Patient Experience Annual Report including Complaints and Patient Advice and Liaison Service

Transcription

1 Patient Experience Annual Report including Complaints and Patient Advice and Liaison Service

2 Contents Page No. 1 Contents 2-3 Introduction 4 Executive Summary Progress towards the Key Milestones: 5-8 Ambition 1 Improve the whole journey 9-15 Ambition 2 Improve communication Ambition 3 Meet care needs Measuring our success 24 Conclusion Appendix 1: Facts and Figures Word cloud generated from Trust s Patient and Carer Experience Strategy Patient Experience Annual Report Page 1

3 Liz Introduction East and North Hertfordshire NHS Trust has as its vision to be amongst the best performing NHS Trusts in the country, with high quality care and excellent patient experience at the heart of all we do. We aim to provide our patients and their carers with the best possible experience whilst they are using our services. This combined patient experience, complaints and Patient Advice and Liaison Service (PALS) annual report demonstrates how the Trust measures progress towards the ambitions set out within the Patient and Carer Experience Strategy. It includes a summary of patient and carer feedback and actions and initiatives to improve patient experience during The Trust s Patient and Carer Experience Strategy was developed based on feedback from discussions with patients, families, carers, public Trust members and staff, as well as a review of national policy and guidance. The strategy focusses on three key ambitions for the Trust:- Ambition 1: We want to improve the experience of our patients and carers from their first contact with the Trust, through to their safe discharge from our care. Ambition 2: We want to improve the information we provide to enhance communication between our staff, patients and carers. Ambition 3: We want to meet our patients physical, emotional and spiritual needs while they are using our services, recognising that every patient is unique. The Trust s Patient Experience Committee (PEC), a sub-group of the Risk and Quality Committee, provides the direction to deliver the strategy. PEC is chaired by a non-executive Director of the Trust and includes representation from the Medicine, Surgery, Cancer, Women s and Children and Clinical Support Service Divisions, Director and Deputy Director of Nursing and Patient Experience, Patient Experience Project Manager, Facilities Manager, Chaplain, Head of Engagement, Organisational Development Team, Carers Lead, Complaints Manager, Health Liaison team, Student Nurse and six patient representatives. The committee met 11 times during and received regular updates on the Trust s patient experience survey results and updates on the Divisional patient experience action plans. Alternate formal meetings and workshop sessions are held monthly to enable the committee to monitor progress towards achieving the three ambitions contained within the Trust s Patient and Carer Experience Strategy. Workshop discussions/presentations have included: * Managing concerns at ward level * DisabledGo * Accessible Information Standard * Inspiring Organs * End of Life Strategy * Carers Lead * Rheumatology service * Trust s Youth Forum * Chaplaincy service Patient Experience Annual Report Page 2

4 Patients and carers are able to provide feedback and raise questions or concerns about their hospital experiences in a variety of ways: Talking to staff in the ward or department Completing one of our local patient experience surveys which includes the Friends and Family Test question (how likely are you to recommend our ward/department to friends and family if they needed similar care or treatment?) Completing one of the national patient experience surveys Writing or ing the Trust Sharing their patient or carer experience story Participating in one of our focus groups/events (e.g. Carers Focus Group, Youth Forum) Posting comments on social media (e.g. Twitter/Facebook) Posting comments on NHS Choices or Patient Opinion Contacting the Patient Advice and Liaison Service Making a formal complaint All feedback is shared with the relevant ward or department to enable teams to share positive feedback and consider suggestions for improvements made by patients and carers. Each ward/ department has a learning from your experience poster which is updated monthly to share the actions that have been taken as a result of patient feedback. The response to key questions from the inpatient experience survey are monitored and reported monthly by ward in the Nursing and Midwifery Quality Indicators. Wards produce action plans to address any areas of concern identified by patients. Each Division has a patient experience action plan which is discussed and monitored by the Trust s Patient Experience Committee. The Trust participates in the national mandatory patient experience surveys co-ordinated by the Care Quality Commission and Department of Health. This feedback is valuable as it enables the Trust to compare performance with other Trusts throughout the country. Last year the Trust received feedback from the national inpatient and cancer surveys and the voluntary outpatient survey. A summary of results from these national surveys is included in Appendix 1. Appendix 1 also shows the full breakdown of patient experience survey responses during This wealth of feedback has helped the Trust prioritise areas for improvement and influenced the actions included in this report. The Trust received feedback from over 86,000 patients in This feedback informs the Trusts improvement plans and is vital to help us on our journey to be amongst the best performing NHS Trusts in the country. Liz Lees Acting Director of Nursing and Patient Experience Patient Experience Annual Report Page 3

5 Executive Summary This annual report includes a summary of progress towards the key milestones identified within the Patient and Carer Experience Strategy These include: Ambition 1: Improve the whole journey Outpatient appointment system/administrative support for Outpatients Engaging with patients when developing Trust services Voluntary Services Steering Group and develop links with the local community Develop and implement End of Life strategy, support education and training regarding end of life Customer care training programme and staff recognition scheme Information on Trust website showing department changes and new signage Ambition 2: Improve communication Patient information leaflets available Information available in alternative formats for patients Support #hello my name is. Improvements in communication categories of surveys Ward information booklets This is Me booklet for patients with dementia and purple folder for people with a learning disability Carers Lead in post and ward staff recognising role of carer Ambition 3: Meet care needs Patient safety elements monitored and information displayed on wards Reduce hospital acquired pressure ulcers and new catheter associated UTIs reported in audit Protected mealtime in place and patients receiving assistance at mealtimes Introduce new menus for inpatients Maintain improvements in cleanliness Information for patients on support groups/advice available The Strategy sets out how the Trust will measure its success either by achieving improvements in our patient experience survey responses, reducing complaints regarding specific areas or by improving our scores and number of responses to the Friends and Family Test survey. The information included in this annual report summarises progress made towards achieving the milestones and includes a summary of the latest patient experience survey data available. The Trust continues to increase the amount of feedback received from patients with 23,921 responses to our local surveys and 86,307 responses to the Friends and Family Test question in Patient Advice and Liaison Service (PALS) and Complaints The report provides an overview of the Patient Advice and Liaison Service (PALS) and Complaints Team activity from Analysis of the themes from complaints and concerns is used to identify areas of the Trust that need additional resources or support to improve patient experience. In addition the information gathered is compared with other patient experience feedback. All feedback from complaints is shared with the relevant ward or department to enable teams to share positive feedback and consider suggestions for improvements made by patients and carers. Feedback from complaints and concerns provides a valuable opportunity to demonstrate to patients and their families that we are listening and acting on the concerns that they raise. The feedback given to us can influence improvements across the whole organisation, not just in teams or individuals. Complaints and concerns contribute to a culture of continuous service improvement within the Trust. Complaints and concerns data is presented quarterly to the Trust Board including learning outcomes and actions taken to prevent a recurrence in the future. There has been a decrease in the total number of complaints received in with 924 complaints received across the organisation. The predominant subject of complaints was communication and delays in treatment or appointment. PALS are an effective resource in supporting patients with real time concerns and the team work closely with both clinical and support staff to resolve concerns in a timely manner. Patient Experience Annual Report Page 4

6 Key Milestones Ambition 1 We want to improve the experience of our patients and carers from their first contact with the Trust, through to their safe discharge from our care. Engage with users to review the appointment system. Business case for administrative support for outpatient team. The Trust made a commitment to improve accessibility to the Outpatient appointment team. It was recognised that both the time to answer telephone calls and the percentage of calls answered needed to improve. Funding was secured in to increase the number of call handlers which had led to improvements in performance. The average call is now answered within one minute and 98% of calls are answered. The graphs below demonstrate the improvements in performance for and : Average time to answer telephone calls to the Contact Centre (in minutes) Percentage of calls answered in Contact Centre The Trust has re-launched an Outpatient Steering Group with support from Four Eyes Insight to look further at patient access to services and clinical pathways in Outpatients. This will build on the work that the Trust has previously undertaken to improve patient experience within Outpatient services. The Trust is particularly looking to reduce hospital cancellations, reduce did not attend (DNA) rates and reduce waiting times in clinics. Patient Experience Annual Report Page 5

7 Actively engage with patients and carers when developing Trust services via the Engagement Team. The year to March 2017 has again seen significant growth in patient and carer involvement through membership and community engagement. Our growing involvement programme has had patients and carers participate in strategy development through to service design. For example, our patients have shaped our new Engagement Strategy published in August Patients and members also played a major part in shaping our university status accreditation confirmed in March Public membership of the Trust has grown by over 25% in the four years to March 2017 and the range and quality of involvement has continued to improve. In October 2016 a new youth forum was established for the Lister hospital Lister Young Voices these committed and engaged young members are already making a big difference to our patient experience. They organised and hosted a Christmas party for children and young people on Bluebell ward and they have commissioned and co-designed a film to persuade young people that coming into hospital is not so bad! Looking forward, the Trust is leading the way in involving patients and public members encouraging them to get involved with our new Sustainability and Transformation Plan (STP). We were the first health organisation across Hertfordshire and West Essex to involve our patients through a public engagement event and we will continue to involve patients in service design and collaboration. Establish Voluntary Services Steering Group and further develop links with the local community to provide services and entertainment for patients. The Voluntary Services Steering Group was established in July 2015 to develop a coherent approach to volunteering across the Trust, focussing on the Lister, QEII and Hertford County Hospitals. The remit of the group is: To ensure that the volunteer policies are fit for purpose and that all volunteers, including third party organisations, adhere to them. To establish the focus and priorities of the service, to identify projects and commission volunteer support. The Voluntary Services Steering Group continues to inform and support the work of the voluntary services department at Lister, New QEII and Hertford County Hospital. Initiatives include: The palliative care team s Butterfly project has now been rolled out across the hospital and funds are being sought to provide a paid co-ordinator. The success of the scheme to involve the local community with Pets as Therapy (PAT) dogs, choirs, hairdressers etc. has prompted the funding of a one year contract for a Patient Experience Co-ordinator to work alongside the voluntary services team. In doing this we hope to increase and enhance those services for patients. This year voluntary services have embarked on a new project to help the Enhanced Nursing Care Team to support patients across the hospital suffering from dementia or other neurological conditions. This group of patients often just need a little reassurance and distraction. The volunteers will be trained and supported by the Enhanced Nursing Care Team. The enhanced care project has encouraged the Voluntary Services Team to take a fresh look at the role of all ward-based volunteers in an effort to offer support and help where it is most needed. Going forward, the ward assistant role will be replaced with a patient companion role, whereby, in addition to supporting meal service, volunteers will be guided by staff to spend time with specific patients. Patient Experience Annual Report Page 6

8 Develop and implement End of Life Strategy for the Trust. Support on-going education and training regarding end of life. Implementation of individualised end of life care documentation. The Trust s End of Life Care Strategic Plan was published in March The Strategy sets out the Trust s ambitions to raise the profile of palliative and end of life care, for all patients to receive individualised end of life care and for clinical staff to receive appropriate training around end of life care, partnership working and providing a quality service. The End of Life Strategy Group is chaired by a Consultant in Palliative Medicine and oversees implementation of the Trust s ambitions for end of life care; in conjunction with the NICE Quality Standard recommendations. The role of the strategy group will be to identify and oversee key areas for improvement through quarterly meetings with representatives from relevant key areas. In addition there will be several task and finish groups which will be responsible for delivering elements of the strategy and will report to the main strategy group. The strategy group will provide an annual report to the Risk and Quality Committee and the Clinical Commissioning Group End of Life Forum. Education on priorities for care of the dying person is now mandatory for all clinical staff including selected non-clinical staff such as porters, ward clerks and housekeepers. The training sessions are delivered by the Specialist Palliative Care Team. On average one session is delivered each month. Alongside this, the Palliative Care link doctors and nurses on the wards also ensure the priorities for care of the dying patient are implemented when it is identified that patients are in the last few days and hours of life. All new members of staff undergo this training as part of their induction process. The Individual Care Plan for the Dying Person is in use on all wards. This has been developed with the aim to ensure maximum comfort, dignity, compassion and sensitive communication at all times. The Trust has also been selected to be a pilot site for Building on the Best programme. This is a national programme working with ten pilot sites across England to deliver compassionate end of life care. In addition, the Trust has specially trained volunteers who provide companionship and support to those who are dying and their loved ones. This initiative is part of the wider Butterfly Volunteer Project which aims at improving services for the dying person and those important to them through volunteer support and displaying an accepted butterfly logo to raise awareness when a patient is recognised as dying. Launch Trust-wide values-based customer care training programme building on the work already undertaken. Launch monthly staff recognition scheme. Two customer care training options were developed with input from the Outpatients team and were offered for a six-month period - a programme for frontline staff and a programme for managers and supervisors on embedding and sustaining a customer care culture within their teams. During this time the training was taken up by clinical and clerical outpatients staff, estates and facilities staff including the main reception volunteers and the ophthalmology team. While feedback from the delegates was good, take-up of the training offered reduced significantly over time, possibly for operational reasons and it was discontinued. Some work was undertaken to consider the implementation of a monthly staff recognition scheme and some clinical divisions have developed their own internal recognition schemes, the winners have sometimes been publicised through the monthly Your Voice newsletter. However, it has not been possible to develop a central monthly staff recognition scheme. Patient Experience Annual Report Page 7

9 Information available on Trust website to reflect changes in department locations/signage A comprehensive review of signage took place at Lister Hospital site in line with the Department of Health Wayfinding Guidance (2005). The hospital has been separated into different coloured zones and, when reaching the correct colour zone, patients and visitors are directed to departments within the zone. Maps are clearly displayed at the hospital entrances and patient correspondence has been reviewed to include directions to the new colour zones. The Trust s website has been updated to include the new site map and directions to wards, departments and outpatient clinics. Lister Hospital site map: Patient Experience Annual Report Page 8

10 Key Milestones Ambition 2 We want to improve the information we provide to enhance communication between our staff, patients and carers. Review patient information leaflets and develop new information as required. Expand on the information available in alternative formats e.g. easy read. There are over 360 patient information leaflets available for patients to access via the Trust s website and there is an ongoing programme to ensure leaflets are reviewed every three years, or earlier in light of new evidence. Each Division has a patient information lead responsible for the review and development of patient information for patients supported by the Trust s Patient Information Co-ordinator. Verbal and written information is offered to patients and carers to meet their individual needs. A wide variety of information is available via the Trust s website. All patient information leaflets state you can request this information in a different format or another language and a policy is in place for staff to access information in alternative formats. Translations of small documents can be arranged via Languageline. For larger documents the department would consider using the services of a translation company. The Trust uses the British Sign Language Interpreting Agency to provide language service professionals to facilitate effective communication with patients who are deaf, deaf-blind or hard of hearing. The Health Liaison Team nurses work closely with families, carers and people with a learning disability to ensure they receive information in an understandable format producing bespoke letters and information in easy read formats to suit individual patients. A Comments, Concerns, Compliments and Complaints easy read information leaflet has been developed with the help of the Health Liaison Team and is available on the Trust s website. Patient Experience Annual Report Page 9

11 In 2016 the Trust s Charity supported the purchase of a hospital communication book for wards and clinical areas. The hospital communication book helps people with a wide range of different needs to communicate with hospital staff during their visit or stay in hospital. It is particularly helpful for patients who have learning disabilities, autism, are deaf or patients whose illness affects their communication skills as well as those who don t have English as their first language. It is separated into clear sections such as food and drink/ pain/ tests and treatment and contains clear and simple pictures and text so patients are easily able to indicate if, for example, they are in pain: #hellomynameis included in divisional patient experience action plans. The Trust has actively promoted the #hellomynameis campaign at public events and all divisions are asked to include this within their patient experience action plan. Improvements in communication categories in patient experience survey responses. The number of complaints throughout the Trust regarding communication decreased from 212 in to 181 in Patient Experience Annual Report Page 10

12 Develop ward information booklets A ward information leaflet has been developed for each ward and copies are available for all inpatients. This leaflet provides a short summary of the key information patients may need to know and was developed with input from staff and patients and the Patient Experience Committee membership. Key information includes: Ward contact details Ward Sisters name and photograph Visiting and protected mealtimes Meals and snacks Ward routine mealtimes, visiting times, times of doctors rounds Who to talk to about questions/concerns Contacting the Chaplains Reducing noise/use of mobile phones How to hire a TV Free Hospital Wi-Fi Personal belongings Discharge from hospital Medication Providing feedback/how to make a complaint Patient Experience Annual Report Page 11

13 This is Me booklet available for patients with dementia and purple folder for people with a learning disability. This is me is a booklet that people with dementia can use to tell staff about their needs, preferences, likes, dislikes and interests. It enables health and social care professionals to see the person as an individual and deliver person-centred care that is tailored specifically to the person's needs. It can help to reduce distress for the person with dementia and their carer. It can also help to prevent issues with communication, or more serious conditions such as malnutrition and dehydration. Nursing staff offer the This is me booklet to all patients with a diagnosis of dementia and encourage relatives/carers to help the patients complete the information supported by staff where necessary. Purple folder available for people with a learning disability My Purple Folder is a Health Action Plan and Health Portfolio held by people with learning disabilities that should be used at every NHS consultation. It holds important health information about the individual that is completed by the individual and/or their carer/supporter. The health professional should make reference to the Purple Folder and contribute to the Health Action Plan within it. The aim is that everyone with a learning disability who wants one will have a Purple Folder and that will be used as a reasonable adjustment improving access to equitable health care. In the year , a total of 306 Purple Folders were offered to Service Users with Learning disabilities within Hertfordshire. Patient Experience Annual Report Page 12

14 Monthly breakdown of Purple Folders issued Purple folders continue to be issued on an ongoing basis for people with learning disabilities. There are several streams of getting the folders issued and all professionals working with people with learning disabilities are encouraged to ensure that people they work with who want one have one. Currently anyone can request a purple folder by contacting the team. The team always issue a copy to any service users supported in hospital who wants one and they are issued free of charge. Carers Lead provides support for unpaid carers through increasing awareness and the promotion of the Carers Policy. Educating Ward staff to recognise importance and expertise of unpaid carers. The Trust recognises its responsibilities to support the needs of all carers of patients who access and use Trust services. In particular through access to information, advice on health and social care or ensuring the necessary support services are in place. Carers are often the people who know and understand the needs of the person they care for best and they have an invaluable role to play. The Trust reappointed a Carers Lead in September 2016 and key actions during the year include: Review of the Trust s Carers Policy which sets out standards for supporting carers to care for their relative or friend in hospital. The Policy includes details of benefits for carers e.g. discounts on car parking, catering and the Health Shuttle service. Development of a carers sticker passport which can be used within the Trust to ensure all staff recognise the caring role. With the Carer sticker, the carer is entitled to discounts in the staff restaurant, coffee shop, and pharmacy shop. The sticker ensures carers can be offered drinks on the wards and snack bags provide nutrition and the opportunity for the patient and carer to eat together. Development of a Carer Support web page on the Knowledge Centre. Implementation of John s Campaign on Dementia and Frailty wards. John s campaign is about the right of people with dementia in hospital to have carers with them at any time. Promotion of Stay with me. Patient Experience Annual Report Page 13

15 Extension of John s Campaign to all wards. All carers can stay with the person they care for in all wards within the Trust, at any time that the carer wishes. Extended visiting hours on all wards to enable visitors to visit patients at a time that suits them. Supported staff to identify visitors who have a caring role and registering them with community services for carers assessment and contingency planning. Working in partnership with community trusts to ensure a smooth transition for carers between acute and community services. Workshop for acute trust and community trust staff to identify and benchmark best practice for carers. Carers Workshop Increasing awareness of the role of unpaid carers. A dedicated Carers Corner providing information for carers, visitors and staff is available. Working closely with ward staff to ensure they include the patients carer to help co-ordinate and expedite discharges. Identifying carers and signposting carers to support and information including referrals to Carers in Hertfordshire/Bedfordshire. Carers Rights Day Updating the Trust s carers leaflet. Review and updated the Carers Survey. Providing dedicated carer information boards in ward areas. Informal carer awareness talks to staff at team meetings with social services, matrons and sisters and individual departments. Patient Experience Annual Report Page 14

16 Our Carers Count day on 28 March 2017 where we recognise all our visitors who have a caring role at Lister and MVCC Hospital. Each carer was given a sunflower to write a message these were displayed for staff, patients and visitors to see. Patient Experience Annual Report Page 15

17 Key Milestones Ambition 3 We want to meet our patients physical, emotional and spiritual needs while they are using our services, recognising that every patient is unique. Patient safety elements monitored and information displayed at ward level. Each ward displays a poster which is updated monthly with information about patient safety and the quality of care on the ward. The poster includes the numbers of infections, pressure ulcers and falls as well as hand hygiene and ward cleanliness audit scores. This poster was developed in conjunction with patients to ensure that it included the information that patients wanted to know. The Trust continues to monitor the number of MRSA and Clostridium difficile infections, falls and pressure ulcers each month by ward and this information is included in the Nursing and Midwifery Quality Indicators which are reviewed monthly. Patient Experience Annual Report Page 16

18 Reduce number of hospital acquired pressure ulcers and new Catheter Associated Urinary Tract Infections (CAUTIs) reported in the national Safety Thermometer audit The Classic Safety Thermometer audit is a national audit which measures the proportion of patients with harm from a fall, pressure ulcer, catheter associated urinary tract infection (CAUTI) and VTE. In the Trust had a target of less than 0.4% new catheter associated urinary tract infections reported in the monthly audits; the Trust achieved this target with 0.25% reported in the year. The number of new (hospital acquired) pressure ulcers recorded in the safety thermometer audits continues to decrease year on year: Patient Experience Annual Report Page 17

19 Protected mealtimes in place on all wards and patients receiving assistance at mealtimes Protected mealtimes are in place to ensure that patients have a dedicated mealtime, free from as many interruptions as possible, so they can enjoy their meal in a quiet and relaxed atmosphere. Nursing staff, clinical support workers and volunteers will help patients with their meals and monitor food intake. Visitors are welcomed on the ward at mealtimes if they are helping their relative or friend to eat their meal. The key messages within the Trust s Policy for Protecting and Managing Patient Meals are to ensure: that there is a calm, quiet environment on the ward to help patients have a pleasant mealtime experience. that patients are properly prepared for their meal before it arrives. the identification of patients who need help with their meal (red tray and red lidded jug) and that help is provided to patients who are unable to eat independently. that non-essential visitors leave the ward and there are no non-urgent interruptions. that family, friends and carers of patients who may wish to participate in the positive meal time experience are welcomed to the ward. that regular audits of protected mealtimes are undertaken and an action plan developed if improvements are needed. Each ward displays a poster on the door showing the visiting and protected mealtimes along with an explanation of protected mealtimes so that those visitors who wish to help their relative or friend know that this is supported. Carers are actively welcomed onto the wards and are supported to continue their caring role if they wish to. The CQC Inpatient survey report asks patients if they received help from staff to eat their meals. Unfortunately the Trust scores reduced from 7.5/10 in 2015 to 6.3/10 in However, the Trust s Meridian inpatient survey has shown a slight improvement in responses to this question from in to in Patient Experience Annual Report Page 18

20 Introduce new menus on inpatient wards The Catering Team provide over 650 patient meals three times every day. The review of catering services undertaken in 2015 identified a number of improvements which have been consolidated and improved on in These include: Enhanced choice of special menus; including revised Halal, children s, Kosher and gluten free options. Provision of smaller food portions to wards with family style service. Continuous review of patient food recipes, adapting recipes to seasonality. Introduction of more modern cuisine with emphasis on latest trends in methods of cooking. Continue to increase use of locally sourced fresh vegetables. Increased ethical procurement - using Red Tractor, Farm Assured, Marine Conservation Society approved fish and increasing use of fresh vegetables. The use and promotion of these items has led to the team achieving The Food for Life Bronze Award in The Trust is now one of only 25 hospitals in the country to be awarded this accolade. Currently 70% of all food offered to patients and visitors is classed as healthy in nature, not just in the ingredients used, but also in the way it is cooked. The Catering Department aim to increase this to 80% by the middle of The Trust has recruited two Housekeeping Training Co-Ordinators who will be assisting the ward housekeepers with the meal service. The ultimate aim is to improve patient experience scores by dealing with issues within set time limits ensuring that all housekeepers are following agreed minimum standards of patient food service. Maintain improvements in cleanliness of hospital The Trust s local inpatient survey asks patients about the cleanliness of the ward. The overall Trust score improved from ( ) to ( ). The Facilities Contracts Monitoring team continue to work closely with our Domestic Services contractor and uses feedback from patients and staff to help identify and monitor areas for improvement. Audit and patient experience feedback are shared monthly with the Domestic Contractor and included in Trust performance reports. The Trust monitoring team ensure that remedial actions are put in place for any areas failing to achieve a green rating and these areas are re-audited the following month. The nursing environmental audit enables staff to monitor cleanliness on their ward or department. The environmental audit scores for the inpatient wards for are as follows: Meridian Environment audit scores Patient Experience Annual Report Page 19

21 Any concerns raised by patients in feedback from surveys, social media or NHS Choices are logged by the Domestic Contractors and evidence provided to the Trust that remedial action has been taken. Positive feedback is valuable and always shared with the contractor and monitoring team. Feedback from patient stories regarding cleaning and the environment, both positive and negative, is shared with the domestic contractor so that positive comments can be shared with the team and actions taken where problems are identified. PLACE (Patient Led Assessment of the Care Environment) PLACE is an annual assessment of non-clinical aspects of patient care including the environment, food, privacy and dignity. All teams include at least two patient assessors. The Trust s PLACE scores for were: Cleanliness Food Privacy, Dignity and Wellbeing Condition, Appearance & Maintenance % 76.20% 87.86% 87.16% % 79.93% 83.34% 89.64% % 69.88% 68.65% 83.03% % 93.90% 82.23% 97.34% The scores achieved by the Trust during the 2016 assessment process show major improvement which reflects the hard work of all teams working together. Whilst there is still more work to be done, these scores show that the Trust is making the necessary improvements and continues to move in the right direction. Clinical areas display information for patients on support groups and advice available. All wards and departments display a wide variety of information for patients and visitors. Where appropriate patient information developed by national support groups, national organisations, charities and clinical networks is offered e.g. Macmillan, British Heart Foundation, Diabetes UK etc. This is a positive way to inform patients about such groups, to use resources well and make use of specialist information. A wide range of local patient information leaflets are also available within wards and departments and on the Trust s website. A wide range of information is also available for patients on the NHS Choices website. The PALS office and the Trust s Carers Lead are also able to provide information and contact details for other healthcare services that are available for patients and their carers. Clinical department pages on the Trust s website include links to relevant national organisations and support groups. Patient Experience Annual Report Page 20

22 Measuring our success Key: On, or exceeding, target Maintaining or limited progress made Not on target to achieve Ambition Progress towards target 2019 Target National Inpatient Survey response to admission date to hospital not changed National Inpatient Survey response to patients knowing when their discharge will be 9.2/10 9.2/10 9.1/10 9.4/10 6.9/10 6.6/10 6.8/10 7.5/10 National Inpatient Survey response to delayed discharge from hospital 5.0/10 5.1/10 5.1/10 6.5/10 Proportion of outpatients who would recommend our Outpatients to their friends and family 92.75% 94.57% 95.29% 94.00% Number of complaints regarding delays in treatment/appointment Number of complaints received regarding cancellation of appointments/clinics Patient Experience Annual Report Page 21

23 Ambition Progress towards target 2019 Target National Inpatient Survey response to patients understanding answers to questions from doctors 7.8/10 8.1/10 8.1/10 8.5/10 National Inpatient Survey response to patients understanding answers to questions from nurses 8.3/10 8.0/10 7.9/10 8.8/10 National Inpatient Survey response to patients being involved as much as they wanted to be in decisions about their care and treatment. 7.3/10 6.8/10 7.1/10 7.8/10 Number of responses to the Friends and Family Test survey 53,141 77,707 86,307 65,000 Patient Experience Annual Report Page 22

24 Ambition Progress towards target 2019 Target National Inpatient Survey response to patients having enough emotional support from staff 6.7/10 6.8/10 6.4/ /10 National Inpatient Survey response to patients having enough help from staff to eat their meals 6.0/10 7.5/10 6.3/10 8.0/10 National Inpatient Survey response to patients overall rating of their experience 7.8/10 7.6/10 7.8/10 8.3/10 National Inpatient Survey response to patients feeling well looked after by hospital staff Number of complaints regarding medical care 8.5/10 8.5/10 8.6/10 9.0/ Number of complaints received regarding nursing care Patient Experience Annual Report Page 23

25 Conclusion We aim to provide our patients and their carers with the best possible experience while they are using our services. We know that involving patients and their carers in decisions about their care and treatment leads to improved patient experience and this is why putting our patients first is one of the Trust s core values. = This report shows that there are many successes and areas of good practice to be celebrated but that we still have much more work to do. The Trust is now well placed to deliver real improvements not only in the quality of services provided by our staff, but also in how those services are experienced by our patients and their families/carers. We will continue to strive to improve the care and treatment that we provide to our patients and look forward to the challenges ahead. John Gilham Chair of Trust Patient Experience Committee Liz Lees Acting Director of Nursing and Patient Experience Carolyn Fowler Deputy Director of Nursing Education, Research & Patient Experience Jenny Pennell Project Manager Nursing & Patient Experience Kim Clarke Complaints/PALS Manager Patient Experience Annual Report Page 24

26 Facts and Figures Appendix 1 National Patient Experience Surveys In 2016 the Care Quality Commission (CQC) consulted on proposals to change the approach to the survey programmes. The changes were proposed to improve the coverage, frequency and value of the data collected. Key outcomes of the consultation are: Pilot approach to discontinue the Outpatient survey as a separate survey and incorporate relevant questions into the adult inpatient survey. Review the Accident and Emergency survey to include all relevant urgent care services. Run the Children and Young People s survey regularly. Run the A&E, Children and Young People s and Maternity surveys on rotation every two years. Implement new approaches to improve the response rates across all surveys. Review bringing forward parts of the publication process to allow trusts to develop action plans sooner. National Inpatient Survey 2016 The annual survey of adult inpatients is undertaken in all NHS acute hospitals and results published by the Care Quality Commission. Adult inpatients were asked what they thought about different aspects of the care and treatment they received. Survey month Report received Response rate No. % July 2014 April July 2015 June July 2016 May Note: In 2015 the national survey sample size increased from 850 to 1250 patients. Inpatients were asked what they thought about different aspects of the care and treatment they received. The survey is divided into 11 sections and a score out of ten allocated for each question and section. Each trust is assigned a category showing whether their score is better, about the same or worse than most other trusts. Section Emergency department Worse Same Same Same Same Same 2 Waiting list and planned admissions Same Same Same Same Same Same 3 Waiting to get a bed on a ward Same Same Same Same Same Same 4 The hospital and ward Worse Worse Same Worse Same Same 5 Doctors Worse Same Same Same Same Same 6 Nurses Same Same Same Same Same Worse 7 Care and treatment Same Same Same Same Same Same 8 Operations and procedures Same Same Worse Same Worse Same 9 Leaving hospital Same Same Same Same Same Same 10 Overall views and experiences Same Same Same 11 Overall experience Same Same Same Same Same Same Patient Experience Annual Report Page 25

27 Compared to other Trusts: The Trust scored about the same as other Trusts for 58 questions in the 2016 inpatient survey. There were seven questions where the Trust scored worse than other Trusts:- Did you know which nurse was in charge of looking after you? (new question) Do you feel you got enough emotional support from hospital staff during your stay? Discharge delayed due to wait for medicines/to see doctor/for ambulance How long was the delay? Did a member of staff tell you about medication side effects to watch for when you went home? Did hospital staff take your family or home situation into account when planning your discharge? Did you see, or were you given, any information explaining how to complain to the hospital about the care you received? Comparing ENHT 2015 and 2016 survey results the Trust scored about the same for 57 questions and significantly worse for three questions: Did you get enough help from staff to eat your meals? After you used the call button, how long did it usually take before you got help? Did a member of staff tell you about medication side effects to watch for when you went home? National Cancer Survey 2016 A number of significant changes were made to the 2015 survey so the national reports do not include any comparisons with previous survey results. It is anticipated that there will be few changes to the questionnaire going forward so in future it will be possible to compare results year on year. The CQC standard for reporting performance based on expected ranges has been used in the 2015 report. This means that Trusts are only flagged as outliers if their scores fall above or below the range of scores that would be expected for Trusts of the same size. The survey was sent to adult patients (aged 16 and over) with a primary diagnosis of cancer discharged from an NHS Trust after an inpatient episode or day case attendance for cancer related treatment in the months of April-June In this Trust 462/669 patients responded to the survey a response rate of 69% (66% nationally). ENHT results No of Questions Score above expected range 0 Score within expected range 35 Score below expected range 15 Questions scoring below expected range: Q. No. ENHT Score National average score 1 Saw GP once/twice before being told had to go to hospital 6 Length of time waiting for test to be done was about right Given complete explanation of test results in understandable way. 10 Completely understood explanation of what was wrong Possible side effects explained in an understandable way Patient Experience Annual Report Page 26

28 Q. No. ENHT Score National average score 14 Practical advice and support in dealing with side effects of treatment 29 Patient had confidence and trust in all doctors treating them 35 Patient was able to discuss worries or fears with staff during visit 38 Given clear written information about what should/should not do post discharge 42 Doctor had the right notes and other documentation with them 44 Beforehand patient had all information needed about radiotherapy treatment 47 Beforehand patient had all information needed about chemotherapy treatment 56 Overall the administration of the care was very good/good 57 Length of time for attending clinics and appointments was right. 59 Patient s average rating of care scored from very poor to very good There are six questions included in phase 1 of the Cancer Dashboard developed by Public Health England and NHS England. The questions were selected in discussion with the national Cancer Patient Experience Advisory Group and reflect the key patient experience domains (provision of information, involvement in decisions, care transition, interpersonal relations, respect and dignity). ENHT scored in the expected range for all of these questions: Patient involved as much as they wanted to be in decisions about their care and treatment. Patient given the name of the Clinical Nurse Specialist who would support them through their treatment Patient found it easy to contact their Clinical Nurse Specialist Patients said that overall they were always treated with dignity and respect by staff Patients said that hospital staff told them who to contact if they were worried about their condition or treatment after they left hospital Patients said that they thought the GPs and nurses at their general practice definitely did everything they could to support them while they were having cancer treatment. Asked to rate their care on a scale of zero (very poor) to 10 (very good) patients gave an average rating of 8.5, this is below the expected range for the Trust and below the national average of 8.7. The Cancer Division patient experience action plan has been reviewed in light of these results. Patient Experience Annual Report Page 27

29 Voluntary Outpatient Survey 2016 (undertaken by Picker Institute) The voluntary Outpatients survey was carried out with adult patients attending an outpatient appointment during the month of February patients were surveyed. ENHT response rate was 45% (average of other Picker Trusts was 48%). There were a total of nine NHS Trusts who took part in this voluntary survey: East and North Hertfordshire NHS Trust Cambridge University Hospitals NHS Foundation Trust Gloucestershire Hospitals NHS Foundation Trust Guy's and St Thomas' NHS Foundation Trust Imperial College Healthcare NHS Trust The Christie NHS Foundation Trust The Mid Yorkshire Hospitals NHS Trust The Royal Marsden NHS Foundation Trust Weston Area Health NHS Trust A total of 40 questions were used in the 2011 and 2016 outpatient survey. Compared to the 2011 survey ENHT shows no significant difference on all 40 questions. Compared to other Picker Trusts (8 Trusts who carried out this survey): ENHT was similar to the Picker average on the majority of questions (52 questions), better for one question and worse for 21 questions. The following questions are those identified by patients as having the most room for improvement. Making improvements in these areas would significantly improve patient experience for a large proportion of patients: Patient not told why they had to wait Other patients could overhear discussions with receptionist Not given choice of appointment time Patient waited for longer than they were told, or were not told how long the wait would be Do not always see the same doctor or member of staff Not fully aware what would happen during appointment Patient not told fully about side effects of medications Patient not fully involved in decisions over best medication Nobody apologised for the delay when waiting to be seen Appointment started more than 15 minutes after stated time The Clinical Support Services Division have reviewed their patient experience action plan in light of these results. Key actions include: Ensuring patients are informed about any delays in appointments and that information is updated on a regular basis by the clinic nurses whilst patients are waiting for their consultation. Senior staff will be undertaking spot check visits to clinics to ensure that information boards are kept up to date and that patients have been kept informed about waiting times. Nursing staff and clinic clerks have developed better communication and present a more aligned, informed approach ensuring the same waiting time information is given to all patients at check in and throughout their wait. Planned re-launch of customer care training programme for Outpatients staff with focus on new staff members to help improve communication. The Outpatients Steering Group, with support from Four Eyes Insight are currently looking at the clinical pathways which includes reducing waiting times in clinics and improving the patient experience in the Outpatients Department. Patient Experience Annual Report Page 28

30 Meridian Surveys The Trust continually monitors feedback from patients and uses this feedback to make changes and improvements to the services it provides. An electronic patient survey system is in place called Meridian which enables patients to provide feedback by completing a survey on a simple electronic device (i-pad) whilst they are in the hospital, or on a paper survey if preferred. During , 23,921 patients completed one of our surveys (excluding the Friends and Family Test survey) an increase from 19,605 surveys completed in Meridian Surveys No. completed No. completed Inpatient 9,685 11,954 Maternity 2,946 3,031 Day Case 2,374 3,679 Outpatients 1,993 2,123 Renal Dialysis Unit 1,016 1,278 Discharge Accident and Emergency Assessment Neonatal Unit Critical Care Community Respiratory - 45 TOTAL 19,605 23,921 Each month around 1,000 patients complete our inpatient survey whilst on the ward. This enables the Trust to monitor feedback month by month and address any areas of concern. The questions asked within the inpatient survey are: Respect and Dignity Did you feel you were treated with respect and dignity while you were in the hospital? Control pain Do you think the hospital staff did everything they could to help control your pain? Involved in decisions Were you involved as much as you wanted to be in decisions about your care and treatment? Discuss worries & fears Did you find someone on the hospital staff to talk to about your worries and fears? Emotional support Do you feel you got enough emotional support from hospital staff during your stay? Noise at night - staff Were you ever bothered by noise at night from hospital staff? Noise at night - patients Were you ever bothered by noise at night from other patients? Call button response How many minutes after you used the call button did it usually take before you got the help you needed? Rate hospital food How would you rate the hospital food? Help to eat meals Did you get enough help from staff to eat your meals? Clean room/ward In your opinion, how clean was the hospital room or ward that you were in? Understand answers from When you had important questions to ask a nurse, did you get answers nurse that you could understand? Understand answers from When you had important questions to ask a doctor, did you get answers doctor that you could understand? Enough nurses on duty In your opinion, were there enough nurses on duty to care for you in hospital? Know nurse looking after Do you know which nurse is in charge of looking after you? (this would be a different person after each shift change) Well looked after by staff During your time in hospital, did you feel well looked after by hospital staff? Patient Experience Annual Report Page 29

31 The following chart shows a comparison of the inpatient survey results between to : Questions added 2014 & 2016 In there was a decrease in satisfaction from patients who were bothered by noise at night from other patients. There were improvements in patients reporting there were enough nurses on duty and rating patient food. Friends and Family Test The Friends and Family Test question is asked of inpatients/day case, maternity, accident and emergency and outpatients. Patients are asked how likely are you to recommend the ward/department/service to friends and family if they needed similar care or treatment. The question must be asked at or within 48 hours of the patients discharge from hospital. The Trust s FFT results for all elements are reported as the percentage of patients who would/would not recommend the service. The NHS England Friends and Family Test (FFT) guidance has been updated to meet the new Accessible Information Standard which places a legal responsibility on providers of NHS funded services to ensure that people with a disability, impairment or sensory loss get information they can access and understand, and any communication support that they need. An easy read version of the FFT survey is offered to people (with appropriate support if needed) who have dementia, learning disability, are profoundly deaf, deafblind, blind/vision loss, have little or no English or low levels of literacy. Guidance is available for staff offering the FFT survey to patients with dementia or a learning disability. The FFT survey is also available on the Trust s intranet and website as a short video clip translated into British Sign Language and translated into different languages. Patient Experience Annual Report Page 30