Feedback, Comments, Concerns and Complaints 2016/17

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Feedback, Comments, Concerns and Complaints 2016/17 1

Contents Introduction 3 Encouraging and Gathering Feedback 5 Encouraging and Handling Complaints 8 Our Culture of Learning from Feedback, Comments, Concerns and Complaints 9 Improvements to services 11 Accountability and Governance 13 Participation Standard Self Assessment 14 2

1 Introduction During 2016/17, the Scottish Ambulance Service was able to demonstrate significant progress towards the strategic objectives in its five year strategy: Taking Care to the Patient. For example, we announced that we would train 1,000 new paramedics over the next five years. During 2016/17, we recruited 254 technicians, we trained193 paramedics. We also recruited 82 specialist paramedics, with 51 of them completing their specialist training in this period. Specialist paramedics are now working as part of a multi-disciplinary team in some GP surgeries in both urban and rural communities to help meet the changing needs of patients. There are a number of benefits in this new way of working: for example, helping keep patients who can be cared for safely in their own homes in their own community, and thereby avoiding unnecessary attendances at hospital. We recognise that the development of our workforce is vital, as we continue to enhance partnership working to support the wider NHS healthcare system, and we have been developing clinical roles for patient facing staff to support the delivery of our 2020 strategy. We have also provided additional investment in the development of clinical advisors in our Ambulance Control Centres (ACCs) and are supporting frontline managers to make more time for supporting frontline staff to improve their work experience and the care experience of our patients. We have now rolled out imatter, the NHS Scotland staff engagement tool, across the Service which is helping improve staff engagement. In November 2016, we began a 12 month pilot of a new way of triaging patients, designed to get the right help to patients at the right time. Prior to starting the pilot, we were able to look at a similar change by the Welsh Ambulance Service and learn how the changes made have improved patient care. Three other English Ambulance Services and Trusts have adopted similar models, providing more opportunities for shared learning across each organisation. The Service continues to have regular discussions with English and Welsh partners to accelerate learning. A comprehensive public awareness campaign helped build awareness of the new way of working, which was complemented by a series of sessions at local Patient Public Forums (PPF) to speak to remote, rural, island and urban communities about how the new model works. We were able to reassure PPF participants that this service development is underpinned by an extensive review of clinical evidence and describe what the new model would mean for patients experiencing immediately life-threatening and non-life threatening emergencies. In addition, people were able to ask What Does It Mean for Me? questions. People were particularly interested in the independent evaluation of the pilot, and we have committed to PPFs that we will share the results of the independent evaluation at the end of 2017. We also continued to enhance our digital capability in 2016/17. We started the second phase of a programme to upgrade the technology on emergency ambulances as part of our longer-term strategy to deliver clinically focused, high quality care to patients This programme is upgrading the current electronic patient record system and providing software to support clinical decision-making. For example, work started on developing and testing an application which will provide staff with immediate access to clinical guidelines, hospital guides, standard operating procedures, major incident information and local patient referral options for those patients who do not need to go to hospital and can be treated safely at home or in the local community. In addition, staff will be able to access incident reporting software inside their ambulance, which was previously only accessible from computers located on stations. Data will be automatically transferred from the vehicle to Service servers to support and 3

drive continuous audit and development of clinical practice. Further testing of the enhanced technology will be followed by a national roll-out during 2017/18. In addition to improvements in the care of patients requiring an emergency response, we have continued to review patients who require scheduled care. A scheduled care operational review group was established to look at our role in providing scheduled transport for patients in partnership with NHS territorial boards, who, in turn, have been reviewing and changing how they provide care to their patients. Many of these patients needs are increasingly complex, which is a factor in rising demand for services. This is a national programme of work, which is complex. We began testing changes to the Patient Transport Service (PTS) in our West Central Division, with input from patients, our staff and our stakeholders. As improvements are tested and refined, they will be implemented more widely to benefit more patients during 2017/18. 4

Throughout the year, we continued to gather patient and carer feedback on how we deliver services at local level. As the role of the Service has become integral to whole system working across healthcare in Scotland, patient and public involvement is increasing carried out in partnership with NHS board colleagues who have an established involvement framework across their localities. This has been helpful for patients and the public to see how the different parts of health and care fit together to care for patients and service users. In 2016/17, we reviewed our governance arrangements for both capturing patient and public feedback gathered during involvement activities, and for sharing what people told us. It was clear that while patient and public involvement is becoming a business as usual activity across our divisions, our governance arrangements were not consistent. In order to gain the maximum benefits from involvement activity, divisional improvement advisers were aligned to divisional involvement leads to help build consistency. This work has been overseen by our Patient Focus Public Involvement (PFPI) Group. 2 Encouraging and Gathering Feedback Patient Opinion We continued to promote Patient Opinion, now Care Opinion, as a helpful channel for feedback from patient and carers who do wish to provide feedback, but do not want direct contact with us about their care experience. In the course of 2016/17, there were 105 posts about care from the Service in 2016/17, which were viewed 62,298 times. This is a 46% increase on the 72 posts in the previous year, which were viewed 50,254 times. 5

While 2016/17 saw a slight increase in posts from relatives and parents/guardians, just under half the posts in both years were written by the patient, with just over a third written by a relative. The volume of posts by month differs across both years, with August seeing the biggest volume of posts in 2015/16, and January seeing the biggest volume of posts in 2016/17. While the criticality scores reflect the end to end patient experience, which may involve more than one NHS Board, overall, posts for 2016/17 were more positive than the previous year. Most posts receive a response from an operations member of staff who will be familiar with the area of the Service about which the author has posted. For example, our national head of ambulance control centres responded to posts about ambulance control centres, including posts relating to booking PTS. Profile of Patient Opinion Authors 2015/16 v 2016/17 Volume of Posts by Month 2015/16 v 2016/17 Criticality Scores 2015/16 v 2016/17 6

Of the six patient and carer experience stories shared our Board meetings during 2016/17, two came from Patient Opinion posts, with patients or carers agreeing to participate in a short film about the positive and negative aspects of their experience, and what good practice they think should be embedded across the Service, and areas they felt needed improvement. We encourage feedback during patient and public involvement. For example, the leaflets produced to describe how the new clinical response model would improve our response to patients, included information to provide feedback. Feedback from both the meetings and views and input gathered via the feedback channels on the leaflets has been fed into the project team responsible for leading the delivery of the new model. It will also be shared with the university conducting the independent review of the model. Accessibility of feedback mechanisms is reviewed regularly. While e-mail and telephone are the preferred methods for providing positive and negative feedback, people can use digital channels, such as our facebook site, if this is easier for them. We also promote the Patient Advice and Support Service (PASS) on our external communications channels. Last year 21 of our 422 complaints were made with help from PASS. This compares to 22 of our 470 complaints the previous year. Over both years, PASS complaints comprised 5% of total complaints. We actively promote PASS in the same way we promote Care Opinion, so people are aware that they can access support to make their complaint, or post their patient experience anonymously, without any direct contact from Service staff. 7

3 Encouraging and Handling Complaints During 2016/17 we received 1,276 complaints and concerns (422 complaints and 854 concerns.) This is a 1.5% increase on the 1,256 complaints and concerns (470 complaints and 786 concerns) received in 2015/16. While complaints handling follows a formal process, where the standard for a response to the complainant is 20 working days, many people contacting the patient experience team with a concern. Should any serious issues in relation to patient care have emerged during the discussion with the person who raised a concern, the concern would be logged as a complaint. The majority of people raising concerns were seeking reassurance or further explanation and information to help them understand why areas of care did not go as well as they expected. Concerns were logged following the same process as complaints, so we could monitor trends and themes in order to drive improvements to patient care. While complaints handling is co-ordinated and quality assured by the patient experience team, the complaints investigation is handled locally by operations colleagues, who will contact the complainant and staff members about the issues raised, in order to promote early resolution of the issues raised. Early conversations with complainant also help put in place a proportionate review or investigation into the circumstances which led to the complaint. Local managers have access to report functions in order to understand what is working well and areas for improvement within divisional service provision. The Patient Experience team review feedback data at national level to identify any emerging trends which might relate to systemic issues. The patient experience manager also sits on the Significant Adverse Event Review (SAER) Group to ensure complaints themes are cross-referenced against SAERs. He is also a member of the UK National Ambulance Service Patient Experience Group (NASPEG) which enables us to look at the patient feedback we receive in the context of other UK ambulance services and trusts. No SPSO (?) Investigation reports were laid before Parliament in 2016/17, compared to one SPSO Investigation Report laid before parliament in 2015/16. There were five SPSO Decision Reports in 2016/17, compared to eight SPSO Decision Reports in 2015/16. The SPSO upheld two complaints, with three not upheld. This compares with five of the eight SPSO complaints in the previous year, which were upheld or some elements of the complaint being upheld, with three complaints not upheld. Complaints handling compliance improved after the introduction of the compliance improvement plan in April 2016. Our compliance rate exceeded 70% in May 2016, with this performance sustained for the rest of 2016/17 reporting period. The Service continues to promote Patient Opinion, now Care Opinion, as a helpful channel for feedback, for patient and carers who do not want direct contact about their experience. There were 105 posts about care from the Service in 2016/17, which is a 46% increase on the 72 posts in the previous year. 8

4 Our Culture of Learning from Feedback, Comments, Concerns and Complaints We have made a clear commitment to ensuring the voice of our patients, their carers and the public have a say in how our services are delivered. This explicit commitment featured prominently in our corporate objectives. The first goal of our 2020 Strategy: Taking Care to the Patient commits to ensuring our patients, our staff and the people who use our services have a voice and can contribute to service design, with people at the heart of everything we do. This goal is translated into action in a number of ways. For example, our project governance documents require project boards to review patient and public involvement requirements in relation to every project to be delivered. Consideration of the patient and public involvement at the earliest stages of scoping our projects enables us to build involvement into our projects from the start. 9

10 Support for our culture of learning from feedback, comments, concerns and complaints is provided through patient and carer stories shared with our board at the start of board meetings. Our award winning, quarterly staff magazine contains an anonymised case study from a recent Significant Adverse Event Review (SAER) which is designed to share with staff where we got things wrong, and where we got things right. The experience of our patients features strongly in chief executive communications with staff. She highlights good practice in the weekly staff update and developments in patient care are a regular topic in her quarterly webcast, where staff from across the Service can put questions to her about any aspects of the staff and patient experience. Patient and carer films are shared across different parts of the Service, so staff can hear directly what matter to them, including where care could have been better, as well as what went well.

The patient experience manager has worked closely with our equalities manager to help people in protected characteristics groups, and organisations which represent people from seldom heard communities are able to give us input into service development as well as knowing how to provide positive or negative feedback and building confidence in our feedback arrangements. For example, colleagues in our West Central division have become familiar faces at a range of activities with the Muslim community. Working with Police Scotland and other organisations, they encouraged community members to consider a career with the Scottish Ambulance Service. There is more work to be done, and we are committed to increasing the diversity of our workforce to support a more inclusive approach to patient and public involvement. As part of this work, information is shared with the community on how we provide care to our patients as well as work to build staff understanding on cultural considerations when responding to emergencies experienced by our patients from minority ethnic groups. Compliments The Service recorded 633 compliments during 2016/17, compared with 628 compliments in the previous year. Attitude and behaviour was the most common theme in positive patient feedback, with praise for clinical skills and teamwork also common. We continue to highlight positive feedback from patients and carers though our internal communications channels, such as the chief executive s weekly update, and through promoting good news stories in the media. We also recognise our staff and our volunteers, who go above and beyond for patients at our annual staff and volunteers awards, and encourage staff to promote staff recognition in other ways: for example, through nominations for the Scottish Health Awards. 5 Improvements to Services Complaint and Concern Themes and Trends Accident and Emergency Attitude and behaviour continues to be the most common theme from complaints and concerns, up 16% year on year. Patient and carer stories about the importance of positive attitude and behaviour have been shared with the HR and OD team, for incorporation into the wider HR and OD plan, including positive patient and carer feedback to help embed good attitude and behaviour. Staff contributions to developing and implementing their imatter actions plans, designed to improve the work experience of our staff, should improve our staff experience and help reduce these types of complaints. In addition to our workforce development activity and recruitment programme, the Service worked with staff and their representatives to develop local solutions in response to pressure points, for example in the North East of Scotland. This has included building co-responding partnerships with GPs and other public bodies, such as Scottish Fire and Rescue Service and Police Scotland to help reach patients quicker and save more lives. Complaints and concerns about delayed response saw an overall increase, with a significant increase in quarter three. Overall, complaints and concerns about clinical assessment, however, have decreased by 33%. These themes will continue to be monitored as the new clinical response model continues to be refined to meet the needs of patients with the right resource at the right time. In addition, the continued expansion of our Community First 11

Responder Schemes (CFRS) and the introduction of co-responder models with the Scottish Fire and Rescue Service and Police Scotland has improved our rates of return of spontaneous circulation (ROSC) which means more people experiencing an out of hospital cardiac arrest are arriving in hospital with a pulse and prepared for care by cardiac specialists. Our CFRS and co-responding models with other organisations are particularly helpful in maintaining resilience in remote, rural and island communities. Accident and Emergency 2015/16 v 2016/17 (includes Ambulance Control Centres) Patient Transport Service (PTS) 2015/16 v 2016/17 (includes PTS Control) While 2016/17 saw decreases in complaints and concerns about staff attitude and behaviour in relation to PTS, and in relation to cancellations and delays in getting patients back home, there was an increase in complaints and concerns about late pick up and missed appointments. These feedback trends were shared with the Scheduled Care Operational Review Group (SCORG) which has been testing improvements on how PTS can better meet the needs of patients requiring support with clinical or mobility issues in getting to and from hospital appointments safely and punctually. 12

6 Accountability and Governance We ensured patients and carers continued to have access to a range of feedback options for providing feedback to the Service. Complaints handling is co-ordinated by the Patient Experience team, with each complaint looked into at divisional level to drive improvement at local level, while identifying systemic issues at national level. Our patient experience manager is a practising paramedic. He is able to identify any potentially serious clinical complaints quickly. He also quality assures complaints investigations before our chief executive reviews them and responds in writing to complainants. Complaints trends and themes are shared in a patient experience paper which is a standing item at our Clinical Governance Committee meetings and our public board meetings. This enables members of our Clinical Governance Committee and our Board to review emerging feedback and complaints themes and trends and hold individuals and groups to account for addressing areas for improvement and for embedding good practice. Complaints Compliance We failed to meet the compliance standard for complaints handling in 2015/16. An action plan to improve complaints compliance was introduced in April 2016. In addition to regular reviews of complaints compliance during divisional reviews, the patient experience manager continued to work closely with operations colleagues at all levels, including the Operations Management Team (OMT) to improve the speed and quality of complaints handling. This included his personal involvement in improvement activity, for example, by attending divisional management team meetings to help resolve issues in relation to speed and quality of complaints handling, and running a joint training session with the SPSO for complaints handling colleagues in operations colleagues. This helped build complaints handling capability across operations and a further joint training session is planned for 2017/18. Performance against NHS Scotland Complaints Handling Standard 13

Scottish Public Services Ombudsman (SPSO) Further work is still to be done on improving the quality of complaints investigations and responses. Nevertheless, one indicator that the quality of complaints handling is improving is the year on year reduction in complaints investigated by the Scottish Public services Ombudsman (SPSO.) There were no SPSO Investigation reports laid before Parliament in 2016/17 and there was a year on year reduction in SPSO Decision Reports in 2016/17 from eight to five. The table below compares the volume and outcomes from SPSO Decision Reports closed during 2016/17. No Investigation Reports were laid before Parliament during this period. 7 Participation Standard Self Assessment Based on the evidence provided in the annual report above and the summary below, the Scottish Ambulance Service considers that we have achieved level three in Section 1 of the Participation Standard. Based on the evidence provided in the annual report above and the summary below, the Scottish Ambulance Service considers that we have achieved level two in Section 3 of the participation Standard. Summary to support self assessment in Section 1 We continue to build relationships with people from protected characteristics groups in order to help them understand how they can access accident and emergency care, and support from the Patient Transport Service. During 2016/17, we continued our visits to Mosques in the West of Scotland. This year, we increased our focus on health awareness and Cardio Pulmonary Resuscitation (CPR) in addition to recruitment advice. During our visits, we have been able to talk about the services we provide, how services are developing to meet patient needs: e.g. the development of care pathways which are helping patients stay at home in their communities, with the appropriate local care and support in place. We have also been able to listen to 14

concerns about treatment procedures which are at variance with the community s cultural practices. Feedback from these discussions has been positive, with community members reassured that staff will provide care in a sensitive and dignified manner. We have also attended events with Muslim charities, providing information on how to access our services and provide recruitment information. We also participated in integration events with refugees to help build awareness of the services we provide and build relationships with refugee communities. We participated in Patient Public Forums across Scotland to help build public awareness of our new clinical response model, including Shetland, North Lanarkshire, South Lanarkshire, Grampian, Tayside, Forth Valley, Moray, West Dunbartonshire and the Western Isles. Non executive members of our board were invited to attend these sessions to hear first-hand the views of attendees. Non-executive board members attended PPFs in Forth Valley, North Lanarkshire and the Western Isles. Feedback from all of the PPFs has been shared with the new clinical response model project team at regular intervals. It will also be provided to the independent evaluation body, who will report on the 12 month pilot before the end of 2017. The patient experience manager has worked closely with operations colleagues to help promote the voice of our patients in developing services and improving our patient experience. This included working jointly with the Scottish Public Services Ombudsman to jointly deliver a training package on the power of an apology to improve complaints handling. Speed and quality of complaints handling improved in 2016/17, with complaints compliance above 70% of most of the year. We also saw a reduction in the number of complaints investigated by SPSO, indicating that the quality of complaints investigations and responses has improved. Other partnership working across the Service included patient involvement in the development of the tender specification for our new Patient Transport Service ambulances. A number of patient representatives, including members of the Renfrewshire Access Panel were invited to a workshop in June 2016, where they could look around our different configurations of Patient Transport vehicles to help develop the tender specification of the next fleet of Patient Transport ambulances. Summary to support self assessment in Section 3 Our PFPI Group met in May, August and November 2016 and in February 2017. The February meeting included a workshop to review a revised terms of reference for the group, which was designed to broaden patient representative participation from the group, by enhancing the opportunities to work with us, both directly as a member of the PFPI Group; or through participation in a reference group which could be constituted to look at a range of issues. These might be related to how care is provided in a specific geographical area, or to a specific patient group, or service development at national level. Patient Experience papers are standing items at our Clinical Governance Committee, which meets quarterly. The Committee scrutinises how we gather and respond to patient feedback, and how we evidence improvement in patient care. Within this paper, the committee also receives an update on all open SPSO cases, complaint themes and mitigating actions. 15

A Person-centred Care Update paper also is a standing item at our Scottish Ambulance Service Board meetings. Our board meetings begin with a film of a patient or carer experience which highlights good practice and areas for improvement. Again, this enables Board members to ask questions about the issues or good practice which were raised in the film and seek assurances that mitigating actions are in place to address the themes raised, or embed the good practice which mattered to the patient or carer. With the permission of the patient or carer, these films are shared across the Service to help promote a learning culture. In order to share and gather good practice from other health professions and from other ambulance services and trusts, we continue to participate in the person-centred collaborative to help accelerate learning and work in partnership with other NHS Boards to engage with patients to understand what matters to them. We are also members of the UK-wide National Ambulance Service Patient Experience Group (NASPEG) which helps us work with other ambulance services and trusts to improve our governance arrangements and to improve our patient experience. 16

Contact us Patient Experience Team Corporate Affairs and Engagement The Scottish Ambulance Service 1 South Gyle Crescent Edinburgh EH12 6AB 0131 314 0000 Scotamb.complaints@nhs.net www.scottishambulance.com