Liverpool Women s NHS Foundation Trust Complaints Annual Report : 203-4
Contents Summary... 3 Strategic Context... 4 Complaint Levels... 5 Location of Complaints... 6 Causes of Complaints... 8 Timeliness of Complaints Response... 0 Access for Complainants... 2 Recommendations... 3 Complaints Annual Report: 203-4 2
Summary Complaints are a valuable source of information on the quality of service the Trust is providing. This report looks at complaints in an effort to understand the factors that may lead to them, what can be done to address these factors, and whether the Trust s response to complaints can be deemed to be both appropriate and sufficient. The report provides:- A summary of complaints received in between April 203 and March 204, Details of the areas of the Trust these complaints focus on, The primary causes of complaints, The Trust s timeliness in responding to complaints. The key findings in 203-4 were:- There were 79 complaints received, a 9% increase from the previous year, The vast majority of complaints, 60%, related to medical treatment and care, The average response time for complaints was 30 working days, a reduction of 6 days from the previous year, The Trust policy is to routinely uphold all complaints locally. The primary conclusions of the report are:- There are well established mechanisms to capture the experience of patients and their families in order to drive continuous improvement. These include the Friends and Family patient feedback programme, use of information gathered through complaints and PALS, and listening to patient stories at the start of key Committee meetings including the Board of Directors. There is a need for a greater focus on, and ability to evidence, changes in practice and the Trust learning lessons from complaints. This report has particularly highlighted deficiencies in ensuring the implementation of actions taken by the Trust in response to complaints and the monitoring of Parliamentary and Health Service Ombudsman investigations. The current understanding of complaints at a Trust level is piecemeal. More holistic oversight is needed to ensure that the Patient Experience Team are not working in silo and that they are allowed to work alongside clinicians in effectively implementing patient-driven change. Complaints Annual Report: 203-4 3
Strategic Context To allow a comprehensive understanding of the Trust s complaints it is important to consider a wider context. There must be recognition of the spotlight that has been firmly shone upon the complaints process within the NHS; the Trust s response to this must be seen to be appropriate. In February 203 Sir Robert Francis published his final report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. Closely following this, in July 203, Sir Bruce Keogh published his review into the quality of care and treatment provided by 4 hospital trusts in England. In October an overview report and a further review of how complaints are handled in the NHS was published by Ann Clwyd MP and Professor Tricia Hart. This highlighted further the deficiencies that exist in the way many Trusts respond to complaints and concerns. In perhaps the most high profile of these, Sir Robert Francis report into the failings at Mid Staffordshire, the author clearly states that a health service that does not listen to complaints is unlikely to reflect its patients needs. Francis stresses the importance of a centralised complaints team and a robust Trust process to monitor complaints was highlighted. Francis is clear that it is only by ensuring such mechanisms are in place that it can be guaranteed lessons are learned within an organisation and repeated failings of a similar nature prevented. It is vitally important that all of Francis recommendations in regard to complaints are visibly acted on by the Trust. It is of paramount importance that Liverpool Women s NHS Foundation Trust responds adequately and in full to all of these external drivers and is open with its patients in explaining how it has responded. There is currently oversight through Clinical Governance Committee of the response to these reports but there needs to be continued commitment at senior level to ensuring this oversight continues, that change to the complaints process is implemented and that the positive results of the change are evidenced continuously both within the organisation and externally. Complaints Annual Report: 203-4 4
Complaint Levels The Trust received 79 complaints in 203-4, an increase of 9% compared to 202-3 s figure of 50. This had been the second successive increase with only 39 complaints recorded in 20-2. The increase is shown in Figure and Figure 2 where it can also be seen that the in April, June and November the Trust received more than 20 complaints compared to an average of 2 per month in previous years. 25 20 5 0 60 50 40 30 20 23 3 54 47 34 35 3 32 50 38 53 40 5 0 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 20-2 202-3 203-4 Figure : LWHFT Complaints by Month Apr to Mar 4 0 Q Q2 Q3 Q4 20-2 202-3 203-4 Figure 2: LWHFT Complaints by Quarter Apr to Mar 4 It is also worth reviewing the numbers of complaints the Trust receives in comparison to its peers. Figure 3 gives details of the complaints received by Liverpool Women s alongside the numbers received by Birmingham Women s and the average for all Foundation Trusts. Also given is the percentage change seen by each in the most recent year for which figures are available. % 20-2 202-3 203-4 Change Liverpool Women's 39 50 79 9% Birmingham Women's 49 43 - -4% Average for All Foundation Trusts 354 377-7% Figure 3: Complaints Comparison It can be seen that complaints at Liverpool Women s in 20-2 were at a level slightly below that seen at Birmingham Women s. This had reversed by 202-3 after an 8% increase in complaints at Liverpool Women s while Birmingham Women s saw a 4% reduction. There was a further increase of 9% during 203-4 at Liverpool Women s with the figures for other Trusts as yet unpublished. These will be closely monitored when they are released to ensure Liverpool Women s does not appear out of step with its most comparable Trust and indeed the national picture. Complaints Annual Report: 203-4 5
The Trust does not necessarily regard the increase in complaints as a negative sign. It is committed to widening the number of channels through which patients can access the complaints arena. It increasingly receives feedback via patient opinion websites and its Twitter and Facebook accounts which can in turn be registered formally. Nevertheless the specifics of all complaints are continually analysed to ensure problem areas are identified with appropriate actions drawn up and implemented to effect change. Location of Complaints As would perhaps be expected the vast majority of complaints (78%) were attributed to either Gynaecology and Surgical Services or Maternity and Imaging. Figure 4 gives a full breakdown of complaints with comparisons against the figures for the previous two 2-month periods. 00 90 80 70 60 50 40 30 20 0 0 48 72 63 65 50 Gynae & Surgical Services 89 Figure 4: Complaints Breakdown by Service 8 0 0 Maternity & Hewitt Centre Neonatal & Imaging Pharmacy 20-2 202-3 203-4 6 5 6 4 5 4 BSA Other 2 Gynaecology & Surgical Services had an overall 2% decrease in complaints compared to 202-3. The decrease brings them back into the line with figures seen in 20-2. As well as a slight reduction in complaints around treatment decisions there has been a significant reduction in complaints concerning communication and staff attitude which is particularly pleasing. Maternity & Imaging had an overall increase of 37% in complaints compared to the previous year. There were 27 additional complaints relating to the treatment or care received by patients, this amounts to a worrying increase of 6%. The remainder of this document provides additional detail on the departments most affected by this increase and the specific reasons behind the increase. Complaints Annual Report: 203-4 6
Hewitt Fertility Centre saw an increase of 80% in complaints with a total of 8 received compared to 0 in 202-3. This is believed to be in large part due to the increased number of patients the centre is seeing. There are also concerns being addressed by management around increased workload, staff absence, and the training and development of new staff Booking, Scheduling & Administration appear on the graph to have seen an exponential increase in complaints. This is largely due to operational changes which mean that previously the complaints may have been masked within the clinical services figures. The isolation of complaints of this nature into a specific BSA category does ask further questions of those services in which complaints have continued to increase. The 79 complaints received by the Trust during 203-4 were spread across 2 departments within the Trust. However, the 0 departments receiving the most complaints account for 87% of the total. Figure 5 builds upon the detail shown above in Figure 4 by giving a breakdown of all complaints by department and also provides a comparison with the number of complaints received in 202-3. Legal Services 202-3 Pharmacy Estates Jeffcoate Ward Bedford Clinic Community Gynaecology (Generic) Urogynaecology Neonatal Unit Maternity (Generic) Imaging Midwifey Led Unit BSA Antenatal Clinic Theatres & Recovery ER Hewitt Centre Gynae Ward Gynae Outpatients Mat Base Delivery Suite 2 2 3 3 3 4 5 5 5 5 6 7 7 8 8 9 0 2 0 6 5 8 8 8 7 20 2 203-4 23 30 0 5 0 5 20 25 30 Figure 5: Complaints Breakdown by Department The most obvious increase has been in the Delivery Suite where complaints have risen from 7 in 202-3 to 30 in the most recent 2 months. In addition to specific complaints about treatment options and the level of care received there are several mentions of lack of communication and patients being left with the impression that they were not being listened to among the Delivery Suite complaints. There are complaints that also make specific Complaints Annual Report: 203-4 7
mention of feeling staffing levels on the Delivery Suite were insufficient. Along with the Delivery Suite, Figure 4 also shows that there have been significant increases in complaints in the, Antenatal Clinic alongside the previously noted increase in the Hewitt Centre and against Booking, Scheduling & Admin. In contrast Gynae Ward has seen a 65% fall in complaints from 23 to just 8. It should be noted that where a specific department has not been identified the complaint has been recorded within a generic Maternity or Gynaecology category. Causes of Complaints Each complaint received is often multi-faceted with concerns expressed about a number of aspects of the patient s experience of our Trust. This is particularly true of inpatient concerns which may cover the multi-disciplinary team and relate to events over a short or extended period of time. With this in mind a great deal of thought goes into how complaints are categorised to ensure it is appropriate to the concerns raised. Figure 6 shows that complaints about medical treatment and care are by far the highest cause of complaint and represent 60% of all complaints received by the Trust. Medical Treatment & Care 9% 4% 4% 3% 0% 60% Perception of Unprofessional Behaviour Communication Midwifery Care Appointments Other Figure 6: Cause of 203-4 Complaints Although midwifery care is categorised separately there is some overlap between this and the medical treatment category. When the two categories are combined the Trust has almost two-thirds of its complaints relating to treatment and care. This has remained constant in comparison to previous years. Of note is the communication category which accounted for 9% of complaints in 203-4 compared to 4% in 20-2. Complaints Annual Report: 203-4 8
The categories are broken down by service in Figure 7. As would be expected, for the clinical areas it is predominantly concerns over treatment that dominate. This is to an even greater degree than was the case when looking solely at the overall Trust figure. Medical Treatment & Care Perception of Unprofessional Behaviour Communication Midwifery Care Appointments Other Gynaecology & Surgical Services 72% 0% 2% 0% 2% 4% Maternity & Imaging 66% 0% 5% 4% 2% 3% Hewitt Centre 6% 0% % 0% 6% 22% Neonatal & Pharmacy 50% 25% 0% 0% 0% 25% BSA 0% 6% 9% 0% 50% 25% Other 0% 0% 0% 0% 0% 00% Figure 7: Cause of 203-4 Complaints by Service Within Gynaecology & Surgical Services 72% of complaints relate to treatment or care received. This compares to 58% in 20-2 when communication had been more of an issue for patients. There has been a particular increase in complaints relating to treatment and care within the Emergency Room ( compared to 4 in 202-3). The perception of unprofessional behaviour category is in line with the Trust figure and has seen a decrease on previous years. Of the remaining complaints no theme attracted more than one complaint during the year. Maternity & Imaging had 66% of complaints relating to medical treatment and care with a further 4% relating specifically to midwifery care. This is an increase from 202-3 when the two categories combined only accounted for 66% of the service s complaints. This is particularly marked in the Delivery Suite where 90% of complaints relate to treatment and care. As well as an increase in raw numbers of complaints the Delivery Suite has seen the proportion of complaints regarding midwifery care increase from 7% in 20-2 and 2% in 202-3 to 7% in 203-4. For the Hewitt Fertility Centre although care remains a significant issue it is not to the overwhelming extent that is seen elsewhere. Figure 7 shows that % of complaints relate to communication with further complaints relating to access to records and the centre s policies meaning that a significant proportion of complaints fall into the Other category. Complaints Annual Report: 203-4 9
Timeliness of Complaints Response The Liverpool Women s Policy for Managing Complaints & Concerns states that all complaints should be acknowledged within 3 working days. It then commits to providing a written response within a maximum of 45 working days. There is some confusion around RAG rating of complaints and discrepancies between the policy and current practice that could be clarified. However, the analysis that follows uses this maximum of 45 working days as the target for all complaints recorded. Figure 8 shows the Trust s compliance against the 45 working day response time. In 87% of cases this has been met. There were 24 complaint cases within 7 departments in which the 45 working day target was not met. The average response time for a complaint was 30 working days, a reduction of 6 days from the previous year. Complaints (203-4) Figure 8: Response Times to Complaints by Department Complaints Responded to within Average Response Days (203-4) 45 days (203-4) Number % Delivery Suite 30 2 70% 35 Theatres & Recovery 0 7 70% 38 Hewitt Centre 8 4 78% 34 Midwifey Led Unit 9 7 78% 39 Mat Base 20 6 80% 34 Gynae Ward 8 7 88% 37 Antenatal Clinic 5 4 93% 8 Gynae Outpatients 8 8 00% 24 BSA 6 6 00% 8 ER 00% 22 Imaging 5 5 00% 33 Gynaecology 4 4 00% 22 Neonatal Unit 3 3 00% 40 Maternity 3 3 00% 27 Community 3 3 00% 27 Legal Services 00% 42 Pharmacy 00% 23 Estates 00% 45 Bedford Clinic 00% 47 Jeffcoate Ward 00% 4 Urogynaecology 00% 5 Trust Total 79 55 87% 30 The department with the most complaints, the Delivery Suite, was also the department in which compliance with the target response time was the lowest, just 70%. Complaints Annual Report: 203-4 0
The average response time ranged from 5 days in Urogynaecology, albeit with only complaint in the year, to over 40 working days in the Bedford Clinic (47), Estates (45), Legal Services (42), Jeffcoate Ward (4) and the Neonatal Unit (40). A response time of over 40 working days means in practice that complainants are waiting over 2 months before their complaint is dealt with by the Trust, a factor that often aggravates initial concerns. A complaint may require cross-service co-operation or involve multiple departments. The impact of investigating concerns across services and departments can build delays into the responses. These are often outside the control of the department the complaint is recorded against, but nevertheless they must keep the complainant informed. Responding quickly is a key factor in the Trust ensuring its complaints process remains personal and responsive to the needs of the individual. Ensuring the experiences of those contacting the Trust are listened to and put right is central to the Health Service Ombudsman s Principles of Good Complaints Handling which promotes a customer focused complaints system. A response to all complaints that is speedy, simple and outlines clear and implemented remediation measures should be the aim of every complaint investigation; it is not possible to show that this is currently the case. Complaints Annual Report: 203-4
Access for Complainants The Trust is committed to allowing access to its complaints system to all its patients. Figure 3 gives details of the ethnicities of those making complaints in 203-4 where they are known. They mirror the profile of the local area closely. No complaints make any reference to ethnicity or indeed any other protected characteristic having been a factor in the reason for the complaint being made. Ethnicity % of Complainants % of Merseyside Population British - White 87% 92% Irish - White 0%.0% Other White 5%.7% White & Black Carribean 0% 0.5% White & Black African 0% 0.4% White & Asian 0% 0.3% Other Mixed 0% 0.4% Indian 0.7% 0.6% Pakistani.3% 0.2% Bangladeshi 0% 0.2% Other Asian 0% 0.4% Black Carribean 0.7% 0.% Black African.3% 0.7% Any Other Black Background 0% 0.2% Chinese 0.7% 0.8% Other Ethnic Category.3% 0.7% Figure 3: Ethnicity of Complainants The Trust and its Patient Experience Team aim to increase confidence of our patients by having a flexible approach to resolving concerns. There is extensive work with staff on the wards and in departments to help prevent complaints by listening to and responding when things can be put right. When further support is needed, the Trust aims to ensure that the complaints process is signposted locally so that patients know how or where to complain. Improving access to information for patients on a range of patient experience initiatives, including complaints is a key focus for the Trust following the Francis Report. The predominant method for making a complaint remains letter or email but by signposting other options such as the Trust s website, social media and patient opinion websites we ensure patients are given a choice. Where contact is initially made in person or by telephone, staff support the complainant in registering their concerns formally with the Trust. Complaints Annual Report: 203-4 2