COMPLAINTS ANNUAL REPORT

Transcription

1 COMPLAINTS ANNUAL REPORT Document Information This paper informs the Quality and Safety Assurance Committee (QSAC) about Complaints that have been received in the financial year This includes reporting on issues that are required under the Local Authority Social Services and National Health Service Complaints (England) Regulations Date: June 2014 Status: Version 1 Current Version: 1.0 Transparency level: Public Author: Victoria Gregory, Patient Experience Manager Owner: Andrew Dean, Director of Nursing and Governance and Executive Lead for Complaints Commissioned by: File location: Complaints Department/Reporting/Board

2 COMPLAINTS ANNUAL REPORT Introduction 1.1 The Trust is committed to resolving complaints to the satisfaction of the complainant and to learn from what has happened and, where appropriate, make demonstrable improvements to services. 1.2 This report provides statistical information and commentary about the Trust s complaints handling for the year including information required to be provided under the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 ( the 2009 Regulations ). 1.3 The 2009 Regulations, which govern NHS complaints handling, are reflected in the Trust s Complaints Procedure which also formally adopts the Parliamentary and Health Service Ombudsman s ( the Ombudsman ) Principles of Complaints Handling, Remedy and Administration. 2. Trust Activity 2.1 Complaints Management Complaints are considered at a senior level in the Trust in recognition of their importance. The Chief Executive is the Responsible Person under the 2009 Regulations and is signatory to all written responses, delegation in his absence is to a member of the Executive The Board receives a monthly Integrated Governance Report which provides information about complaints and the key learning that has arisen in that month together with a summary of compliments received. The Board also receive monthly Patient Stories that are sourced from complaints and compliments (stories alternate between a positive and negative story). Those that are derived from complaints, set out the complaint from the service user or carer perspective, illustrates the impact of an event or scenario and what the Trust has undertaken to remedy it and prevent reoccurrence in the future A Board Committee (QSAC) receives a quarterly aggregated report of learning, themes and statistical information about Complaints, Claims, Incidents and Safeguarding and it receives the Complaints Annual Report Information about complaints, including learning to a monthly Serious Incident and Governance Group and quarterly to an Integrated Governance Group All complaints are reviewed at weekly by the Patient Experience Team Meeting Chaired by the Patient Experience Manager who is the designated Complaints Manager under the NHS complaints regulations and monthly where Trust wide learning and actions are reviewed All complaints are risk rated and identified whether they should be escalated to the Trusts weekly and monthly Serious Incident Governance Group and/or the Trusts weekly Risk Intelligence Group The Patient Experience Team comprises the Patient Experience Manager, four Patient Experience Leads and a Governance Administrator. They manage the Complaints Procedure, undertake investigations and work to resolve complaints and provide an interface between the Trust and the Parliamentary and Health Service Ombudsman (the Ombudsman) and other 2

3 organisations regarding complaints. They also provide guidance, training and support to staff handling complaints, as well as complainants, and staff against whom complaints are raised. 2.2 Number of Complaints Received The Trust received 403 complaints (366 written, 49 verbal) in which is 12 fewer than figure of To provide a context, the Trust had 35,756 new referrals during the year and a bed usage at 157, 828 which totals 193,584. The number of complaints at 403 represents 0.21% of the number of referrals and bed usage. In terms of community contacts at 428, 639 the number of complaints represents 0.09% Figure 1 below shows the distribution of complaints for each borough is as follows: Figure 1: The 5 year trend in Figure 2 below shows an uplift in the number of complaints in 2009 to 2011 which is when the 2009 Regulations were implemented which saw informal complaints being logged centrally as formal complaints (the 2009 Regulations removed the distinction between formal and informal complaints) and possibly due to the Patient Advice and Liaison Service (PALS) at that time. This year marks a slight downturn in the number of complaints possibly due to the re-introduction of PALS and the roll out of alternative forums to provide feedback such as Care Connect and Patient Opinion (see paragraph 2.11 below). Figure 2: 3

4 2.2.5 Figure 3 below shows how the 5 year trend is broken down by borough: Figure 3: 2.3 Source of Complaints The majority of complaints came from the complainants themselves about their own concerns (82%) followed by their relatives (13%), advocacy (2.5%), carers (.05%). The remainder 2.45% is from friends and other sources such as solicitors. 2.4 Gender and Ethnicity Profile The gender of the 403 complaints were: 219 female; 156 male; the remaining 23 were either from joint partners or organisations with no gender The ethnicity profile of the service users of the Trust, based on new referrals received in the year is set out below. The highest profile is White groups at 68% and this group is has the highest number of complainants at 43%. The number of Black group referrals are 8% and the number complainants are 11%. The number of Asian group referrals are 6.8% and the number of complainants is 3%. The lowest representations are Ethnic groups (other and Chinese) 3.9% with complainants at 0.9% and Mixed White groups referrals at 2.8% with complainants 2.4%. 4

5 2.5 Acknowledgement Rates Under the 2009 Regulations all complaints are required to be acknowledged within 3 working days of receipt of the complaint. The Trust set a performance indicator that all complaints are to be acknowledged with within 3 days in at least 75% of cases This indicator has been exceeded in that 87% of complaints were acknowledged within 3 days. 2.6 Responses Rates Ethnicity Profile New Referrals Total Asian or Asian British/other background Asian or Asian British/Bangladeshi Asian or Asian British/Indian Asian or Asian British/Pakistani Black or Black British/African Black or Black British/other Black or Black British/Caribbean Mixed/other Mixed/White and Asian Mixed/White and Black African Mixed/White and Black Caribbean Other Ethnic Groups/Chinese Other Ethnic Groups/other White/other White/British White/Irish Not stated Total Complainants Total The 2009 Regulations dispensed with the requirement to respond to complainants within 25 working days which had been in place prior to 1 st April However, the Trust has set a performance indicator that all complaints are to be responded to within 25 working days in at least 75% of cases Timeliness and responsiveness are key factors in complaints handling and this year the Trust was concerned that the complaint handling structure in place to meet this indicator was not working effectively. Changes were made to the structure and additional resources were invested (a summary of the changes made are described at paragraph 2.10 below). This has had a positive impact on meeting the indicator which has been exceeded since the new structure has been in place. This is reflected in Figure 4 below. 5

6 Figure 4: : Percentage of responses within 25 working days Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Summary of the Subject Matter of Complaints The top three categories of complaints were: General Procedures at 40% (163 complaints), Clinical at 24% (95 complaints) and Attitude of Staff at 20% (79 complaints) shown at Figure 5 below. Figure 5: The largest category is General Procedures which is broken down into 4 sub categories as set out in Figure 6 below. Communication and information to patients represents 66% (108 complaints) and accordingly has been a focus of development this year (see paragraph 2.11 below). Figure 6: 6

7 2.8 Well Founded Determination In assessing whether complaints were well founded a determination was made upon whether a complaint was upheld, partially upheld or not upheld. Where a complaint was either upheld or partially upheld these complaints were deemed as well founded. During this review a category of indeterminate was created and is where a complaint is received where, for example, the Trust cannot uphold nor not uphold the complaint as there is insufficient evidence to do so. This would include complaints where a patient may be expressing their mental illness through the complaint and perceiving events that are a symptom of a psychosis or where facts cannot be substantiated either way On this basis 45% of complaints were considered to be well founded (17% upheld and 28% partially upheld), 40% were not well founded (i.e. not upheld), 4% were withdrawn, 3% of cases no consent was received from the patient to reply to the complainant about them and so could not be responded to, 7% were investigated under other procedures (such as Serious Incidents or Safeguarding Vulnerable Adults protocols) and 0.25% (1 complaint) was excluded under the Complaints Regulations because it was too old to enable the Trust to reply An analysis of how the upheld and partially upheld complaints are made up in terms of category of complaints is set out in the table below. The numbers upheld are broadly consistent with the highest areas of complaints received, namely, General Procedures, Attitude of staff and Clinical A summary of how complaints were upheld, partially upheld or not upheld is set out at Figure 7 below showing that General Procedures was the highest well founded category. Figure 7: 7

8 2.8.5 The General Procedures category has 4 sub-categories of which is Communication and Information to Patients which has the highest number upheld complaints as set out below in Figure 8. Figure 8: 2.9 Referral to Parliamentary and Health Service Ombudsman The Ombudsman is the point of recourse for a complainant if they are not happy with the outcome of complaint response or the way a complaint has been handled. The Ombudsman reviews Trust complaint files where there has been a referral and may make recommendations about future handling or taking additional steps There have been 9 referrals to the Ombudsman which represent 2 of all complaints received this year (this is a significant reduction from last year which saw 29 referrals representing 6% of complaints) In context of the ratio of complaints received to referrals this Trust this represents 2.2%. The case outcomes are set out below in Figure 9. Figure 9: Not Upheld Partially Upheld Upheld Withdrawn Request for further response Open 2.10 Matters of Importance arising out of complaints or complaints handling This year the Trust implemented improvements and changed the way it handled complaints following consideration of the Report on the Mid- Staffordshire NHS Foundation Trust Public Inquiry by Robert Francis QC ( the Francis Report ), Review of the NHS Complaints System by The Right Honourable Ann Clwyd MP and Professor Tricia Hart (the Clwyd/Hart Report) and the Government s Response This changes reflected a review of the role, size and scope of the Complaints Department (now the Patient Experience Team), how it can be more patient 8

9 focussed, its reporting and how it can better embed actions and learning in the Trust. Improvements include: (1) Increased Investment The handling of complaints is undertaken by a larger Patient Experience Team of 6 comprising the Patient Experience Manager, 4 Patient Experience Leads and 1 Governance Administrator (PALS and complaints). This has entailed new job descriptions and increased resources to reflect the new ways of working. (2) Wider remit and integrated working The Patient Experience Team take a more holistic approach to patient experience not solely dealing with complaints but it also operates a Patient Advice and Liaison Service (PALS) advice line and holds PALS surgeries on wards focussing on early resolution, the team also are part of the pilot for Care Connect (see paragraph 2.11 below) where the team resolve concerns quickly within a 2 and 5 days local performance indicator and have become responders on Patient Opinion (see paragraph 2.11 below). In addition to investigating complaints, the team undertake Root Cause Analysis investigations for Serious Incidents. (3) Better links regarding patient safety The Trust Complaints Policy has been reviewed this year and a Standard Operating Procedure has been introduced to provide governance to the wider remit of the team. They strengthen the procedures where a concern or complaint is received that raises patient safety issues and that would be better dealt with under the Safeguarding Vulnerable Adults or Children procedures or Serious Incident procedures. These improved pathways assist in the escalation of risk (see paragraph (4) below). (4) Improved risk handling Complaints have always been risk rated on initial assessment of the complaints when they are received. This is now subject to weekly review and cases that are noted as presenting a serious risk are escalated to a weekly Serious Incident and Governance Group which considers cases and identifies any risk intelligence that should appropriately be reported on the Trust-wide Risk Register for action. This does not only relate to individual complaints that may be highly risk rated but also to complaints where a risk theme is emerging or a cluster of complaints in a particular team, ward or person. (5) Embedding Learning and improved reporting Learning from complaints is now better reported in that the Patient Experience team report monthly to the service boroughs where clinical care is provided at their local governance groups about the complaints (and serious incidents and claims). The team seek assurance that local actions have been or are planned to be taken regarding upheld or partially upheld complaints that required action or learning. The Patient Experience Team meets weekly to discuss learning and cases and review all responses on a monthly basis to draw out themes 9

10 from learning. Monthly Board reports are provided about complaints and learning as part of an Integrated Governance Report and a quarterly reported on themes is planned for the Board in 2014/15 (at the time of writing this has now happened). The Board also receive Patient Stories, alternating between a negative and a positive story sourced generally from complaints and compliments. Learning is also reviewed monthly at a Serious Incident and Governance Group, reported at an Integrated Governance Group and a Quality and Safety Assurance Committee (a Board Committee). (6) Independent investigations and skills The Patient Experience Team is part of the Quality Governance Department which is within the Corporate service structure, separate to managerial and clinical services provided by the boroughs. The team can therefore offer a much more independent investigation than previously (when it was undertaken by staff the boroughs where clinical services are provided) and are better able to challenge information that is submitted to them. The team has a clinical advisor to advise on practice and Lead Investigator on hand (also within corporate services) to advise on complex cases. The team has access to the Medical Director and Director of Nursing for Trust wide clinical issues or proposed changes of practice. The team are trained in Root Cause Analysis investigation methodology and a business case is planned for next year for a qualification in complaints handling. (7) Timeliness and Responsiveness The initial focus of the team when it took over investigations in October 2013 was to clear a backlog of outstanding cases and to ensure that the Trusts key performance indicator to respond within 25 working days in at least 75% of cases was met. Since November 2013 this indicator has been exceeded at shown at paragraph 2.2.6, Figure 4. (8) Open and transparent Culture The new Complaints Policy highlights the principles of openness and honesty in complaints handling. As part of the investigations and response preparation, the Trust s potential mistakes and areas for improvement are discussed openly along with the proposed remedies. (9) Quality of Responses The preparation of responses to complainants is subject to levels of scrutiny by a Patient Experience Lead with a remit for quality review, the Patient Experience Manager and the Head of Head of Quality Governance before it is sent to the Chief Executive for consideration The new arrangements are working well and the team are receiving positive feedback regarding the way concerns and complaints are handled. A sample is as follows: It has been a while since I contacted you but as a courtesy to yourself, as you have been extremely helpful.. 10

11 Thanks so much.very sorry to keep coming back to you, but you seem to be the most efficient source of knowledge Thank you for the way you handled my complaint Thank you for the continued communication which has been first rate and let me feel that I was at least not being ignored when going through an initial complaints process Anyways - a massive thank you for all the help and support that has been available here, you really do have a substantial impact Great that there is now a PALS department at Springfield and you are one of the best PALS people I have spoken to The response has answered all my questions; I am very pleased with the response. Thank you Matters where action has been taken to improve services In response to complaints raised, the Trust may take action to resolve the issue which may not result in improved systemic changes but would include, for example, the arrangement of a second opinion of a patient s diagnosis, a change of clinical team or consultant, issuing a formal apology if things have gone wrong, compensation for loss of property or review of care plan and changes made where appropriate. Also the Patient Experience Leads raise individual learning points to staff directly or by attending and reporting to Clinical Governance Groups on a monthly basis The highest number of complaints relates to the Communication and Information provided to patients. Whilst the attitude of staff number of complaints was lower, we feel that that the two categories are linked i.e. a member of staff with a positive attitude would communicate information well. There are four key actions that the Trust has taken to improve services and have an impact on this theme, as follows: (1) Listening into Action (LiA) This is a national programme implemented at the Trust, which places staff at the centre of decision making in the Trust and empowers staff to make changes to the way they work to improve the quality of care they provide. Engaging and valuing staff has a positive impact on attitude of staff and communication more generally. Feedback from staff across the Trust at LiA events and visits to wards highlighted that sufficient staff on the wards was a key issue for the Trust. When talking to service users and carers, they valued the continuity that an established nursing workforce brings and for them this means better care from someone you know and who knows you. As a result investment in nursing was planned (see (3) below). Additionally, a LiA programme of work, taken forward by a team on Seacole ward developed ways of better communicate with patients and their families Engaging staff and making them feel valued will have a positive impact on attitude and communication more generally: 11

12 o Dedicated staff allocation So that patients are better informed about their day, a member of staff is allocated to a patient at every shift so that they can discuss with patients the plans for the day, what to expect and how the staff member will help. o Community Meetings made more robust Information provided at community meetings has a set agenda including Staff messages where staff convey information, such as: patient rights as an informal patient, whether there will be a new admission and how they can be made to feel welcome, any changes in the ward team or whether any there will be any absences. If a patient feels that their treatment has changed without their consent this can be raised and then taken forward by the team. It has been recognised on the ward that some patients find it difficult to speak at the community meeting so a patient representative is voted by other patients who feel more comfortable highlighting general issues through another patient. The patient representative can raise issues directly with the ward manager who can address them. o Feedback questionnaires have been developed and provided to carers, relatives and friends of patients who visit the ward. This is to convey that they are cared for and that their views and experience counts as well as assisting the ward staff to consider what information and support is needed. The three questions asked are: 1: What help/support have you needed from the clinicians/hospital since your loved one became unwell? 2: Do you feel you have the knowledge and/or skills to support your loved one? 3: When your loved one is in hospital, what are three things that matter to you most? The information is used to improve the communication and support which includes a carers and family board on the ward which provides information about the inpatient stay, photograph being taken of the ward and used in a ward booklet so that families can picture the environment before a loved one is admitted and share it with other family members who may not be able to visit. The responses over a 3 month period will be collated and themes identified so that future changes can be developed and considered for Trust wide roll out. (2) Quality Boards A framework for all inpatient wards to make visible and store information about services so that patients, carers and visitors can access it easily. This has included Quality Boards for key messages about the ward to be displayed including a Learning and Improving 12

13 section and a Tell Us What You Think section. (3) Review of nursing resources The resourcing profile of nurses on wards is an important factor in allowing sufficient time for staff to communicate effectively with patients, as well as the quality of the clinical and caring role they undertake. As reported in the last year s Complaints Annual Report, a review of this resource was planned. In October 2013, it was announced that a substantial number of new nursing staff would be appointed as part of a 2.1 million investment in patient care. The Trust is creating the posts to ensure the best possible quality of care to service users by ensuring we have sufficient numbers of qualified, permanent staff to look after them. This gives the Trust one of the best ratios of staff to patients and qualified to unqualified staff across London Mental Health Trusts (4) Changes to correspondence Following a review, the Patient Experience Team recommended that all outpatient correspondence relating to appointments has a strapline offering letters or reports that are sent, to be brought back at the next appointment if the service user would like to discuss any aspect of what was sent. This will provide a forum between the service user and clinician to clarify any points of misunderstanding. Options for service users to provide feedback is also being put on their discharge summary sent to them when discharged. (5) Improving ways to provide feedback to the Trust Providing different ways to receive communication, act on it and respond has been a focus this year. There are 3 key platforms: (a) Patient Opinion The Trust renewed its licence this year to an online web based platform where the public can post feedback about the Trust and we respond marking any planned changed or changes that have taken place. The Patient Experience Team are responders on the site and this is being widened to clinical and managerial staff. The Team are bloggers on the site covering issues such as: Tackling stigma, How would you like your complaints resolved ; Tell us what you think and What you say can make a difference, inviting the public to start a dialogue. (b) Care Connect Care Connect is a web based platform for the public to report a problem, write a review or ask a question and respond: The Patient Experience Team resolve issues that are raised and send a response. 13

14 (c) Real Time Feedback (RTF) There are RTF kiosks on all inpatient wards to enable patients and service users to provide feedback about how we are doing as a Trust, as well as raising comments, concerns or compliments. Feedback can also be provided online and plans have been made this year to make RTF available to patients in the community via tablets. (6) Patient Advice and Liaison Service (PALS) 2.12 Compliments To improve the quick resolution of concerns, a method of escalating a complaint and a means of facilitating better communication and providing information by way of signposting the Trust has reintroduced PALS. This comprises a PALS Advice Line ( ) and PALS surgeries which are held on the ward by the Patient Experience Team The Patient Experience Team logged 692 compliments this year and below is set out how this attributed to each borough and a sample of compliments received follows. Service Area Number Kingston & Richmond 149 Merton & Sutton 198 Wandsworth 181 Specialist 146 Corporate 18 TOTAL Kingston and Richmond services Twickenham and Hampton Community Mental Health Team (CMHT) I can't tell you how much I have appreciated all your help and support during the last year. Thank you so much..." "I'm sure I would not have done it without your help and advice. We will be forever grateful to you. We would like to give you a big thank you, you always seem to go that extra mile." "Thank you again for another year of 100% support to the household. It makes such a difference knowing there is someone to call upon should I need it. I really do appreciate all you have done. With very best wishes" Azaleas ward I would just like to thank you and the carers and nursing staff in the Azaleas ward for the care and attention you have given my father over the months he was on the ward. We knew he was well looked after which was always a big weight off our minds 14

15 Kingston Child and Adolescent Mental Health Services (CAMHS) "...I guess I wanted to write to you and thank you endlessly again for all the things and skills you taught me. You helped me throughout the hardest year of my life so far and when I see myself participate or complete things that I found hard or distressing, it was partly due to the support I had from you during that year. I again wish you all the best and thank you for everything you did for me." Merton and Sutton services Early Intervention Service My mother reported multiple bits of positive feedback about yourself - that you had "worked really hard", "done a lot", were "brilliant", and she "can't fault him at all". Jupiter ward You know what I find with Jupiter, you are always so helpful, so nice, polite and really helpful whenever I have to speak with you." The staff at Jupiter Ward are truly remarkable. Really made the difference to me getting well and staying well. Norfolk Lodge I just wanted to drop you a line to thank you so much for the remarkable progress that my brother P has made since he has been at Norfolk Lodge. Everyone has been so supportive and caring towards him I cannot thank you all enough. P has always been an isolationist and uncomfortable around people but since he has been there and around you, I have seen that he now talks about his friends at Norfolk and participates in many activities. He has also found something that he is good at, which is bowling, aside from the fact that he has never done any activities like that, ever, it is remarkable to me that he is so good at it, enjoys it and I can see confidence and pride come through. From such a fun activity have come so many positive aspects. He has also told me that you both cook together and that you have been tutoring him on how to use a computer both very important life skills. I know that you may not always get feedback on all the wonderful progress that come from your efforts and activities but rest assured they do not go unnoticed. Thank you for making such a big difference in P s life Specialist Services Obsessive Compulsive Disorder/Body Dismorphic Disorder (OCD/BDD) Just wanted to thank you so much for all your help and support over the last year from our first phone call, you have worked with us to make sure [patient name] achieved his goal of getting to Uni. And we appreciate you helping him through his recent blip." 15

16 I cannot express to you in words how grateful I am for all your help and support over this year. Thank you so much. Thank you for all your help this year which has enabled me to overcome my OCD and get better" Adult Eating Disorders (Outpatients).I really just wanted to drop you a line to say thank you... thank you for not turning me away, for not chastising me.for not judging me and for giving me the help and encourage and access to all of the amazing professional services that have enabled me to recover and move on with my life..i don't think at the time I realised just how good the services and facilities available to me were, so I would like to repeat my gratitude once more... It has made me understand just how lucky I was in terms of the service available. Hume ward I am writing these recommendations on the behalf of our son A and the rest of our family to express the wonderful and intervention work that [the] team are doing on Hume Ward... We are happy about the care that our son has received from manager and her team and the Happy, Colourful and Caring environment that they have provided. He has been given his confidence back...hume ward has restored my faith in Springfield Hospital." Wandsworth services Rose ward Since my arrival here on Rose Ward all the staff, both the nurses and doctors, have been especially supportive in looking after both my physical and mental health. I seem to be progressing very well and hopefully my recovery will continue. One specific incident highlighted in my mind is an occasion where I displayed symptoms of slurred speech and the team quickly arranged for me to have a scan. The facilities on the ward are excellent and the food is very nice. I think they do a fantastic job on the ward. I like that there are a selection of activities available on the ward and I think it is great to be in an environment where I am not bullied." Balham, Tooting and Furzedown Community Mental Health Team (CMHT) Thank you very much for all your time and your concern about our son. Cannot thank you enough we have much more hope. Improving Access to Psychological Therapies (IAPT) Wandsworth At this low period in my life, the weekly get together and follow up gave me purpose, focus and deep understanding of my situation. It was great to be able to work with other women in similar circumstances. Plus, the expert guidance, advice and care from [names] who facilitated the group, made me feel comfortable and at ease when sharing my intimate thoughts and information. Thank you for helping me through this... 16

17 3. Conclusion 3.1 There has been a focus this year on improving complaints handling and significant positive changes have been implemented that are working well. Key areas of development have been taken forward and introduced aimed at improving communication and information to patients being a theme arising from complaints. Also, timeliness of responses has been significantly been improved with responses being sent within the Trust s performance indicator since November Compliments far outweigh the number of complaints (403 complaints 697 compliments) this year and the number of referrals to the Ombudsman have been more than halved. 4. Recommendation 4.1 QSAC is requested to note this report and approve its publication. 17