CYFARFOD BWRDD IECHYD PRIFYSGOL UNIVERSITY HEALTH BOARD MEETING. Ombudsman Annual Letter

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1 CYFARFOD BWRDD IECHYD PRIFYSGOL UNIVERSITY HEALTH BOARD MEETING DYDDIAD Y CYFARFOD: DATE OF MEETING: TEITL YR ADRODDIAD: TITLE OF REPORT: CYFARWYDDWR ARWEINIOL: LEAD DIRECTOR: SWYDDOG ADRODD: REPORTING OFFICER: 24 th November 2016 Ombudsman Annual Letter Mandy Davies, Interim Director of Nursing, Quality and Patient Experience Mandy Davies, Interim Director of Nursing, Quality and Patient Experience Pwrpas yr Adroddiad (dilewch fel yn addas) Purpose of the Report (delete as appropriate) Ar Gyfer Penderfyniad Ar Gyfer Trafodaeth For Decision For Discussion Er Gwybodaeth For Information ADRODDIAD SCAA SBAR REPORT Sefyllfa / Situation The Public Services Ombudsman for Wales acts as an office of appeal should a person be dissatisfied with the outcome of a public body s final response or with the manner in which it has been investigated. The Ombudsman publishes an Annual Report detailing the work of his office and provides comparative information regarding complaints received by his office from across the country. The Ombudsman also issues letters, addressed to each health body, providing a greater breakdown of the organisation s specific information. The attached letter demonstrates the relative effectiveness of the resolution of complaints by Hywel Dda University Health Board that have been referred to the Ombudsman. Cefndir / Background. The attached letter for describes the types of complaints referred to the Ombudsman and their ultimate resolution. Asesiad / Assessment 36% of all complaints referred to the Ombudsman come from the health sector and this is a slight increase over the previous year, however there is a slight decrease in the number of cases being upheld following investigation by his office. Hywel Dda University Health Board received 15 Final Reports when the complaint was upheld in whole or in part from formal investigations. The Health Board also achieved more early resolution settlements than any other Health Board. This is also an indication that complaints are being referred to the Ombudsman due to delays and communication in the management of cases. The Board will be aware of the backlog of concerns and the work/progress undertaken over this period to improve this position. It is also an indication that whilst the Health Board is striving to improve this position and prevent complaints being referred to the Ombudsman due to delays, once notified, the Board is actively and effectively engaged in resolving them, which has reduced the number of formal investigations being undertaken. Page 1 of 4

2 The Ombudsman praised Hywel Dda University Health Board for being welcoming, open and engaging in the resolution of issues. He also appreciated the work undertaken to clear the backlog of complaints, which has now been completely resolved. The Board, through separate reports under performance and improving experience, will be aware that 4% of formal complaints remain open over a 6 month period, however further improvement is required, particularly in the area of maintaining communication with those raising concerns and staff involved. However, his main concern is the apparent difficulty in engaging some clinicians in the complaint process leading to unacceptable delays and related dissatisfaction and mistrust on the part of the complainant, which is a theme he has also identified in other health board areas. Since publication of this annual letter, the Health Board is meeting quarterly with the Ombudsman s Liaison Officer who has also engaged in training events, such as the Consultant Leadership Programme to raise the profile of the Ombudsman s investigation process and to share findings from investigations. This will be extended to investigation officers throughout the Health Board and clinical managers/leaders. During the period 1 st April 2016 and October 2016, 65 cases brought against Hywel Dda were closed by the Ombudsman, of these 49 were closed at the pre investigation stage and 6 during an investigation. 8 Final Reports were received. For the same period, Hywel Dda leads all other health boards in resolving 30% of complaints that have proceeded to formal investigation by having a proposal to settle accepted. The Health Board currently has no formal investigations for which a response is being prepared. The Ombudsman is also establishing a Health Sounding Board to gather feedback on their services and processes as well as to improve the information exchange between the Ombudsman and key stakeholders. Hywel Dda will be represented on this body. Argymhelliad / Recommendation The Board is asked to receive the Ombudsman Annual Report for information. Amcanion: (rhaid cwblhau) Objectives: (must be completed) Safon(au) Gofal ac Iechyd: Health and Care Standard(s): Amcanion Strategol y BIP: UHB Strategic Objectives: Gwybodaeth Ychwanegol: Further Information: Ar sail tystiolaeth: Evidence Base: Rhestr Termau: Glossary of Terms: Partïon / Pwyllgorau â ymgynhorwyd ymlaen llaw y Cyfarfod Bwrdd Iechyd Prifysgol: Parties / Committees consulted prior to University Health Board Meeting: Standard 6.3 Listening and Learning from Feedback. The management of concerns about NHS services is an important part of the quality, safety and experience agenda and forms an important part of the Health Board s strategic decision making and service improvement process. NHS Concerns, Complaints and Redress Regulations (Wales) 2011 Included within the body of the report Improving Experience Sub-Committee Page 2 of 4

3 Effaith: (rhaid cwblhau) Impact: (must be completed) Ariannol / Gwerth am Arian: Financial / VFM: Risg / Cyfreithiol: Risk / Legal: Ansawdd / Gofal Claf: Quality / Patient Care: Gweithlu: Workforce: Cydraddoldeb: Equality: All concerns have a potential financial implication; whether this is by way of financial redress following an admission of qualifying liability or an ex-gratia payment for poor management of a process; or an award made by the Ombudsman following his review of a concern. Information from concerns raised, highlights a number of clinical and service risks, which should be reflected in directorate and corporate risk registers. There are financial and reputational risks associated with complaints that are upheld or not managed in accordance with the regulations. The s22 Report received from the Public Services Ombudsman carries reputational risks and increased financial penalties for failures to comply with agreed actions. Under the revised regulations the Health Board now has a duty to consider Redress as part of the management of concerns, which carries financial risks associated with obtaining expert reports and redress packages. Improving the patient experience and outcomes for patients is a key priority for the Health Board. All concerns are taken seriously and investigated thoroughly in accordance with the procedures. Information from concerns raised, highlights a number of clinical and service risks, which should be reflected in Directorate risk registers. All directorates are required to have in place arrangements for ensuring lessons are learnt as a result of investigation findings on concerns and that appropriate action is taken to improve patient care. The putting things right process is designed to support staff involved in concerns and incidents. All managerial staff have a responsibility to ensure staff are appropriately supported and receive appropriate advice throughout the process. The success of the putting things right process is very dependent upon the commitment and support from staff across the Health Board not only as part of the investigation process to ensure this is done in an objective and timely manner, but in the encouragement of patients and their families to raise concerns and provide feedback to support organisational learning. The process is established to learn from concerns; it is designed to ensure the process is fully accessible to patients and their families. The aim is to involve patients throughout the concerns process and to offer face to face meetings with relevant clinicians, wherever possible. In order to ensure full accessibility of the service, advocacy is offered in the form of CHC complaints advocates and specialist advocacy will be commissioned where necessary Page 3 of 4

4 e.g. mental health; learning disability; children s advocacy. The concerns literature is accessible in a range of languages and formats and translation services will be available where required. Page 4 of 4

5 Our ref: NB/LG/MM 28 July 2016 Sent by Dear Mr Moore Annual Letter 2015/16 Following the recent publication of my Annual Report I am pleased to provide you with the Annual Letter (2015/16) for Hywel Dda University Health Board. Overall my office s caseload has increased by 4% this year, but I am pleased to say that public body complaints fell by the same amount; only the second time in a decade this has happened. However, disappointingly the NHS in Wales was the only sector in my jurisdiction that saw a rise in complaints which now count for over a third of all public body complaints; a total increase of 51% in the last five years. As expected most complaints about the health sector related to clinical treatment in hospital but I m pleased to see a drop in the number about clinical treatment outside hospital. Complaint handling is one area that saw a significant increase this year over 60%. This suggests that health boards need to do more to ensure they are adhering to Putting Things Right and correctly implementing their local complaint handling processes. This year saw an encouraging 20% increase in the number of public body complaints settled voluntarily. Once again there has been a slight drop in the number of complaints upheld by my office and just under half the number of Public Interest Reports issued. Of the seven Public Interest reports issued, five related to health boards. These reports covered a range of themes including poor management of sepsis, incorrect discharge and failure to correctly treat stroke. Whilst an ageing population and continued austerity is placing greater strain on our health service, we must endeavour to drive up standards to improve patient experience in Wales. One way to do this is by giving patients a voice through learning from complaints. One way I intend to do this is by issuing special reports highlighting particular themes that arise from my investigations. I published the first of these in February focusing on the poor quality of out of hours care in Welsh hospitals, which called for an independent systemic review. If the new Ombudsman legislation comes in to effect this year, I plan to use own initiative powers to drive more of these thematic reports.

6 Last year I assigned Improvement Officers to five of Wales Health Boards, along with an overall lead for Health, placing greater emphasis on best practice and corporate cultural development. I hope that through better engagement with these bodies there will be an improvement in complaint handling and learning from complaints; however I believe fresh legislation is required to really have an impact on ending poor service delivery. Now the Fifth Assembly is in place we will be pushing ahead with the new powers and I hope to see the new PSOW Act introduced early next year. You will find below a factsheet giving a breakdown of complaints data relating to your health board along with explanatory notes. This correspondence is copied to the Chair of your Health Board for consideration by the board. I will also be sending a copy to your contact officer within your organisation and would again reiterate the importance of this role. Finally, a copy of all annual letters will be published on my website. Yours sincerely Nick Bennett Ombudsman

7 Factsheet With regards to your Health Board, the number of complaints received by my office marginally decreased from 101 in 2014/15 to 98 in 2015/16. The vast majority of these cases were about clinical treatment in hospital (46) and complaint handling (25). There were 24 cases were taken into investigation compared to 15 last year. Improvement Officer Review My Improvement Officer has found the Health Board has been welcoming and open in sharing information and engaging from the outset. This is demonstrated most clearly by the 50% increase in early resolutions ( quick fixes ) achieved in the past year. A satisfactory and quick resolution is a more positive experience for not only the complainant but also everyone involved. The Health Board has clearly worked hard in the past year to clear a significant backlog of concerns that had built up and were still outstanding. However, some very serious delays were found in a few cases. This is naturally reflected below in the number of cases about complaint handling alone but it is also a feature in a number of those other cases which has clinical care as the main focus of the complaint. It would be fair to say that in many of the cases evidencing serious delays a recurring identifiable issue has been the significant delay of clinicians in engaging in the complaints investigation. This was amply illustrated from files seen. There were repeated attempts from complaint handlers to get relevant comments or information from some clinicians, with the inevitable delay this caused in then responding to the complainant. Unsurprisingly, many of those complainants who become aware of the delay in clinician response will be dissatisfied with the actual response on receipt, perceiving, rightly or wrongly, that the reticence or delay on the part of the clinician must indicate there is something to hide. My Improvement Officer s goal this year is to improve greater clinician engagement in complaints early on in the process, so enabling the complaint handler to achieve better timeliness of complaint handling overall. Therefore, as a starting point, my officer will be involved in the Health Board s Consultant Education Programme where she intends to convey this message, and the overall benefits in turn it brings for the Health Board and complainant overall. Finally, the Health Board has evidently taken some positive steps to respond to findings made by my office over the past year in an effort to improve, including additional proposed structure changes. I hope that this culture of openness and learning continues. A) Comparison of complaints received by my office with average for health bodies, adjusted for population distribution. In total my office received 98 complaints during against Hywel Dda University Health Board compared to a health board average of 80.

8 B) Comparison of complaints by subject category with Health Board average Subject Hywel Dda University Health Board 2015/16 Health Board Average 2015/16 Appointments/ Admissions/ Discharge and transfer procedures 8 5 Clinical treatment in hospital Clinical treatment outside hospital 4 6 Continuing care 3 8 Medical records/ Standards of record keeping 2 1 Non-medical services 1 1 Services for older people 0 0 Services for vulnerable adults 0 1 Patient list issues 2 2 Complaint-handling De-registration 0 0 Rudeness/inconsiderate behaviour/staff attitude 0 0 Poor/no communication or failure to provide information 1 1 Regulation and Inspection 0 0 Recruitment and appointment procedures 1 0 Other 5 7 TOTAL 98 93

9 C) Complaints taken into investigation by my office with health board average 2015/16 Hywel Dda University Health Board 2015/16 Health Board Average Number of complaints taken into investigation D) Comparison of complaint outcomes with average outcomes for health bodies, adjusted for population distribution Complaint Outcomes 2015/16 Hywel Dda University 2015/16 Health Board average Health Board Out of jurisdiction 7 7 Premature Other cases closed after initial consideration Discontinued 1 0 Quick fix / Voluntary settlement Section 16 Upheld in whole 1 0 or in part Other report upheld in whole or in part Other report not upheld 1 6 Withdrawn 1 2

10 E) Comparison of Health Board times for responding to requests for information with average for health bodies and All Wales response times, 2015/16 (%) 100 Hywel Dda HB 75 Average HB response time Average All Wales response time <1 week 1 to 2 weeks 2 to 3 weeks 3 to 4 weeks 4 to 5 weeks 5 to 6 weeks Over 6 weeks F) Summaries Casebook Casebook

11 Casebook

12 Casebook

13 Appendix Explanatory Notes Section A compares the number of complaints against the Health Board which were received by my office during 2015/16, with the Local Authority average (adjusted for population distribution) during the same period. Section B provides a breakdown of the number of complaints about the Council which were received by my office during 2015/16 with the with the Health Board average for the same period. The figures are broken down into subject categories. Section C provides the number of complaints against the Health Board which were investigated by my office during 2015/16 with the Health Board average (adjusted for population distribution) during the same period. Section D compares the complaint outcomes for the Health Board during 2015/16, with the average outcome (adjusted for population distribution) during the same period. Public Interest reports issued under section 16 of the Public Services Ombudsman (Wales) Act 2005 are recorded as Section 16. Section E compares the Health Board s response times during 2015/16 with the average response times for all Health Boards and all public bodies in Wales during the same period. This graph measures the time between the date my office issued an investigation commencement letter, and the date my office receives a full response to that letter from the public body. Finally, Section F contains the summaries relating to the Health Board appearing in the Ombudsman s Casebook during 2015/16. Feedback We welcome your feedback on the enclosed information, including suggestions for any information to be enclosed in future annual summaries. Any feedback or queries should be sent to lucy.geen@ombudsman-wales.org.uk or matthew.aplin@ombudsman-wales.org.uk