COMPLAINTS /PALS MERTON CLINICAL COMMISSIONGING GROUP

Transcription

1 COMPLAINTS /PALS MERTON CLINICAL COMMISSIONGING GROUP Annual Report 2016/17 1

2 Date Version Author Notes August 2017 One Chris Baker COMPLAINTS REPORT... 3 DEFINITION OF SERVICES... 3 COMPLAINTS AND PALS RECEIVED... 4 COMPLAINTS AND PALS PER QUARTERS... 5 NUMBER OF MP CASES... 6 KEY PERFORMANCE INDICATORS (KPIS)... 7 COMPLAINT THEMES LEARNING FROM COMPLAINTS BENCHMARKING COMPLAINTS RISK GRADING (ONLY COMPLAINTS ARE RISK GRADED) PUBLIC HEALTH SERVICES OMBUDSMAN (PHSO) DECISIONS CONCLUSIONS AND RECOMMENDATIONS

3 Complaints Report Openness and transparency is a high priority for NHS Merton Clinical Commissioning Group (). The is committed to providing access to information and support to their community. This report is an activity report for complaints received in 2016/2017. The report also highlights any themes and trends of the type of concerns that are being raised. To protect the identity of the complainant the information has been anonymised. Definition of Services Following review of the report published in October 2013 by the Right Honourable Ann Clwyd MP and Professor Tricia Hart A Review of the NHS Hospitals Complaints System Putting Patients Back in the Picture, which defines a case being either a Complaint or PALS, we have amended the way in which we record cases and have amended all cases recorded since 01/04/2013 to reflect this. Patient Advice and Liaison (PALS) Enquiries offering information and advice to patients, carers, the public and staff to ensure quick resolution of enquiries or questions raised about services provided by or commissioned by the local. Although this service is not provided to the on occasion, there are enquiries that are not formal and have been considered a PALS. Complaint expression of dissatisfaction about any aspect of service that the provides or commissions and requires a formal investigation and a written response that addresses all of the concerns raised. The report provides information on complaints that are directly to the. It also gives a broad overview of those which are not directly to the, or where the has been party to a joint response to the complainant. 3

4 Complaints and PALS received From 1 April 2016 to 31 March 2017, there were a total of 57 complaints and 89 PALS enquiries received on behalf of Merton. Every complaint and PALS forwarded to or received by the Complaints and PALS team is recorded on the complaints database. This data has formed the basis of this report. Complaints and PALS are generally received by phone, and letter, either at Merton or directly to the Complaints and PALS team. It should be noted telephone enquiries made to Merton may have been dealt with internally and these calls may not have been recorded to be reflected in this report. The graphs below show the complaints and PALS received by South East CSU for the years 2015/16 and 2016/17: Complaint Numbers / / PALS Numbers / /

5 Complaints and PALS per Quarters There were 57 new complaints throughout the 4 quarters in 2016/17, which is significantly less than the 84 reported in 2015/16. Twenty-one of these 57 were received in Quarter 1 (36.8%) while Quarters 2 and 3 received 10 each before a slight jump to 16 in Quarter 4. This is significantly less than 2015/16 where three of the 4 Quarters reported over 20 new complaints. There were 89 new PALS in the 4 quarters of 2016/17, up from the 68 reported in 2015/16. These flowed evenly throughout the first three quarters (26, 28 and 23 respectively) before a drop in Quarter 4 where there were only 12 PALS cases reported. Summary of Complaint Numbers Summary of PALS Numbers / / / /

6 Number of MP Cases The table below highlights the number of complaints, whether the was required to respond and if the complaint originated from an MP. There were 6 MP complaints for 2016/17 and 20 MP PALS for a total of 26 MP cases: The six MP complaints were received throughout the four quarters, two each in Quarter 1 and Quarter 2, and one each in Quarter 3 and Quarter 4. Nine of the 20 MP PALS were received in Quarter 2 (45%) while only one was received in Quarter 1. In Quarter 4, the four MP PALS cases were all in regards to the Wilson Health Centre. 6

7 Quarter 4 Quarter 3 Quarter 2 Quarter 1 and non Non and non Non and non Non and non Non Key Performance Indicators (KPIs) The target for acknowledging a complaint or PALS enquiry is three working days. For the year s complaints and PALS received, the average time to acknowledge a complaint or PALS was less than two days. The average time for South East CSU to acknowledge a complaint was less than three days, the average time to acknowledge a PALS case was less than two days. South East CSU also measures the time taken to acknowledge complaints and PALS internally through KPIs. Average number of days to acknowledge Complaint MP Complaint PALS MP PALS The table above details the KPI performance for acknowledgements this quarter. The data is split down to show if the was the right body to respond to the concerns along with where the complaint originated. The target for providing a response to a complaint is 25 working days, with a 20-day target for the CSU to send the response to the. 7

8 The following tables provide more information regarding the total complaints and PALs received and their response times: 8

9 The breakdown of the 12 complaints cases that exceeded the 20-day and 25-day response timescale are as below: ID Type of Enquiry 219 Complaint 224 Complaint 345 Complaint 361 Complaint 489 Complaint Related Date Received Details Subjects Days to respond 20/05/16 Complaint about IFR process. IFR 26 20/05/16 OMBUDSMAN investigation IFR 318 Was the complaint upheld? Not upheld Report only 24/06/16 Ombudsman Investigation CHC 294 Unknown 04/07/16 08/08/16 Patient was unhappy with the response to his complaint Ref. 350 and has further questions. Complaint about the way a CHC assessment was carried out without the family present and the lack of communication. IFR 62 Partially upheld CHC 51 Upheld 9

10 720 MP Complaint 739 Complaint 898 Complaint 1069 Complaint 1071 Complaint 10/10/16 13/10/16 08/11/16 10/01/17 MP registering constituent's concern regarding rumours that the GP surgery at The Wilson Health Centre is to be closed Patient unhappy with treatment at the Minor Surgery Service and the attitude of the staff. Complaint re quality of bereavement support MH services given to partner of victim of serious crime PHSO request for records and information as they are investigating this case. GP; COMMISSIONING 219 STAFF ATTITUDE 58 Report only Not upheld ACCESS 27 Upheld CHC 156 Unknown 10/01/17 Complaint about time taken to arrange CHC CHC 35 Upheld 2140 Complaint 13/03/17 Patient complaint about New Victoria Hospital in SW London refusing his referral from GP under the Private/Public agreement due to payment problems from.. ACCESS 55 Partially upheld 2161 Complaint 13/03/17 Complaint that the have not completed retro CHC claim as recommended by Ombudsman CHC 26 Partially upheld 10

11 Complaint Themes The themes of the 19 Merton direct complaints received in 2016/17 are: Of these 19 cases: Theme Number of Complaints Continuing Healthcare 8 Individual Funding Request 4 Commissioning 2 Staff Attitude 1 Access 4 5 upheld 5 partially upheld 5 not upheld 2 reports only 2 unknown outcomes (PHSO investigations) The five upheld cases were all either Access (3) or CHC (2), including two cases relating to Connect Health. Three of the five partially upheld cases also to CHC, meaning that five of the eight CHC cases were either upheld or partially upheld. The other two partially upheld cases were IFR (1) and Access (1). Out of the 19 complaints, three were MP complaints and only one of these was upheld. This was a case relating to physiotherapy services at the Nelson Centre raised by Stephen Hammond MP. The other two MP cases were raised by Siobhain McDonagh MP. 11

12 PALS Themes Of the 89 PALS enquiries received in 2016/17, 52 were directly to Merton. The themes for all the 52 Merton direct PALS enquiries are tabulated below: Theme Number of PALS Enquiries Commissioning 16 Continuing Healthcare 14 Communication 2 Estates 1 Individual Funding Request 8 Access 2 Freedom of Information 1 Mental Health 2 Prescribing 3 GP 2 Provider Services 1 There are no particular trends of note during the year other than that Commissioning and Continuing Healthcare account for 30 of the 52 enquiries (58%). The 16 commissioning enquiries cover a range of areas, although three relate to the Wilson Medical Practice, three relate to St George s Hospital and two relate to IVF funding. The remaining eight commissioning enquiries relate to topics such as physiotherapy services, acupuncture, equipment for patients and financial contributions to a local hospice. 12

13 Non- Complaints Themes Of the 57 complaints received during 2016/17, 38 were not directly to Merton. The subject areas for these non- complaints are listed below: Subject Number of Complaints Access 5 Continuing Healthcare 2 Provider Services 9 Commissioning 2 Communication 1 GP 9 Treatment/Care 4 Complaints Handling 3 Mental Health 2 Staff Attitude 1 Provider Services and GP complaints were most common (9 each) accounting for almost half of cases. These were complaints such as GPs not carrying out referrals or instructions correctly, dissatisfaction with services received and appointment issues at GP practices. Of these 38 complaints, none were upheld and two were partially upheld. The rest were either not upheld, withdrawn or were outcomed as reports only. 13

14 Non- PALS Themes Of the 89 PALS enquiries received in 2016/17, 37 were not directly to the. The subject areas for these PALS enquiries are tabulated below: Subject Number of PALS Enquiries GP 12 Provider Services 13 Access 5 Communication 4 Treatment/Care 1 Continuing Healthcare 1 Staff Attitude 1 The main theme with these enquiries is that 25 of 37 (68%) relate to either a General Practitioner (12) or Provider Services (13). GP enquiries received ranged from complaints about GP attitude, GP registration queries and available GP practices in the area. Of the 13 provider services enquiries, these were far ranging, such as enquiries about community nursing, retinal eye screening, audiology and gynaecology. 14

15 The below table shows a breakdown of all complaints and enquiries cases received in 2016/17, by quarter and by the subject matter. Complaints may have been categorised under multiple subjects where necessary. Learning from Complaints In total, only five of 57 complaints were upheld in 2016/17. Two of these cases provided some lessons learnt. In case 898, which to the quality of bereavement support in Mental Health services, the lesson learnt was for the new admin team to record all contacts and offer more face-to-face appointments to improve the quality. The other upheld case was 489, which to a CHC assessment carried out inadequately. Following an apology and a new assessment, the lesson learnt was that if a social worker is not available within two weeks of the referral, the Decision Support Tool would be completed without them. 15

16 In addition, case 975 was partially upheld and provided a lesson learnt. This case to the effectiveness of the MSK service provided by Connect Health. The lesson was for the to review the cancellation policy with Connect Health in light of the complaint. Benchmarking Benchmarking with the other s South East CSU can be provided. Work will be carried out to obtain permissions from each of the 9 s to release their data. The data will be provided in sets of London and Kent. When a agrees for their data to be benchmarked, the details will be redacted. Benchmarking will also be looked at after the South East CSU merger with NEL CSU. NEL CSU currently provides a complaints service to 11 North/East London s as well as s in Anglia and Northampton. Complaints Risk Grading (only complaints are risk graded) Formal complaints are graded accordingly on receipt by South East CSU using a Risk Grading Matrix. Grading is based on the actual consequences and the potential for future complaints on a similar issue. Grading of Complaints provides the potential to flag serious risks to the. Where a complaint is graded at 15 or above, the Complaints team will alert the. There were no cases graded as 15 or above in 2016/17. Complaints that are not dealt with by South East CSU Complaints team, but by other organisations in the area i.e. GP complaints referred to NHS England or hospital complaints are ungraded. 16

17 Public Health Services Ombudsman (PHSO) Decisions There were two PHSO cases in 2016/17, both of which fell in Quarter 1. One to IFR and one to CHC. The IFR case (PHSO ref HS /0049) was not upheld, with no action taken against the. The CHC case (PHSO ref HS /0045) remains open and under investigation by the PHSO. Conclusions and Recommendations Merton has seen a drastic reduction in the total number of complaints made in 2016/17 when compared with 2015/16 numbers, with an average of seven fewer complaints received per quarter. This perhaps indicates improvements in services provided; particularly as only 19 were specifically Merton complaints and less than 25% of these were upheld. However, the number of enquiries received has increased with an average of five extra per quarter. The majority of enquiries relate to commissioning and CHC and, where the enquiries are non-, predominantly focus on GPs and GP practices. CHC enquiries tend to centre on delays, processes and communication and as such are perhaps areas to focus on to provide a more robust CHC service that reduces enquiries. MP complaints were limited to just six throughout the year, with a further 20 MP PALS cases. It is important to note that all the MP PALS (4) received in Quarter 4 pertained to the changes at Wilson Health Centre. KPI performance indicates that the CSU is generally able to meet the relevant KPI standards for Merton, but improved flow of information between and CSU could help to improve response times. In addition, there are not often any lessons learnt sent to the CSU once a case is concluded. This restricts the ability to provide learning points and identify any trends in reporting work. Chris Baker Data Analyst NELCSU Date: August