Complaints Annual Report 2013/14

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1 Complaints Annual Report 2013/14

2 1. INTRODUCTION This is the complaints annual report for Hampshire Hospitals NHS Foundation Trust (HHFT) for the period 1 April 2013 to 31 March Hampshire Hospitals NHS Foundation Trust (HHFT) serves a population of approximately 600,000 and provides one high-quality service across three hospitals in Andover, Basingstoke and Winchester and outlying sites. The National Health Service Complaints (England) Regulations 2009 requires that all Trusts provide an annual report on the handling and consideration of complaints. This report provides detail of the required inclusions and in accordance with the NHS Complaints Regulations and will also be made public on the Foundation Trust website and sent to commissioners of the Foundation Trust services. 2. LISTENING Improving patient experience is important to us. We are committed to providing the best care for patients, focusing on the quality of care in every service and working together to continuously improve the experience and outcomes of care provided for all. The Trust encourages a culture that seeks and then uses peoples experience of care to improve quality and welcomes the comments, complaints, compliments and concerns of the people who use our services. The Trust recognises that there are times when its actions do not meet the expectations of those that use our services. When that happens the Trust has a policy which sets out the procedure to make sure that it listens and responds to complaints and concerns from patients, their relatives and carers and that complaints are properly investigated and monitored. The Trust understands that by listening to people about their experiences of our services, staff can learn new ways to improve, and prevent the same issues from happening in the future. By seeking, monitoring and acting upon feedback, we are able to make improvements in areas that patients, their relatives and carers say matter most to them. Effective complaints handling is a cornerstone of the patient experience and the Trust aims at all times to provide local resolutions to complaints and takes all complaints seriously. By listening and responding to complaints we aim to remedy the situation as quickly as possible and ensure that the individual is satisfied with the response they receive. The learning from complaints is used to improve things for the people who use them as well as for the staff working in them. We take all negative feedback very seriously and our Chief Executive sees all complaints when they arrive and reviews all responses personally before they are sent. Complaints handling and any trends or themes identified from them are shared and discussed regularly by the Executive Team and the Board of Directors and are reviewed within each of the divisions across the organisation on a monthly basis. 3. SUMMARY OF NHS COMPLAINTS PROCEDURES 3.1 The NHS complaints regulations In April 2009 the NHS Complaints Procedure was amended and the latest NHS (Complaints) Regulations came into force. The Local Authority Social Services and NHS Complaints (England) Regulations 2009; are a Statutory Instrument that all Trusts including Foundation Trusts have a 1

3 duty to implement. Whilst the procedures are not prescriptive, the regulations set out various obligations on NHS bodies in relation to the handling of complaints. Since 1 April 2009, there has been a single approach across Health and Adult Social Care to dealing with complaints. The regulations set out a two stage complaint system: Stage 1 Local resolution working with the complainant to understand and resolve their concerns in a timely and proportionate fashion Stage 2 Referral to the Parliamentary and Health Service Ombudsman (PHSO) if local resolution is not successful, the complainant can refer their case to the Ombudsman for review. The national complaints legislation requires that concerns raised by the public are responded to personally and positively and that lessons are learnt by the local organisation. The process focuses on the complainant and enabling organisations to tailor a flexible response that seeks to ensure all complainants receive a positive response to their complaint or concern. It places an emphasis on resolving them as fairly and as quickly as possible and ensuring that lessons are learned and shared to improve the experience of care. The Parliamentary and Health Service Ombudsman is a free and independent service, set up by Parliament. Their role is to investigate complaints that individuals have been treated unfairly or have received poor service from government departments and other public organisations and the NHS in England. If local resolution is not successful, the complainant can refer their case to the Ombudsman for review. The Ombudsman makes the final decisions on complaints about the NHS for individuals. They use what they learn from complaints to help public services get better. 3.2 The NHS Constitution The NHS Constitution, published in January 2009, sets out the rights of patients when making a complaint: To have any complaint made about NHS services dealt with efficiently and to have it properly investigated; To know the outcome of any investigation into a complaint; To take a complaint to the independent Health Service Ombudsman, if they are not satisfied with the way it was dealt with by the NHS; To make a claim for Judicial Review if they think they have been directly affected by an unlawful act or decision of an NHS body; To compensation when they have been harmed by negligent treatment. The NHS Constitution also makes the following pledges which the NHS commits to achieve: To ensure patients are treated with courtesy and receive appropriate support throughout the handling of a complaint; To acknowledge mistakes which happen, apologise, explain what went wrong and put things right quickly and effectively; To ensure that the organisation learns lessons from complaints and uses these to improve NHS services 2

4 3.3 The principles of good complaint handling The Trust actively encourages staff closest to the care and services being received to deal with concerns as they arise so that they can be remedied quickly and be responsive to individual needs and circumstances. Such timely intervention can prevent an escalation of the complaint and achieve a more satisfactory outcome. The approach to complaints handling across the Trust focuses on the complainant and is based on the principles of good complaints handling. These have been published by the Parliamentary and Health Service Ombudsman and endorsed by the Local Government Ombudsman and the principles are: Getting it right Being customer focused Being open and accountable Acting fairly and proportionately Putting things right Seeking continuous improvement Independent Investigation the Trust will identify the most appropriate staff to investigate a complaint. Independent investigation will be carried out by appropriately qualified staff sufficiently removed from the incident with no conflict of interest. Where the facts determine that an independent investigation cannot be carried out by Trust staff an external opinion may be commissioned. 4. ANNUAL COMPLAINTS FIGURES HHFT is organised into three clinical divisions. They are Surgical Services, Medical Services, and Family and Clinical Support Services, each of which are led by a Medical Director and Operations Director, collectively supported by Corporate Services as the fourth division. The formal complaint numbers during 2013/14 have been collected for each site and division and the number and type of complaints received for HHFT have been closely monitored and analysed in order to identify themes and trends and inform future improvements moving forward. A total of 606 formal complaints were received by the Trust during 2013/14. The 606 complaints were represented across the divisions and are outlined in the table below: Division Number of formal complaints 2012/13 Number of formal complaints 2013/14 Family & Clinical Support Services Medical Services Surgical Services Corporate, Operations & Support Services TOTAL The 606 complaints received in 2013/14 is a 9% increase from the 557 formal complaints recorded during 2012/13. A difference of less than 10% for formal complaints is not considered significant when reporting the national annual complaints figures referred to as the KO41a collection. The largest increase occurred within surgical services and is represented by the increase in proportion of complaints relating to waiting times, communication and information. 3

5 The number of complaints received per month for each division since April 2012 is presented in the graphs below: Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Corporate Family Medicine Surgical Total The number of complaints received per month for each site since April 2012 is presented in the graph below: Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 AWMH BNHH RHCH There has been an overall increase (less than 10%) in the number of complaints received throughout the year across the 2 larger hospitals. The particularly high numbers in February and March 2014 once again reflect the busiest period for the Trust and are consistent with previously noted seasonal variation with higher volumes in quarter 4 consistent with the demands of winter pressures. 4

6 5. RESPONDING When an individual complains they are referring to their experience and therefore, all complaints for the period 01 April March 2014 were upheld by the Trust and handled accordingly. The following definitions are used to provide clarity about whether an issue of concern is handled within the NHS complaints procedure and to ensure that the Trust provides the most appropriate response: Complaint A complaint can be defined as an expression of dissatisfaction with the service provided (or not provided) or the circumstances associated with its provision which requires an investigation and a formal response in order to promote resolution between the parties concerned. Concerns - A concern can be defined as a matter of interest, importance or anxiety which can be resolved to the individual s satisfaction within a short period of time without the need for formal investigation and formal correspondence. Concerns are received by staff throughout the organisation. Where it has not been possible to resolve the concern quickly (i.e. by the end of the next working day) and to the satisfaction of the person/s raising it, they will be asked if they would like their concern investigated as a formal complaint under the NHS Complaints Regulations (2009). All concerns whether resolved by the next working day or not, will be recorded and reported and reviewed, collated and analysed along with the data recorded from complaints. In many respects, the distinction between a concern and a complaint is artificial. Both indicate some level of dissatisfaction and require a response. It is important that concerns and complaints are handled in accordance with the needs of the individual case, and investigated. All concerns and issues raised are recorded. During 2013/ concerns were raised with the customer care team who worked with staff within the Divisions to resolve the concerns and issues raised. All of the concerns raised are reported in the same way as complaints. In order to ensure that complainants have access to appropriate support, as part of the complaints handling process, complainants are signposted to the National Health Complaints Advocacy Service for help in making their complaint. All complainants are signposted to the Parliamentary and Health Service Ombudsman (PHSO) (stage 2 of the NHS complaints process) in case they wish to take their complaint further. The Trust follows the Department of Health guidance and legislation (the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009) which outlines the requirement to acknowledge all formal complaints within three working days. Under the current legislation Trusts have six months in which to resolve a complaint to the satisfaction of the complainant, providing a more flexible agreement with each complainant. HHFT aims to provide a response in as timely a manner as possible, working to an internal benchmark of 25 working days. The graph below displays the percentage acknowledgement rate within 3 days and the percentage responded to within 25 working days from July 2012 to march

7 % Acknowledged within 3 days % Responded to within 25 days Throughout 2013/14 the Trust achieved an average 94% acknowledgement rate within the required 3 working days. This is a significant improvement from the 87.1% achieved in 2012/13. During 2013/14 there was an overall improvement with an average 54% of all complaints responded to in 25 working days with a range between 41% and 70%. Improving the number of responses made within 25 working days will remain one of our aims for 2014/15 as a commitment and desire to improve the effectiveness and responsiveness of our complaints handling. Many of the complaints closed outside of the agreed timescales were either complex ones which involved more than one service area or organisation, or those which raised additional issues during the course of the investigation and complaint handling. There is a commitment to communicate more effectively with complainants where delays are expected and to negotiate revised timescales in order to resolve complaints to the satisfaction of the complainant. 6. CATEGORIES OF COMPLAINTS Complaints are recorded and categorised to help the organisation identify themes and trends and identify improvement actions in response to the findings. The Trust returned the required annual KO41a collection to the NHS Information Centre in April The return records the number of written complaints received about hospital and community services made by (or on behalf of) patients received between 1 April 2013 and 31 March The data includes all complaints upheld and is broken down by service area (who was complained about) and by subject area (what was complained about) and will be published by the NHS Information Centre in July / August The subject for the categorisation of formal complaints is presented here, based on the KO41 categories. Total number of Subject / Category complaints Admissions, discharge and transfer arrangements 31 Aids and appliances, equipment, premises (including access) 12 All aspects of clinical treatment 301 Appointments, delay/cancellation (in-patient) 13 6

8 Subject / Category Total number of complaints Appointments, delay/cancellation (out-patient) 53 Attitude of staff 58 Communication/information to patients (written and oral) 76 Consent to treatment 2 Failure to follow agreed procedure 2 Hotel services (including food) 1 Mortuary and post mortem arrangements 2 Others 34 Patients' privacy and dignity 9 Patients' property and expenses 3 Personal records (including medical and/or complaints) 4 Policy and commercial decisions of trusts 2 Transport (ambulances and other) 3 Grand Total 606 The most common themes for complaints during the year were: 1. Care; central to the Foundation Trust s values and a focus of training, supervision and appraisal of staff. Themes from complaints are being used to inform training priorities and some complainants have shared their experiences to support improvements which have been particularly powerful. 2. Communication and information; patients, their relatives and carers need to be fully informed about their care and treatment. There has been an increased focus on communication skills and effective sharing of information within customer care training at induction and as part of on-going staff training, and this will continue. In addition, staff are being encouraged to deal proactively with concerns as they arise so they can be quickly resolved. 3. Waiting times; patients need to be kept informed about the reasons for delays or cancelled appointments. The Foundation Trust has introduced electronic information screens within outpatient areas to display waiting times and has an extensive programme of work underway to improve appointment scheduling and management. These themes have become a focus locally for quality improvement initiatives. The Trust has set out its values which clearly express the standards of behaviour expected as the Trust stays focused on caring for our patients as our number one priority. A monthly complaints report is produced to enable the Trust to monitor the categories of complaints and concerns so that any issues can be addressed accordingly at both Trust wide and divisional level. This year we have reviewed the total number of complaints as a percentage of overall patient activity. During 2013/14 there have been less than 2 complaints received per 1000 inpatient admissions and outpatient attendances and less than 2.5 complaints per 1000 Emergency Department attendances. 7

9 7. COMPLAINTS AND THE PARLIAMENTARY AND HEALTH SERVICES OMBUDSMAN (PHSO) If a complainant is dissatisfied with the way their complaint has been dealt with by the Foundation Trust and local resolution of their complaint has not been satisfactory, they can take their complaint to the independent Parliamentary and Health Service Ombudsman (PHSO) for review. In 2013, the PHSO launched its five year strategy which changes the way it deals with complaints. Their new approach means they will conduct full investigations into more complaints than previously and make recommendations for action based on the outcome of their investigation. There were four open referrals with the PHSO at the start of 2013/2014. Three of these referrals were not accepted for investigation and one remains open with an on-going joint investigation by the Health Service Ombudsman and Local Government Ombudsman. Nine new referrals relating to care provided by the Trust were received by the Ombudsman in 2013/2014, representing 1.5% of the total number of formal complaints received. Five of the nine referrals are still open. Two were not accepted for investigation, one was not upheld following investigation and one was partly upheld with recommendations made for the Trust to action. The recommendations and Trust response is outlined below: PHSO recommendation Apology Improve falls management policies and procedures Financial remedy HHFT action Apology for failure to deliver specific service to the standard required Trust Falls Co-ordinator appointed Review of falls risk assessment processes Development of falls prevention and management training for all ward staff Dementia nurse specialist appointed Trust falls management policy updated and publicised Financial remedy made for expenses incurred and distress experienced 8. CUSTOMER CARE TEAM Our customer care team provide a central point of contact and receive feedback provided in person, by telephone and in writing via and letter. The customer care team are available to receive compliments and comments, and respond to enquiries, concerns and complaints with the aim to resolve them quickly and effectively. All the feedback received is shared with staff for their review and action. We have developed customer care standards in collaboration with patients, their representatives and staff to ensure a positive experience for our patients, their relatives and carers. These are included in our customer care training and form part of our induction programme for all new staff and volunteers. 9. COMPLIMENTS AND COMMENTS Many compliments are received from patients, their relatives and carers about the care provided. 735 compliments and thank yous were made in writing to the Chief Executive s office during 2013/14 and were formally recorded and shared with our staff and are outlined in the table below: 8

10 Division Number of compliments and thank yous Medical services 195 Surgical services 362 Family and clinical support services 165 Corporate services 3 TOTAL 735 Many more letters and cards are sent directly to our wards and departments thanking staff for the care they received. These are not formally recorded but are shared with staff to recognise the excellent care they provide every day. To give the public an opportunity to acknowledge staff s care and compassion, Hampshire Hospitals NHS Foundation Trust hosts an annual Director of Nursing Awards (DONA) ceremony for staff at all sites in Andover, Basingstoke and Winchester. This award publicly celebrates our nurses and midwives, and nursing and midwifery teams. Nominations are made by members of the public for an individual or a team for their care, commitment and compassion. Last year, there were 214 nominations from members of the public for staff to receive a DONA award. HHFT also presents a monthly WOW! Award recognising when staff go the extra mile. At Hampshire Hospitals, the WOW! Awards were first introduced in 2009 and more than 100 WOW! award nominations are now received each month from patients and staff. Nominations are considered by a panel which includes Foundation Trust governors and a small number of winners are chosen who are surprised in their workplace by Chief Nurse Donna Green and presented with a certificate. WOW! Award winners are invited to a quarterly celebration lunch with their colleagues, the board of directors and Foundation Trust governors, to celebrate their work in going the extra mile in customer service, innovation or patient safety. During the year there have been a total of 1166 WOW! Award nominations were made by staff and the public for individuals and teams across the Trust. Nominations were made in the category of Above and Beyond, customer care, patient safety and innovation. We are very proud that HHFT was named best organisation for Serving the Community by The National WOW! Awards in Beating competition from the private and public sector the Serving the Community award recognised the use of imaginative ways to delight customers and how the customer is placed at the heart of everything they do. This is an incredible achievement and recognition of our staff s commitment. NHS Choices provides another valuable way for patients to provide online feedback to us about their care. The site allows patients to rate their experience at a hospital, out of five stars. The ratings are averaged over the last two years which provides an overall star rating. At the end of the year, our hospitals received the following ratings on NHS Choices: Basingstoke and North Hampshire Hospital 4 stars based on 91 ratings Royal Hampshire County Hospital 4 stars based on 44 ratings Andover War Memorial Hospital 5 stars based on 10 ratings All comments posted on the site are reviewed by the Chief Executive and are sent to the relevant staff within the divisions for their review and action. Individuals leaving comments of concern are encouraged to contact the customer care team to discuss them more fully in an attempt to listen, respond and learn. 9

11 10. LEARNING FROM COMPLAINTS The Trust recognises the importance of learning from complaints and the value of sharing this learning across the organisation. While our evidence shows us that we have robust checks in place, we are not complacent and we continue to listen and make changes when we don t get it right. We act on feedback to make improvements to our services wherever possible. In response to the feedback received this year we have taken the following actions: Action to Remedy Serviced the call bell system Updated patient information provided during antenatal care Improved menus and choices for patients with coeliac disease Introduced a medicine helpline for patients following discharge Introduced electronic display boards in outpatient areas to provide updates on waiting times Customer care training to improve staff interactions with patients, their relatives and carers. Equipment has been purchased to improve the environment Estates work has been undertaken to improve facilities Changes have been made to the time breakfast is provided A carers survey has been introduced to identify appropriate support for carers Improvements have been made to patient information Displays of who is who on the ward and contact details to discuss concerns Introduction of more ward based volunteers to provide additional time to spend with patients Shared lessons Positive and negative feedback has been shared with individual staff for reflection and action Feedback shared with staff in supervisory meetings on a 1:1 basis Details and recommendations of complaints and concerns have been shared with teams Complaint scenarios and patient stories used in training to raise staff awareness Changed policies and procedures Process for escorting patients in x-ray changed Pathway of care developed for the urgent management of back pain 24/7 labour line introduced in partnership with South Central Ambulance Service A new booking system that allows for specific transport requirements to be highlighted in addition to their standard booking codes Updated falls management policy and falls risk assessment process Staff training Programme of customer care and communication skills training tailored to specific wards and departments in response to concerns and complaints received Specialist dementia training provided to nursing staff on wards and in the emergency departments Falls prevention and management training 10

12 Medicines management training Training provided to emergency department staff to identify and respond to neutropenic sepsis using the HEAT pathway (History Examine Action Treat) Training sessions for maternity staff in hypnotherapy birthing techniques Pain management for patients at the end of their life 12. KEY ACHIEVEMENTS 2013/14 Following the Francis inquiry the Prime Minister instigated a review into the handling of concerns and complaints in NHS hospital care in England. The Clwyd Hart Report A review of the NHS hospitals complaints system. Putting patients back in the picture was published in October 2013 and made a large number of recommendations to improve hospital handling of complaints. We understand that complaints are an important part of feedback and that they are a strong indicator of patient experience. Whilst many of the recommendations are part of existing practice in our complaints handling, we have taken the following actions to improve the way we respond: Developed and provided training for staff in how to handle concerns and complaints Reviewed with staff the importance of early contact and conversation with complainants to understand their issues of concern, to determine complexity and reach agreement about how best to respond Introduced a range of measures to enable better monitoring and analysis of complaints to help to ensure that trends and themes are recognised and responded to swiftly Continuing to encourage staff to actively seek and welcome positive and negative feedback and to promote improvements following feedback through a system of sharing lessons learned Working with the Wessex complaints network to strengthen the co-operation and consistency of approach between NHS providers in the region. Providing investigation training to staff who handle incidents and complaints Using complaint case scenarios and learning from complaints within customer care training Enabling volunteers to support patients who wish to express concerns or complaints Promoting an acceptable level of independence at the local resolution stage. The Trust will identify the most appropriate staff to investigate a complaint. Independent investigation will be carried out by appropriately qualified staff sufficiently removed from the incident with no conflict of interest. Where the facts determine that an independent investigation cannot be carried out by Trust staff an external opinion may be commissioned. This year we have introduced the complaints and concerns policy for HHFT as an organisation to improve the consistency of our complaints service across our three sites, where previously individual policies were used. The policy sets out the process for complaints and offers guidance for our staff on how to respond to concerns and complaints. There have been continued improvements to complaints handling through increasing the level of personal contact with complainants via the telephone or in person in order to promote early contact and shared agreement in relation to a complaints management plan. Many complainants and their family were offered a meeting at the beginning or as part of the formal complaint process. We have increased the involvement of people who have provided feedback in making changes, for example in training and awareness raising with staff and we have developed bespoke customer care training for wards and departments in response to learning from the complaints of people who use their services. We have started observational activities and focus groups with 11

13 people who have provided feedback and this continues to be a quality priority for the Trust in 2014/14. We have also developed a complaints handling training programme to equip staff. We use the themes from complaints, concerns, the Friend and Family Test feedback and patient surveys to inform service improvement activities at divisional, specialty and ward level. We used this variety of feedback in 2013/14 to inform our quality priorities for 2014/ CHALLENGES FOR 2014/2015 There are a number of challenges for 2014/15 and the recommendations from the Clwyd Hart report, the Patients Association s standards for good complaints handling and the Ombudsman's principles of good complaint handling will form the basis of an improvement work programme and action plan in relation to the Trusts handling of concerns and complaints in 2014/15. We continue to work with Clinical Commissioning Groups to responding to the changes in the way joint complaints are handled and the choice complainants have to have their complaints investigated by the provider or the commissioner of the services to which their complaint relates. There have been changes to the health complaints advocacy service but we continue to work with Healthwatch to ensure that advocacy support is accessed and utilised for maximum benefit. 14. Improvements planned for Trust wide complaints handling for 2014/ 2015 include: Embedding the improvements made which ensure closer working with the divisions Improving the understanding and awareness of how to raise concerns and complaints for patients, their relatives and carers Introducing an updated satisfaction survey to provide feedback on the experience of the complaints handling process Developing patient stories and listening events to learn from patient experience Monitor the number of reopened complaints due to the complainant being dissatisfied with the Trusts response to the complaint Ensuring that lessons learned are shared throughout the organisation and embedded in the services we provide. Introducing a Trust wide measure for grading of the seriousness or severity of a complaint and process of escalation and review for serious complaints. Implement complaints training for all staff involved in complaints handling Ensuring that the recommendations of the Francis report and Clwyd Hart Report in relation to complaint handling are embedded within the organisation Building on the work for improving response rates within the Trust target of 25 working days Continuing to develop Datix reporting system and tailor to maximise effect for reporting and trend analysis Continuing to develop complaints metrics that can used for benchmarking with other peer organisations Participating in a service evaluation with Healthwatch Hampshire 12

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