staff that involve accusation of misconduct should be referred to Human Resources for advice / action (see Disciplinary and Grievance Policy). Issues that could potentially involve the media need to be discussed with the Trust Communications Department. Issues relating to child protection should be discussed with the Trusts Named Nurse or Doctor for Child Protection The Complaints Lead should always be informed by the Directorate Clinical Lead if a complaint is particularly complex or is proving difficult to resolve. The Complaints Lead will inform the Director of Nursing, Midwifery, Service Improvement and Operations as the accountable director. The opportunity to discuss approaches at an early stage may help to prevent a complaint escalating to an Ombudsman Review Effective communication mechanisms must be established between the staff working within complaints, incidents and claims. This will help to ensure a consistent approach and avoid duplication and confusion to the complainant The relevant matron (or Department manager) within the directorate/specialty will coordinate the investigation. 20

21 The nominated lead individual at directorate and Department level will always be the Clinical Lead or Matron, or in Departments with no Clinical Lead or Matron, the Department Manager. They will coordinate the investigation and ensure a response is drafted; action plan developed and followed up Whenever possible a conciliatory approach should be taken, this should include telephone or direct contact with the complainant. This is especially important if the complaint is particularly complex. The Patient Experience Team Leader will support the nominated lead to set up an initial meeting with the complainant if deemed appropriate in assisting the investigation For each complaint the lead will ensure the investigation is proportionate to the level of the complaint. The lead investigator will be independent to the part of the service that is being complained about. The investigation will include: Meeting with the complainant if appropriate; Taking statements from the people involved (Appendix 20); Ensuring staff involved in complaints are aware of support mechanisms and how to access these (Appendix 21); Reviewing health care records, policies and procedures as appropriate (whenever possible documented evidence to support statements should be sought); Taking independent expert advice if needed; Formulating a draft response (as if replying to the complainant); Ensuring that the response addresses all the issues identified in the complaint management plan raised; Re-assessing the severity grading of the complaint at the end of the investigation; Concluding whether the complaint is upheld or not; Consideration of the need to reimburse expenses or losses where fault has been identified. This will include for example the cost of lost property or incurred expenses. Advice 21

22 should be sought from the Complaints Lead where necessary. Developing an action plan (Appendix 22) for every complaint (even if the action plan says no action required); Ensuring all relevant documents including staff statements, policy documents, file notes are collated for inclusion into the complaint file. Keeping contemporaneous records of the investigation within the Complaint Management Plan The draft response management and action plan will be returned to the Directorate Clinical Lead at least six working days before the agreed response date for quality assurance The Directorate Clinical Lead will assess the quality of the response to ensure all concerns have been addressed in a comprehensive and appropriate way The response will then be reviewed and signed by the Directorate Clinical Lead (Appendix 23) and sent to the Chief Executive who will review the response and sign the covering letter (Appendix 24) All responses to MPs will be reviewed and be signed by the Chief Executive (Appendix 25) All response letters to the complainant must inform them of their right to ask the Parliamentary and Health Service Ombudsman to review their complaint The complaint service user satisfaction survey (Appendix 26) will be sent to every complainant with the final response letter. The feedback from the survey will be analyzed and reported in the quarterly trust board report The Directorate Clinical Lead is responsible for ensuring follow up and monitoring of action plans and demonstration of directorate wide learning from complaint trends. 22

23 If the complainant remains dissatisfied, the Directorate Clinical Lead should pursue alternative means of local resolution. This could include further investigation, meeting with the complainant or lay conciliation. The directorate lead will liaise with and seek advice and support from the Clinical Director, General Manager, and the Complaints Lead for help with complex or difficult to resolve complaints. 5.4 Parliamentary and Health Service Ombudsman Review If a complainant remains dissatisfied after local resolution they can ask the Parliamentary and Health Service Ombudsman (PHSO) to undertake a review of their case. The PHSO will assess the complaint using the Principles of Remedy, Good Administration and Good Complaint Handling (2009). These principles provide guidance to organisations on how they should handle complaints. The overarching principles are: Getting it right Being customer focused Being open and accountable Acting fairly and proportionately Putting things right Seeking continuous improvement The PHSO review will seek to demonstrate that the trust has acted appropriately when assessing the complaint to identify if there is evidence of maladministration or service failure. The PHSO will request the Trust to provide a copy of the complaint file and health care records. After undertaking the review the PHSO will inform the Trust whether the review has upheld the complaint and the corrective action that the trust must implement. Complaints referred to the PHSO will be monitored by the Complaints Lead and reported to the Trust Board. 23

24 5.5. Unreasonably persistent complainants Most complaints are entirely reasonable. However a few are not. Some may for example, abuse or threaten members of staff or continue to raise new concerns when their previously stated concerns have been addressed. If an investigation lead becomes concerned that a complainant is becoming unreasonable they must seek assistance from a senior manager. It is vital that any restrictions placed on the complainant should be as a result of fair and consistent policy; therefore any request to cease or limit a complaint investigation to a complainant who is considered to be unreasonably persistent needs to be made to the Complaint Lead. It may be necessary to request the complainant only makes contact with a named individual by one contact method only, for example either by telephone, or in writing. The complainant must be informed that raising complaints that have already been responded to will not be re-opened or reinvestigated. If appropriate the complainant should be informed that abusive correspondence or threatening behavior will not be responded to. The use of an advocate to mediate should be considered. The named individual should ensure a comprehensive record of all contact is maintained in the complaint management plan. If it becomes necessary to consider ceasing all contact with the complainant a report should be prepared and presented to the Chief Executive, who will be required to make the final decision. 24

25 6. Reporting Feedback The Directorate Clinical Lead will be expected to report (verbally and in writing) to their Directorate Boards and the PPI Steering Group on a quarterly basis on the following: Numbers of complaints, concerns, comments and compliments (4C s) Themes of the 4C s Achievement of timescales for complaints response Robust evidence to demonstrate that lessons have been learned as a result of 4C s feedback. This information is collated and reported to the Trust Board in accordance with this policy 7. Learning from Patient Feedback All directorates and Departments will be required to have systems in place as part of their governance arrangements to ensure feedback is reviewed. They will ensure that themes emerging from feedback are identified and that action is taken that demonstrates changes have been made to benefit patients / carers. These arrangements will show that lessons have been learned, and the patient experience has improved, as a result of complaints, concerns, compliments, comments and all other forms of feedback. Action plans of directorate activity will be produced and submitted to the PPI Steering Group on a quarterly basis and will be incorporated into reports to the Trust Board to demonstrate to the board that appropriate changes and/or service improvements have been implemented. 25

26 8. Training It is the Directorate Clinical Lead s responsibility to ensure that all staff receive training in customer care, issue resolution, the role of PALS, Patient Experience Team, requirements of Patient and Public Involvement and Engagement and the associated procedures during their induction to the Trust and as part of their continued professional development. Continued training will be reflected in their Personal Development Plan (PDP). Staff who are required to lead complaint investigation will have additional training on the complaint procedure, communicating with complainants, investigating complaints, root cause analysis, conciliation techniques and recording and reporting requirements Staff will be expected to use the Responding to Complaints Guidance Notes. Records of customer care and complaint training will be maintained as evidence of compliance within each directorate and Department. Appendix 27 provided details of training required. 9. Roles and Responsibilities 9.1 Board Level Responsibilities The Chief Executive Is the named officer with responsibility for ensuring that the Trust complies with the statutory obligation to ensure that patients views are heard, acted upon and that complaints are dealt with in compliance with the Department of Health directives. 26

27 9.1.2 The Director of Nursing, Midwifery, Service Improvement and Operations Has overall responsibility delegated from the Chief Executive for ensuring that effective systems and processes are in place to deal with patient feedback and ensure that feedback is shared and acted upon to continually improve the quality of care provided Trust Board The Trust Board is required to ensure that robust systems are in place that enables feedback to be heard, actioned and lessons learned in order to provide the best possible care leading to an improved patient experience. The Trust Board is required to receive reports about complaint numbers, themes, trends and relevant actions; this report will also include details of concerns, comments and compliment feedback and will be provided on a monthly basis. 9.2 Trust wide arrangements Complaints Lead Accountable to the Director of Nursing, Midwifery, Service Improvement and Operations, the Complaints Lead is responsible for the overview and Trust wide monitoring and evaluation of this policy. This post holder is responsible for ensuring that effective reporting to the Organisational Risk and Patient and Public Committee and the Trust Board on a monthly and quarterly basis in compliance with this policy. The reports will identify themes, trends and actions taken to improve services across the Trust [see Appendix 28]. 27

28 9.2.2 Patient Experience Team Patient Experience Team Leaders reporting to the Complaints Lead will ensure all new concerns and complaints are triaged and processed in according with the complainant wishes. They will ensure the coordination of all aspects of the 4C s in support of delegated directorates Senior and Patient Experience Coordinators will support designated directorates in the provision of the 4C s processes by ensuring complaints and concerns are responded to within the agreed timescales and providing the PALS as required. Patient Experience Administrators will receive and distribute all incoming media to the team and be responsible for the upkeep of DATIX for designated directorate 4C s activity. All team members report to the Complaints Lead and provide support to facilitate compliance with this policy. 9.3 Directorate Arrangements Clinical Directors are accountable to the Chief Executive for ensuring directorate compliance with this policy. Clinical Directors have delegated this responsibility to Directorate Clinical Leads Directorate Clinical Leads / Matrons or the General Manager/Head of Service (where there is no Clinical Lead / Matron) Accountable for ensuring that Directorates comply with all aspects of this policy. They will provide quarterly trends and reports to the Directorate Team and the PPI Steering Group. This responsibility includes: Reviewing all complaints that relate to the directorate; Ensuring that all investigations are robust and consistent; 28

29 Ensuring that all responses to complainants are of the agreed quality and address all issues; Ensuring that themes are identified across the directorate as a result of the full range of Patient & Carer Feedback, and that action plans are produced that demonstrate subsequent actions are consistently taken to improve services. They will ensure that staff within the directorate receive sufficient support and training to ensure they are competent to respond to patient and carer feedback (complaints, concerns, comments, compliments and other forms of feedback) appropriate to their level of involvement. 9.4 Operational Team (Directorate & Departments including Corporate Departments) Directorate / Department, Clinical Director or Executive Director [as head of a Corporate Function] The Clinical Director or Executive Director [as head of a Corporate Function] is accountable for ensuring effective implementation and compliance with this policy including the monitoring of action taken as a result of feedback Directorate Specialty Matron Named individuals will be responsible for leading the complaint investigation, responding to the complainant and developing and monitoring an action plan Ward and Department Managers Each ward and Department manager will be responsible for ensuring that all staff within their team have read and understood the Trust s Policy. They must also ensure that all team members have received customer care training and understand their responsibilities when responding to the 29

30 specific needs and concerns of patients and carers. Staff should aim to resolve matters locally wherever possible. All wards and Departments will have a visible Your Thoughts on Our Service / Patient Feedback comments collection boxes and display boards for the public. These will display the corporate information about how to give feedback. The ward/department manager will be responsible for collecting, analyzing and circulating feedback from the comments boxes. 9.5 All Staff All Trust employees have a responsibility to respond to the concerns of patients, their relatives and carers. This will include promptly assisting them if possible, directing them to additional help if required and signposting to the complaints procedure if needed. 10 Equality and Diversity The Trust is committed to ensuring that, as far as is reasonably practicable, the way we provide services to the public and the way we treat our staff reflects their individual needs and does not discriminate against individuals or groups on the basis of their ethnic origin, physical or mental abilities, gender, age, religious beliefs or sexual orientation. Demographic data will be included in Trust Board reports and trend analysis undertaken. If there is any identification that any group of people are underrepresented this will be reported to the PPI Steering Group who will advise on the implementation of corrective development plans. 11. Monitoring and Evaluation The Complaints Lead will continuously review the complaint process across the Trust. This will incorporate the consistency of the complaint process, internal quality of the investigation, responses, actions taken and the satisfaction of complainants. 30

31 At Directorate level assurance needs to be given that all staff are competent to respond to patient feedback, and that lead investigators have the skills and confidence to undertake a thorough investigation and formulate a response. The directorate must also have clear evidence of involving patients and public and as a result of feedback able to demonstrate improvements to services for patients and carers. To ensure compliance with this policy:- Directorates will present quarterly reports for their specialties to the PPI Steering Group. The Complaints Lead will collate Trust wide data and submit monthly and quarterly reports to the Organisational Risk and Patient Partnership Committee and the Trust Board, demonstrating compliance with agreed key performance indicators. (Appendix 29) The Trust Board and NHS East Midlands will receive an annual report on patient and carer feedback, including numbers, trends and themes along with actions taken to improve services for patients and reduce adverse feedback. The Complaints Lead will monitor relevant activity each year to ensure that the policy and Trust actions are fully implemented and compliant with the Standards for Better Health, [Patient Focus Domain 14a, 14b and 14c] and the NHSLA Risk Management Standards [4 and 5]. 12. Associated Guidelines Related Policies / Strategies i ii iii iv v Raising Concerns at Work (whistle blowing) Policy Management of incidents [including near misses] Policy Claims Handling Policy Aggression, Violence and Harassment Policy Disciplinary Policy 31

32 vi vii viii ix x xi Grievance Policy Media Policy Patient Advice and Liaison Service Policy Patient and Public Involvement Strategy Equality and Diversity Strategy Voluntary Services Policy 13. References DOH (2009) NHS Complaints Procedure DOH (2009) Listening, Responding, Improving - A Guide to Better Customer Care DOH (2009) NHS Constitution DOH (2008) Duty to Involve DOH (2008) Health and Social Care Act PHSO (2009) Principles of Remedy PHSO (2009) Principles of Good Administration PHSO (2009) Principles of Good Complaint Handling 32

33 Appendix 1 Process for Handling NHS Choices feedback NUH Communication team and PALS account receive alert that feedback has been posted on NHS Choices Website Patient Experience Administrator reviews content of feedback and alert Patient Experience Team Leader Patient Experience Team Leader advises which Directorate should respond Patient Administrator forwards alert to relevant Clinical Lead, requesting response within 5 working day Clinical Lead provides response to Patient Experience Administrator Patient Experience Team Leader reviews response and forwards to Communication Team Patient Experience Administrator inputs information into relevant DATIX module 33

34 Appendix 2 WARD/DEPARTMENT COMPLIMENT LOG Ward/Department: Month: Contact Name: Tel No: Cards/letters Gifts Other Please return at the end of each month to the Patient Experience Team Thank you 34

35 Compliment Handling Process Appendix 3 Compliment received by ward or Department (this may be directly from patient/carer, from Patient Feedback via trust internet or NHS Choices, from Chief Executive in writing or any other format) Ward or Department acknowledge compliment as appropriate Ward or Department staff log compliment Compliment log sent to Patient Experience Team Monthly Patient Experience Administrator inputs details of compliments to database Patient Experience Administrator collates by speciality and reported in monthly directorate 4C s summary report Patient Experience Administrator collates by Directorate and reported in quarterly Trust Board Report 35

36 Appendix 4 WARD/DEPARTMENT COMMENT LOG Ward/Department: Month: Contact Name: Tel No: Comments Action Outcome Please return at the end of each month to the Patient Experience Team Thank you 36

37 Appendix 5 Comments Handling Process Comments received by ward or Department (this may be directly from patient/carer, through the Your views leaflet, from Patient Feedback via trust internet or NHS Choices or any other format) Ward or Department acknowledge comment as appropriate. If received through PALS the Patient Administration team member will acknowledge Ward or Department staff undertake any required action Comments log forwarded to Patient Experience Team Monthly Patient Experience Administrator inputs details of comments to database Patient Experience Administrator collates by speciality and reported in monthly directorate 4C s summary report Patient Experience Administrator collates by Directorate and reported in quarterly Trust Board Report 37

38 Appendix 6 Process for Handling of Concerns and Enquiries received by Nottingham University Hospitals in relation to the Nottingham NHS Treatment Centre NUH PALS receive the concern or enquiry by telephone, face to face, electronically or in writing Assessment indicates the concern or enquiry relates wholly or predominantly to the Treatment Centre Client is informed that the concern or enquiry needs to be passed to the Treatment Centre, NUH PALS ensure consent to share information is obtained and make client aware of the need for consent regarding patient confidentiality if person raising concern is not the patient NUH PALS team pass the concern or enquiry to the Treatment Centre by telephone or Treatment Centre team acknowledge receipt of the concern or enquiry and take responsibility to provide satisfactory outcome to the client NB Client can be given the direct telephone contact number of the Treatment Centre Governance Team as required ( ) 38

39 Appendix 7 Concern Report Form Date received Name of person raising concern Patient Name Hospital No: Ward/Dept. Date of Birth:... DETAILS OF CONCERN (Please indicate by placing an X) Admission Cleanliness Attitude Incontinence/bowel care Food & Nutrition Communication Medical Care Nursing Care Tissue Viability Privacy & Dignity Patient Safety Infection Car Parking Health Records Signage Transport Portering Other Specify: Patient Property Discrimination Discharge Waiting Time OUTCOME (Please indicate what you did to resolve the concern/s above) Was the client satisfied with your actions Completed by:- YES NO (Refer to Line Manager or PALS) Sign. Print name Designation Return completed forms to Patient Experience Team 39

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