Complaints & Compliments Annual Report

Transcription

1 Complaints & Compliments Annual Report

2 Introduction We are proud to publish the Compliments and Complaints Annual Report for 2014/2015. The Trust recognises that our patients and service users have a range of experiences when using our services. It is essential that we provide people with a mechanism to feed back to us both positive and negative experiences. Where possible, we should take immediate action to put things right and where this is not possible it is important that we have a robust complaints process. The Trust adheres to the statutory instrument 309 which came into effect in April These require NHS bodies to provide an annual report on complaint handling and consideration, a copy of which must be available to the public. This report provides an overview of the Trust s Complaints and Patient Advice and Liaison Services (PALS) activity between 1st April 2014 and 31st March PALS has maintained its position with patients, the public, staff and external organisations as a department that is responsive and proactive to queries and concerns. PALS remain an effective resource in supporting patients and their representatives, and staff to respond to real time queries and concerns, putting the patient at the heart of everything it does. The complaints management team seeks to maintain an appropriate level of contact with the complainants and external agencies; whilst working with the responding business units to compile a response or hold a meeting that effectively addresses the complaint concerns on behalf of the Chief Executive. It is important to note that every formal complaint response is seen and signed off by the Chief Executive. The Trust has improved on how it's manages complaints and concerns and will continue to aim to improve further in 2015/2016. National Context In February 2013, Robert Francis QC published his Public Inquiry into Mid Staffordshire Hospitals NHS Foundation Trust. He wrote, A health service that does not listen to complaints is unlikely to reflect the early warning signs that something requires correction, to address such issues and to protect others from harmful treatment. A complaints system that does not respond flexibly, promptly and effectively to the justifiable concerns of 2

3 complainants not only allows unacceptable practice to persist, it aggravates the grievance and suffering of the patient and those associated with the complaint, and undermines the public s trust in the service. This report prompted the Prime Minister and Secretary of State for Health to commission a review of NHS hospital complaints handling. The review was co-chaired by the Rt Hon Ann Clwyd MP for the Cynon Valley and Professor Tricia Hart, Chief Executive, South Tees Hospitals NHS Foundation Trust. The review looked at how complaints about care and treatment in NHS hospitals made by patients, their relatives and carers are listened to and acted on by hospital staff. The report was published in October 2013 and focussed on four areas for change: Improving the quality of care Improving the way complaints are handled Greater perceived and actual independence in the complaints process Whistle blowing COMPLAINTS AND COMPLIMENTS In 2014/15 the Trust has continued to welcome patient feedback. Following a review of the Complaints and Concerns Policy, there has been a continuing focus to ensure that we effectively and efficiently answer complaints and concerns in a timely manner and continually use this information to improve our services. 2012/ / /15 Number of complaints Number of informal concerns & enquiries

4 / /14 PALS Concerns/Enquiries 2014/15 Formal Complaints PALS ACTIVITY PALS OVERALL CONTACTS Total 2013/14 Percentage 2013/14 Total 2013/14 Percentage 2013/14 Pals Concern % % Enquiry % % 188 8% % 52 2% 57 2% % % Compliments Ex Gratia - payments Total As the figures show, PALS activity has been rising and we dealt with over 3400 different types of contacts in 2014/15: including concerns, enquiries, compliments, and ex-gratia payments. The breakdown shows a rise of over 850 concerns and enquiries (which represent the majority of the activity) since the last financial year. It is thought that increased Trust activity, national campaigns and local patient feedback campaigns (of Making Your Moments Matter) have contributed to this rise. The Information and Support Hub will be opened within the PALS office at the end of May 2015, and it is anticipated that this will bring a further increase in activity for the PALS service. Apr- May- Jun Compliments Enquiry Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar Total

5 Compliments Enquiry 100 Ex Gratia Pals Concern 50 Mar-15 Feb-15 Jan-15 Dec-14 Nov-14 Oct-14 Sep-14 Aug-14 Jul-14 Jun-14 May-14 Apr-14 0 Further breakdown of data by business units can be found in Appendix A COMPLIMENTS The Trust has widened the ways by which compliments are received, with the Comments from Friends and Family and NHS Choices website adding a rich source of information to the compliments received in writing by the Trust. The high number of compliments received is very encouraging and are fed back to the department teams to reinforce good practice. TYPE OF POSITIVE COMMENT DATA RECEIVED TOTAL NHS Choices/Patient Opinion/Trust Website (Figures cannot be separated retrospectively) 187 Online sources: Twitter/Derby Telegraph (as above) 127 Family and Friends Test (These are positive comment totals and cannot be separated) COMPLAINTS FORMAL COMPLAINTS OVERALL Formal complaint Apr14 May14 Jun14 Jul14 Aug14 Sep14 Oct14 Nov14 Dec14 Jan15 Feb15 Mar15 Total

6 FORMAL COMPLAINTS BY DIVISION Total % of Total Integrated Care % Medicine and Cancer % Diagnostics, Surgery & Anaesthetics % Corporate 10 1% Corporate - Facilities 15 2% Corporate - Finance & Info. 1 0% Trust-wide 9 1% % Total MONTHLY COMPLAINTS BY DIVISION Integrated Care Corporate Trust-wide Medicine and Cancer Corporate - Facilities Diagnostics, Surgery & Anaesthetics Corporate - Finance & Info. There has been an increase in complaints from 736 last year to 819. This is felt to be due to the public s heightened awareness of the option to complain. This trend reflects the local and national picture, and our own internal campaign related to Your Views Matter. Proportionately, there have been a higher number of concerns this year and we have made significant effort to resolve people s concerns quickly, reducing the need for them to follow the formal complaints process. The focus of improvements since April 2014 has been to drive forward change following the Francis Report and the Clwyd/Hart Report and to put patients at the centre of everything we do when handling complaints and concerns. This has been achieved by taking forward the Patient Association Good Practice Standards for NHS Complaint handling. The Trust policy has been updated in line with these reports and the Patients 6

7 Association Standards, supported by the roll out of the complaints management system, DATIX. The most significant changes have been the introduction of triage within one to two hours, provisional grading of all complaints by senior members of the complaints team, making personal contact with each complainant by telephoning them to discuss their complaint, what outcome they are seeking and ensuring there is a robust complaints management plan. The management plan means that complainants expectations are better managed from the outset, ensuring that complaints are dealt with in a timely manner and the complainant is assured their concerns are being addressed effectively and within a reasonable timeframe. It is also important to note that the ownership of the complaints process in the divisions is now much stronger, with the teams improving the way they respond to complaints and concerns. This has been supported by Risk training and serious complaints are now escalated immediately to Risk and Governance, Divisional Nurse Directors and/or Executive Directors for action. Although we do not wish for more people to be unhappy with the service they receive, we welcome all feedback as it means that more people are telling us about their experience. The key areas of focus have been: Ensuring that all key staff are trained to deal effectively and efficiently with complaints and concerns Embedding systems and processes to make sure that learning and improvements from complaints and concerns are part of our core activity and robust action is taken to put things right when required Consolidating the use of the electronic information system to ensure that complaints and concerns are responded to in a timely manner Embedding the Complaints Review Group, Chaired by the Trust s Head of Corporate Complaints/PALS, to carry out monthly reviews of the quality of our complaint responses. This provides additional rigour and quality to the complaints management processes. The Group has noted an improvement in both response times and the 7

8 quality of responses provided. The Group also feeds back to staff to ensure that learning takes place The Trust has enlisted the support of the Patients Association in surveying all people who make a complaint, about their experience of the complaints process. Learning from complaints will continue to take place at several different levels of the Trust, at Board, Divisional, Business Unit and local ward and department levels. The Trust works closely with the association to monitor feedback on the way we handle complaints. Joint working is taking place with the Patient Experience Team and the Complains/PALS Department to ensure that trends are monitored on complaints and concerns and further work carried out to embed learning throughout the Trust. The Trust has appointed a Head of Corporate Complaints and also agreed to additional staffing within the department to ensure that the Trust deals efficiently and effectively with complaints and concerns. A master class on complaints handling has been delivered, led by the CEO. Further plans are in place to source and deliver dedicated complaints investigation training. Complaints Received by the Health Service Ombudsman The Parliamentary and Health Service Ombudsman (PHSO) represents the second and final stage of the NHS complaints process. The Trust continues to work directly with PHSO to satisfactorily resolve complaints. A person may refer to the PHSO if they do not feel that the Trust has responded to all of their concerns, or they are unhappy with the way in which we have dealt with their complaint. The PHSO gives the Trust the opportunity to ensure that all local resolution has taken place to try and resolve the issues and will give an independent view on the complaint. The outcome/final decision of a PHSO investigation can be to uphold or not uphold the complaint, depending on whether they find that the Trust has acted correctly or that there was a problem. If the complaint is upheld, the PHSO can make recommendations to put things right. The complaint is not upheld when the PHSO feels the Trust has acted correctly or that there was a problem but we have already done enough to put things right. 8

9 In 2014/15 there were 10 new referrals received by the PHSO. Themes/Trends No specific themes have been identified. The complaints received include the following issues: Care on a specific Ward fluid monitoring, medication dosages, treatment of lymphoedema, diagnosis of irrecoverable kidney failure Diagnosis unclear, discharged issues Allegation that spinal surgery went wrong and concerns regarding aftercare Missed diagnosis of pneumonia Care following gastric band surgery Failure to remove cancerous node Misdiagnosis of pancreatic cancer Allegation that PE was not monitored and was not treated appropriately Hospital acquired Clostridium Difficile, poor ward hygiene Child s MRI scan cancelled after they were sedated Closed PHSO investigations 2014/15: There were 6 PHSO investigations closed in 2014/15. Upheld 0 Partly Upheld 1 Not Upheld Recommendations/Outcome compensation paid for complaint relating to a child s MRI scans being cancelled after they had been sedated. (Partly upheld case) Meetings between complainants and staff Meetings between patients and/or their representatives and staff in response to their complaints provide a beneficial method of sensitively addressing concerns. In 2014/15 the Trust held 179 meetings. 9

10 The option of a meeting with appropriate staff members is offered by the Trust from the outset of the investigation, where appropriate. The Corporate Complaints Department and the respective Divisions work hard to provide a timely meeting date, however, scheduling can be affected by the availability of staff. The Trust is considering options as to how best set meeting dates with the minimum disruption to front line services that meet the needs of the complainant. Meetings are recorded on to CD and the original copy provided to the complainant; this method of recording complaint discussions has been in place for the last six years and is appreciated by complainants. MONTH/YEAR 2014/ / / / / / / / / / / /03 LOCAL RESOLUTION MEETING There has been a gradual increase in the number of complaint meetings held during 2014/15. Generally, it is found that meetings are more beneficial to patients, families and Trust representatives, as direct discussions and explanations can lead to increased understanding and resolution. Further analysis is being undertaken to look at re-opened complaints and how many arise from written responses compared to local resolution meetings. Internal Audit - Complaint Management A review of the complaints management process within the Trust was completed between December 2014 and March The review examined the effectiveness of controls in place and was undertaken in accordance with the Public Sector Internal Audit Standards. 10

11 The review was, therefore, performed in such a manner as to provide an objective and unbiased opinion. Since October 2012 the Trust has undertaken a considerable amount of work to improve its management of complaints, including the introduction of a revised Policy and Procedure on Handling Concerns and Complaints on 1st August The draft report from the 2014/15 review confirms that the Trust has continued to make good progress in developing its complaints systems and the control infrastructure established by the Trust was robust. It established that the Trust is now placing greater emphasis on the consistent application of the control framework established and demonstrating compliance through the Datix Complaint Management System. A brief summary of the areas of good practice identified during the course of the review is provided below: The Trust s Policy and Procedures on Handling Concerns and Complaints alongside Standard Operating Procedures details responsibilities for all staff involved in the complaints handling process and step-by-step instructions Staff are encouraged to acknowledge and respond to concerns locally and guidance is available on the Trust intranet to support staff to do so There was evidence of strong leadership and accountability processes within the complaints team during the auditor s visits A Complaints Review Group has been established which meets each month and uses the Patients Association peer review template and scorecard to review a sample of complaints to facilitate reflection and learning Work to refine and build on the complaints handling process is continual. Care Quality Commission (CQC) inspection 2014 Complaints Management Findings The CQC conducted an inspection of the Trust in December 2014 and complaints management was a focal point for the inspection. The CQC had previously given the Trust an improvement notice in 2013, predominantly due to the timeliness of providing 11

12 complaint responses. A significant amount of work has taken place on this and we are pleased to say that, after scrutiny, the CQC removed the compliance notice and deemed the Trust compliant against Regulation 19 of the CQC Provider Compliance Assessment. The following areas of good practice were identified: Nursing staff told us that they received positive feedback and learning from complaints. Feedback from patients was shared in a variety of ways, including staff noticeboards, s, team/ward meetings and newsletters on the back of staff toilet doors. Ward managers had tried different ways to share the information to ensure that it was seen by all staff. The Medical Director produced a newsletter which included learning from complaints. Within the Maternity and Gynaecology service, complaint themes were shared with staff on their mandatory training days and by the Supervisors of Midwives when they met for their annual appraisal. Complaints were reviewed and discussed at the department meetings. Full CQC findings can be found on their website Service improvements as a result of learning from complaints It is essential that the Trust continues to learn from complaints, and ensures learning results in service improvements which are embedded in everyday practice. Being receptive to feedback means reflecting on what improvements can be made and putting the patient at the heart of everything we do. Outlined below are some service improvement examples from the Divisions, which are responsible for implementing and monitoring lessons learned through their governance systems. EXAMPLES OF OUTCOMES AND LEARNING FROM PREVIOUS COMPLAINTS INTEGRATED CARE DIVISION 12

13 1. Patient fall with fractured pelvis A 92 year old lady was admitted following a fall at home in which she sustained a multifragmentary left proximal humeral fracture (fractured pelvis). Following a period on an orthopaedic ward she was transferred to London Road Community Hospital (LRCH) for ongoing care and rehabilitation. The lady fell whilst mobilising to the toilet. She was mobilising with a quad stick and supervision of one Healthcare Assistant (HCA), as advised by physiotherapists, when the HCA stepped ahead of her to remove a wheelchair that was obstructing the patient s path, the lady lost her balance and fell landing on her left side. Recommendations and actions Ward was contacted to share the findings of this report, in particular the need for improved communication when transferring patients back to LRCH wards. Emergency Department (ED) staff were reminded of the importance of returning all patient paperwork to LRCH wards when patients are returned there following review in the ED. The Senior Sister audited five patient care plans per week to ensure all risk assessments are up to date. A meeting to be offered to the patient and next of kin to discuss the findings of this investigation and to address the issues raised in their formal complaint. 2. Paediatric complaint The issues highlighted were primarily around communication; misinterpretation of information and lack of information given to the child s parents. raised, all of which were resolved in a timely manner. Four concerns were Examples included delays in medication, poor communication with clinic cancellation, and parent unhappy with the process of the vaccination clinic. Recommendations and actions Individual feedback was given to those involved with the complaint and the concerns raised. Further work will be undertaken in the outpatient department with management of clinics and providing timely information to children/families about 13

14 cancellations of clinics. The process of the vaccination clinic is also currently being reviewed and with the potential new introduction of a different preparation of vaccine the current issues can be resolved to make the clinic more efficient. 3. Maternity complaints There were two complaints related to the safeguarding of children, both highlighting the importance of good communication between the Trust and our partner agencies. Recommendations and actions There has been joint working ongoing with the Trust maternity safeguarding team and Social Care to improve documentation and information sharing between agencies. DIVISION OF SURGERY, DIAGNOSTICS AND ANAESTHETICS 1. Waiting time in the Surgical Assessment Unit (SAU) Two complaints identified a significant wait in the Surgical Assessment Unit, which included a patient waiting for pain relief and an issue for a patient waiting for medication following admission to hospital. These complaints also highlighted issues in relation to patients waiting to see a doctor on arrival on the Unit. Recommendations and actions Entonox (a form of gas given to patients to ease pain) training for new staff members had already commenced and a review of staff training needs now forms part of one of the junior sister s role to ensure that this situation does not reoccur. The Trust is currently recruiting additional consultant cover to address the issue of senior medical cover in Surgical assessment areas. In addition, the Trust is looking at ways of changing the hospital s on-call rota to provide more medical support in assessment areas. The management team have discussed the escalation process with nurses in charge of the department, including the senior ward sister, to make sure that learning from the complaints is shared with all staff. 14

15 The staff on duty at the time of the complaint were informed and instructed to access the pain management e-learning module to support their understanding around patients perception of pain. 2. Ophthalmology care received Two complaints pertaining to the care of patients in Ophthalmology at a weekend were received in October and November; education and patient education was identified as an action point. Recommendations and actions The consultant has spoken with the attending doctor and has also provided refresher training for, and spoken to all of the other doctors regarding managing patients and the protocol for treating patients presenting with a retinal detachment at the weekend. The need to properly explain the precise requirements of posturing has been stressed, including taking into consideration the patient s particular circumstances, and the message that they give regarding transferring other patients to an alternative hospital The Ophthalmology department developed a patient information leaflet which fully explained and emphasized the process and the necessity of posturing following a retinal detachment 3. Cancellation of surgery due to the unavailability of records There had been issues regarding the cancellation of patients on the day of the surgery due to the unavailability of health care records. Recommendations and actions Health Records has advised all General Managers and Assistant General Managers that if medical records cannot be located for an elective admission, this must be escalated to a Senior Manager in Health Records in advance of the day of 15

16 surgery, in order to allow Health Records to prioritise the location of misfiled records The location of medical records commences when a theatre list is booked Medical records are requested if they are booked to Health Records at the point of booking More medical records are now being retained in the waiting list office instead of sending them back to Health Records, ensuring they are available for procedures The tracking process for medical records has been reiterated and adhered to by all staff in the department Theatre lists are being booked more in advance providing more time to locate medical records An escalation process is in place. If medical records are missing this is escalated to the General Manager and Assistant General Manager of the Surgery Business Unit and a decision is made by them whether or not to cancel surgery It has been agreed that if medical records are still missing, then it is appropriate to cancel surgery the day before, rather than on the day itself. Plans for 2015/2016 The Trust has made significant improvements with regard to the complaints management processes and it is important that improvements continue to be made. We have developed a complaints improvements plan for 2015/2016 focussed on responsiveness and organisational learning and this will be monitored through the Patient Experience Committee. The plan will focus on the following: In liaison with the Trust s Organisational Development and Training review, complaints handling training needs will be reviewed across the Trust, through the development of a robust training strategy. Continue to explore a more structured timeframe in which to provide meetings between complainants and Trust staff. Undertake a reorganisation of the PALS/Complaints department to strengthen its delivery of high quality responses and meetings. Deliver an interactive area for patients and relatives to access real time information in the PALS areas through the introduction of the Information and Support Hub. 16

17 Work will continue to target improvement on the timeliness of complaints management, ensuring that trajectories are met through regular performance monitoring at department level on the number of breaches taking place and the reasons for those breaches. The Trust will set up the learning pilot in the Emergency Department through the guidance of the internal delivery team made up of Legal, Risk, Complaints and Patient Experience. Work will be carried out to look at specific learning from complaints in the ED function. Learning Action Plan monitoring will be conducted through the DATIX system. This will be critical to ensure actions can be monitored electronically and learning is embedded throughout the Trust. Further work will be done to promote how we use the learning from Parliamentary Health Service Ombudsman (PHSO) cases. Datix will be used to capture the actions and then will be monitored to ensure recommendations are being followed through. 12 month follow up will be carried out to evaluate if the learning has been embedded. Further work will be done around cultural competence to ensure that all the communities that use the services of the Trust are able to understand how to make a complaint or compliment and that it is accessible. Overall, this year the Trust has improved immensely on the way it handles and deals with issues raised by patients. Work will continue to improve the quality and learning from complaints and concerns. Learning is critical and will help the Trust to continually improve the services we provide. Being receptive to feedback, means reflecting on what improvements can be made, putting the patient at the heart of everything we do. For further information about the information outlined in this document, please contact the Trust on dhft.contactpals@nhs.net. 17