Homerton University Hospital NHS Foundation Trust Annual Complaints Report 2 217 1
Introduction Homerton University Hospital NHS Foundation Trust strategy highlights the quality of patient experience as one of its key objectives. The Trust delivers integrated care to patients at home and in hospital and for the vast majority of our patients, the care and service they experience is good and they do not feel the need to raise issues or concerns. However, where this is not the case, the Trust is committed to providing an open, supportive and honest response to issues or complaints raised either directly with our staff, through our Patient Advice and Liaison Service or as a formal complaint. The Trust has provided inpatient care to over 52 patients with just under 12 attendances at Accident and Emergency, over 27 outpatient appointments and just under 6 community attendances and contacts between April 2 and March 217. In the same time period there have been 1815 contacts dealt with by the Patient advice and liaison service and 425 formal complaints received (<.8%). This report provides an update on complaints over the last year at Homerton University Hospital NHS Foundation Trust. As always the Trust approaches complaints as an opportunity to learn and improve as well as explain/inform and apologise where needed. Complaints are defined as an expression of dissatisfaction with the care/treatment received which cannot immediately be resolved by local (including PALS) action or an apology. They can be written or verbal. Homerton Approach to resolving and responding to complaints In line with recommendations for good governance process in responding to complaints and guidance from the Patients association, the Homerton approach to complaints focusses on: 1)Providing a clear and accessible process for making a complaint This is achieved through: high visibility positioning of the PALs service at the front of the hospital, ready accessibility to leaflets explaining the PALS and complaints process in every ward and department, inclusion of complaints information within the welcome packs on the wards clear signposting to the PALS service (and from there to complaints) on the Homerton website. 2
In recognition of the diversity of the community served by our services, Homerton offers translations of Complaints and PALS information in 9 of the most commonly spoken languages as well as signposting to interpretation and advocacy on the website and in 5 of the most commonly spoken languages within the PALS and complaints leaflets 2)Standards for complaints management and escalation The Trust has standards for responding to complaints which comply with the statutory requirements for complaints handling published in the National Health Service Complaints Regulations (29) 1 and are based on the principles for good complaint handling as set out by the Parliamentary & Health Service Ombudsman (PHSO) 2 : Getting it right Being customer focused Being open and accountable Acting fairly and proportionately 1 NHS England & Social Care England. The Local Authority Social Services and National Health Service Complaints (England) Regulations (29). 2 PHSO Principles of good complaints handling (29) 3
Putting things right Seeing continuous improvement [ANNUAL COMPLAINTS REPORT 2-17] The Trust complaints response process builds from local acknowledgement, apology and resolution, through the Patient advice and liaison service (PALS) to the formal complaints process and response. The PAL Service aims to : Provide information and support to patients, their families and carers. Listen to concerns, queries, suggestions or views. Help to sort out problems on behalf of patients, their families and carers. Learn from experience about what the hospital gets right and where there is a need for improvement. If resolution is not achieved by the service through the initial responses, or if the patient wishes to go straight to a formal complaint, the complaints team will manage the complaint under the following timescales. Complaints Response Statutory timescales Actions Local timescales Acknowledgment 3 days Acknowledge receipt. 3 working days Provide a written response Add to Datix and circulate to Divisions to identify a lead 6 months Agree complaints timescale and plan Resolve using conciliation, mediation, investigation, review panel or other methods. 3 1 working days 3 working days or subject to agreement with complainant, a longer period. (With effect from 1 st January 217). The Trust has acknowledged receipt of all complaints in 2/17 in an average of 1.74 working days with 53 complaints acknowledged outside the target time of 3 working days. Reasons for delays in acknowledgement time include staff availability and workload as well as a small number of delays in transfer between the PALS and complaints teams. While the Trust aims to investigate and provide a response to any complaint within 3 working days, there are some complex complaints which can require much longer to provide a full response particularly if associated with a serious incident investigation or with extensive and difficult issues. These complaints are nominally clock stopped to allow additional time for this process and the complainant is made aware of this and the reasons behind this. 4
3) Action taken and sharing of Lessons learned As part of the investigation approach, there is an emphasis on transparency and accountability; acknowledging when things have gone wrong and outlining what has been put in place to put it right. The Trust has developed a quarterly newsletter which shares lessons from Complaints and PALs contacts across the organisation. The newsletter identifies themes and key areas of learning to be shared at team meetings, emailed out to all staff and discussed at clinical governance meetings Quality and timeliness of complaints responses Weekly CLIP (Complaints, Litigation, Incidents and PALs) meetings are held in each division and chaired by the Divisional Head of Nursing and Associate Medical Director. These meetings review PALS contacts and complaints and oversee the process of investigating, responding and acting on the issues raised in the complaint. Monitoring Reports on complaints progress are sent to the Divisions by the central complaints team and the monthly divisional performance review monitors performance Weekly meetings are also held by the Chief Nurse with the complaints team to review all current complaints investigations to ensure that responses are being progressed and are issued where possible within the Trust target of 3 working days. At Trust level, complaints and their performance management are reported at Trust management board on a monthly basis and by division as part of the quarterly governance review. 5
Quarterly reporting of complaints process to the Patient Experience delivery group and monthly reporting to TMB includes monitoring of themes and sharing of lessons learnt across divisions and departments. Assuring the quality of responses Complaints responses are drafted by the investigator with support from the complaints officers and then reviewed by the Divisional or Departmental lead for complaints and the Chief Nurse and Medical Director before sign off by the Chief Executive. Each complaint response is therefore read a minimum of 3 times by progressively more senior staff prior to sign off. Executive level of oversight allows scrutiny of the quality of the complaints responses and assurance that they have been both adequately investigated and appropriate actions put in place as well as lessons learnt. It also ensures that there is a strong connection between the Clinical and executive teams in understanding and addressing issues raised. In spite of the rigour of review, there are inevitably some complaints responses which do not provide the level of detail required or address the issue raised adequately. All complaints letters invite the complainant to raise any issues or requests for further information via the complaints team. The Trust will attempt to provide additional answers and information wherever possible. Benchmarking Performance Using experimental data available through NHS digital, it has been possible to compare numbers of complaints with other organisations of differing sizes using the rate of complaints per Consultant episode. However, as an integrated care organisation, this reflects only the hospital related services and does not make allowance for additional community services delivered by the Trust. Best comparisons are therefore with other integrated care Trusts which include Barts health, Whittington, and Lewisham and Greenwich. The rate of complaints at Homerton is higher than the national rate but around the average within the Trust s comparator group PALS contacts and Complaints 2-217 Between April 2 and March 217, the PALS service dealt with 1815 PALS contacts. The majority of these were resolved successfully by the PALS service and less than 1% (6) converted 6
to a more formal complaint. PALS contacts which convert to complaints contributed to 39% of the total of 425 complaints investigated and responded to, by the Trust. Although there was an overall increase in the number of complaints, the Trust has seen a slowing in the rate of rise in complaint numbers for the first time since 213 with an increase of less than 1% this year compared to an average rate of increase of just under 18% from 213 2. This reduction has almost entirely been in the Integrated medicine and rehabilitation services (IMRS) division which is the only area in the Trust to see a reduction in the number of complaints received albeit on the back of a steep rise in number the previous year. Surgery, Women s and Sexual Health (SWSH) have seen a 17% increase in the number of complaints this year, most of which relates to general surgery which had an increase of 55% in the number of complaints. A rise in complaints addressed to corporate services reflects an increase in patients complaining about issues related to eligibility for free treatment under the NHS. This is an area that with further stringency in rules around eligibility is likely to grow. 3 Year Comparative Data by Division 2 15 1 5 191 1 3 151 136 136 59 37 28 32 23 1 2 9 CORP CSDO ENVIRO IMRS SWSH 2/17 215/ 214/15 Timeliness of response The Trust reset the target response time for complaints to 3 working days in January 217 with a target of 8% of responses within that time, prior to that the target was 75% within 25 days. The Trust has achieved its target in only 4 months in the last year. The average rate has been 71% of responses returned within the target time (excluding those complex complaints which are clock stopped). This is considerably better than last year when only 45% of responses were returned within target Responded within time Apr- May - Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- 17 Feb- 17 Mar- 17 Tota l % Responded within time 71% 76% 83% 63% 91% 79% 71% 66% 61% 62% 76% 56% 71% Delivery of timely responses to complaints is a key objective although this should not be achieved by sacrificing effective investigation and high quality responses. Factors impacting on delivery within the response time are numbers of complaints and workload, staff availability and engagement with the clinical services involved. Peak months for complaints numbers received in recent years appear to be March and September. It is difficult to understand the reasons for this 7
and a more detailed review of the reasons for complaints in these months will be needed if the trend continues. Complaints received by Month 5 45 4 35 3 25 2 15 1 5 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2/17 215/ 214/15 Complaints themes, lessons and Actions In line with previous years and national trends, the highest numbers of complaints are about Medical care including diagnoses, treatment and contact with medical staff followed by Nursing Care, Staff attitude and Communication. However, a newer complaint theme has appeared with the rise in the number of complaints associated with transport services and this has formed an area of focus for improvement over the last year. 8
Theme 1. Medical Care 139 complaints (29%) Complaints are spread between a number of specialities with higher numbers of complaints reflecting the numbers of patients seen by the speciality e.g. Emergency Department and Obstetrics. Description of types of complaints Sub-categories within complaints about medical care include missed and incorrect diagnoses, differing expectations of treatment outcome, miscommunication and failure to provide information. Actions to improve patient experience Sharing of lessons learnt across specialities and divisions QI project on shared decision making Direct feedback where appropriate Theme 2. Nursing Care 46 complaints (11%) Complaints reflect failings in timeliness of care, privacy and dignity and compassion. Description of types of complaints Sub-categories within complaints refer to lack of personal care and hygiene, not responding immediately to requests for help, poor levels of communication and lack of compassion Actions to improve patient experience Sharing of lessons learnt across wards and divisions Study days for Nursing staff on communication for better outcomes Direct feedback to individuals with performance management where appropriate Trust and confidence workstream for nursing staff Theme 3. Transport 27 complaints (6%) Increasing numbers of complaints associated with the service provided by Arriva Description of types of complaints Sub-categories within complaints refer to delays resulting in failing to get to OPD appointments, inadequate facilities for patients with specific seating needs, long delays to transport to return home Actions to improve patient experience Increased standards for response times with more rigorous application of these Greater responsiveness for out of hours service Re-organisation of the call centre New management team The ongoing themes of staff attitude and communication issues are being addressed as part of the Homerton values work. Inevitably, in an area where more than 7 different languages are spoken and cultural and behavioural mores and expectations differ hugely, there are occasions when miscommunication or misinterpretation may occur. However, where complaints identify either an individual issue or a need for training to address a communication theme then both feedback and 9
instruction to individual members of staff occur and additional support and learning are developed. 1
Complaint by Service Area/Speciality 2-17 45 42 41 39 4 35 3 25 2 15 1 5 31 28 25 14 14 13 9 9 9 9 8 8 7 6 6 6 5 5 5 5 4 4 4 4 4 3 3 3 3 3 3 3 2 2 2 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Accident and Emergency Elderly Care / Medicine Maternity / Obstetrics General Surgery Transport Trauma & Orthopedics Ear, Nose & Throat (E.N.T) Radiology (Imaging / X-Ray / CT & Cardiology Fertility Gynaecology Main Outpatients Paediatrics Bariatric Surgery Gastroenterology Urology Central Booking Dermatology / GPSI Service Primary Care Psychology Service Continuing Care at Home Finance Neonatal / Transitional Care Phlebotomy Adult Community Nursing - Cluster 1 Breast Surgery Endoscopy Foot Health Sexual Health / Young People Colorectal Surgery Discharge Planning Healthcare Records (H.C.R) Maxillo-Facial & Oral Surgery Rehabilitation Respiratory Medicine Therapy Service Starlight Children's Services Community Paediatrics Foetal Medicine / Welfare Intensive Therapy and Critical Care Physiotherapy Acute & Chronic Pain Services Administration Adult Community Nursing - Cluster 2 Anaesthetics Cancer Services Catering / Domestic Children's Complex Care and Specialist Community Midwifery Complaints and Legal Diabetes Dietetics & Nutrition Environment Estates Facilities HIV & Genito-Urinary Human Resources Integrated Independence Team Language Services / Bi-Lingual Advocacy Laboratory (Haematology, Pathology, Lower GI Surgery Neurology Outpatients & Neuro-Physiology Regional Neurological Rehabilitation Patient Advice and Liaison Service Podiatry / Chiropody Primary and Urgent Care (PUCC) Rheumatology School Nursing Security Sickle Cell Services (Acute & Community) Wheelchair Services 11
Complaint by Service Area/Speciality 215-2 45 4 35 3 25 2 15 1 5 41 38 36 33 2 17 13 1 1 9 9 8 8 6 6 5 5 5 5 5 5 4 4 4 4 3 3 3 3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Elderly Care / Medicine Accident and Emergency (A & Maternity / Obstetrics Trauma & Orthopedics General Surgery Transport Gynaecology Fertility Cardiology Ear, Nose & Throat (E.N.T) Bariatric Surgery Respiratory Medicine Gastroenterology Main Outpatients Starlight Children's Services Paediatrics Breast Surgery Discharge Planning Maxillo-Facial & Oral Surgery Radiology (Imaging / X-Ray / Sexual Health / Young People Urology Adult Community Nursing - Continuing Care at Home Endoscopy Podiatry / Chiropody Foetal Medicine / Welfare Neonatal / Transitional Care Occupational Therapy Physiotherapy Adult Community Central Booking Dermatology / GPSI Service Diabetes Estates Foot Health Health Visiting Neurology Outpatients & Regional Neurological Hospital Palliative Medical Phlebotomy Primary Care Psychology School Nursing Security Sickle Cell Services (Acute & Therapy Service Acute & Chronic Pain Services Allergy Service Audiology Clinical Haematology Coloproctology Colposcopy Colorectal Surgery Community Gynaecology Community Midwifery Facilities Information Governance Intensive Therapy and Critical Medical - DEFOE Ward Primary and Urgent Care Rehabilitation Rheumatology Switchboard Telecoms Tuberculosis (TB) 12
Clock Stops Clock Stops are put in place when a complaint has been received by the Trust and is either extremely complex requiring multiple service involvement or a face to face meeting has been arranged with the complainant as part of the investigation process. Out of the 425 complaints received during April 2 and March 217 a total of 24 complaints were Clock Stopped for these reasons. This is a reduction on the number of clock stops in 215- (34). Clock Stopped Complaints 1 3 CSDO CORP SWSH IMRS 2 ENVIRO Outcome of investigations The finding of each complaint investigation is recorded by the Trust once the final response has been sent to the complainant/patient. In total, 229 complaints (54%) were either upheld or partially upheld by the Trust. Investigation Outcome Apr 2 - Mar 217 176 148 2 15 1 5 11 81 9 13
Method of raising complaints The table below shows the method by which each complaint was received by the Trust. Email and letter remain the preferred method used by complainants to log their complaints. 18 Mode of Complaint 18 14 12 1 8 6 4 2 2 59 GP Alert Email In Person Letter MP Letter Verbal Statement 93 6 8 77 Telephone Complaints requiring follow up Once a complaint has been investigated by the Trust, and a response has been sent, a complainant may request further investigation to address outstanding concerns or questions that seem unanswered. In such circumstances, the Complaints Team will re-open the complaint either making arrangements for a meeting to be held with certain members of the Trust or to request the Investigation Lead to review the outstanding issues or queries raised. Subject to the nature of the request, the complaints team may decide with the approval of the Head of Patient Response & Resolution or Chief Nurse to clockstop the complaint whilst a meeting is arranged or other investigations take place, particularly if this involves a Serious Incident or Root Cause Analysis investigation. All complaints which are subject to a further investigation/follow-up meeting are closely monitored and reported to each Division on a weekly/monthly basis to ensure that the follow up to the complaint is handled in an effective and timely manner and where possible, responded to within twenty five working days. The complaints team have now introduced a new system for managing and monitoring follow-up complaints to ensure we have an effective and robust system to manage the increased number of follow-up complaints being received Referral to the Parliamentary and Health Services Ombudsman (PHSO) Where complaints have not been resolved at Local Level, complainants are advised that they can approach the PHSO to ask for their complaint to be considered for independent review. Data from the PHSO is only available for the first 2 quarters of 2-17. Out of the 425 complaints made to the Trust in 2/217, 4 were accepted by the PHSO for further investigation according to Trust figures. Of these only 1 complaint has been closed since then and only 1 upheld. The overall rate of complaints upheld by the PHSO is averaging 4% so this appears lower than average. 14
Request Number of complaints received by the PHSO between 1 April 2 and 3 September 2 Number of cases accepted for investigation (period April 2 - March 217) Number of Cases that remain open (period April 215 March 2) 1 April 22 June Information 31 4 3 Number of complaints upheld in April 2- September 2 1 Number of complaints partly upheld Number of complaint cases not upheld in April 2 September 2 (three are still open) 3 (from previous years) Number of pre 215/ cases still open 1 Conclusion Although the numbers of complaints continued to rise in 2-17, it is heartening to see a slowing of the rate of rise. In addition, many fewer complaints were accepted for investigation by the PHSO (11 were accepted in 215-) and only one has been upheld in 2-17. The increased focus on investigating, responding and learning from complaints will have played a part in this. The pressure on resource (particularly clinical staff) in order to deliver timely and appropriate investigations and responses is a growing issue, despite the improvements to our complaint response times. However, there are many positive outcomes to the lessons learnt as a result of response and resolution of complaints and therefore this part at least should be viewed in a helpful and positive context. 15