Integrated Patient Experience Report for Q3 and Q4 Report for the AWP NHS Trust Board. Serial:

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1 for Q3 and Q4 Report for the AWP NHS Trust Board Meeting Date: Meeting Time: Agenda Item: Serial: : This Report is presented by the Executive Director of Nursing, Compliance, Assurance and for Information in the Public session of the Board. Purpose of this Report: Report Summary To provide the Board with clear information and evidence relating to the patient experience across the Trust using this information to identify: Trends Learning Actions taken Planned improvements Ongoing challenges This format of this report is subject to ongoing refinement and future reports will clearly demonstrate triangulation between the information supplied through reports such as this, and contributions which demonstrate the experiences of service users in the quality of services received. Board Decisions Recommended: The Board is recommended to receive the report and note progress. To discuss the issues identified and advise on any areas needing further actions. Quality and Safety Implications of the Report: Improving the patient experience to ensure safe high quality person centred services for all. Actions Arising from the Report: Implementation of the actions identified as a result of the learning from triangulating service user and carer feedback. ALE 5.2.2, 5.2.5, 5.2.8, CQC 1,5,6,10 and 17 Report Links Report Sponsor: Executive Director of Nursing, Compliance, Assurance and

2 IG Toolkit NHS Constitution Appendices 2a patients and the public your rights and pledges Access to healthcare Quality and care environment National approved treatments Respect, consent and confidentiality Involvement in your healthcare and the NHS Complaints and redress Appendix 1: Complaints and outcomes by SBU 2011/11 Appendix 2: Percentage of cases by the five dimensions of care for PALS and Complaints by quarter from 1 st April 2008 to 31 st March Appendix 3: Breakdown of Complaints and PALS by SBU for 2010 to 2011 by quarter. Appendix 4: Actions taken on issues covering the five dimensions of care, identified by PALS and Complaints from 1 st April to 31 st March Appendix 5: Examples of praise received by PALS during Quarter 4 (1 st January to 31 st March 2011). Appendix 6: Progress on Community and Inpatient surveys improvement plans. Appendix 7: Incidents and near misses information Agenda Item: 009 Serial: Page 2 of 25

3 1. Overview 1.1. The purpose of the Integrated Patient Experience report is to provide the Board with clear information and evidence relating to the patient experience across the Trust. The information and evidence is drawn from a range of sources including:- PALS and Complaints Praise received National and local surveys Independent inspections by Care Quality Commission (CQC) Mental Health Act (MHA) visits and Local Involvement Network (LINks) visits. Incidents and near misses 1.2. The information from these sources is used to provide both a baseline position and the identification of trends and emerging concerns. The quality of this information will continue to improve as more consistent triangulation is introduced. At this stage, triangulation is drawn from PALS, complaints and surveys. However, future reports will draw on the full range of available evidence, including Trust performance scorecard, CQC visits, thematic reviews, Patient Opinion and NHS Choices Using the information sources identified above, the report informs the Board on:- Trends Learning Actions taken Planned improvements Ongoing challenges This report should be seen in the context of the range of other Board reports and Trust activity that highlight the progress, achievements and improving outcomes for patients, service users and carers that the Trust and its staff are routinely delivering, as set out in the Trust Performance Management Strategy. This format of this report is subject to ongoing refinement and future reports will clearly demonstrate triangulation between the information supplied through reports such as this, and contributions which demonstrate the experiences of service users in the quality of services they receive. 2. PALS and Complaints analysis and discussion Agenda Item: 009 Serial: Page 3 of 25

4 2.1. There were 1019 PALS enquiries (excluding praise) and 230 complaints in 2008/2009, 1576 PALS enquiries and 252 complaints in 2009/2010 and 1688 PALS enquiries and 305 complaints in 2010/ PALS and Complaints are well publicised both internally and externally and, as expected, the numbers of people who have raised concerns, requested information or complaints has risen since 1 April This pattern is similar to that in other NHS trusts This rise is in line with the rise in the number of service user contacts across the Trust which has increased from 522,031 during : to 640,980 during : to 705,078 for All complaints are responded to within 25 working days. A confidential report is submitted monthly to the Executive Management Team (EMT). EMT monitors complaints referred to the Healthcare Ombudsman via the Performance Executive Management Team meeting. PALS and Complaints issues raised by the five Dimensions of Care 2.5. PALS and Complaints cases are recorded and categorised using the Department of Health five Dimensions of Care: Access and waiting; Safe high quality coordinated care; Information and choice; Building relationships; Clean comfortable place to be In the year the Trust received a total of 305 complaints. Of those, 135 (44%) were either upheld or partly upheld. The table in Appendix 1 provides a breakdown of these figures by SBU, for each quarter During 2010/2011, the two Dimensions of Care service users and carers have been most concerned about are: building relationships and better information, communication and choice. This is a consistent pattern over the last three years. However, in the last two quarters concerns about safe high quality coordinated care through complaints have increased. The reasons for this are being explored and will be discussed at Patient Experience, Environment and Partnership Management Group (PEEP). Appendix 2 provides a Agenda Item: 009 Serial: Page 4 of 25

5 detailed breakdown of the percentages of cases by the five Dimensions of Care for each quarter for the last three years The dimension of care with the highest percentage of enquiries over the period April 2008 to March 2011 for PALS is Information and Choice. From attendance at national and area PALS and Complaints meetings, this would appear to be in line with other PALS services nationally. In Quarters 3 & 4, over 45% of PALS Information and Choice enquiries were from people seeking further information or signposting Any one complaint may cover a number of issues, spanning more that one Dimension of Care. The trends identified for each SBU may differ from those across the Trust as a whole. The most common issues by SBU for are: Older People - access and waiting Adults - safe high quality coordinated care Specialised and Secure building relationships SDAS better information communication and choice The full breakdown of complaints by SBU for is provided in Appendix 3. The themes emerging from the issues raised are continually reviewed by PALS and Complaints and fed back monthly to the SBUs for actions to be taken Benchmarking against other mental health trusts for PALS and Complaints will be undertaken annually following the publication of their annual reports. It may not be possible to provide full benchmarking information in relation to all Trusts as Foundation Trusts are not obliged to publish this information. PALS and Complaints actions, improvements and challenges When a complaint or PALS concern indicates a potential improvement or issue in need of addressing, actions are agreed and will be implemented by the relevant ward, team or SBU. Many of these will be very specific to an individual issue. However, analysis of PALS enquiries and complaints over the last three years shows that some issues recurred despite actions taken; these were categorised as persistent. Some examples of persistent issues include: Continuity of care Confidentiality and information sharing Agenda Item: 009 Serial: Page 5 of 25

6 Staff attitudes to service users and carers Staff not acknowledging carers Medication management Lack of Aspergers service in some areas Persistent issues demonstrate the need for an SBU or trust wide response. For example, a trust wide service user discharge letter has been implemented to improve the discharge process and administration of the MHA process. This as resulted in significant improvements in the last two quarters of 2010/ Detailed information on persistent concerns and the actions or solutions that will address them are shown in the table in Appendix 4. This table shows where previously persistent concerns have begun to improve. It also shows areas that are improving over time but may still need monitoring. New, emerging concerns are also noted. 3. Praise analysis and discussion 3.1. Praise from service users and carers is a valuable source of evidence on the patient experience. Wards and teams forward praise to PALS for recording. In 2010/2011, 687 items of praise were received directly from wards and teams Praise is also received through the Trusts via national and real time surveys, for example, there were 730 positive comments (from a total of 1623 responses) received from adults and older people with the Community Mental Health Survey and 55 positive comments (from 133 responses) with the Adult Inpatient Survey Examples of items of praise received through PALS and surveys are provided in Appendix Feedback from national and local surveys and plans for improvement 4.1. Trusts are required by the Department of Health to carry out annual patient surveys to understand the views of people who have used health services. Feedback from national and real time surveys demonstrates where service users and carers consider their care to be good and where there is room for improvement. Agenda Item: 009 Serial: Page 6 of 25

7 4.2. The Community Mental Health Survey was carried out nationally from 2003 to In 2009, the national survey was an Inpatient Survey following which the national survey reverted to the community mental health survey. The Trust has continued to carry out both surveys. The Community Mental Health Survey provides feedback for the Adult and Older Peoples SBUs, while the Inpatient Survey provides feedback for Adults The basic sample size for the Community Mental Health Survey is 850. The Trust chose to send this survey out to one in three service users for the last two years to provide us with data, enabling internal benchmarking by area to be carried out The Trust has chosen to repeat the inpatient survey each year. This means that all adults who were admitted to inpatient units in 2010 will have had the opportunity to give their views about their care The national Community Mental Health and Inpatient Surveys provide feedback on: Community Mental Health Survey Care and Treatment Health and Social Care Workers Medications Talking therapies Care Coordinator Care Plan Inpatient Survey About the Ward Hospital Staff Care and Treatment Service Users Rights Leaving Hospital Overall Care Review Day to Day Living Crisis Care Overall 4.6. In response to concerns raised by service users and carers in surveys, actions are put in place locally and SBU improvement plans are developed to address key areas and improve the quality of care. Progress is monitored through PEEP. See Appendix 6 for details of Agenda Item: 009 Serial: Page 7 of 25

8 progress to date on improvements made in the Adult and Older Peoples SBUs In line with other Trusts, we have developed a process to elicit service users views on a monthly basis. These are known as real time surveys and the results will be shared in future Board reports by means of a patient experience dashboard Real time surveys provide feedback for all SBUs from both inpatients and service users in the community. In the Older Peoples SBU, the inpatient survey has been adapted in an innovative way to enable organic patients to give their views. Questions are focussed on issues arising from national survey feedback Real time surveys enable current concerns to be responded to immediately by staff, as they are undertaken monthly. In the Specialised and Secure SBU, the results are displayed for service users on notice boards within two weeks of the survey taking place. Improvements are monitored through the feedback from service users in subsequent real time surveys. This approach is now being replicated across the Trust by all SBUs Benchmarking of Specialised and Secure results for the last year demonstrate improvements for most questions. Initial results from SDAS also indicate an improving picture. 5. Independent inspections Mental Health Act Visits 5.1. There have been 10 CQC Inspection visits (associated with the Mental Health Act) in Q3, and 12 in Q4, totalling 22 for the two quarters. All of these were to inpatient teams in Older People (7), Adults of Working Age (7) and Specialised and Secure Services (8). These visits raised a range of issues on an individual basis from each inspection. The visits continue to show that common issues raised are consistent with the CQC Annual Reports on the application of the MHA in AWP. All inspection reports from the CQC were considered by the relevant team, and action plans reviewed by the relevant SBU Clinical Director and NCAS Directorate before return within the prescribed timescales. In January, at their meeting with the Mental Health Legislation Committee (MHLC), the CQC noted the significant improvement in the return by AWP of action plans arising from inspection visits in 2010/ The issues which arise most consistently from these inspection visits are: Ward fixtures and environment (including cleanliness) Agenda Item: 009 Serial: Page 8 of 25

9 Section 58 (consent to treatment and appropriate documentation) Section 17 (leave) There has been a significant improvement in the instances of issues around Section 132 (patients rights) since the previous report, due to the administration of the MHA process being subject to an action plan monitored by the MHLC. Local Involvement Network Inspections 5.3. No LINk visits were undertaken during this period. An informal visit by Wiltshire Involvement Network to Charterhouse in Trowbridge is scheduled for April Incidents and near misses 6.1. Overall, projected incident numbers suggest a slight reduction this year (2010/11), though this position may yet change. See Table 1 in Appendix 6 for annual figures According to national benchmark data, AWP is currently 33 rd out of 57 mental health trusts in terms of reporting number. The Trust s benchmark position for incident report is difficult to read from the NRLS reports as they do not provide raw data, but overall it appears the Trust has improved its position with regard to its ranking amongst other mental health trusts on the previous year. A breakdown of annual rankings from October 2007 onwards can be seen in Table 2 Appendix Incidents are ranked by type and there can be more than one type of incident for each event. Overall, violence and aggression remains the most prevalent incident. See Table 3 Appendix 6 for details of ranking of incidents by case. SBU data shows that the exception is the Older People s SBU, where personal injury is the most common occurrence Risk rating percentages remain broadly consistent year on year. See Table 4 Appendix 6 for the breakdown of annually report risk rating Serious incidents are reported externally to the Strategic Health Authority and Lead Commissioner. The definition of incidents for external reporting has changed over time and therefore, monthly comparisons need to be treated with care. Table 5 in Appendix 6 shows external reports by PCT area. Agenda Item: 009 Serial: Page 9 of 25

10 7. Recommendation The Board is asked to: Receive this report and note progress made; 7.2. Discuss key issues identified in this report; 7.3. Advise on any areas needing further actions. 8. Author and Additional Report Contributors Alison Griffin, Head of Engagement and Responsiveness contact number Linda Hutchings, Head of Risk and Compliance contact number Agenda Item: 009 Serial: Page 10 of 25

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14 Appendix 4 Actions taken on issues covering the five dimensions of care, identified by PALS and Complaints from 1 April 2008 to 31 March 2011 Dimension Access and waiting Service not provided - no commissioned Aspergers services in the area. Potential discrimination figures are Persistent (P) or Improving (I) P What s been done /potential solution Awaiting commissioning decisions for areas where no current AWP provision. Further information required. currently low but gradually increasing Appointments cancelled I Service Redesign plans include clear scheduling processes planned from first contact to ensure user choice and agreement of appointment times and venues, with more services offered outside of usual working hours. Monitored through performance scorecard Delays in offering service P Service Redesign plans include clear standards for service responses for assessment, recovery and intensive support Service redesign Safe high quality coordinated care Discharge process no explanation to service users, discharged without a meeting, service users don t understand concept of step up and down. New I Trust wide service user letter implemented. Service Redesign to ensure rapid reaccess to service for those users discharged within 12 months, to promote clearer step up and down support Medication no explanation of side effects, not enough time with service users. P Medicines management group to review issues. Agenda Item: 009 Serial: Page 14 of 25

15 Dimension Use of MH Act legislation relating to enforced use of medications not explained, use of restraint without debrief Requests for change of clinicians SU being ignored when request made and then not being implemented Continuity of care when staff are on leave or sick leave seasonal. Not passing information over to support service user or ensuring service user seen. CPA meetings taking place without significant consultation Lack of activities on inpatient units boredom for service users not being motivated to take up new activities available Integrated Patient Experience Report Persistent (P) or Improving (I) I I P P I What s been done /potential solution OP SBU trialling medication safes for individual service users to improve medication administration. Delivery of MHA monitored by Mental Health Legislation Committee Workgroup formed who are reviewing Policy so that staff know process throughout the Trust Service Redesign will establish new community team models with a team approach to caseload management in order to ensure that the whole team has information regarding all users rather than a single practitioner. CPA policy review and audit Service Redesign plans are for a 7 day a week therapeutic activity programme for all acute units, with Occupational Therapy and Physiotherapy support broadening to weekends and in-patient skill mixes resourced to ensure this can be occur. Information and choice Confidentiality and information sharing (this is increasing) Misleading information told things that are not followed through or P P Volunteers recruited for specific activities. Acute Care Forum review and Staff training. Consent to share information process to be reviewed. Agenda Item: 009 Serial: Page 15 of 25

16 Dimension incorrect. MH Act sectioning SU not informed of rights or what section or don t remember Integrated Patient Experience Report Persistent (P) or Improving (I) I What s been done /potential solution Administration of MHA process subject to action plan monitored by MHLC has resulted in significant improvements in the final two quarters of 2010/11. Admin errors in correspondence P RiO implementation should improve record keeping Health records - Tone of SU notes New Recovery CQUIN. Entries to be in the first person. Using strength based approach. Staff have been reminded of the importance of maintaining this improvement. Building relationships Time with service user 1:1 basis, not being treated equally staff often in office Time with staff - not communicating purpose of visit Telephone manner not returning calls, staff not giving full name, voic messages not up to date Attitude of staff as hostile, dismissive, inappropriate, rude and impatient and sometimes inappropriate comments made in public. I P P P Protected time implemented. In OP SBU notices have been placed on wards inviting carers and relatives to book time with the matron or ward manager to improve involvement and communication. Protected time implemented Service Redesign has recognised the need for significant improvement in the quality and consistency of customer service responses from first access to the service onwards. Service Redesign Customer Service improvements planned for all teams with particular focus on new contacts to the service who are least clear as to how they access support. Delays in provision of information P Improvements in patient information process. Agenda Item: 009 Serial: Page 16 of 25

17 Dimension Attitude to carers dismissive of knowledge carers have and sometimes show a lack of respect Lack of support, perceived threats of enforcing medication Integrated Patient Experience Report Persistent (P) or Improving (I) P I What s been done /potential solution Carers strategic framework action plan. Patient safety initiative to improve acknowledging and listening to carers. Carers survey being implemented to obtain further feedback. Medication group initiatives Safe clean place to be in Loss of property and lack of storage (Lost property has increased by more than 200% from 7 in Quarters 1&2 to 23 in Quarters 3&4) Concerns regarding safety have risen from 3 cases in Qtr 1 and 2 to 9 in Qtr 3 and 4. Numbers remain small and in different areas, however some concerns regarding risk factors associated with placement of electric sockets/light cords. Catering food removed from service trolley too soon. Secure services staff were unaware of the protocol. New P New New Purchase of individual safes for patients currently underway. Missing clothing being further looked into by SBU director. OP SBU considering use of new technology to prevent loss of personal possessions. A regular log book of outstanding works will be reviewed in terms of timeliness by the Ward Manager and the Estates Department, and there will be a cleaning schedule (signed by cleaners) around shower/showerheads. All ward staff will be advised of the 'display life' of meals, via poster, individual and team meetings. Service User Involvement worker looking into issues around catering in more detail. Agenda Item: 009 Serial: Page 17 of 25

18 Appendix 5 Integrated Patient Experience Report Examples of praise received by PALS during Quarter 4 (Jan to Mar 2011) Thanks for everything you ve done for Dad, as you know he s much happier and enjoying life at last, you ve been great, without you none of it would have gone so smoothly, for that dad and I are very grateful (CMHT Older People Social Worker) Thank you very much for the wonderful care you gave me during my stay in hospital (Cove Ward Long Fox Unit) A big thank you for doing a difficult job with cheerful kindness and efficiency (Ward 4 Older people) The Crisis team in Bath were excellent every member of the crisis team that visited always new my history they were all very professional and very caring (Bath Crisis Team) A big thank you, for you have managed to get me back to a place I never thought I would see again. (Older People Victoria Centre) You are both professional and consistent in your practice and very polite a useful support in terms of advice and guidance filling in forms as English isn t my parents first language it s been lovely having ethnic professionals.aiding communication. You have been a sympathetic ear and listened to our struggles. I really appreciate you both (Adults of Working Age Inner City Support and Recovery Team.) Thank you so much for your patience, encouragement and support during my time here. You made a very difficult time bearable and have greatly contributed to my currently happy life. (Elizabeth Casson House) We were therefore quite prepared for poor casual and uncaring treatment of our daughter, it was in reality quite the opposite her own private clean room and bathroom, excellent food and always wonderful smiling attentive staff, what a revelation (Fountain Way Beechlydene). Agenda Item: 009 Serial: Page 18 of 25

19 Examples of praise from the 2010 national Community Mental Health Survey I see my CPN regularly and know I can phone if I have a problem, which is good for my mental health.... there has been a consistent level of support and I have felt listened to and valued in decisions which greatly help my mood, stops me from feeling helpless... and makes me feel more pro-active in improving my own care.... my care coordinator is very good, helpful, informative, accessible and always explains things fully to me. Examples of praise from the 2010 Inpatient Survey Over half of all the praise received from the inpatient survey was about relationships with staff, including the following: They made you feel you are a person who is wanted by someone, not someone that is no good for anything. The general care I received at was very good and I felt completely at ease and safe. The staff were wonderful. Main staff were very good and attentive and listened well to concerns. Art/OT activities very helpful. General ward atmosphere was good and friendly. All staff were very good, in every way. Thank you. Examples of praise about staff received from real-time surveys Specialised and Secure Services The Ashdown nursing team are the best team of nurses that I have come into contact with since coming through 2 other hospitals. It's many years since I've met so many good, nice people. The nursing staff and domestics are incredible, they work so hard. Specialist Drug & Alcohol Services Agenda Item: 009 Serial: Page 19 of 25

20 I wasn't given up on and from here on in the level of service and care has been first class, I feel heard, understood and helped, I truly enjoy coming to my sessions of 1 to 1 and the help I received getting in to residential care was amazing. I find that staff are very good in listening and planning your own way of becoming drug/alcohol free. The workers are open minded and very aware people are different which helps you to talk / be frank and honest about problem. Adults The staff are very friendly, helpful. And as my recovery was apparent I enjoyed a joke or two with all staff. I have found the OTs very helpful and the nursing staff very good. Older People Staff always able to ask when I felt I needed some answers to any queries, always helpful and caring. I have found both the ward and OT staff very helpful. I have found that my privacy has been respected. There has been good contact between the ward staff, my support worker and my family. Agenda Item: 009 Serial: Page 20 of 25

21 Appendix 6: Progress on Community and Inpatient surveys improvement plans 2010 Community Mental Health Survey 8.1. The overall care provided by the Trust was rated as excellent or very good by 58% of the 1418 service users who responded. Benchmarked data shows that AWP scored in the top 20% of trusts for the question about staff treating service users with respect and dignity. For the full report and improvement plans, see Appendix A, B & C to the NCAS Board Report for Oct Adult SBU improvement plan The majority of the actions in the adult improvement plan for the 2010 Community Mental Health Survey have been implemented or are on track. Improvements to date include: initial appointment letters to service users have been reviewed and amended as required to make sure that staff communicate clearly about appointment times monitoring to ensure improvements to care coordination and annual care plan reviews monitoring to ensure service users know who their care coordinator is, and how to contact them when necessary improved staff awareness of information for service users about medication Older Peoples Improvement Plan - The majority of the objectives in the Older People s Community Mental Health Survey improvement plan 2010 have been achieved. Improvements include: monitoring to ensure that service users know who their care coordinator monitoring to ensure that staff offer service users a copy of their care plan and have annual care reviews improved information to ensure that the purposes and possible side effects of medications have been clearly explained increasing access to psychological therapies as part of service redesign work. Progress on all improvement plans is monitored regularly and the plans are reported to PEEP Adult Inpatient Survey 8.4. The objectives in the improvement plan for the 2010 Adult Inpatient Survey include: ensuring that staff have knowledge of previous care given to service users people s physical health needs are met on admission increasing the provision of activities on wards The majority of actions are on track to meet completion dates. An example of a completed action is that there has been an increase in the number of Agenda Item: 009 Serial: Page 21 of 25

22 service users having physical health checks within seven days of admission. 100% of service users are now screened for VTE as part of these tests. Improvement plan outcomes will be measured through Acute Care Forums and SBU IG As a result of one in three service users being sent this questionnaire, we had sufficient responses to allow us to analyse the results by area. Local plans have been developed for both surveys to ensure that issues highlighted as needing improvement in any one area are addressed alongside the trust-wide priorities. Agenda Item: 009 Serial: Page 22 of 25

23 Appendix 7 Table 1 Incidents per year from 2006/7 to 30 September / / / / /11 Incidents Near Miss Total Table 2 Report date Ranking against other Mental Health Trusts April 10 March rd (out of 57) Oct 09 March th April 09 Sept st Oct 08 March th April 08 Sept rd Oct 07 March th Table 3 Agenda Item: 009 Serial: Page 23 of 25

24 AWP type of ranking of case Reason for Incident 2006/07 Violence, Abuse, Harassment Personal Injury (Slips, Trips, etc) % 2007/08 % 2008/09 % 2009/10 % 2010/ Self Harm Security Incident Incident relating to Service User Care Medication Error Consent Fire Medical Device / Equipment Other Table 4 % Risk rating by grade and percentage Grade 2006/ / / / /11 % % % % % Red Orange Yellow Green Agenda Item: 009 Serial: Page 24 of 25

25 Table 5 External reports by PCT area PCT 2008/ / /11 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Banes Bristol N.Somerset S.Glos Swindon Wiltshire Total Agenda Item: 009 Serial: Page 25 of 25