Complaints Annual Report 1 April 2015 31 March 2016 Prepared by: Tammy Diles, Head of Patient Experience April 2016.
Contents 1. Executive Summary 2. Key Objectives Addressed during 2015/16 and objectives for 2016/17 3. Complaints 4. PALS 5. Parliamentary and Health Service Ombudsman (PHSO) 2
1. Executive Summary The Complaints Annual Report for 1 April 2015 to 31 March 2016 has been prepared in accordance with the Local Authority Social Services and NHS Complaints (England) Regulations 2009. The Trust recognises that our patients and services users have a range of experiences when using our services. It is essential that we provide people with a mechanism to feed back to us both positive and negative experiences; this will support us in being the most caring provider of healthcare. Where possible, we should take immediate action to put things right and where it is not possible it is also very important to have a robust complaints process. PALs have maintained its position with patients, public, staff and external organisations as a department that is always responsive and proactive to queries and concerns. PALs remain an effective resource in supporting patients and their representatives, and staff to respond to real time queries and concerns, putting the patient at the heart of everything it does. This has been further supported by moving the PALs Hub to the main entrance late December 2015. Feedback from patients, relatives and staff has been extremely positive regarding the move. The Complaints management team has been proactively seeking to maintain appropriate level of contact with the complainants and external agencies and to compile a response or hold being open / complaint resolution meetings that effectively address the complaint concerns on behalf of the Chief Executive. It is important that every formal complaint response is seen, scrutinised and signed off by the Chief Executive. The Trust has delivered improvements in the way complaints and concerns are managed during 2015/16 and aims to continue those improvements into 2016/17. 3
2. Key Objectives Addressed during 2015/16 The Complaints Team worked to the following objectives during the first part of 2015/16 To embed the implementation of the revised complaints process. This increases the ability of Divisions to actively oversee the successful and timely management of their complaints To launch a regular complainant s survey process to obtain feedback from complainants and make improvements By end of July 2015, to embed the practice of Divisions preparing a Group LEAP (Learning from Experience Action Plan) to capture the month s complaints learning / action themes. The Group LEAPs are saved to a central database enabling a single Divisional view of their SI and Complaints LEAP To update the complaints department work plan to reflect the need to facilitate on-going Trust improvement priorities e.g. facilitate Divisional complaints officer working across the Trust To review Trust learning needs with complaints and complainants and prepare possible training and other proposals To review Trust needs to publicise awareness concerning the prevention of complaints and meeting complainant needs Following changes in processes, systems and within the complaints leadership, some of these objectives were adapted during the reporting period to meet the needs of the complainant and department. 3. Key Objectives for Complaints 2016/17 The following objectives have been set for 2016/17: To continue to register, monitor and effectively liaise with complainant to ensure they are fully informed at all times throughout the investigation To engage and support Divisions to ensure a personalised, empathetic response within the agreed timeframe To achieve and maintain 95% compliance with responding to the complainant within the agreed timeframe To support quarterly In Your Shoes sessions to obtain and learn from patient experiences To implement the recommended actions received from PHSO Trust wide, to support cross Division Learning 4
3. Complaints The Trust continues to welcome patient feedback. There has been a continuing focus to ensure that we effectively and efficiently answer complaints and concerns in a timely manner and use this rich information to improve the services that we provide. 2013/14 2014/15 2015/16 Number of complaints 1286 1032 802 (Figure 1) There has been a steady decrease in the number of complaints received by the Trust over the last three years. This is felt to be due to the work being undertaken by the complaints team working more collaboratively with the Divisions. The most significant changes have been the introduction of the Complaints Coordinators and PALS Officers being aligned to the appropriate Division and making personal contact with the complainant to discuss the complaint, what outcome they are seeking and ensuring they follow the best practice whilst the investigation is being undertaken but maintaining contact with the complainant throughout to keep them better informed. It is important to note that the Divisions are taking better ownership of the complaints received to ensure learning is embedded for every complaint. The Chief Executive has worked closely with the Complaints team to ensure that they are quality checking letters for more empathetic and supportive responses to ensure that patients are at the heart of everything we do and supports us as an organisation to be the most caring healthcare provider. All complaints are welcomed as this supports us in making changes and learning and ensures that we are a listening provider that people are confident their issues will be heard, taken seriously and addressed all within the agreed timeframe. 5
600 Complaints By Division 2013-2016 500 400 496 417 463 361 300 249 245 200 126 132 125 108 90 100 61 66 63 51 25 32 0 (Figure 2) Clinical Support Services & Cancer Corporate Medicine Surgery Women and Childrens Urgent Care The table above (figure 2) represents complaints received by the Divisions over the last three years. There has been notable decrease in the number of complaints being received. The only exception is Urgent Care as this new Division was formed towards the end of 2014/15. Previously these complaints would have been attributed to Medicine Division. This supports 2013/2014 the work that the 2014/2015 team and Divisions 2015/2016 have been undertaking to ensure that learning from complaints is captured and used to ensure improvements are made. 5 1 Oth Health Prov 6
300 Top 3 Causes of Complaints 2013-2016 250 251 200 185 194 150 100 122 88 128 102 135 116 50 0 2013/2014 2014/2015 2015/2016 (Figure 3) Due to changes made to the Datix reporting system early 2014, subject fields were amended, therefore the three subjects for year 2013/14 no longer exist. Complaint response rate April 2015 to March 2016 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 34.1% 39.4% 63.4% 60.4% 52.4% 52.6% 53.3% 45.7% 56.9% 65.0 20.0% (Figure 4) 10.0% 7 0.0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan
The table above (figure 4) represents the complaint response time. Over the last six months the complaints team have been working more effectively and efficiently to ensure the complainant is responded to in the agreed timeframe and that they are kept fully informed throughout the investigation. 100% of complaints were acknowledged by the complaints team within three working days of receipt in 2015/16. Complaints Outcomes - Upheld/Not Upheld/Partially Uphel No Data - April 2015 to March 2016 350 333 300 282 250 200 150 186 162 100 50 (Figure 5) 0 The table above (figure 5) represents whether complaints were not upheld, partially upheld or upheld. Due to the changes on the Datix system there are 186 cases with no data. 333 were not upheld, 282 being partially upheld and 162 being upheld. No Data Not Upheld Partially Upheld Upheld Complaint Outcome 8
4. PALS 2013/14 2014/15 2015/16 Number of PALs 1243 1924 1847 (Figure 5) As the figures show (figure 5), PALs activity has been rising and the Trust has dealt with over 1847 contacts in 2015/16 including concerns and enquiries. The breakdown shows a rise of over 604 concerns and enquiries from 2013/14 to 2015/16. The increase is thought to be due to the PALs Hub which was relocated late December 2015 to the main entrance; this was reported as being very beneficial to the patient, carer and general public. Two additional PALs Officers were recruited early 2016 which has supported in recording requests for information. 9
5. Parliamentary and Health Service Ombudsman (PHSO) The Parliamentary and Health Service Ombudsman (PHSO) represents the final stage of the NHS complaints process. The Trust has been working on its relationship with the PHSO to ensure that all details are submitted in a timely manner. A complainant may contact the PHSO if they do not feel that the Trust has responded to all of their concerns, or they are unhappy with the way in which we have dealt with their complaint. The outcome of the PHSO investigation can be to uphold or not uphold the complaint, depending on whether they feel the Trust has acted accordingly or that there was a problem. The PHSO can make recommendations to ensure that the Trust learns from the complaint. Further work planned for 2016/17 will be done to promote how we use learning from PHSO cases. Action plans are being owned by the Divisions and shared at Patient Experience Group Meeting to ensure cross Divisional learning. Overall, this year the Trust has improved immensely on the way it handles and deals with issues raised by patients, relatives and carers. Work is on-going to continually improve the quality and learning from complaints and concerns. Learning is considered critical and supports the Trust to continue on its journey in improving the services and make it the most caring provider of healthcare. Being receptive to feedback, being open and transparent and less defensive means reflecting on what improvements can be made, putting the patient at the heart of everything we do. PHSO Report Data, 1 April 2015 to 31 March 2016 Cases referred to the PHSO: 24 Cases assessed by PHSO: 23 Cases investigated by PHSO: 22 Cases upheld by PHSO: 1 Cases partly upheld by PHSO: 4 Outcome of formal investigations The outcomes of two investigations reported to the Trust in 2015-2016 are as follows: Case reference: CLS-14078-PHSO, PHSO ref: HS-236424-0134 The complaint consisted of three concerns: A) The patient and her husband heard a loud crack at approximately 01.00 hours when she turned in bed in the ward. She was given morphine to help with her pain but it was later found that she had fractured her femur, though an X-ray confirming this was not ordered for over 24 hours and took place 4 days later; B) A consultant discussed the patient s terminal cancer in an unsympathetic manner, not having realised that it was the first time they had been given this news; C) Lack of adequate pain relief and a delay in referring the patient to the palliative care team. 10
The PHSO partly upheld the complaint. It found that the care and treatment given in respect of the fracture was not in line with recognised quality standards and established good practice. The delayed referral to the palliative care team was outside of recognised quality standards, though her pain control during that time was within them. The way the bad news was broken to the patient was not within recognised quality standards but no recommendation was made about this because the Trust had already addressed it. The PHSO recommended that the Trust write a letter to the complainant, to recognise and apologise for the failings identified; and produce an action plan outlining the improvements made as a result of the complaint. Case reference: CLS-8166-PHSO, PHSO ref: HS-227997-0100 The complaint concerned a patient who had a hernia and was suffering from bowel cancer: he was not well enough to be operated on. The patient experienced a fall in the ward and became a palliative patient. The complainant felt this was the fault of staff and led to his death. This was investigated by the Trust as an SI and a Root Cause Analysis Report concluded that the fall had been preventable. The PHSO partly upheld the complaint. It found that the patient s lying and standing blood pressure should have been taken to establish the risk of postural hypotension (and, therefore, falls) and his medication should have been reviewed by a doctor. It could not be established that these omissions caused the fall or that completing those actions would have prevented it. The Trusts response to the complaint provided good explanations and implemented changes but failed to explain adequately how these would be monitored, going forward. It was found that the patient s pain management was in line with recognised quality standards. The PHSO felt that the family should have been given wider visiting rights at that time and experienced unnecessary distress as a result, and that there was inadequate communication from a nurse after the patient passed away. The PHSO recommended that the Trust provide evidence of how it is monitoring the effectiveness of the improvements made on the ward, and should pay the complainant 500 for the unnecessary distress caused by the failings in visiting/communication. 11