9.3. NHS Orkney Board Agenda Item 9.3. Date of Meeting 26 August 2010 OHB Paper Number. Title Patient Feedback Annual Report 2009/2010

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1 9.3 NHS Orkney Board Agenda Item 9.3 Date of Meeting 26 August 2010 Paper Number OHB Title Patient Feedback Annual Report 2009/2010 Purpose of Report To present the Annual Report in respect of patient feedback received by the Board during the year ended 31 March Recommendations To note the Annual Report and seek assurance that action has been taken where appropriate Attachments Patient Feedback Annual Report 2009/2010 Author Lead Julie Tait Patient Experience Officer Rhoda Walker, Director of Nursing and AHPs Contact Details

2 Patient Experience Balfour Hospital New Scapa Road Kirkwall Orkney KW15 1BH Date: April 2010 Tel: Fax: Enquiries to: Julie Tait Patient Feedback Annual Report / Purpose of Report: To present the Annual Report in respect of patient feedback received by the Board during the year ended 31 March Background: The NHS aims to provide effective and efficient health care to the people of Scotland. The organisations and staff that make up NHS Scotland are committed to providing the highest quality of care possible. Patient Feedback is a valuable source of information to the Board and can be collected in many different ways, including, complaints, compliments, comments, suggestions, patient satisfaction surveys, face to face and in groups. Patient Feedback provides the raw material for a research driven programme of continuous improvement to patient experience. Based on the feedback and its findings, services can be re-designed and improved. Changes can be monitored and fed back to stimulate further research and service development. NHS Orkney collects feedback in the form of complaints, comments, concerns and compliments however, the organisation is becoming more open to gathering patient feedback within individual departments to use as a means of learning and making improvements. 3. Complaints: The NHS complaints procedure was introduced in 1996 requiring Boards to establish a procedure for dealing with complaints. The Board welcomes formal complaints and utilises the process to identify areas for improvement. It is acknowledged that in a small community patients are generally reluctant to complain when things go wrong. The most satisfactory outcomes to complaints are achieved when a complaint is dealt with fully and effectively at local resolution stage this is when the Board seek to provide prompt investigation and resolution of a complaint at local level, normally within 20 working days. 3.1 Hospital and Community Services: During the period 1 April 2009 to 31 March 2010, 18 formal complaints were received by the Patient Experience Officer in regard to Hospital and Community Services. This compared with 17 received during the previous twelve months. It is evident that over the past few years Orkney NHS Board Headquarters: Garden House, New Scapa Road, Kirkwall, Orkney KW15 1BQ Caring for the people of Orkney Chair: John Ross Scott Chief Executive: Cathie Cowan Orkney NHS Board is the common name of Orkney Health Board

3 that the numbers of complaints received have fluctuated to have peaks and troughs however, the last 3 years have continued to increase rather than decrease. Of the 18 complaints investigated, 7 were not upheld, 7 were partially upheld and 4 were upheld. 3.2 Verbal/Informal Complaints: There were a number of verbal and informal complaints received both by the Patient Experience Officer and at departmental level. These were investigated and dealt with informally at source. In the Patient Feedback report of 2008/2009, members were informed that NHS Orkney have in place Comment and Suggestion forms and boxes which patients can post any feedback they may have. These are followed up by the PFPI Co-ordinator. There have been 32 comments/suggestions received in the last 12 months. NHS Orkney also has a Feedback facility on the NHS Orkney website which members of the public are able to make use of. This facility is not so widely used. 3.3 Primary Care Services: There were 6 complaints received by the Board regarding General Medical Services (GMS). General Practices have received and investigated 13 complaints, all of which were resolved at source. This is an increase on the previous year, where 9 GMS complaints were recorded. The practices also received many expressions of thanks, cards plus gifts during the same period. 3.4 Other NHS Organisations: Six complaints were received regarding services provided by other NHS organisations, again an increase from the last 12 months, when we only received two. These were passed to be investigated through those organisations complaints procedure. One complaint was passed to NHS24 and one complaint was passed to Scottish Ambulance Service. The remaining 4 complaints were forwarded to the NHS Grampian Feedback Service for investigation and response. 3.5 MSP / MP - Constituents' Concerns Raised: There are occasions when patients contact their MSP in the first instance to make a complaint. During the period 1 st April st March 2010, the Chief Executive received 16 expressions of concern or complaint which had been addressed through their MSP. Issues included: Travel Costs Dental services Mental Health Services Nursing services to Island residents GP services to Island residents Patient transfer concerns C.Diff Complainants are increasingly contacting their MSP/MP for further answers but there has been a decrease in this area since 2008/ Independent Advice and Support Service (IASS): The IASS offer advice and support for all NHS users and can help patients if they have any comments or complaints about any aspect of the health service. The Patient Experience

4 Officer provides information on the service to complainants so that they may use the service if they feel unable to raise concerns themselves. During the year , the IASS acted on behalf of 7 clients who made a complaint against the NHS. Nationally the Independent Advice and Support Service (IASS) have been working more closely with the NHS and an IASS NHS Partnership event workshop was held in September 2009 which the NHS Orkney Patient Experience Officer and the Orkney IASS Officer attended. The workshop aimed to identify a day in the life of an IASS Officer and a Complaints Officer. Case studies were presented and those attended discussed how these would be dealt with by each of the organisations. The Patient Experience Officer found the workshop to be very worthwhile and informative. It is hoped to continue this joint working in the future however under the Patients Rights Bill, this service is expected to change marginally and be known as the Patient Advice and Support Service. More information on this change is detailed below under the heading of Patients Rights Bill. 3.7 Scottish Public Services Ombudsman: During the year 2009/2010, the Ombudsman received 3 complaints from Orkney residents who were unhappy with the response they had received from NHS Orkney through the complaints procedure. One complaint was not upheld and NHS Orkney were found to be without error. One complaint was also not upheld however, recommendations were made to the Board on how improvements could be made. This included recommendations on training and induction for junior doctors. The third complaint received by the Ombudsman is still ongoing and no outcome has been received as yet. 4 Compliments: There will also be occasions when patients wish to show appreciation for the services they have received and it must be highlighted that there are many unrecorded compliments received each year by departments and staff as well as those detailed in this report. There were 425 recorded and reported expressions of gratitude, cards, and letters plus gifts and donations received during 2209/2010. It should be recognised that compliments by far out way the number of complaints received and the many unrecorded expressions of gratitude received by staff is largely unknown. Departments who have carried out Patient Satisfaction Questionnaires recognise that the compliments received within these surveys are most beneficial to their staff in reminding them that patients are, in the most, very happy with the services received from NHS Orkney and its workforce. 5. The Complaints Process: NHS Boards still await information on how to improve their complaints process following the Craigforth Review which was published in May 2009 and NHS Orkney have been included in a focus group to comment on the recommendations made in that Review. However, NHS Orkney are currently reviewing its own complaints process to ensure that all aspects of patient feedback are taken into account and that it includes information on working actively to encourage the organisation to use patient experience feedback as a learning tool. 6. Improving Services: The Can I Help You? Learning from Comments, Concerns and Complaints Complaints Procedure Guidelines states that Local clinical governance arrangements must include procedures for ensuring that information gained from patient feedback, including complaints, is used to improve service quality.

5 NHS Orkney s current complaints procedure attempts to ensure that any recommendations, actions or changes highlighted through a complaint are implemented by the manager tasked with investigating the events surrounding a complaint. The Patient Experience Officer also, on occasion depending on the nature of the action, will follow up with the line manager to ensure actions have been progressed. The Clinical Governance Operational Group, lead by Alan Bruce, Clinical Governance Co-ordinator, also receive a full report of complaints, action agreed and improvements implemented. As lead, Alan Bruce, follows up on the report by asking those Managers who investigated the complaint to provide evidence that what has been agreed, has been progressed During the last year 2009/2010, NHS Orkney received 18 formal complaints, broken down by quarter as per the tables below. April to June July to September October to December January to March Of these 18 complaints, 7 were found to require no follow up or action required. The 11 complaints requiring follow up are listed below in more detail: Issue Raised / Recommendation Made Remedial Action Taken Date Complete Comments Lack of correct information given relating to air ambulance travel and Distribution of Travel Packs not carried out Incorrect information on ID requirements given to patient relative who had to travel in an emergency by scheduled air service Dissatisfaction with level of care given to hand injury on attendance at A&E nursing and medical Lack of arrangements made for discharge of elderly patient and personal care arrangements whilst on ward Travel Policy required review now fully implemented Issuing of Travel Packs had not been carried out consistently by Primary Care or Ward staff. Issued reminder to staff/wards/met with Practice Managers/Article in local paper to promote packs Staff reminded of correct procedure for patients/family travelling on air ambulance and form now available in the wards regarding emergency travel without ID form now available in the wards regarding emergency travel without ID Clinical Training to be organised with Orthopaedic Surgeon and clinical protocols are being reviewed. Induction and training arrangements for staff involved in managing clinical presentations is also being reviewed Date of discharge and home care arrangements have been reviewed to ensure a care package is ready to commence once discharged from hospital Staff reminded to be mindful of patients feelings on personal care and to ask if assistance is required April 2009 Although these actions were taken, it appears that travel packs are still not being handed to patients consistently (statement made at PPF meeting in April 2010) May 2009 Not known Not known

6 Dissatisfaction at cancellation of appointment and contents of cancellation letter department change of appointment letter altered to include an apology Nov 2009 Recommendation also adopted in medical records department Complex complaint concerning NHSO/SAS/Primary Care clinical care, transport, treatment, medication given, delay in air ambulance Critical Incident Review was held 13 action points highlighted as a result (copy can be provided on request) A number of actions were implemented immediately (Nov 2009) Some actions may still be outstanding Lack of appointment at Physiotherapy Complex complaint regarding care of elderly couple falls, staff attitude, staff attention, communication, conflicting information on how fall happened Complaint re whole service provided by MARS Patient assaulted by another patient on Ward Dental Care and attitude of dental staff Patient Experience Officer suggested that Physiotherapy department review how appointments are cancelled and rebooked when carried out by a non-administrative member of staff Complaint remains ongoing at this time however, complaint highlighted substantial learning including staff communication, dealing with relatives, providing up to date and accurate information, falls risk assessment, monitoring of falls. An independent Review Team undertook an investigation and assessment of case. (Report available on request) Patient Experience Officer contacted MARS Service and arranged for Commissioning Manager to attend appointment with complainant and patient. Commissioning Manager suggested documentation keeping required improving however received further evidence that electronic records had been kept. This is an ongoing situation for this complainant and patient and Commissioning Manager now monitoring to ensure service provided is effective. changes made to the ward environment and to the specialist clinical support received from NHS Grampian patient offered new denture free of charge as a good will gesture No known ongoing Jan 2010 Family had/have longstanding issues around the MARS System which need to be addressed as an ongoing concern. There was positive feedback from family following appointment but no further information has been received March 2010 This has involved making changes to the ward to ensure there are quiet areas away from confused March 2010 patients. Staff on duty have a mechanism whereby they can quickly contact Grampian Psychiatrist clinical advice NHS on-call for

7 7. Better Together Patient Experience Programme: The Better Together Scotland s Patient Experience Programme rolled out its GP and Inpatient Surveys during November 2009 and January 2010 respectively. At the time of writing, the GP Survey raw data results have been made available to Boards. NHS Orkney plan to investigate the data and look at what patients have highlighted as priority areas and what improvements may be needed throughout Primary Care. The Inpatient Survey has been very well responded to with a 62% response rate by Orkney patients at the close of the survey. Raw data results should be available shortly and again, NHS Orkney will investigate this information and identify what patients feel works well and not so well within the Balfour Hospital. The results of both these surveys should inform and help develop improvements within the organization. A further Better Together survey is expected this year, which will look at Long Term Conditions. 8. Patients Rights Bill: The Patient Rights (Scotland) Bill was introduced to the Scottish Parliament on 17 March The Bill is intended to improve patients experiences of using health services and support people to become more involved in their health and healthcare. It will support NHS Scotland s aspirations for an NHS that respects the rights of both patients and staff. The key provisions in the Bill are: 1. Every patient has a right that the health care they receive: is patient-focused, which means that it takes into account the patient s individual needs, has regard to the importance of providing the optimum benefit to the patient s health and wellbeing, allows for patient participation in decisions about their healthcare, provides appropriate information and support to allow them to do so. 2. It introduces a guarantee (to be known as the treatment time guarantee) that eligible patients will start to receive treatment within 12 weeks of their treatment being agreed. The treatment time guarantee will apply to planned and elective care that is carried out on an inpatient or day case basis. The details of this will be in secondary legislation. Treatments would include, for example, hip and knee replacements, cataracts, heart operations, hernias. 3. It gives every patient the right to make a complaint or provide feedback about NHS care and services, and to have access to support to do so, if they require it. 4. Establishes a Patient Advice and Support Service (PASS) to replace and enhance the existing Independent Advice and Support Service (IASS). PASS will provide information and help to patients, carers and members of the public, to raise awareness of their rights and responsibilities when using health services. The Patient Advice and Support Service will also support patients to make a complaint about their healthcare if they require help. 5. Creates Patient Rights Officers, who will staff the PASS and carry out its functions. Their main roles will be to: help and support patients to make complaints if they require it; provide information about health services; raise awareness of, and advise on patient rights and responsibilities, and; direct patients to other useful types of support such as advocacy or communication support services.

8 9. Conclusions: Patient Feedback is an extremely valuable way to gather useful information that can affect change and improvements There has been a slight increase in the number of formal complaints, GMS complaints and complaints forwarded to other NHS Organisations received compared to the previous year. Patients are increasingly contacting their MSP in regard to complaints, either before or after contacting the Patient Experience Officer. The Complaints Procedure is currently being reviewed and renamed internally to take account of all patient feedback but will also be subject to further changes following the publication of the Craigforth Review Making it Better: Complaints and Feedback from Patients and Carers about NHS services in Scotland Issues arising from the complaints reviewed have contributed to an improved service The Better Together Patient Experience Programme is being fully progressed in the Board and the results of both the surveys should inform and help develop improvements within the organization. The introduction of the Patients Rights Bill will improve patients experiences of using health services and support people to become more involved in their health and healthcare. The Independent Advice and Support service is a valuable service to those patients who feel uncertain about contacting the Board directly. Julie Tait Patient Experience Officer

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