DH Review of NHS Complaint Handling Submission by the Foundation Trust Network (FTN)

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1 DH Review of NHS Complaint Handling Submission by the Foundation Trust Network (FTN) 1. Introduction 1.1 The Foundation Trust Network (FTN) is the membership organisation for the NHS acute hospitals and community, mental health and ambulance services that treat patients and service users in the NHS. The FTN helps those NHS trusts deliver high quality, patient focussed, care by enabling them to learn from each other, acting as their public voice and helping shape the system in which they operate. The FTN has over 220 members more than 90% of all NHS foundation trusts and aspirant trusts who collectively account for 65 billion of annual expenditure and employ more than 630,000 staff. 1.2 We welcome the opportunity to engage with the Department of Health (DH) Review of Complaints on behalf of our member organisations. Our submission has been informed by a document review and a range of trusts among our membership who have contributed examples of their own practice in handling, and responding to, complaints. We look forward to supporting the DH team to test early recommendations at the next meeting of our Quality Working Group in June, and to continuing our partnership with the Parliamentary Health Service Ombudsman (PHSO) to raise awareness of good complaints handling among our members, including offering a dedicated workshop on complaints in our annual conference programme. 1.3 We would be pleased to continue our engagement with the review, and to provide feedback on more detailed proposals at the appropriate time. 2. Key messages The role of the boards is central in developing learning organisations which embrace a culture of transparency and improvement. The leadership within the organisation clearly has a key role to play in ensuring processes are in place to investigate complaints, acknowledge mistakes and apologise, ensure individual cases gain redress and crucially act to use complaints information improve services. However the single most important message to emerge from the DH review in our view would be the importance of the board in generating a learning organisation which is transparent and does not create an atmosphere of fear or blame; Staff feedback has a key role to play alongside that of patients/service users and the public. Establishing a culture of transparency where staff feel empowered to raise issues without fear of blame was considered fundamental by member organisations who contributed to this submission; Complaints form one key source of performance information and need to be analysed holistically in the context of outcomes data, patient safety information, feedback on patient 1

2 experience and wider feedback and compliments from patients/service users, staff and the public; While national standards can be helpful, we would advocate sufficient flexibility for local application across a broad range of health and care providers. We would strongly encourage the review team to broaden its remit to consider care settings other than hospitals where the principles of good complaint handling could be equally applied. 3. Response 3.1. What common standards can be applied to the handling of complaints? Most trusts already operate a staged complaints process, and many of our members offer standards relating to the time in which they aim to respond to complaints, often to acknowledge all complaints within three days of the complaint being made, and to provide a written response within 25 days of the complaint being made. Our members are keen to make their service standards explicit, and to manage expectations about how swiftly complaints may be resolved. For instance, Moorfields Hospitals NHS Foundation Trust commits to a letter from the Chief Executive within 25 days, the Medical Director from Wrightington, Wigan and Leigh NHS FT personally intervenes if an issue is not resolved within three months of the complaint being made, University College London Hospitals (UCLH) commits to a written response with a covering letter from the Chief Executive within 25 days 1 and South Tees Hospitals NHS FT 2 commits to acknowledging and responding to complainants as soon as possible to take account of the wide range of issues which can be raised through the complaints process. The PHSO has published a series of principles of good administration, of good complaint handling and for remedy which seem to us to be a useful starting point in developing future standards, and a helpful framework. Some trusts such as Southern Health NHS Foundation Trust already apply the PHSO principles throughout their complaints procedures. We also welcome PHSO s recent report, The NHS hospital complaints system 3 which identifies the core significance of leadership and learning in ensuring responsiveness to complaints, as well as a need to improve communication and responsiveness. Of the complaints received by the PHSO, the main causes of hospital complaints result from poor local explanation (19%) and a lack of acknowledgement of mistakes locally (18%). It will clearly be important for any national framework of standards to encourage and support trusts to train their staff to communicate often difficult messages to patients and their families, and to invest time in ensuring their questions are answered as fully as possible. Our members are also keen that any new standards are practical and focus on measurable improvements for patients, rather than adding unduly to the existing bureaucracy they often face. Given the diversity of providers within health and social care, it would be useful to develop a set of broad principles which could be equally and locally applied. One of our members from a specialist trust mentioned the difficulty they have in applying national standards across a range of areas data/assets/pdf_file/0018/20682/the-nhs-hospital-complaints-system.- A-case-for-urgent-treatment-report_FINAL.pdf 2

3 Although we understand that the DH review is focussing predominately on hospitals, it is important to recognise that foundation trust and NHS trust activity spans the acute, community, mental health and ambulance sectors and involves care in a number of care settings. It will be important that any national standards are sufficiently flexible to be applied across the health sector and indeed to primary and social care settings where it is equally important to ensure good communication and patient involvement in care, as well as to maintain the paramount importance of patient safety. We would expect different provider sectors and the PHSO to be involved in the detailed development of further standards for complaint handling, and the FTN would be pleased to facilitate further engagement with our members in support of this How intelligence from concerns and complaints can be used to improve service delivery, and how this information can be made available to service users and commissioners. Most of the members we spoke to as part of this review were committed to making information more transparent for the public but admitted that high level complaints data was not currently publically available. We certainly agree that trusts should make their complaints procedures transparent and available for patients online, as well as in other formats including readily accessible information on wards and other trust premises. Particular consideration should also be given to those services where complaints are more likely to occur for instance in end of life care. Providers may find it useful to be more open and explicit about their service standards so that patients and their families are clear about the timeframes and standards of care that they can expect. We would advocate for any such standards to be locally developed, perhaps underpinned with national guidance. In our view, it is important for trust boards to analyse complaints information in the context of other information on quality and performance, including information on patient experience, outcomes and safety. We would have some reservations using scores or ratings based on complaint levels to inform organisational assessments as it is not an exact science and can reflect the views of those patients who feel most able to complain. Should complaints data be published, it will therefore be most useful to the public if set into context with other data about patient experience, safety and outcomes. For instance, Moorfields Hospitals NHS FT is undertaking a piece of work to link patient experience data more closely with complaints and identify any trends, as well as to better evaluate if the changes they make on the back of complaints are having a positive effect which is identifiable through patients feedback on their experience of care. They are also developing patient narratives which are put together by a fellow patient observing how other patients are treated within the hospital. This has been a very powerful variant on patient stories, which we know are used regularly by boards to bring to life data on complaints, feedback and patient experience in a more direct way. We are also supportive of developing a mature debate in which national or local targets do not automatically seek to reduce complaints. NESTA research 4 comments on how complaints are increasing across public services, citing this as a positive sign that the public feel a service is worth 4 le_of_complaints_in_transforming_public_services 3

4 improving, and that their voice will be heard, and our members generally look to increase complaints and other feedback by ensuring these processes are as accessible as possible. For instance, Manchester Mental Health and Social Care NHS Trust acted on feedback from service users and carers to improve its medicine management processes by taking practical steps including changing pharmacy providers to improve prescription services available in the community and reduce errors at the interfaces between primary and secondary care services, undertaking research to investigate prescribing errors in mental health to identify areas of risk and using peer review, educational events for all staff and tougher medicine management processes for certain medicines to reduce error and share learning. Finally, it is worth reiterating the point that a number of partner agencies can help in ensuring the public received adequate sign posting to make their complaint. Partners include local trusts and their partner agencies, social care services, and national bodies including the Care Quality Commission The role of the Trust Board and senior managers in developing a culture that takes the concerns of individuals seriously and acts on them Our members are fully committed to ensuring their boards have the information required to take decisions to improve services and to be accountable for the quality of the care their organisations provide. Information on complaints, PALs information and wider patient feedback is made available to the majority of boards at least quarterly. Our members are also developing other ways to support the board to analyse and act on complaints information. For instance, Moorfields Hospital NHS FT appoints a non executive director (NED) on rotation to play a key role in overseeing complaints information and the response to those complaints. This objective second pair of eyes helps to support the board in its role to interpret trends in complaints data and take action to improve services. Several of our members commented on the importance of the leadership role of the chief executive and the medical and nursing directors in responding and taking ownership of complaints, as well as championing the learning process arising from complaints. Wrightington, Wigan and Leigh NHS FT (WWT) encourages the board to ask patients for their feedback during ward walks and other engagement activity and ensures comments received by the board during these activities are fully followed up. A number of our members present patient feedback and additional PALs information together with formal complaints to the board, so that they gain a full picture of feedback and concerns from patients/service users, their families and members of the public. WWT uses an internal RAG rating for complaints to ensure the board is aware of any outstanding and unresolved complaints as well as identifying trends, actions and learning from complaints. They also engage consultants and staff members at different levels to present on key projects relevant to patient safety to the board with positive effect. 4

5 3.4. The skills and behaviours that staff need, to ensure that the concerns of individuals are at the heart of their work; how complainants might more appropriately be supported during the complaints process through, for example, advice, mediation and advocacy; Many of our members who have contributed to this submission commented on a need for staff at all levels to receive some training on communication skills, and appropriate behaviours as part of their induction and indeed formal medical training. Medical and Nursing Directors, and Directors of Quality and Assurance frequently play a leading role in overseeing complaints. For instance at WWL, the Medical Director reviews RAG rated complaints weekly to keep track of trends and all responses. The Medical and Nursing Directors meet weekly to review settled litigation cases, Coroner s inquest and feedback, SUI and any relevant clinical incidents trends. The medical director, the nursing director or the chief executive respond personally to the patient or family of any complaints rated as red (i.e. unresolved) to provide a personal update on where their complaint is within the process. They also offer a meeting to the patient and family of any patient subjected to harm. Moorfields Hospitals NHS FT is offering all frontline staff, including doctors, a half day customer care course, and WWL has invested in training for consultants for whom this is a development need. Southern Health NHS FT offers induction training on customer care and complaints processes as well as Investigating Officer training. Their complaints team respond to requests for support from colleagues internally and attend staff meetings to discuss learning from individual complaints and emerging themes. The trust is also developing e-learning with video scenarios to support complaints handling The handling of concerns raised by staff, including support for whistleblowers. Our members recognise the central importance of supporting staff and of having processes in place which mean their concerns, feedback and indeed, complaints can be acted on quickly. In addition to their formal whistleblowing procedures, Moorfields have recognised the value of having a nominated staff member which staff can go to who is removed from their direct line management structure. They are also introducing a system of staff at all levels in the organisation who will be available to receive anonymous concerns or complaints from staff to ensure staff are not intimidated by reporting upwards to their seniors. Moorfields also runs a Privacy and Dignity group which staff of all levels can attend to provide feedback and raise issues of concern. Southern Health NHS FT is considering a proposal for the complaints department to host a hotline which staff can call to report concerns. Manchester Mental Health and Social Care NHS Trust encourages high levels of incident reporting from service users and staff and uses a multi-disciplinary incident review tool alongside a competency assessment framework for nursing staff to identify and share learning. May 2013, FOUNDATION TRUST NETWORK 5