Leicestershire Partnership NHS Trust Annual Complaints Report 2016/17 Rob Hasker Complaints Manager July 2017 0
Introduction The Trust welcomes feedback from patients, their families, friends and carers. Their feedback is a valuable way of improving the experience the Trust offers to those that use our services. Every complaint is an opportunity for us to learn and make improvements and we understand the importance of handling complaints effectively for people who use our services. As part of a continued improvement process the Trust launched a revised complaints process in April 2016. The new process ensured that complaints received about the Trust s services were managed consistently under the requirements of The Local Authority Social Services and National Health Services Complaints (England) Regulations (2009) with a principal aim to resolve complaints fairly, quickly and to identify lessons learnt to effect service improvement. 1
Key Figures In 2016/17 the Trust received 372 complaints, compared with 346 in 2015/16......this represented an increase of 26 complaints In addition we input to 58 complaints that were led by other organisations, compared with 66 last year This year we achieved this for 99.5% of complaints... We are required to acknowledge complaints within 3 working days...compared with 97.1% in 2015/16 One of the key changes to the complaints process was the requirement for investigators to telephone the complainant in order to fully understand the complaint and agree the scope of the investigation along with a timeframe for completion. 94% of complainants were contacted by telephone. The 6% of complainants who could not be contacted by telephone received a letter from the investigator outlining the timescale for completion and the concerns to be investigated. 2
Performance The response timescale is agreed by the investigator in collaboration with the complainant. Complaints that can be resolved, at the complainant s request with a verbal response, can be done so within 10 days. The Trust s performance is shown below, by quarter. Performance is measured as the percentage of complaints that were sent to the complainant within the agreed timescale. If a timeframe was renegotiated once, this is considered within time. If it was not negotiated, or was extended more than once, this is considered out of time. Whilst there has been a steady improvement in the percentage of complaints that were sent to the complainant in time, it is clear that further work is required to ensure that performance reaches the target of 95%. The Complaints Team sends regular information to the service regarding complaints that are nearing the end of their agreed timescale. There is also a clear and improved escalation process as Head of Services are now advised when a response is close to breaching, or has breached its agreed deadline. 80 Performance by quarter 70 60 50 40 30 20 10 Advocacy 0 Q1 Q2 Q3 Q4 % 48.9 41.7 58.7 73.2 In Leicestershire there are two advocacy organisations that support people when making a complaint. POhWER is a nationwide charity that provides information, advocacy and advice services. LAMP is a specialist mental health charity advocating for service users in Leicestershire, Leicester and Rutland. Of the 372 complaints received in 2016/17, only 11 complaints were received through an advocacy service. This was 2.9% of complaints in the year. All complainants are sent a leaflet advising them of the advocacy service with their acknowledgment letter. The Complaints Team are also liaising with the advocacy service, to improve and raise awareness of the service. Information about the advocacy service is also provided on the Trust s website. 3
Complaint Themes The Trust s top themes of complaints received in the last three financial years are shown below: 2014-15 2015-16 2016-17 Attitude of staff 62 Attitude of staff 75 Attitude of staff 63 Appointments 44 Nursing care 39 Appointments 41 Nursing care 39 Communication 35 Nursing care 40 Communication 35 Appointments 27 Patient expectations and service delivered 32 Clinical advice/treatment 31 Clinical advice/treatment 18 Clinical advice/treatment 25 Top themes over the last three financial years 80 70 60 50 40 30 2014-15 2015-16 2016-17 20 10 0 Attitude of staff Appointments Nursing care Communication Clinical advice/treatment Patient expectations and service delivered 4
Other than patient expectations and service delivered the top five themes of complaints are relatively consistent with the last three financial years. Complaints across the Trust cover a range of services and there was no identifiable trend for why patient expectations and service delivered had seen an increase. This category of complaint considers what the patient may have expected from a service against what it could deliver, such as home visits, frequency of attendance by a district nurse or the support provided by a community mental health team (CMHT) following discharge from an inpatient ward. Attitude of staff, however, continues to receive the highest number of complaints. Attitude of nursing staff was fairly even across the three directorates, with 15 of 27 complaints relating to Adult Mental Health/Learning Disability (AMH/LD). Complaints relating to attitude of medical staff were almost exclusively within AMH/LD, with most complaints received about consultant psychiatrists in the community mental health teams (CMHT). The number of complaints relating to nursing care has remained consistent over the last three financial years. Of the 40 complaints received, 31 were for Community Health Services (CHS), 18 of which related to care provided by District Nurses. The complaints raised a variety of issues from missed appointments to concerns over how fully implemented the agreed care plan was implemented by the nurse. Other cases highlighted poor communication between the nurses along with a lack of effective handover. There were also complaints regarding blood tests that were taken by a nurse and late cancellations, causing difficulty for the patient who had to make arrangements at short notice. Complaints relating to clinical advice and treatment were received by all three directorates, however AMH/LD had the highest number and this was spread across both inpatient wards and CMHT s. Most of the complaints related to clinical advice and treatment for CHS were received by the podiatry team. These related to concerns over the treatment that had been provided with one complaint highlighting poor cutting of a toe that required follow up treatment from the GP. In Families, Young People and Children (FYPC) all clinical advice and treatment complaints related to Child and Adolescent Mental Health Services (CAMHS). Complaints focused on a lack of appropriate care plans, along with the types of treatment and interventions suggested. The chart below shows the complaints received by the services over the past three financial years: 200 180 160 140 120 100 80 60 40 20 0 AMHLD CHS FYPC Corporate 2014-15 2015-16 2016-17 5
Learning from complaints - AMH/LD Within AMH/LD a high number of complaints related to the attitude of medical staff and clinical advice/treatment. Further review of these complaints indicated that there were similarities between the types of complaints that had been raised. Often a patient would express concern that they had not understood what the doctor had said, and then found it difficult to challenge this. There were also concerns that doctors lacked empathy or understanding of complexities of certain conditions or addictions. Doctors, and complainants, advised that communication needed to be more effective. Following a complaint regarding the communication at an appointment it was agreed that all patients would receive a copy of their care plan, to ensure that they had the opportunity to take away a written account, rather than relying upon recalling the consultation. All doctors also have the opportunity to discuss complaints they are involved in, with a senior member of medical staff, during their annual appraisal. The service have also identified areas of improvement regarding communication between consultants when a patient s care is transferred. The Trust has a process in place that the last clinic letters are reviewed prior to seeking a new patient for a review appointment. It is, however, acknowledged that best practice would be to review a patient s full record. The service are working with the Trust s Health Information Services to review the use of the electronic patient record system so significant information can be communicated more effectively. To address waiting times the service has introduced changes to the booking process for outpatient appointments in selected CMHT s. This is known as partial booking and allows the service to keep clinic times available until they contact patients to book appointments for the following month. This has reduced the number of appointments cancelled by the Trust, due to the unavailability of doctors. Liaison Psychiatry saw an increase in relation to waiting times, and this was due to difficulties in appointing a permanent consultant. This position has now been recruited to. Provide copies of care plans to patients Changes to the booking systems for outpatients, to keep clinic times available Improve communication between patient and doctor 6
Learning from complaints - CHS Community services have identified a theme around nursing care within the City. This is being addressed by the Matrons who are reviewing caseloads and ensuring that decision making is appropriate and accurate. Following a complaint within community hospitals outlining communication difficulties experienced by an inpatient with hearing difficulties, a review was undertaken of resources that could be used to support alternative forms of communication. A communication folder is to be developed for all wards which will contain laminated pictures of items and actions to support communication with patients. Expertise from Learning Disability and Speech and Language Teams is also being sought to ensure appropriate and consistent resources are used. In response to a community hospital complaint a review has been undertaken of staff knowledge & understanding of the Continuing Health Care process. Gaps were identified in terms of training. Training in the framework & process is being delivered to identify leads to support this prior to the introduction in March 2017 of a new end to end process with the Clinical Commissioning Groups (CCG s). Staff attitude has been raised within community hospitals and is being addressed through training on the wards. New leadership is being implemented to ensure that the Trust values are embedded and support fully. One complaint identified the use of appropriate language which was not clear and constructive. The patient did not understand what was being asked and therefore was unable to manage the tasks as well as they could have done. Wording such as non-compliant is no longer used and there are new processes in place to ensure that staff discuss therapy goals with patients and relatives. Improve resources on the ward, with help from speech and language and learning disability team Staff training on understanding of continuing health care processes Therapy goals to be fully discussed with patients and relatives 7
Learning from complaints - FYPC As a result of a complaint it was identified that the Child and Adolescent Mental Health Service (CAMHS) were unable to access patient records until consent had been received from community paediatrics. Now the CAMHS team have asked administrative staff to obtain consent in advance of appointments. This will ensure that the appointment is more constructive and prevents patients from having to repeat information they have already provided. Patient expectations have been a common theme in FYPC. One complaint raised concerns about inconsistences in how support was provided, along with waiting times for appointments. It was identified that prioritisation models for waiting lists were in place, but had not been followed appropriately. This was clearly disappointing and fell below the expected standards of communication. Waiting lists were reviewed and FYPC staff were involved in the creation of guidance to provide to families already on a list, to ensure that expectations were met and families were not left with little, or no, support. Ask for consent ahead of appointments Guidance introduced to ensure families have support Prioritisation models to be followed for waiting lists 8
Outcomes The Trust assesses and records the outcome of each complaint, considering whether the issues were substantiated following the investigation. The Trust uses the following criteria to assess this; - Upheld the investigation has substantiated the complaint, indicating that the Trust made mistakes or provided a service not in line with expectations or processes. - Partially upheld the Trust made some mistakes in providing care/treatment, but not all against what had been complained about - Not upheld the Trust acted in accordance with its processes when providing the care and there were no failings identified The decision as to whether the complaint was upheld, partially upheld or not upheld is the responsibility of the investigator. In 2016/17 64.4% of complaints were either upheld or partially upheld. This compares with 71.5% last financial year. This does not include complaints that were withdrawn or currently ongoing, as an outcome has yet to be determined. Withdrawn 4% Ongoing 2% Upheld 27% Not upheld 32% Partially upheld 35% 9
Satisfaction surveys As part of the revised complaints process, all complainants are given the opportunity to feedback on their experience of the complaint process. Satisfaction surveys are sent to complainants approximately six months after they raised their complaint. At the time of reporting 302 surveys had been sent to complainants, pertaining to complaints that had been received by the Trust between April 2016 and January 2017. 42 completed surveys have been returned, indicating a 13.9% response rate. The results from the survey indicate that further work is required to make it easier for people to make a complaint. Timescales need to continue to be negotiated with the complainant and more work is needed to make staff aware of the variable timescales and their appropriate use. Demographics Information on the demographics of complainants is provided and stored through our complaint record system, Safeguard. This collects the age, gender and ethnicity of the person affected by the complaint. It also provides information on who made the complaint. This information is listed in appendix 1. As can be seen in the data the ethnicity of the complainant was not known in 351 of cases. This is because the team rely on the clinical record of the patient, and the absence of data is due to this not being recorded. 10
Complaints referred to the Parliamentary and Health Service Ombudsman (PHSO) In 2016/17 12 complaints were referred to the Parliamentary and Health Service Ombudsman (PHSO). Of these three were handled by the Trust in 2016/17, seven in 2015/16 and two in 2014/15. Outcome of PHSO review of complaints Number Upheld 1 Partially upheld 0 Not upheld 4 Returned to the Trust for local resolution 1 Draft decision received 2 Remains with the PHSO for investigation 4 The complaint that was upheld related to care provided and support during a CHC assessment. The PHSO found delays in the Trust identifying and instigating the CHC process and communication with the family fell below the expected standard. The Trust also did not fully acknowledge the failings or remedied the impact that these failings caused. The Trust was asked to provide an action plan to demonstrate the improvements made and acknowledge the impact to the family. At the time of writing this report this action plan is ongoing. During 2016/17 the Trust also received the PHSO decision on five complaints that been under investigation prior to April 2016. Three complaints were not upheld and two were partially upheld. The complaints that were not upheld were initially received by the Trust for investigation in March 2014, October 2014 and September 2015. The two partially upheld were received in December 2013 and February 2014. As a result of these complaints several service improvements were made. An assessment is now undertaken for all inpatients within 72 hours of admission using the Malnutrition Universal Screening Tool (MUST). Two physical health matrons work at the Bradgate Unit. Monthly spot checks of nutrition and hydration standards are completed within all inpatient areas and the Trust has strengthened staff awareness regarding support and advice for people struggling with drug and alcohol misuse. 11
Conclusion 2016/17 saw significant changes to the way in which the Trust manages its complaints. The new process, launched at the start of the financial year, aimed to place complainants, their carers and families at the centre of the investigation. To ensure that the Trust understood the wishes of the complainant and the outcome they sought from their complaint, 94% of complainants were contacted by telephone, to agree the scope of the investigation and a timescale for completion. Each quarter an analysis is provided of data from incidents, complaints and Patient Advice and Liaison Service (PALS) feedback. This provides assurance that robust systems and processes are in place to learn from incidents, complaints and PALS activity by cross-referencing information on the actions. The directorates are asked to provide an analysis of any common themes, along with recommendations and actions taken as a result. The new process has been widely supported by the directorates and key people involved in the investigation of complaints have been crucial in ensuring its delivery and continued success. The Trust has strengthened its process, improved the outcomes for people making a complaint and can demonstrate learning from the feedback provided. In the last annual report key improvement actions for 2016/17 were identified. Each of these improvements have now been implemented The complaints policy has been launched and embedded across the Trust During 2016/17 the Trust has undertaken three Peer Review Panels, with four scheduled for 2017/18 The categorisation of complaints is checked by the investigator, to ensure that the complaint has been logged appropriately and to ensure a more accurate analysis of patient safety related complaints A process has been developed for ensuring complainants are offered a satisfaction survey after their complaint has been closed Two online learning modules for staff, handling patient feedback and investigating and responding to complaints, have been launched in 2016/17 12
Moving forward The complaints process continues to evolve and there is scope for further improvement. The Trust s response performance, which is measured in whether the complainant received their response within the agreed timeframe, is steadily increasing and work is still required to ensure that this continues to improve. For 2017/18 the following activities are planned to make further improvements to the complaint process: 1. Undertake quality review of complaint responses 2. Review further correspondence received from complainants to identify common themes 3. Continue to survey all complainants 4. Continue to embed peer review panels 5. Reach performance target of 95% 6. Strengthen our working relationships with other organisations including the PHSO, local Trust s, Healthwatch and the Clinical Commissioning Groups (CCG s). In conclusion there have been significant improvements to the complaints process in 2016/17. The complainant is more involved in the scope and timescale of their investigation. Processes have been strengthened to ensure that learning is captured clearly and the responses fully answer the concerns raised. For 2017/18 there will be a significant effort and drive to embed this process and to improve how we manage, learn and respond to complaints. 13
Appendix 1 Demographics of persons affected by complaint 2016/17 Age of person affected by complaint Age range Number 0-18 79 19-64 203 65+ 90 Gender of person affected by complaint Gender Number Male 182 Female 170 Not specified* 16 Unknown* 4 *Not specified would indicate that the patient had chosen not to disclose their gender, or do not feel that male or female is applicable **Unknown is that this information has not been collected. Ethnicity of person affected by complaint Ethnicity Number Not known/not specified 351 White British 12 Not stated 4 Indian/British Indian 2 Any other mixed background 2 Gypsy/Irish Traveller 1 Source of complaint Source Number Patient 131 Parent 89 Other 78 Carer/Relative (i.e. offspring/sibling) 41 Spouse 16 Advocate 11 Member of Parliament (MP) 4 PALS 2 14