NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group Governing Body Agenda Item: 2.4 Tuesday, 29 July 2014 Purpose of Paper For Discussion Title Annual Complaints Report Responsible Jean Fruend, Executive Nurse Author of the Report Anne Greenley, Head of Clinical Quality, North of England Commissioning Support (NECS) Recommendation(s) The Governing Body is asked to receive the report Summary This annual report provides an overview of the number and type of complaints received by the CCG and managed by the NECS complaints team. The report sets out trends and themes identified in the complaints received and also identifies areas for improvement. It does not include complaints relating to other providers as they are managed by that provider and included in the respective organisations own annual reports. Complaints relating directly to Primary care are also excluded from this report as this service falls under the remit of NHS England with the Area Teams as the commissioner of primary care. Financial Implications Legal/Regulatory Implications Assurance Framework/Risk Register Implications Details of relationship to the NHS Constitution Details of Patient and Public Involvement and/or Implications Has an Equality Analysis been completed? Attachments Please detail any Committees or Forums at which this paper has previously been tabled Not applicable NHS organisations, including CCGs, must deal with complaints in accordance with The Local Authority Social Services and NHS Complaints (England) Regulations 2009 Not applicable to this report This report relates to the each of the 7 principles as set out in the NHS Constitution. It also relates to each of the NHS values and patients rights as detailed in the report. Not applicable Not applicable to Annual complaints report None Page 1 of 9
Page 2 of 9
Annual Complaints Report 2013/14 Page 3 of 9
1. Introduction This is the first Annual Complaints Report for NHS Hartlepool and Stockton-on-Tees (HAST) Clinical Commissioning Group (CCG) for the reporting period April 1 st 2013 to March 31 st 2014. HAST CCG are supported by the North of England Commissioning Support Unit (NECS) in the commissioning of high quality care services for their local populations and their governance and assurances processes; the management of complaints relating to their commissioned services is part of this function. 2. Background and Context The NHS Constitution sets out the following patient s rights concerning complaints and redress: You have the right to have any complaint you make about NHS services acknowledged within three working days and to have it properly investigated. You have the right to discuss the manner in which the complaint is to be handled, and to know the period within which the investigation is likely to be completed and the response sent. You have the right to be kept informed of progress and to know the outcome of any investigation into your complaint, including an explanation of the conclusions and confirmation that any action needed in consequence of the complaint has been taken or is proposed to be taken. You have the right to take your complaint to the independent Parliamentary and Health Service Ombudsman or Local Government Ombudsman, if you are not satisfied with the way your complaint has been dealt with by the NHS. You have the right to make a claim for judicial review if you think you have been directly affected by an unlawful act or decision of an NHS body or local authority. You have the right to compensation where you have been harmed by negligent treatment. The NHS Constitution also makes the following pledges which the NHS commits to achieve: to ensure that you are treated with courtesy and you receive appropriate support throughout the handling of a complaint; and that the fact that you have complained will not adversely affect your future treatment (pledge); to ensure that when mistakes happen or if you are harmed while receiving health care you receive an appropriate explanation and apology, delivered with sensitivity and recognition of the trauma you have experienced, and know that lessons will be learned to help avoid a similar incident occurring again (pledge); and to ensure that the organisation learns lessons from complaints and claims and uses these to improve NHS services (pledge). Page 4 of 9
3. The Complaints Process Where a complainant wishes to raise an issue with the CCG regarding healthcare services that have been provided to them there are several ways in which NECS may, with the authorisation of the CCG, manage that complaint: Complaints about providers commissioned by the CCG. These will normally be referred to the provider for initial investigation, with oversight from the NECS complaints team and/or the CCG if required by the complainant; Complex complaints that involve issues from 2 or more providers commissioned by the CCG. These may be co-ordinated by the NECS complaints team to ensure that a single response is received either from a named provider who takes the lead for the complaints response, acting on behalf of the CCG as commissioner. Complaints involving Primary Care Services. Any complaint that involves a primary care provider should be referred to the NHS England complaints management process. Complaints about the CCG or decisions made by the CCG. These are coordinated and managed by the NECS complaints team, with input from the relevant technical experts within the CCG and NECS. 4. The Francis Report and the Clwyd/Hart review of complaints procedures The first inquiry led by Robert Francis QC into serious failures in care at Mid-Staffordshire NHS Foundation Trust between 2005 and 2008 highlighted widespread and systemic deficiencies in care at the Trust. The report found that contributing factors included ineffective action in response to patient complaints. A second inquiry led by Robert Francis QC in to the events at the Trust, examining the role of the commissioning, supervisory and regulatory bodies, published its report on 6 February 2013. This report made a number of recommendations with regard to the handling of patient complaints. In his response to the report the Prime Minister said he had asked Ann Clwyd MP and the chief executive of South Tees Hospitals NHS Foundation Trust, Tricia Hart, to advise on how NHS hospitals can handle complaints better in the future. Their report, Putting Patients Back in the Picture, was published in October 2013. A summary of its findings and recommendations, and the Government s response, can be found in Hard Truths, the Journey to Putting Patients First. The NECS complaints process on behalf of the CCG has been informed by this policy and also the NHS England framework Guide to good handling of complaints for CCGs published in May 2013. Page 5 of 9
5. CCG Complaints Activity There were a total of 20 issues raised by NHS Hartlepool & Stockton-on-Tees CCG patients that were managed by the NECS complaints team in 2013/2014. Complaints team activity 2013/2014 Redirected to Other NHS Org Outside Complaints Regs MP Issue Comments/Concern Informal complaint Formal Complaint Of the issues that were raised: 0 2 4 6 8 10 12 14 16 Fourteen (14) were managed as formal complaints. Of these, 13 were acknowledged within three working days with one taking five days to acknowledge. This equates to a 93% performance across the year. One (1) was redirected to another organisation for management, with the patient agreeing to contact NHS England directly to make a complaint about Primary Care. One (1) was outside of the NHS Complaints Regulations as it was concerning an organisation complaining about Continuing Healthcare (CHC) funding processes. This was managed within the established CHC processes. One (1) was an MP enquiry that the complaints team were unable to progress directly with the patient due to difficulties in contacting them. A response was, however, provided to the MP. The three other issues raised were from patients raising informal concerns or issues. Two of these were regarding CHC Funding Decision and one was regarding concerns about the respiratory services in Hartlepool. All of the issues falling outside of the formal complaints processes were responded to within established processes. Page 6 of 9
The fourteen formal complaints received by the CCG were made about the following organisations: 7 Complaints 13/14 by Organisation 6 5 4 3 2 1 0 HaST CCG NEAS NTHFT Stockton Council TEWVFT The fourteen formal complaints received were categorised as follows: Complaint Category Late Ambulance 2 Appointments - 1 Access/Location Attitude of Medical staff 1 CHC Funding Decision 5 Clinical Care 2 Equipment 1 Expenses/Claim Problem 1 Operation - Adverse 1 Outcome Page 7 of 9
Not Upheld 3 Ongoing 3 Partially Upheld 1 Passed to CHC Appeals Process 2 Passed to Provider 4 Upheld 1 The fourteen complaints received had the following outcomes: Of the three complaints that are currently ongoing, two (2) relate to highly complex issues where NECS are co-ordinating responses from multiple organisations. One relates to a Serious Incident (SI) reported by North East Ambulance Service - the investigation report went to the HaST CCG SI Panel on 27 th June 2014 and the complaint will remain as ongoing until the outcome of the SI investigation is shared with the family. This report provides a breakdown only for complaints which come to the CCG or via the NECS complaints team directly as the majority of complaints would be made direct with service provider. The provider reports detailing trends, themes and lessons learned will be reviewed as part of that Provider Clinical Quality Review Group. 6. Complaints Themes, Significant Issues & Actions The following key themes or issues were identified: Continuing Healthcare The most significant theme arising from the issues managed by the NECS complaints team is that of CHC funding decisions and process. The largest number of formal complaints were made in this area, along with some informal concerns and issues. The issues that have arisen have been around effective communication with patients, adherence to the agreed CHC processes and the length of time taken to reach decisions on funding. These are themes that have been repeated across other CCG areas where the pressures on the CHC teams to clear the backlog of retrospective claims has had a clear impact on CHC funding decision-making timescales and process. Action Taken A Kaizen rapid improvement event was held to look at the overall management of CHC and specifically in the management of the issues that have arisen out of CHC complaints. Clear internal communication, clear external communication and processes that are understood and adopted by Page 8 of 9
all were the main areas identified for improvement. Agreed actions for continuous improvement are reviewed at 30, 60 and 90 day report out meetings with the Director sponsor and senior leads. Inappropriate use of the complaints process As a result of new organisational arrangements from 1 st April 2013, there were a number of issues raised with the CCG in 2013/14 that were passed to NECS to be managed through the complaints process that could have more appropriately been managed through alternative processes. As both the CCG and NECS have matured as organisations clarity about process has improved. Action Taken NECS have reorganised their complaints management function and have undertaken a review of internal processes to ensure that all issues are effectively managed through the most appropriate process. There were no other significant themes or trends identified within the issues that were raised with the CCG and NECS complaints team. Service improvement All complaints provide the CCG with quality information relating to patient and carer experience and as such are used to inform the commissioning of services. Complaints information is also triangulated with other sources of intelligence such as incident reports which is used to inform service improvements. Required of the Governing Body The Governing Body and requested to receive the report. Page 9 of 9