1 This report is available in other languages and formats on request

Transcription

1 A report on the learning, action and improvements made or proposed in response to feedback, comments, concerns and complaints about NHS Shetland health care services NHS Shetland values and welcomes any comments or suggestions for improving the services we provide and wants to hear about anything you liked or disliked about the service or care given. If you think there is or might be a better way of providing services or care then please pass on your ideas. There are many ways in which you and your family can get involved to help shape and improve your local health services. This now includes participating online. For the year 1 April 2013 to 31 March 2014, this report 1 comprises: 1. a summary of the range of ways we gather feedback on our own services and those provided by our health service providers (e.g. GPs, Dentists, Opticians and Community Pharmacists); 2. how we encourage and handle responding to any complaints received; 3. our culture, including training and development for NHS staff on responding to feedback and concerns; 4. examples of how we can demonstrate improvements to services as a result of complaints and feedback; and 5. the way we report feedback and complaints to our Board Members and clinical teams to ensure we learn from this and make changes to improve our services. NHS Shetland is committed to improving services for all our patients and their families. One of the best ways we can do this is by hearing directly from you about your experience of healthcare and treatment and understanding what actions we can take to make services better for you. 1 This report is available in other languages and formats on request 1

2 1) How can you feed back to us about your care? NHS Shetland continues to work hard to encourage feedback from service users in order to learn how to make improvements. Patient experience is now built into our audit and service improvement programme, meaning that all clinical teams have to undertake an appropriate evaluation of the experience and satisfaction of its patients and service users on a regular basis. The results from gathering patient feedback, lessons learned and actions taken are reviewed by the Board s Clinical Governance Committee and shown in the Quality Report which the Board receives at each meeting. Alongside such initiatives, patient feedback, be it as a suggestion, comment or concern about your experience of using our service is really appreciated - it's your health service and we do take note of your feedback, learn from it and take action because of it. Positive feedback is also welcomed and appreciated by the people delivering services. There are a number of ways we can get feedback: Through departmental audits of patient experience and satisfaction Through patient surveys (for inpatient stays and through national initiatives such as the recent Health and Care Experience postal survey about GP care or the national Maternity Patient Experience survey) On the independent Patient Opinion website ( This is an online third-party feedback tool which captures patient and carer experiences of NHS services. Through our Comments and Suggestions scheme. This is a paper-based slip for providing us with feedback, which can be given anonymously. When this is the case, although we cannot respond directly, we still look into any matters raised and ensure we learn from the feedback. From the Patient Advice and Support Service (PASS) provided by the Citizens Advice Bureau Informal and formal complaints (see below) Through our Public Participation Forum. This is a network made up of patient groups, members of the public, carers and voluntary organisations that work in partnership with NHS Shetland. The network is open to individuals or groups who have an interest in health and health related issues. Patients, their families and the wider public can of course provide comments and feedback to the person involved in your care. Printed information leaflets and posters about Feedback and Complaints, Patient Opinion, the Comments and Suggestions scheme and the PASS service should be available in all our public waiting areas. You can also visit our website page on Patient Feedback, 2

3 Comments, Concerns and Complaints at to find out about ways to tell us about your experiences. There is always someone available to speak to you about the different ways you can provide feedback and take a note of this - you can contact us by phone on or You can also contact us in writing at NHS Shetland, FREEPOST NATN251, Comments and Suggestions, Lerwick, ZE1 0FF. If you wish to make a complaint you can visit our website at for further advice on how to do this, or you can write to us Complaints Officer, Montfield Upper Floor, Lerwick, ZE1 0LA or call on or You may also find the Feedback and Complaints factsheet - pdf helpful. This gives information on the support available to help you make your views known. What happens next? When we receive feedback we always try to acknowledge this quickly and tell the person or group that has given us the feedback what we will do with it. On occasion we receive feedback which is anonymous, but we still send this to the appropriate department(s) for consideration. If someone provides feedback in an open forum (for example on the Patient Opinion website), and we would like to get more information to investigate the matters raised, or we would like to respond in greater detail directly to the service user, we encourage them to make contact with us offline so their patient confidentiality is protected. All the feedback we receive is logged by Feedback and Complaints staff and reported anonymously to Board Members to ensure emerging trends are understood by those that are responsible for seeking assurance about the smooth-running of the service. Feedback is also considered through clinical governance work and discussed as a learning tool in staff meetings such as GP practice meetings, hospital ward meetings and community services meetings. 3

4 2) How we encourage and handle complaints We value complaints alongside all of the other forms of feedback and actively welcome and encourage you to let us know when we get things wrong in order that we can make improvements and maintain the quality and safety of our services. When we receive a complaint we ask one of our Senior Management Team to carry out a thorough investigation into the matters raised. We encourage the complaint investigator to make contact with the complainant at an early stage in their investigation process so that it is clear to both parties what needs addressing and the possible outcomes resulting from the process. The formal complaints process can take up to 20 working days to be completed, as it is often necessary, as part of the process, to take actions such as retrieving medical records and speaking with a number of staff. If someone contacts us and they are not sure if they wish to make a complaint, we try to encourage a more direct discussion with the staff or service involved in order to achieve an earlier resolution of their concerns. We are monitored by Board Members, and ultimately the Scottish Government about how many of our complaints we respond to within 20 working days. We are this year introducing a change to our performance monitoring by adding a measure that considers the quality of our response by looking at how many of our complaint responses require follow-up correspondence or are taken further by the complainant (e.g. sent on to the Scottish Public Services Ombudsman or MSPs). The Complaints Officer is planning in to visit key departmental meetings, and also independent contractor meetings such as the Primary Care Representatives meeting and the Eye Care Network meeting to discuss how to handle complaints appropriately and also ensure common learning points from feedback and complaints are shared with their colleagues. Complaints handled by NHS Shetland in 2013/14 Number of complaints 44 0* 32 Number where Mediation used Number responded to within 20 days *NHS Shetland complaint handlers and investigators have attended a session with representatives from the Scottish Mediation Network to understand how best to identify suitable cases for mediation. This is where someone neutral to the complainant and NHS Shetland will mediate between both parties to try and reach an outcome that works for both. In 2013/14, as in previous years, we saw a fairly event split of formal complaints between community services (22) and hospital services (19), with three that spanned the two areas. 4

5 Top five themes emerging from 2013/14 complaints: Access to treatment Communication Failure to diagnose & treat Staff attitude Treatment For the two dominant themes of access to treatment and staff attitude, these are broken down as: Access to treatment A&E waits Dental GP Hospital Other Staff attitude by group Consultants Dentists GPs Nurses Other A detailed summary of all formal complaints handled by NHS Shetland in 2013/14 and the actions taken to improve services as a result can be found at Appendix A of this report, or on our website at The Medical Director, the Director of Nursing and Acute Services and the Director of Community Health and Social Care meet on a regular basis to consider the complaints that have been received and also all the serious or adverse events they have been alerted to (which may or may not have been identified through a complaint). This ensures the serious issues are fully understood by the directors responsible for clinical service provision and that there is an agreed approach to the actions that are taken and the learning that needs to be shared with the relevant clinicians. Often complaints and adverse events span more than one staff group which makes this multidisciplinary review essential. 5

6 Complaints handled by Family Health Service Providers (independent practitioners including GPs, opticians and community pharmacists) Independent practitioner area* Number of complaints Number where Mediation used Number responded to within 20 days GP Optician Pharmacist *Complaints relating to salaried GP practices (for 2013/14 Lerwick Health Centre and Whalsay Health Centre) are included in the figures for complaints handled by NHS Shetland. Issues raised in complaints Concern re confidentiality/delay in treatment Communication between primary and secondary care Staff attitude Wide ranging, non-descript concerns Misunderstanding between GP and patient who was hard of hearing Summary of action taken to improve services as a result Protocol put in place re communicating with patient s carer re results/queries Equipment supplied to patient s home to minimise delay between symptoms, testing and treatment Meeting between patient, representative, GP and Practice Manager matter resolved Advice taken about response. Patient cannot recall writing letter of complaint. Letter of explanation and apology for any offence caused 6

7 Informal complaints We also have an informal complaints process as we accept that on occasion people do not wish to make a formal complaint but they have enquiries or concerns which require internal investigation. There are also occasions when someone wishes to make a complaint but it is not possible to get the patient s consent, and we therefore use the informal complaints process. In such circumstances, we are unable to provide feedback about the outcome of the process other than to assure the person raising the concerns that appropriate action is being taken. In 2013/14 we dealt with 21 informal complaints, which split down as 12 within primary care, five within secondary care and four regarding administrative processes. The key themes found are as below: Top themes emerging from 2013/14 informal complaints: Access to treatment Communication Staff attitude Treatment A detailed summary of all informal complaints handled by NHS Shetland in 2013/14 and the actions taken to improve services as a result can be found at Appendix B and also accessed on our website at 7

8 3) Developing a culture that values all forms of feedback Clearly if we are to really take on board the learning from feedback and complaints, and encourage staff to see the value in this, we need to ensure they understand what we are trying to do, and also give them the confidence to deal directly with people s concerns or know how to help them provide feedback through the most appropriate route. All new members of staff attend an induction day to make sure they are aware of the Board s key policies and procedures and how they are expected to behave. Part of this induction is a section on feedback and complaints where staff learn about the various ways the Board can get feedback, some examples of front line resolution and how this is always the first choice in handling concerns, and also how complaints can link to serious and adverse events. One of the key messages given at this induction session is about why the Board actively encourages feedback, and how it tries to ensure that as a result of it, actions are taken to improve services and that the learning is shared throughout the organisation. Staff are also encouraged to use a series of e-learning modules on feedback and complaints that have been developed by NHS NES in order to further their knowledge in this area. The increase in use of social media such as the Patient Opinion website as a platform for providing feedback about NHS care is valued by NHS Shetland. When feedback is received through this route, an automatic alert is triggered to all Board Members and Heads of Service, who can see the positive and negative comments alike, and also how we respond to them. We try to actively encourage new staff to look through the feedback we have received and consider how any learning points can be applied in their areas. Such a transparent method of receiving feedback is not without its challenges however, with a number of service providers concerned that open social media platforms are not appropriate forums to enter into dialogue about patient care. Whenever we receive feedback that requires a personal response we encourage the individual to make contact offline for this purpose. We periodically use internal communication methods such as our intranet and Team Brief newsletter to promote the various feedback methods to staff. We also had a display for a number of weeks in the Gilbert Bain Hospital servery which provided information both to staff and members of the public about the different feedback routes and also some examples of the types of feedback that had been received. In the coming months we plan to do more to draw attention to case studies where an individual s feedback has led to tangible improvements in service. 8

9 4) Improvements to services as a result of feedback and complaints It is really important that we learn from the feedback and complaints we receive. As you will see at Section 2, a large proportion of the complaints raised are about staff attitude and communication issues. The latter can refer to frustration and misunderstandings between healthcare professionals and patients, but also between GP and hospital based services or between NHS Shetland and other health boards. Staff are regularly reminded of the importance of communication and how the patient feels about their care. Work is also being done to review pathways for specific treatments to try and make sure there are fewer steps in the process and a greater understanding of these so that less goes wrong with the communication. This is a particular challenge for NHS Shetland as a number of patient pathways mean individuals receive care locally and outwith Shetland, often in Aberdeen. We have in recent years received a number of formal and informal complaints and also formal and anecdotal feedback about the care pathway for orthopaedic treatment such as hip and knee replacements where surgery is carried out away from Shetland. Patients have also described what they feel to be wasted or difficult trips for follow up appointments to off island surgery. As a result of this, with the aim of streamlining the process for staff and improving the quality of care for patients, physiotherapist Linda Halcrow undertook a project to understand where this orthopaedic pathway could be improved. Resulting changes have seen the standardisation of referral paperwork to reduce variation and duplication, which in turn can speed up the time it takes for the patient to have their operation. Staff have also been working closely with the Golden Jubilee National Hospital in Glasgow to establish video-conference follow-up appointments for people who have had hip or knee replacement surgery there. The first clinic was held in February 2014, with physiotherapy and medical imaging involved at the Shetland end and the arthroplasty follow-up team in Glasgow. If an x-ray is needed it is done on the day of the appointment and can be viewed electronically by the specialist team in Glasgow. The consultation takes place over a video-link, so patients have one visit to the Gilbert Bain Hospital rather than a two day trip to Glasgow which can be very challenging for people who have recently had surgery. Patient Muriel Bazeley (left) is reviewed three months after her hip replacement surgery, with support from Linda Halcrow, Physiotherapist and Lynda Bussetil, Assistant Practitioner at the Shetland end, and Fiona Macbeth, Arthroplasty Practitioner/Physiotherapist at the Glasgow end 9

10 We are now exploring ways in which patients accessing other mainland hospitals can also receive telehealth follow up, rather than attending appointments on mainland Scotland. Another example of a change we have made as a result of feedback we have received in 2013/14 was following a story provided to us through the Patient Opinion website. We were contacted by a lady who had been recalled following routine breast screening and who had travelled to Aberdeen for further tests to be carried out. The leaflet provided at the Aberdeen follow-up clinic about the procedure undertaken had a blank space under the next appointment date and time header, which it was explained by staff, was for Aberdeen patients so they understood before they left the clinic when they would get their results. The Shetland patient pointed out this was in sharp contrast to how she felt she had no clear idea of when, where and how she would get her results following her return to Shetland. Through the Patient Opinion website the Director of Nursing and Acute Services encouraged the lady to make contact in person and when this happened the care episode was discussed in full. As a result of the feedback, we have developed a simple business card with contact details for the Breast Care Team, Shetland Secretary and the Outpatient Department and have asked colleagues at NHS Grampian to ensure Shetland service users do not leave their appointments without this information. There is also a prompt on the card so we can understand how a patient wishes to be contacted to ensure there is no delay in communicating if further follow up tests are required. The full dialogue can be read on the Patient Opinion website at Key themes arising from feedback and complaints The key themes arising from formal and informal complaints are included in Section 2. Other feedback mechanisms a) Patient Opinion During 2013/14 we received 21 contacts from patients and their carers through the Patient Opinion website. The Director of Nursing and Acute Services actively promotes the use of Patient Opinion with the local media following Board Meetings, and we tend to see a spike in activity at these points. These stories have been viewed 9,404 times in all which shows what a useful, open and transparent tool this social media site is for encouraging feedback. Moderately critical Mildly critical Minimally critical Not critical (as rated by Patient Opinion moderators) 10

11 The feedback we get through Patient Opinion is in the main for hospital based services and the dental service. We plan to do more in 2014/15 to continue to raise awareness of the website for those receiving community based services. b) Comments and Suggestions In 2013/14 we received 15 pieces of feedback through our Comments and Suggestions scheme. These were from service users and also from staff, and contained some helpful information to help us continue to improve our services. These were predominantly rated as moderately critical, with minor concerns raised. Critical Moderately critical Positive and moderately critical Positive Over half of the 15 comments and suggestions were in relation to the day surgery unit two were positive about staff and their professionalism, but most were comments about how busy the unit was and the long waits for procedures after arriving at the beginning of a theatre session. As a result of the feedback received, work has been done to improve verbal communication with patients at their preoperative assessments, and the printed information given at this point has also been revised to explain why there can sometimes be a wait. In addition to this, some minor changes have been made to the unit to increase the space available for patients to get ready for their procedure and this has had an impact on the way in which we can manage the flow of patients through the unit and keep within agreed appointment times. The unit is continually looking at ways to improve its waiting times for patients but also ensure that theatre time is used as efficiently as possible. One other theme resulting from the comments and suggestions we received was from staff who were frustrated with people smoking on hospital grounds and also that there were no ashtrays so the gathering cigarette ends were an eyesore. The Board s Smoking Policy has been revised and as a result of the feedback a number of things have been put in place which include clearer signage so that patients know they should not smoke on the grounds and benches have been moved to deter smoking in areas on the hospital site. The Health Improvement Team has been supporting patients and hospital staff to offer nicotine replacement and smoking cessation support and patients have been given disposable pouches if they do wish to smoke out with the hospital grounds to reduce litter. c) General feedback We have also documented 24 episodes of general feedback in 2013/14. This varies in nature and proves more challenging to identify themes. There were however instances of concern about staff attitude, access to services and communication which mirrors the feedback we receive through the other feedback mechanisms. The general feedback and the actions taken to make improvements will be highlighted to staff alongside all the other feedback summaries as there is often opportunity to learn across departments and services. Staff will also continue to be reminded by their relevant managers of the importance of ensuring patients feel they understand what is happening with their care and that they are being listened to. 11

12 d) General feedback to independent contractors We have been advised about two pieces of feedback received from independent GP practices in the year 2013/14. The first of these related to the type of music being played in the waiting area. The team felt the music was varied and that it was difficult to suit all tastes it was also explained its primary purpose was to ensure no discussions taking place in the consulting room could be overheard rather than for entertainment reasons. The second was with regard to a patient who wished to clear the air with a GP who had not understood the patient was concerned. A mediated discussion took place and the patient was satisfied with the outcome. A full summary of the actions taken to improve services as a result of all the feedback and complaints we received in 2013/14 can be found at: Formal Complaints Appendix A Informal Complaints Appendix B Patient Opinion Appendix C Comments and Suggestions scheme Appendix D General documented feedback Appendix E All the appendices referred to above are also available on our website at Quarterly reports for the Patient Advice and Support Service can also be found at this link. e) Compliments To put some of the more negative feedback we receive into context, we are now actively trying to improve the ways we collate positive feedback about the services we deliver. Much positive feedback is provided face to face when staff see patients and service users, and it is not a sensible use of time to try to capture this. We do also receive positive feedback through the Patient Opinion website, through the numerous thank you letters and cards that are received, and through public acknowledgements such as in the Shetland Times newspaper. We will continue to work on ways to improve how we record positive feedback in the coming weeks and months. Accident and Emergency, and Wards 1 and 3, maternity and Ronas Ward between them receive on average 140 thank you cards per quarter. Positive feedback is also received on a more sporadic basis by many of the community teams and allied health professionals such as physiotherapists and podiatrists. We have also received a number of positive comments about the training we deliver, the health promotion interventions that are undertaken and the quality of the food that is provided by the kitchen staff. 12

13 5) How we report feedback and complaints An anonymised summary of all formal complaints, the outcome of the complaints and the actions taken as a result of them is provided to Board Members as part of the Quality Strategy report which is a standing item on every Board agenda. Board Members take a keen interest in formal complaints and have had some useful insights into particular issues through further discussion at the meetings. Board Members have also in the past requested changes to the way the formal complaints are reported to ensure they are getting the most information they can from them. This formal complaints summary and the feedback we receive through Patient Opinion is also discussed through the Clinical Governance Committee which meets at least four times a year. Some of the serious complaints, which can be regarded as serious and adverse events in their own right are discussed at some length through this forum, and also at appropriate multi-disciplinary meetings to ensure all staff learn from the feedback. Anonymised formal complaints data is also submitted to Information Services Division Scotland, allowing the information to be scrutinised by the Government s Health and Social Care Directorate and also benchmarked against other Health Boards. The Board receives a summary of all other forms of feedback (as described in this report) on an annual basis. Any emerging themes of concern would however be brought to the attention of appropriate managers by the Complaints Officer at the point in the year where this was necessary. As described in Section 2, key members of the senior management team (the Medical Director, Director of Nursing and Acute Services and the Director of Community Health and Social Care) meet to discuss serious complaints and adverse events regardless of how they have been notified of them, to ensure appropriate action is taken and that the learning opportunities are disseminated and embedded into the culture of the organisation. All formal and informal complaints are recorded by the Complaints Team in a way they can be searched and reported on when medical staff have their annual appraisals and revalidation exercise which allows them to remain registered with the General Medical Council. The requirement to consider any complaints received as part of this process will be extended to include nursing and midwifery as part of revalidation requirements set out by the Nursing and Midwifery Council (the regulatory body for nurses, health visitors and midwives). At a meeting to discuss the outcomes of the Francis enquiry into the Mid Staffordshire Hospitals Trust in July 13, non-executive Board Members confirmed they felt well informed about feedback and complaints but agreed to continue to consider how reporting could be refined and improved. 13

14 And finally... We hope you find this report of interest and that you will feel encouraged and able to work in partnership with us to help improve the services we provide. This report has been considered by the Board of NHS Shetland to inform what further work will be useful in this area. A copy of this report has been sent to the Scottish Ministers, the local Patient Advice and Support Service, Healthcare Improvement Scotland and the Scottish Public Services Ombudsman. 14

15 NHS Shetland Annual Feedback and Complaints Report for 2013/14 Appendix A Summary of Formal Complaints in 2013/14 15

16 NHS Shetland summary of formal complaints in 2013/14 Summary Staff Group(s) <= 20 wkg days 1 Patient dignity / staff attitude Consultant / Nursing If not, why Outcome Actions Y Upheld Upheld as experience found to be lacking in terms of patient dignity. Apology offered about distress caused by remarks. Standard pre-operation procedures discussed with consultant and Medical Director. Staff reminded of the standards expected in communication with patients and their relatives. 2 Communication and support 3 Access to dental treatment Mental Health Y Upheld Upheld as although the investigation found that mental health staff had done their best to alleviate the situation before taking further action, the overall communication and support was lacking. Dental N Delay in Upheld Upheld as the complainant had had an unsatisfactory wait for an investigation appointment. report being Suggestion for complainant to join the Brae waiting list which is produced much shorter. Explanation offered about measures being taken to actively recruit and retain dental practitioners. 4 Staff attitude and length of wait GP / Admin Y Partly upheld Explanation offered that patients were seen on clinical need. Team meeting to consider how best to communicate potential waits. 5 Access to dental treatment Dental Y Upheld Upheld as the complainant had had an unsatisfactory wait for an appointment. Suggestion for complainant to join the Brae waiting list which is much shorter. Explanation offered about measures being taken to actively recruit and retain dental practitioners. 6 Length of wait A&E Y Not upheld Not upheld as length of wait was within the four hour standard and reasonable for the patient s symptoms, given there was an emergency elsewhere, out of hours. 7 Careless treatment and staff attitude AHP Y Not upheld Not upheld as clinician was reviewed and assessed as fully competent to handle patients with additional treatment requirements. Apology given that the complaint felt the clinician had been uncaring. 8 Access, Admin, N Delay in Upheld Local points answered. NHS Grampian still to respond to 1

17 Summary Staff Group(s) <= 20 wkg days communication and Consultants treatment 9 Staff attitude and poor communication with NHS Grampian 10 Given incorrect information about cancer screening results 11 Missing records and lack of ownership of issue 12 Incorrect/ illegal prescription 13 Access for treatment 14 Mental Health service support If not, why Outcome Actions receiving information from NHS Grampian Consultants N Delay in receiving information from NHS Grampian Partly upheld 2 outstanding issues being chased through local complaints officer. Guidance given to staff on using socially unavailable coding Discussions regarding the options for acknowledging receipt of referrals Apology offered from member of staff and consideration given to how intimidating a ward round may seem to a patient. NHS Grampian to review personal leave arrangements to ensure scan requests are processed in the absence of any individual reaffirm with secretarial staff the need to document calls from the public and the responsibility of staff to act timeously identify an individual who is responsible for communicating on behalf of the NHS if a patient is transferred to private care Nursing Y Upheld Complaint upheld as the wrong information had been given to the patient. Review of procedures to ensure such results are only given over the telephone in exceptional circumstances, and that there are robust guidelines in place for conveying information accurately. Dental admin N Delay in correctly identifying patient records Upheld Further training in place for member of staff Unreserved apology given, and meeting offered Upheld as record keeping not sufficient to determine actions taken, and also misfiling of records. Explanation offered about how records should transfer. GPs Y Not upheld Not upheld as Medical Director satisfied the care had been appropriate for the patient. Dental Y Upheld Upheld as delay and cancellations not satisfactory circumstances explained Mental Health N Number of Upheld Clearer communication regarding hospital discharge and ongoing individuals care required. Standard Operating Procedures for CMHT services involved in being developed. response sign off 15 Staff attitude/ competence Dental Y Upheld Upheld as there were some difficulties with operating equipment which led to frustration. Support offered to individual and additional training provided. 16 Child immunisation Admin Partly Partly upheld as there had been an error with immunisation

18 Summary Staff Group(s) <= If not, why Outcome Actions 20 wkg days error lack of upheld schedule. Offer to meet to answer any further questions in detail. communication 17 Access for Dental Y Upheld Upheld as delay not satisfactory circumstances explained treatment 18 Access for Dental Y Upheld Upheld as delay not satisfactory circumstances explained treatment 19 Access for Dental Y Upheld Upheld as delay not satisfactory circumstances explained treatment 20 Failure to diagnose AHPs Not upheld External review sought from NHS Grampian. Minor points flagged re and treat 21 Access for treatment 22 Access for treatment note taking. Dental Y Upheld Upheld as the complainant had had an unsatisfactory wait for an appointment. Explanation offered about measures being taken to actively recruit and retain dental practitioners and also doing more to ensure reception staff make the best use of available appointment slots for each dentist and hygienist/therapist. Dental Y Upheld Upheld as the complainant had had an unsatisfactory wait for an appointment. Explanation offered about measures being taken to actively recruit and retain dental practitioners and also doing more to ensure reception staff make the best use of available appointment slots for each dentist and hygienist/therapist. 23 Staff attitude Consultant Y Partly upheld Potential miscommunication which has been reflected on by individual concerned. 24 Staff attitude Consultant Y Upheld Concerns discussed in detail. Consultant may have been abrupt owing to pressures at the time apologies offered. 25 Staff attitude / diagnosis and treatment Partly upheld Consultant N Seeking additional information from other clinicians involved 3 Clinical care as good as could be expected for someone who is not a specialist in the area in question. Apology given for an expression used which was intended to provide reassurance but with hindsight could be seen as flippant and uncaring. Case discussed with clinical teams both in Shetland and Aberdeen. 26 Inappropriate discharge Consultant Y Not upheld Notes review did not find any evidence to suggest the discharge had been premature. 27 Breach of confidentiality Community nursing Y Partly upheld No evidence to support claim. General concerns about healthcare provision to be discussed with the local Community Council. 28 Missed diagnosis Consultant Y Not upheld Care and investigations offered by consultant team found to be appropriate for the patient presentation. Additional information

19 Summary Staff Group(s) <= 20 wkg days 29 Overlong wait in A&E 30 Delay in technical input 31 Access for treatment 32 Access for treatment 33 Communication issues with referral request for second opinion 34 Co-ordination and communication of patient care If not, why Outcome Actions forwarded which has been reviewed by staff in question. A&E Y Upheld Complaint upheld as although the wait for non-emergency care was due to medical staff being in high demand elsewhere in the hospital, there were learning points regarding communication between NHS24 and the patient, and also NHS24 and A&E. Dental Y Partly upheld 4 Delay acknowledged as less than ideal, however demand is unlikely to dictate resources are prioritised differently in future. Quality of product will be reviewed. Dental Y Upheld Upheld as the complainant had had an unsatisfactory wait for an appointment. Explanation offered about measures being taken to actively recruit and retain dental practitioners and also doing more to ensure reception staff make the best use of available appointment slots for each dentist and hygienist/therapist. Dental N Delay in investigation report being produced GP/Consultant/ Admin Upheld Y Partly upheld Upheld as the complainant had had an unsatisfactory wait for an appointment. Explanation offered about measures being taken to actively recruit and retain dental practitioners and also doing more to ensure reception staff make the best use of available appointment slots for each dentist and hygienist/therapist. Meeting in place to discuss outcome. Additional information provided for referral process. Communication issues discussed within secretarial team. MDT PC/SC Y Upheld Further guidance to be put in place regarding discussions with next of kin, and the level of information sharing that is agreed between all parties. 35 Attitude/treatment Dental Y Partly upheld 36 Attitude/lack of Open diagnosis 37 Lack of diagnosis/failure to treat Consultant N Complex complaint involving a number of clinicians GP/AHP N Complaint asked to make contact in first instance Partly upheld Partly upheld as the patient felt they had not been listened to. Experience discussed with member of staff. Clinical care found to be reasonable, but it is not possible to determine if communication with clinicians regarding out of area treatment was as robust as it could have been.

20 Summary Staff Group(s) <= If not, why Outcome Actions 20 wkg days to clarify some issues 38 Failure to diagnose/treat Consultant N Meeting required to discuss Partly upheld Discussion about the importance of communication with patients at consultants group meeting. 39 Referral vetting procedures and communication Consultant Y Upheld Case discussed with clinician involved. Letter template amended to improve communication. 40 Post operative difficulties and staff attitude Consultant Y Partly upheld Clinical care reasonable but communication regarding success of operation and wound care may have been improved. 41 Staff attitude GP N GP on leave Upheld Case discussed with GP involved. Apology offered about how wording of response could have caused upset to patient and explanation of what message GP was trying to communicate. 42 Alleged carelessness with drugs in ward area 43 Lack of diagnosis, treatment and staff attitude 44 Quality of experience Nursing Y Not upheld Case discussed with nursing and pharmacy staff. Not upheld as Director of Nursing & Acute services found no evidence to support the claim. Consultant Y Upheld Apology offered for breakdown in communication, staff reminded of blood test results protocol and information leaflet to be distributed in future. GP/GP admin N Complex complaint involving a number of clinicians Not upheld Full investigation of all aspects of points raised. Offer made to continue to support patient locally. 5

21 NHS Shetland Annual Feedback and Complaints Report for 2013/14 Appendix B Summary of Informal Complaints in 2013/14 16

22 NHS Shetland summary of informal complaints in 2013/14 Summary Staff Group(s) Actions 1 Antibiotic prescribing/diagnosis of family member LHC Explanation offered about antibiotic prescribing and the resistant effects antibiotics can have if too regularly prescribed to patients. Advised about what procedures to take should they wish to make a formal complaint. 2 Difficult appointment/general feeling not being helped Mental Health Complainant wished to see a different clinician and receive a different type of treatment. Explanation that the treatment given was already the type of treatment the complainant felt would benefit them. Advised that there was only one trained clinician able to offer this treatment. 3 Difficulty in contact at NHS Grampian to re-arrange date understanding of Surgery Advised that their consultant did not operate in Shetland and probably had the shortest waiting list in Aberdeen. why surgery is being done in Aberdeen and not Lerwick. Offered local surgery which could cause delay but complainant was happy to take Aberdeen appointment. Communication difficulties followed up with NHS Grampian. 4 GP diagnosis LHC Meeting held with relevant staff to discuss the diagnosis and complaints issues. Explained to complainant all points raised were discussed and resolved at meeting. 5 Staff attitude/alleged breach of Community Investigated by relevant staff and reported back to the complainant. confidence Nursing Complaina nt was issued all the information and NHS policies regarding confidentiality. 6 Query notification of DNA at NHS LHC Identified that copy of patient s letter must have gone astray in post. Grampian not passed on by GP to patient Process for when patients do not attend a hospital appointment discussed between NHS Shetland & NHS Grampian colleagues to minimize miscommunication. 7 Delay to MRI scan referral GBH Appointment followed up and was scheduled for a few days later. 8 Poor communication around Patient LHC Investiga ted by relevant staff Travel/ARI/ receipt of test results Apologies sent on behalf of ARI, Patient Travel & LHC for inconveniences caused through mistakes. Procedures re-communicated to staff where relevant. 9 Poor communication/ct scan PC & SC via Apologies sent regarding poor communication booked and then cancelled Scalloway HC ARI spoke to patient to explain why there was no clinical need for a CT scan. Complainant confirmed they understood what had happened and thanked staff for their help. 1

23 NHS Shetland summary of informal complaints in 2013/14 10 LHC appointment system LHC Complainant was frustrated with appointment service. Explained the procedures for an appointment, allocated times and demands for appointments. Emergency appointment details passed to complainant for future reference. Offered to try making an appointment at that time on their behalf with the choice of doctor they requested. 11 Unhappy with past root treatment, tooth discoloured, advised NHS cannot help Dental Complainant advised completion of root treatment was delayed due to the patient s following appointments being used to treat issues which needed more immediate attention. Discolour due to poor oral hygiene which patient was regularly advised about. 12 Patient travel/discharge issues from ARI Travel Due to breakdown in communication between ward staff and complainant they were reimbursed for cost of flight to Shetland. 13 Query of what are clinical & nonclinical reasons when applying for travel off island Travel Complainant was unable to claim back travel expenses to travel off island to Aberdeen due to it being for non-clinical reasons. Was explained that the same treatment was offered locally therefore attending ARI was classed as non-clinical. 14 Delay in response to bridge work Dental Response from service outstanding. 15 Discharge transport time mix-up Ward 3 After investigating, letter was sent to complainant apologising for the mix up 16 Pathway delay in surgery date Secondary Care Investiga ted by relevant staff 17 Unavailability of emergency appointment due to health centre closure for OOH training LHC Complainant was advised why there was a delay and received reassurance and an apology for the reasons behind the delay. Complainant was unhappy to learn when arriving at LHC that it was closed for training Explained to the complainant the importance of training days for GP s and the procedures that are taken when these days are in place. Advised that further advertising will be looked into to communicate this more through the community. 18 Queried dental waiting list times Dental Complainant was unhappy with position on waiting list 19 Patient complaint to NHS Grampian, unable to get app due to apparent language difficulties Complainant felt patients with LHC had more priority over other patients, they were advised this is not the case & LHC do not have any access to dental patient data Advised as they are undergoing cancer treatment they are eligible to receive priority treatment - this had not been recorded on the dental system until this point. Complainant was satisfied with response and thanked staff for their help. Yell HC Local intervention at NHS Grampian request established that emergency appointment had already been offered for that day. 2

24 NHS Shetland summary of informal complaints in 2013/14 20 Query re: Junior Dr access to patient s previous med history 21 Allegation patient was given an overdose of morphine A&E Being followed up but delay due to request for patient notes to be shared with junior doctor (no longer working for NHS Shetland). Ward 3 Medical records investigated into the amount of morphine administered and why. Explained to the complainant that the amount of morphine administered was correct in level with the pain the complainant was experiencing and the medical attention received was appropriate. 3

25 NHS Shetland Annual Feedback and Complaints Report for 2013/14 Appendix C Summary of Patient Opinion feedback in 2013/14 17

26 Stories and responses About this report This report lists a selection of stories and responses published on Patient Opinion. It was created on 13 June Which postings are included? This report shows stories in the NHS Shetland subscription, which includes stories about NHS Shetland. The report is also filtered to show only stories about NHS Shetland submitted between 01/04/2013 and 31/03/2014 Frequently asked questions How do I find the original story online? If you are viewing the report on a computer, you may be able to click the reference number to the right of the story. This will take you to the story online. If you are viewing the report on paper, you can find story number X online at: Why might a story appear more than once in the list? Some stories are about more than one service. If so, the story will be listed under each service it is about. What do the story counts mean? To the right of an organisation/service you will see a count. This tells you the number of stories listed in the report about that organisation or service (including any services run by that organisation/service). What do the view counts mean? The view count to the right of a story tells you the number of times the story has been viewed on Patient Opinion by public users (excluding subscribers and the PO team). Why might unexpected services appear in my report? The services listed in the report depend on the stories that are included, and that depends on how you have filtered the report. So, for example, if you have filtered only according to where authors live, you may find they have used services some distance away. Sharing and reuse Contributors to Patient Opinion want their stories to get to those who can use them to make a difference, so we encourage you to share these stories and responses with others. Postings submitted via Patient Opinion itself can be shared subject to a Creative Commons licence. You can copy, distribute and display postings, and use them in your own work, so long as you credit us as the source. Material submitted via NHS Choices is licenced under Crown Copyright. About Patient Opinion Patient Opinion is a not-for-profit social enterprise which enables people to share the story of their care, and perhaps help care services make changes. For more information, contact us via:

27 Show/hide responses This report lists 21 stories NHS Shetland 21 stories I was treated with dignity and was included in all decisions Nifty159 the patient 04/04/2013 I was recently operated in for the removal of a large cyst and a hysterectomy. The operation took place at Raigmore in inverness. My first indication that something might be a miss was bleeding following my Tamoxifen. I was scanned in Orkney then in Shetland and was impressed by the way in which this was handled, with medical staff who explained what was happening at every stage in the process. As I have to avoid having anything put into my arms, following a bilateral mastectomy I had to have needles inserted into my foot, not an easy option. At no point did any of the folk dealing with me make me feel as if I was being a nuisance. I saw the surgeon in Inverness and had a minor operation on Christmas eve to determine what might have caused the bleeding and whether there was any sign of cancer again. Both before and after the operation I had everything explained and went home with a discharge letter, which I could read and share with my doctor. I was given the results of the scan and the operation, along with the decision to operate, within four weeks. I was impressed at the speed of which I was informed, given that it had been the christmas and new year period and the time it can take to get the results from an Aberdeen hospital. I was given a definite date in late February with the provision that it could be earlier if there was a cancellation and I was able to take advantage of it. This was the case and I was able to have my operation in early February. At every stage of this experience in Inverness, I was treated with dignity and was included in all decisions. Because of my previous history I agreed wholeheartedly with the surgeons that I could have a hysterectomy when the cyst was being removed. I left the hospital several days later to fly home and again the airport was made aware that I should get preference when boarding. All staff at the airport were very helpful and made the trip home easier than it might have been. Again I had a discharge letter which I discussed with my very helpful and supportive doctor. I feel that the reason I am recovering so quickly is because of the very good treatment at Raigmore and the support of my local doctor in allowing me to go to this hospital. Some very unfortunate experiences in ARI over the years (especially in regard to my cancer treatment) have made me feel devalued, unsafe and adamant that I will not go to this hospital again. I would also like to note that Inverness was very clean, unlike the last ward in Aberdeen. Finally I have just been told after 2 weeks my operattion that their is no sign of cancer with my surgeon taking the time to phone me and let me know. I could not better the treatment I had. Linda Oldroyd NHS Grampian 12/04/2013 It is good to hear of your positive experiences of care at Raigmore, but disappointing that you found care in Grampian to be below the standard all patients deserve. We would like to assure all patients and carers that safety and cleanliness issues are taken very seriously by NHS Grampian and that we value all patients and staff for their contribution to the health and well being of our population. We hope that any future experiences you might have in Grampian are both safe and of high quality. Thank you for taking the time to post this feedback. Julie Tait Patient Experience Officer NHS Orkney 16/04/ views Patient Opinion 2014 Report dated 13 June 2014 Page 2