PALS & Complaints Annual Report

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1 PALS & Complaints Annual Report

2 This report provides a summary of patient complaints received in 2013/14. It includes details of numbers of complaints received during the year, performance in responding to complaints, Parliamentary and Health Service Ombudsman investigations, and action taken by the Trust in response to complaints. Summary Delivering a quality service to our patients is one of the Trust s core strategic priorities. Key national programmes to drive improvement in patient experience include Quality Accounts, the Care Quality Commission national patient survey programme and CQUINs (Commissioning for Quality and Innovation). Croydon University Hospital has a strong focus on improving patient experience and this continues to develop and evolve. There are both well established and some newer mechanisms to capture the experience of patients, and drive on going improvement. The Friends and Family test (FFT) has been used to capture, analyse and report patient satisfaction with our services in the Trust since April Now the Friends and Family Test is being offered to staff to measure their satisfaction with the organisation as a place to work or as a place to receive care or treatment. The Staff (FFT) survey is anonymous and gives staff the opportunity to provide feedback on areas for improvement. The introduction of the Staff FFT by NHS England therefore represents a commitment at a national level to amplify and strength the voice of the people working in the NHS and to promote positive listening and learning, which will further support service improvement in a culture of transparency, honesty and openness. The Trust is using the initiative Listening into Action which is a staff engagement programme that is already making a big difference to our patients. By listening to staff, valuing their ideas and implementing them, we are improving patient experience. The Francis Report on the inquiry into the failings in Mid Staffordshire Hospitals highlighted serious failures with the complaints process in that hospital and the review of NHS complaints undertaken by Ann Clwyd MP and Professor Tricia Hart provides new guidance and statutory responsibilities for responding to complaints and concerns. Appendices 1: Gap analysis. Action Plan The Trust continues to work hard and is implementing changes within year 2014/15 to ensure its complaints process is personal and responds to the needs of the individual to ensure their experience is listened to and put right simply and quickly. Patient complaints are reported to the Board on a monthly basis, in addition to weekly activity reports. Main points to note for 2013/14: 699 complaints were received and 3247 PALS contacts recorded Complaints and PALS contacts both increased by 32% compared to 2012/13 85% of complaints were upheld in full or part after investigation End of year performance shows 51% of complaints responded to within 25 days against a target of 80% 7 cases were referred by complainants to the Parliamentary and Health Service Ombudsman for review, representing 1% of complaints received 2

3 Complaints activity During 2013/14, 699 formal complaints were recorded, which represented an increase of 32% over complaints for 2012/13. Changes to directorates, which took effect in November 2013, mean that direct comparisons to previous years may not be accurate, but Surgery (up 105%), Family Services (up 58%) and Estates (up 30%) showed the greatest percentage increases. Adult Care Pathways continues to receive the greatest number of complaints across all directorates. During the year, the Parliamentary and Health Service Ombudsman (PHSO) requested a review of 7 cases where they had been contacted by the complainant. This represents 1% of complaints received. Of these, five are currently under review, one case was closed as the PHSO declined to investigate after review and one case was closed with recommendations from the PHSO. The PHSO also made recommendations on one case which had been referred for review in 2012/13. In both cases where the PHSO made recommendations the Trust was asked to send a further letter of apology and in one case the PHSO awarded the complainant 150. For the clinical directorates, the level of complaints continues to reflect a very low level of concerns by reference to the total number of patient epsiodes carried out, as reflected in the chart below. Complaints by Patient Episodes 2013/14 Directorate Complaints Patient Episodes Percentage Adult Care Pathways Directorate % Cancer and Core Functions Directorate % Family Services Directorate % Surgery Directorate % Totals: % 3

4 The chart below shows complaints received over the last three years, comparing activity quarter on quarter. Complaint numbers were broadly consistent through 2011 to 2013, with numbers reduced slightly for 2012/13 compared to 2011/12, but levels have increased steadily throughout 2013/14. Complaint performance The Trust aims to acknowledge all complaints within three working days; for 2013/14 the Trust acknowledged 82% of all complaints within three days, an improvement on 72% achieved for 2012/13. The Trust has an internal target that a written response to the complainant should be sent within 25 days in 80% of cases. The Trust responded to 51% of complaints within 25 days, an improvement upon the level of 38% for 2012/13. The need to improve further is recognised by the Trust and active steps have been taken to see the Trust target achieved during the 2014/15 year. Complaints by Service The following tables illustrate the distribution of complaints during 2013/14 and provide a comparison with 2012/13. The tables ignore areas where only a small number of complaints were received. The levels of complaints remained mainly unchanged for most areas, with either small increases or falls. Inpatient services, Obstetrics and Gynaecology, and Eye day care all show significant drops in the number on complaints received, whilst Trauma and Orthopaedics and General Surgery showed increased complaints (up by 4

5 28% and 12% respectively). The greatest increases were recorded in Elderly Care wards (up by 164% to 37 complaints) and Urology (up by 133% to 14 complaints). Complaints by Service 2013/ Complaints by Service 2012/ The levels of complaints remained mainly unchanged for most areas, with either small increases or falls. Inpatient services, Obstetrics and Gynaecology, and Eye day care all shows significant drops in the number on complaints received, whilst Trauma and Orthopaedics and General Surgery showed increased complaints (up by 28% and 12% 5

6 respectively). The greatest increases were recorded in Elderly Care wards (up by 164% to 37 complaints) and Urology (up by 133% to 14 complaints). Complaints by Subjects The top ten subjects of complaints have remained unchanged from 2012/13, and apart from the top six subjects, levels of concern are broadly unchanged. Clinical care and treatment remains the subject raised most frequently, although complaints on this subject have fallen by 35% since 2013/14. The subject showing the biggest fall in complaints is Nursing and midwifery care, which has shown a fall of 53% since the previous year. These two areas undoubtedly reflect the actions taken to address staffing levels and the efforts made to recruit permanent nursing staff, thus reducing reliance on agency and bank staff. Attitude of Staff (up by 38%) and Communication (up by 20%) have increased. Administration also showed an increase of 28% over 2012/13, but this may be attributable to the initial teething problems encountered following the introduction of the Trust s new patient record system in October The chart below shows how the subjects relate to the four clinical directorates, and this is broadly in line with the spread of complaints. Adult Care Pathways has a greater number of complaints relating to discharges, and this may reflect the wider issues arising from the discharge of elderly patients. 6

7 Complaint Outcomes We are committed to providing an open, honest and straightforward response, with robust complaint handling at a local level. Of the complaints investigated in 2013/14, 7% of cases were reactivated for further local resolution, indicating the complainants were dissatisfied with the response they received from the Trust. This represents no change from 2012/13 and illustrates the continuous effort to provide comprehensive responses. The Trust is required under the complaints legislation to assess and record whether or not the issues were considered to be substantiated following investigation. During 2013/14, 58% of the complaints investigated were upheld in full, which is an increase from 2012/13 (46%). PALS The Trust dealt with a total of 3247 PALS concerns during 2013/14, an increase of 32% from 2012/13. 7

8 The table below compares the change in the level of contacts on the highest recorded subjects since 2012/13. Subject 2013/ /13 % increase Information CHS Service % Access department % Formal complaint advice % Access make/ change appointment % Delay outpatient appointment % Cancellation rescheduled outpatient appointment % Appointment query % Poor communication oral % Poor administration 76 0 Poor communication over treatment % Appointment cancelled without notification 59 0 Loss of personal belonging % Attitude nurses % Information discharge % Admissions query % The table shows that there have been marked increases in concerns which relate to access to hospital departments, and these are almost all related to the considerable difficulties which patients experience in telephoning the Trust on published numbers. 8

9 The frustrations experienced by patients in contacting the Trust is a significant factor in the increased enquiries recorded about how to make a formal complaint. PALS also continue to act as an information point for Trust services, with the single highest number of contacts relating to requests for information. PALS by Ethnicity (Enquirer) White - British White - other white Mixed white and Asian Indian Pakistani Other Asian Black Carribean Other Black Not stated 9

10 Ethnicity In year Patient ethnicity has been recorded to indicate where specific action may be needed to ensure that all service users are aware of how to register a concern or complaint. Action has been taken to ensure that ethnicity is recorded consistently in the patient administration system and by the Complaints and PALS team. Compliments Compliements received 2013/ Accident and Emergency Clinic/Health centre Day care unit Patient's home Imaging 40 Intensive care unit / high dependency unit Laboratory 30 Office/Admin/Catering 20 Outpatient department Theatre 10 Other organisation 0 Adult Care Pathways Directorate Cancer and Core Functions Directorate Corporate Directorates Estates and Facilities Directorate Family Services Directorate Surgery Directorate Therapy departments Ward / adjacent areas The Trust received 533 compliments in year. The majority of these were from inpatients complimenting on the care they received whilst an inpatient. Patient Experience Service changes 13/14 as a result of issues raised. The Trust has made a number of changes and improvements in response to patient complaints. Listening to patient feedback and engaging with the experiences of patients through meetings, patient stories and Listening into Action events, supports our staff to improve the standard of care and service provided. Throughout the year complaints have fed into staff education and learning, reflective practice across multi disciplinary teams and changes to local practice and procedures where lessons have been learnt. During 2011/12 the Trust provided patient experience training through the Garnet Foundation which was well attended. Further focus on patient experience will form part of the Trust s improvement work over the coming year. The following are examples of some improvements we have made during the year 13/14 Communication: Patient due to undergo an endoscopic retrograde cholangiopancreatography (ERCP). The patient developed a cold prior to the admission and was prescribed antibiotics by his GP. He was informed he would be assessed by the anaesthetists on the ward prior to proceeding with the ERCP. After an overnight stay it was recommended that the procedure should not go ahead. The patient complained that he should not have been advised to come to hospital which had caused inconvenience and worry. The Trust apologised and accepted that the patient s experience was unsatisfactory. As a result of the complaint the patient was given assistance in rebooking the ERCP and liaised with the Consultant directly to minimise 10

11 further frustration. In future, in the event a patient is in contact with the Trust prior to an admission, describing symptoms of a cold/flu, the clinician will seek the immediate advice of the anaesthetist. The patient replied to the trust s response quoting I did hope my observations and experiences would result in a proper investigation, and am pleased to note that not only have you looked into my complaint in some detail but as a result, have decided that improvements should be made. Quality of care and experience: A child was brought to the Emergency Department (ED) with an injury to his forehead. Tissue adhesive (glue) was used to close the wound. During the procedure some glue spilled into the child s eye which caused the eye lashes to adhere to one another. The Trust apologised for the distress this event had caused. It was recognised that the doctor should have protected the eyes while using tissue adhesive to manage the head wound. It was apparent that the parents were not given adequate assurance and support during a distressing event and an apology was given. as a result of the complaint the ED management of facial wounds has been reviewed and eye protection is now standard practice for injuries such as these. A patient complained after a portacath (medical device under the skin) had been fitted which was not correctly flushed and dressed and the patient developed complications. The Trust apologised and has reviewed its policy for insertion of femoral lines. A protocol for administering portacaths has been written and distributed to staff with training. 2014/15 moving forward Performance for the year 2013/14 in relation to complaints was poor. There were a number of factors inputting into this which have been reviewed and acted upon. This summary plan provides information as to What actions have been taken to date Outcomes to date from those improvements On going monitoring and assurance Team redesign The current complaints team and way of working have now been redesigned. There is now a named individual who has responsibility for leading on specific areas or whole directorates. This lead then takes full ownership of: All complaints for the directorate, logging, monitoring and completing responses Weekly meetings with directorates lead Weekly review of all open complaints by directorate with the Complaints manager. This means that there is the development of working relationships between complaints and the Directorates and also a greater learning and understanding of key issues. This also allows identification of themes in addition to Datix reports. The PALS and Complaints service are now two separate services. The complaints team focus solely on complaints enabling the team to read the complaint thoroughly and deciding on whether it can be dealt with as an informal complaint, formal complaint or by PALS. Process redesign 11

12 There have been a number of key changes in the process of managing complaints to address some of the serious delays. The full breakdown of the new flow is attached at appendix 1. However key changes have been: Review of the current mailbox system Talk to us. This was not being used effectively and had turned into a communication point. There was lack of ownership of issues identified and true complainants often got missed. This has now been reviewed and reworked so that the only mails received are those from concerned individuals. The inboxes for complaints, PALS and talktous are now manageable and are monitored, actioned and cleared within 3 working days. PALS and compliments are also actioned within that timescale. All new complaints received are dealt with immediately by the directorate leads. One key person allocates and these are then acted on. This has improved our three day response target to now be 100% All new complainants now received direct contact by the Complaint team lead. The complaints team contact patients by telephone, where possible on receipt of their complaint, to talk through their concerns and try to resolve informally. I.e. speaking directly with the head of department, matron, operations manager requesting them to contact the complainant directly. These are logged as informal complaints and once the directorate confirms to the complaints lead that the complainant is happy with the outcome it is closed on datix. The PALS team then deal directly with queries that have a quick turnaround. Prior to this all complaints were logged as formal and also not resolved as quickly. The positive impact of this more responsive approach can be seen in the drop of complaints received since it was put into place in May. 34 complaints were received in May 2014, compared to 59 in April and 69 in March. There is a significant drop in complaints received within this 3 month period March 2014 April 2014 May

13 New reports are now being received form Datix that clearly breakdown the patient process by Directorate and provide a clearer management tool for identifying potential delays and acting quickly to resolve them. All collated complaint reports are reviewed by the Complaints manager prior to going to the Chief executive for sign to ensure consistency and quality There is now an on going internal training and liaison plan by the Complaints manager. The training and education needs of the immediate team have been reviewed and are being acted on On going assurance/ next steps Currently the Complaints function is part of a Listening into Action' programme; the outcome is expected to address the on going need to identify and monitor actions as a result of complaints. 13

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