BOARD OF DIRECTORS PAPER COVER SHEET. Meeting date: 28 February 2007 Agenda item: 8.3

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Geoffrey French
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1 BOARD OF DIRECTORS PAPER COVER SHEET Meeting date: 8 February 7 Agenda item: 8.3 Title: COMPLAINTS REPORT QUARTER 3 6/7 (1 October 6 31 December 6) Purpose: To update the board on the number and type of complaints received in Quarter 3 of 6/7 and the changes made as a result of the investigation process. Summary: In quarter 3, 79 formal written complaints were received. (A further 17 requests for loss and compensation were also received). 97% of complaints were fully responded to within working days, an increase from 89% in quarter of this year. The trust also received 198 letters of thanks/commendation for quarter 3. Recommendation: For Information Prepared by: Michael Norton, Complaints Lead Presented by: Marie-Noelle Orzel, Director of Nursing & Service Improvement This report covers: (Please tick relevant box below) Healthcare Standards (CORE C1 Monitor please specify which standard) Healthcare Standards (DEV T Finance please specify which standard) Service Development Strategy Performance Management Local Delivery Plan Business Planning Assurance Framework Complaints Other (Please specify)

2 COMPLAINTS & COMMENDATIONS Quarter 3 6/7 1 October 6 to 31 December 6 Compiled by the Complaints Department for Marie-Noelle Orzel, Director of Nursing and Service Improvement. Please contact her on (139) 187 with any queries or comments. 1. Developments An exercise to identify the average cost of a complaint was carried out. This involved an estimate of the average time spent on a complaint by the various members of staff involved from the Chief Executive and Director of Nursing & Service Improvement to Consultant(s), Matron(s), Complaints Lead and secretarial support. For a complaint where information is required from x Consultants and 1 x Senior Matron the average cost was calculated as Over a year this will give an average cost of around 17,.. This figure is for original average complaints and does not include the costs incurred when second letters are received or when a case is referred to the Healthcare Commission. Miscellaneous costs such as telephone calls and the administration time for retrieval of medical files, filing etc have also not been included.. Summary of Activity A total of 79 formal written complaints were received this quarter (7 formal written complaints last quarter and 71 in the same quarter last year). In addition to the 79 formal written complaints, the trust received 17 requests relating to Loss and Compensation claims. Complaints & Compensation Claims Received /1 1/ 1/ 1/ 1/ /3 /3 /3 /3 3/ 3/ 3/ 3/ / / / / /6 /6 /6 /6 6/7 6/7 6/7 No of Contacts Of the 79 complaints received: were made directly by the patient; 7 complaints were made by relatives, and 7 complaints were made by an advocate (i.e. ICAS or solicitor), friend or MP. With 1137 patient episodes for this quarter, formal written complaints represent less than.7% of overall patient activity with the Trust. This equates to one formal written complaint for every 1397 patient episodes. The number of commendations decreased from 18 to 198. The ratio of commendations to complaints for this quarter is: :1 1

3 3. Response Rates 3.1 Complaint letters acknowledged within working days: 96% (96% last quarter, 93% in the same quarter last year). Acknowledged within Days /1 1/ 1/ 1/ 1/ /3 /3 /3 /3 3/ 3/ 3/ 3/ / / / / /6 /6 /6 /6 6/7 6/7 % of Complaints 6/7 3. Response to letter of complaint completed within working days*: 97% (89% last quarter, 87% within working days in the same quarter last year). Response in / Days* 1 % of Complaints /1 1/ 1/ 1/ 1/ /3 /3 /3 /3 3/ 3/ 3/ 3/ / / / / /6 /6 /6 /6 6/7 6/7 6/7 * Following an amendment to the NHS (Complaints) Regulations with effect from 1 st September 6, the Trust now has working days to complete an investigation (previously working days). Commendations Commendations received for this quarter: 198 (18 last quarter and 198 for the same quarter last year). Commendations Number

4 . Face-to-face Meetings Three meetings were held this quarter ( last quarter and for the same quarter last year). Current status of face-to-face meetings: all closed. 6. Trends and Patterns The analysis of complaints provides the Trust with a range of users views relating to the service experienced. For the third quarter this year the Trust received 79 formal written complaints. (A further 17 requests for Loss and Compensation were also received for this quarter). These 79 complaints are reviewed under the following themes: 9 related to Access and Waiting (1 in the previous quarter) related to Clean Safe Place to be (7 in the previous quarter) 9 related to Information, Communication and Choice (1 in the previous quarter) 1 related to Building Relationships (13 in the previous quarter) 38 related to Safe, High Quality care (3 in the previous quarter) These figures are plotted on a monthly basis as follows, to ensure any trends are identified: Access & Waiting Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan-6 Feb-6 Mar-6 Apr-6 May-6 Jun-6 Jul-6 Aug-6 Sep-6 Oct-6 Nov-6 Dec-6 Clean, Comfortable, Safe Place 3 1 Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan-6 Feb-6 Mar-6 Apr-6 May-6 Jun-6 Jul-6 Aug-6 Sep-6 Oct-6 Nov-6 Dec-6 Information, Communication & Choice Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan-6 Feb-6 Mar-6 Apr-6 May-6 Jun-6 Jul-6 Aug-6 Sep-6 Oct-6 Nov-6 Dec-6 3

5 Building Relationships Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan-6 Feb-6 Mar-6 Apr-6 May-6 Jun-6 Jul-6 Aug-6 Sep-6 Oct-6 Nov-6 Dec-6 Safe, High Quality Care Management Actions and Reviews to Procedures A record of the number and type of complaints are routinely sent to directorate managers and matrons. They are encouraged to provide examples of changes that have been implemented, or are planned, as a result of their complaint investigation. Some of these changes are listed below: Changes implemented: A patients mother complained that her daughter did not receive regular monitoring. As a result of the complaint, the ward Matron arranged for the respiratory nurse specialist to provide training for her staff. (Directorate of Medicine) A patient complained about a remark a member of staff made regarding likely test results and the negative effect this could have on the patient s application to the DVLA. Staff training provided to remind staff not to comment on test results as DVLA medical staff make the final decision on any eyesight applications. (Directorate of Specialist Surgery) A complaint was made in respect of the poor reception when she was admitted to the ward. Training given to the staff on the importance of meeting and greeting new admissions to the ward. (Directorate of Medicine) A patient was discharged incorrectly back to his home address when the correct procedure was a return to his nursing home. Family complained about the distress this caused and assurance given that practice has been changed and check list amended to ensure this does not happen again. Staff also reminded of the importance of checking correct discharge details are held. (Directorate of Critical Care) Following a complaint regarding an early discharge from hospital, plans introduced to ensure medical outliers have a clear discharge plan and to be reviewed at an appropriate time and not left until the end of the day. (Directorate of Medicine)

6 Changes planned: Following a complaint received from a patient regarding missed medication plans to introduce a computerised diary system for timely administration of medication in the Oncology Department are being introduced. (Directorate of Medicine) Complaint made by the family of a deceased patient that indicated a clear breakdown in communication between ward staff and Pharmacy. Both units to review procedure for dispensing medication at weekends. Ward staff to complete incident report in future and Pharmacy to remind ward staff to check on whiteboard for progress of prescription. (Directorate of Surgery 1 and Directorate of Professional Services) Complaint made that staff did not deal appropriately with patient who had learning disabilities on admission to unit. Matron has arranged for Learning Disabilities nurse to provide training sessions and to link development of this with specific care needs. (Directorate of Medicine) Following a complaint regarding a lack of any emergency assessment respiratory markers (respiratory rate, peak flows), unit matron has arranged for senior respiratory matron to provide her staff with update sessions. (Directorate of Medicine) 8. Training and Awareness For this quarter, the complaints lead has presented complaint procedure training programmes to, in total, 16 staff. 9. Ethnicity monitoring 3 (9%) ethnic monitoring forms were returned (33% last quarter and 8% for the same quarter last year): returned as White British ; 1 returned with Not Stated.

Corporate Services Employment Report: January Employment by Staff Group. Jan 2018 (Jan 2017 figure: 1,462) Overall 1,

Corporate Services Employment Report: January Employment by Staff Group Jan (Jan 20 figure: 1,462) Jan % Overall 1,520 +58 +4.0% 8 Management (VIII+) 403 +52 4.8% Clerical & Supervisory (III to VII) 907