Patient Complaints Annual Report 2015/16

Patient Complaints Annual Report 2015/16 Compiled October 2016 Sophie Dalton Head of Patient Relations and Complaints King s College Hospital NHS Foundation Trust Denmark Hill London SE5 9RS Kch-tr.patientcomplaints@nhs.net

CONTENTS Executive Summary 3 Page Overview of complaint numbers 4 Denmark Hill Bromley sites Complaints and PALS contacts Trust wide for 2015/16 5 Complaints by Service Area 6 Complaints measured against Trust activity 8 Complaints by Division 8 Divisional Complaints measured against Trust activity 12 Causes of complaint 13 Grading (severity) and outcomes 19 Ethnicity, age and access 20 Parliamentary and Health Service Ombudsman 21 Learning from feedback 23 2 King s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16

Executive Summary This report provides a summary of patient complaints received between 1 April 2015 and 31 March 2016. It includes details of numbers of complaints received during the year both for the Denmark Hill and Bromley sites, performance in responding to complaints, Parliamentary and Health Service Ombudsman investigations and actions taken by the Trust in response to the complaints. The report aims to provide assurance that the Trust is responding to patient complaints in line with its procedures, Department of Health legislation, and service standards expected by the Parliamentary and Health Service Ombudsman. Patient Experience reports provide integrated quarterly data on complaints, PALS contacts, HWRD survey results and the Friends and Family test survey. Points to note: In 2015/16, the Trust received 803 complaints Denmark Hill 464 and Bromley sites 339. Overall, an organisational decrease of 21% compared to 2014/15 (974). 20% reduction in complaints (Denmark Hill) and 14% reduction on the Bromley sites. 9,236 PALS contacts recorded - 10% increase from 2014/15. End of year performance of 45% in responding to complaints within 25 working days (Denmark Hill 44% and Bromley sites 47%) 2% of complaints were referred to the Parliamentary and Health Service Ombudsman. 1400 Written Complaints - King's College Hospital NHS FT since 2010/11 (incorporating complaints on Bromley sites from 2013/14) 1200 Bromley site Denmark Hill 1000 435 800 395 600 339 400 768 200 560 588 639 579 464 0 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 3 King s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16

The table below provides the recent comparative data on the numbers of complaints received amongst the Shelford Group of NHS Foundation Trust Hospitals. Organisation *Nationally, there was a 4.5% decrease in complaints received 2015/16 data provided by NHS Digital Overview of Complaint Numbers Denmark Hill Complaints 2015/16 Complaints 2014/15 % increase/ decrease King's College Hospital 803 974-21% Addenbrooke's 519 523 1% Central Manchester 1160 1023 13% Guy's and St Thomas' 1122 938 16% Imperial College 1145 1242 8% Newcastle upon Tyne 629 717-14% Sheffield Teaching Hospitals 1378 1354 2% University Hospitals Birmingham 680 775-14% University College London 712 833-15% 464 complaints were received in 2015/16 which is a 20% reduction compared to the previous year (579) and the lowest number of complaints recorded for Denmark Hill since 2010. 9% of complaints (43) were re-opened during the year for further response which is consistent with previous years. The end of year performance in responding to complaints within 25 working days was 44% which is improved on 2014/15 (35%). The ratio of complaints during the year, to patient activity (per 1000 patient attendances) was 0.4 compared to 0.6 in 2014/15 and 0.8 in 2013/14. First received Complaints responded to within 25 Days % Response Rate within 25 Days 15/16 Q1 90 38 42% 15/16 Q2 136 50 37% 15/16 Q3 129 57 44% 15/16 Q4 109 57 52% Totals 464 202 44% 4 King s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16

Bromley Sites 339 complaints were received in 2015/16, a 14% reduction compared to the previous year (395). 12% of complaints (42) were re-opened during the year for further response which is an increase on the previous year (34). The end of year performance in responding to complaints within 25 working days was 47% which is improved on 2014/15 (37%). The ratio of complaints is 0.5 to 1000 patient attendances compared to 0.76 in 2014/15. First received Complaints responded to within 25 Days % Response Rate within 25 Days 15/16 Q1 68 29 43% 15/16 Q2 90 34 38% 15/16 Q3 89 50 56% 15/16 Q4 92 46 50% Totals: 339 159 47% Complaints and PALS contacts Trust wide for 2015/16 The number of complaints received on all Trust sites significantly reduced in 2015/16 (803) and has continued to fall since 2013/14 (768 Denmark Hill, 435 Bromley sites). Compared to patient activity within the Trust, this is measured to 0.5 complaints per 1000 attendances. Complaints received have ranged between 43 and 83 a month (a monthly average of 67 complaints), with Denmark Hill receiving on average 39 complaints per month, while Bromley sites received 28 complaints per month. The Trust has a challenging target of responding to complaints within 25 working days given the complexity of cases it often receives. We know we can do more to improve the quality and timeliness of our complaint responses and in the coming year we will continue to improve our complaints handling and this is a priority for the Board. In 2015/16 the average response rate at Denmark Hill was 51 working days and at the Bromley sites 48 working days. All new complaints are triaged by the central complaints team with the aim of providing complainants with the opportunity to have their experience addressed by PALS, where intervention is felt possible. This approach has consistently been applied since October 2014. It is generally felt that concerns relating to the Denmark Hill site have been more successful to defuse than those concerning the Bromley sites; in part this reflects the type of experiences coming to our attention, but also the expectations of the complainants in how they wish their concerns to be handled. PALS contacts increased by 10% during the year which is a smaller increase than that seen in the previous year. 5 King s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16

The Trust also regularly receives positive patient experience stories via patient opinion websites, HRWD, through social media networks, Twitter and Facebook. From January 2017, the Trust will start to record compliments in addition to comments, complaints and concerns. Complaints by Service Area The charts below illustrate the distribution of complaints between the service areas of patient care over the past few years. On the Denmark Hill site, the decrease in all categories is evident; a total of 256 inpatient complaints (including maternity) which is 55% of the total complaints at Denmark Hill and outpatient complaints is 208 (45%). On the Bromley sites, a total of 184 inpatient complaints (including maternity) were received (54%) and outpatient complaints is 155 (46%). Denmark Hill Maternity complaints have remained static since 14/15 (27 from 31) while conversely on the Bromley sites, there is a significant reduction compared to the previous year (a 67% decrease from 27 to 9). Complaints about emergency care have also encouragingly reduced across both sites in 2015/16 (DH, 48 from 90; PRUH, 54 from 73). 6 King s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16

7 King s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16

Complaints measured against Trust activity Denmark Hill 2013/14 2014/15 2015/16 Inpatient attendances Number of inpatient complaints Inpatient Complaints per 1000 attendances Outpatient attendances Number of outpatient complaints Outpatient Complaints per 1000 attendances 415 296 256 137,298 131,409 130,049 3.0 2.3 2.0 265 203 160 667,421 689,461 818,203 0.40 0.29 0.2 Bromley sites 2014/15 2015/16 Inpatient attendances Number of inpatient complaints Inpatient Complaints per 1000 attendances Outpatient attendances Number of outpatient complaints Outpatient Complaints per 1000 attendances 203 184 82,983 86,433 2.45 2.1 118 101 371,143 488,703 0.3 0.2 Complaints by Division Each complaint is assigned to a principle Division regardless of other specialities that may be involved in another aspect of the complaint. The following tables illustrate the distribution of complaints by the key Division during 2015/16 for Denmark Hill and Bromley sites and also complaints received over a two year period. 8 King s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16

9 King s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16

The following table provides each Division s responsiveness to complaints in 2015/16. Divisions achieving 60% and above are highlighted. DIVISION Complaints No. Responded Within 25 Days % Response Rate Within 25 Days No. Responded Late Ambulatory 53 22 42% 30 Sexual Health 4 4 100% 0 Dental 25 14 56% 12 Critical Care & Theatres 13 8 62% 6 Clinical, Scientific & Diagnostic Services 12 8 67% 4 Day Surgery 5 1 20% 4 Liver 54 19 35% 25 Renal 9 5 56% 4 Surgery 148 51 34% 84 Cardiovascular 36 22 61% 13 Neurosciences 73 32 44% 38 Clinical Haematology 19 9 47% 9 Medical Specialties 107 36 34% 66 Therapies 7 1 14% 6 Emergency Department 87 34 39% 49 Women's Services 39 25 64% 14 Maternity 53 36 68% 17 Child Health 29 16 55% 12 CEF (Capital, Estates & Facilities) 28 15 54% 12 Corporate Affairs 1 1 100% 0 Other Trusts 1 0 0% 1 Totals: 803 361 45% 406 10 King s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16

It is worth noting in particular that: Ambulatory and Local Networks (including Dental) had an overall 32% reduction of complaints compared to 2014/15 (119, 81). This reduction is due to fewer complaints at the Denmark Hill site (50 from 92) in most ambulatory specialities; however Ophthalmology saw a small increase (15, 11). Complaints on the whole related to medical treatment (including dental outcomes and complications) and the administrative processes (appointments, communication, and admissions for treatment). Liver, Renal and Surgery (LRS) had an overall 16% reduction in complaints across all hospital sites compared to 2014/15 (211, 252). The distribution of complaints has remained relatively unchanged with Surgery receiving 3 complaints per 1000 patient attendances and 0.3 outpatient complaints per 1000 patient attendances. Complaints relating to a surgical waiting list or patient discharge were quite high at both sites (13 DH, 16 Bromley sites) and concerns relating to clinical treatment (surgical decisions/outcomes) were higher at the Bromley site than at Denmark Hill (41, 17). Medical Specialties notably at the Bromley sites, there was a higher number of complaints relating to patient discharge planning and arrangements. This included communication of plans with family/carers, challenges on medical fitness to be discharged from hospital and the after care information/social services input. Networked Services Complaints about Clinical Treatment were the highest at Denmark Hill within Neurosciences (32). Complaints are often complex and are linked to surgical decisions and dissatisfaction with outcomes, however less than half of these were found to be well founded when investigated. Inadequate communication with patients was often identified as a cause for patients not feeling satisfied with care. 11 King s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16

Divisional Complaints Measured against Activity Inpatient Complaints Denmark Hill 15/16 Patient episode Complaint per 1000 14/15 Patient complaint per 1000 13/14 Patient complaint per 1000 Ambulatory 6 13,948 0.4 9 13,104 1 5 14,346 0.3 Dental 4 11,891 0.3 6 11,943 1 11 13,346 1 Liver 17 12,328 1.4 26 11,125 2 44 10,576 4 Renal 3 1,413 2.1 2 1,412 1 4 1,583 3 Surgery 37 11,803 3.1 47 13,641 3 66 13,977 5 Cardiac 23 3,446 3.6 18 6,557 3 16 6,587 2 Haematology 10 14,347 0.7 9 13,218 1 9 12,995 1 Neurosciences 33 8,402 3.9 49 8,560 6 54 8,615 6 TEAM 47 17,360 2.7 37 17,584 2 68 18,911 4 Child Health 16 14,356 1.1 19 13,870 1 18 13,871 1 Gynaecology 8 4,563 1.8 11 4,736 2 10 5,147 2 Obstetrics 33 11,045 3.0 31 13,385 2 54 16,869 3 Outpatient Complaints 15/16 Patient episode Complaint per 1000 14/15 Patient Complaint per 1000 13/14 Patient Complaint Per 1000 Ambulatory 22 150,571 0.1 46 134,654 0.3 32 134,266 0.2 Dental 18 134,189 0.1 31 111,618 0.3 29 118,791 0.2 Liver 23 46,687 0.5 17 36.639 0.5 27 40,986 0.7 Renal 6 18,347 0.3 4 15,158 0.3 5 21,657 0.2 Surgery 26 85,909 0.3 34 82,574 0.4 38 91,235 0.4 Cardiac 2 34,781 0.1 5 27,486 0.2 8 30,445 0.3 Haematology 5 65,085 0.1 3 48,282 0.1 1 22,388 - Neurosciences 25 41,683 0.6 18 40,326 0.5 40 43,953 0.9 TEAM 6 39,632 0.2 8 81,651 0.09 5 118,788 - Child Health 5 46,485 0.1 12 31,845 0.4 14 37,995 0.4 Women s Health 7 107,446 0.1 10 103,494 0.10 39 106,856 0.4 Bromley Sites Inpatient Complaints 15/16 Patient Episodes Complaint per 1000 14/15 Patient complaint per 1000 Ambulatory 2 11,947 0.2 5 11,153 0.45 Dental 1 1,653 0.6 0 1322 0.00 Liver 6 7,528 0.8 3 4,903 0.61 Surgery 51 18,913 2.7 61 20,694 2.95 Cardiac 7 1,979 3.5 3 2223 1.35 Haematology 0 5,971 4 6,077 0.66 Neurosciences 11 2,025 5.4 9 1,702 5.29 TEAM 61 17,995 3.4 59 16,486 3.58 Child Health 5 6,675 0.7 4 6,262 0.64 Gynaecology 15 3,560 4.2 13 3,782 3.44 Obstetrics 17 5,795 2.9 30 5,807 5.17 12 King s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16

Outpatient Complaints 15/16 Patient Episodes Complaint per 1000 14/15 Patient Complaint per 1000 Ambulatory 26 146,121 0.2 19 126,724 0.15 Dental 2 24,901 0.1 3 21,726 0.14 Liver 8 11,232 0.7 7 8,416 0.83 Renal 0 2,981 1 1,607 0.62 Surgery 34 117,932 0.3 50 97,060 0.52 Cardiac 4 16,536 0.2 3 11,030 0.27 Haematology 4 57,515 0.1 4 63,198 0.1 Neurosciences 4 7,139 0.6 3 6,029 0.50 TEAM 6 36,670 0.2 4 27,995 0.14 Child Health 3 13,013 0.2 4 10,683 0.4 Women s Health 11 44,410 0.2 13 36,543 0.4 Causes of complaint In April 2015 changes were made to the National Complaint framework (K041) and there is now a quarterly data set return rather than an annual one. The information obtained from the KO41 collection monitors written hospital and community health service complaints received by the NHS. Each complaint is considered on a case by case basis to ensure the issues raised are carefully and appropriately considered. Whereas some complaints relate to a single episode of care or experience, others can be multi-faceted and may involve multiple clinical specialities and/or require comments from another NHS hospital or service. All complaints are allocated against subject areas, as set out by the Department of Health. Our top 5 subject categories of complaint in 2015/16 are: Clinical Treatment (provided by a doctor/dentist) 45% Patient Care (nurse led care) 12% Admissions, discharge and transfers 11% Communications 10% Values and Behaviours (staff) 5% 13 King s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16

Denmark Hill Direct comparison with last year is difficult because of the subject category changes introduced in 2015/16. Clinical treatment now refers only to contact and care provided by a clinician whereas in past years it encompassed all clinical treatment provided by the full clinical multi-disciplinary team. A separate category for nursing led care is also now applied, which includes patient nutrition and hydration. However, clearly a complaint relating to clinical treatment (doctor led care) is the predominant cause of a complaint being made (206-44%), while 52 (11%) concern care provided by nursing/midwifery staff. Complaints relating to admissions, discharge and transfers have doubled in 2015/16 (50) compared to 25 complaints last year, but this may reflect the broader range of issues which now fall within this category. Denmark Hill - Primary subject of complaint 2015/16 % of complaints Clinical Treatment (doctor led care) 206 44% Patient Care (nurse led care) 52 11% Admissions, discharge and transfers 50 11% Communications 50 11% Values & Behaviours (Staff) 27 6% Appointments including delays and cancellations 23 5% Transport (Ambulances only) 11 2% Access to treatment or drugs 10 2% Trust Administration 6 1% Waiting Times 6 1% Facilities Services 5 1% Prescribing errors 4 1% Privacy, dignity and wellbeing 4 1% Integrated Care 3 1% End of Life Care 2 0% Other 5 1% Totals: 464 100% Denmark Hill - Primary subject of 2014/15 % of 2013/14 % of complaint complaints complaints Admissions, discharge and transfer 25 4% 33 6% arrangements Aids and appliances, equipment and 8 1% 10 1% premises Outpatient appointments 27 7% 54 5% delay/cancellations & delay in clinic Inpatient delay/cancellations 31 7% 54 4% Attitude of staff 46 10% 80 9% Clinical Treatment all aspects 339 51% 390 56% Communication oral and written 46 10% 76 9% Consent to treatment 3 0% 3 0% Privacy and Dignity 11 2% 13 3% Patient s property and expenses 4 1% 7 0% Personal records 5 1% 9 2% Transport (ambulances and other) 15 2% 15 2% Hotel Services (including food) 0 0% 1 0% 14 King s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16

Just under half of the inpatient complaints received at Denmark Hill relate to clinical treatment (doctor led care), with concerns raised in all specialities, but slighter higher in Obstetrics, Neurosurgery, cardiology, and orthopaedics. Because complaints reflect a personal experience, it is difficult to be precise about any common themes but some of the issues raised include a perceived delay or failure in treatment or a procedure (medical and surgical patients), inappropriate surgical management, post-operative management either a developed complication or outcome not as expected, and obstetric management (labour). Running throughout most complaints are communication issues and the negative impact this has had. Poor attitude and behaviour is a trigger for a complaint when staff do not display empathy and compassion or are brusque and do not appear to be willing to give the patient the voice to speak. Outpatient complaints include the Emergency Department cases and therefore the number of clinical treatment complaints is reflected in the overall number. Complaint issues include missed or incorrect diagnosis in the Emergency Department, for instance when an x-ray is not ordered and an undiagnosed fracture is later confirmed. Missed or incorrect diagnosis (surgical patients, which includes neurosurgical), post-treatment/procedural complications raised by dental patients, and delays in treatment commencing in medical specialties. The following tables illustrate the main complaint themes by quarter for both inpatient and outpatients. 15 King s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16

Bromley sites Just under half of the complaints received in 2015/16 related to an aspect of clinical treatment (doctor led care) 159 (47%) which is significantly down in terms of number received compared to 2014/15 (224), even taking into consideration that patient care (nurse led care) is now captured separately. Complaints concerning admission, discharge and transfer have increased to 38 from 28 in 2014/15, representing 11% of the total number of complaints. Communication likewise went up to 32 from 24 last year but complaints about the behaviour of staff decreased to 12 from 34 in 2014/15. Bromley sites - Primary subject of complaint 2015/16 % of complaint Clinical Treatment (doctor led care) 159 47% Patient Care (nurse led care) 43 13% Admissions, discharge and transfers 38 11% Communications 32 9% Values & Behaviours (Staff) 12 4% Appointments including delays and cancellations 11 3% Waiting Times 9 3% End of Life Care 7 2% Prescribing errors 7 2% Access to treatment or drugs 4 1% Facilities Services 4 1% Trust Administration 4 1% Privacy, dignity and wellbeing 3 1% Transport (Ambulances only) 3 1% Integrated Care 2 1% Consent to treatment 1 0% Totals: 339 100% 16 King s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16

Primary subject of complaint 2014/15 % of complaints 6 months Oct-Mar 2013/14 % of complaints Admissions, discharge and transfer arrangements 28 7% 9 5% Outpatient appointments delay/cancellations & delays in clinic 25 6% 11 6% Inpatient delay/cancellations 28 7% 20 10% Attitude of staff 34 9% 15 8% Clinical Treatment all aspects 224 55% 106 54% Communication oral and written 24 6% 25 13% Consent to treatment 1 0% 1 1% Privacy and Dignity 2 1% 1 1% Patient s property and expenses 0 0% 1 1% Personal records 9 2% 3 2% Transport (ambulances and other) 6 2% 2 1% Complaints concerning clinical treatment (doctor led care) represent 47% of the total number received; of these 55% relate to an outpatient episode or Accident and Emergency attendance. Patient concerns include missed or incorrect diagnosis (including missed fractures), delay or failure to provide surgical treatment or procedure and inadequate clinical assessment. Like Denmark Hill, communication issues run through most complaints, and concerns in regard to a discharge have increased. This includes the involvement of carers/family in the discharge planning, medical fitness for discharge, and home care support. 17 King s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16

18 King s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16

Grading and outcomes Complaints are triaged and graded on receipt for severity using the Department of Health s grading guide. The initial grading is determined by the Patients Complaints team based on content of the complaint and is reviewed by the receiving Division for appropriateness. Complaints graded as high priority (amber) have continued to decrease on the Denmark Hill site over three consecutive years 138 cases in 2013/14, 90 in 2014/15 and 59 in 2015/16. High severity cases have likewise decreased on the Bromley sites from 50 in 2014/15 to 40 cases. Low severity complaints have also decreased on both sites which reflect the local resolution work we have continued to focus on this year. By managing an unsatisfactory experience promptly, the overall complaint numbers have reduced. Complaints that raise serious concerns are routinely reviewed by senior clinical colleagues and are linked to a patient safety investigation under Duty of Candour, where appropriate. In 2015/16, 8 serious complaints were received (2 Denmark Hill and 6 Bromley sites). At Denmark Hill, the cases were in Cardiology and Neurology, and at Bromley; Ophthalmology, Cardiology, Gynaecology, Stroke and Haematology (2). Grading Denmark Hill Number of complaints & % of total received 19 King s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16 Bromley sites Number of complaints & % of total received Low unsatisfactory experience 134 (29%) 68 (20%) Medium service or experience below reasonable expectations High significant issues regarding standards and quality of care Serious serious failure causing serious harm 269 (58%) 218 (66%) 59 (13%) 40 (12%) 2 (0%) 6 (2%)

During 2015/16, about half of the complaints investigated have issues (either in full or in part) which were considered to be substantiated. Denmark Hill 50% were upheld which is better than 2014/15 (54%). Bromley sites 53% were upheld which is also an improved position to 2014/15 (61%). Ethnicity, age and access The Trust widely promotes the opportunity for patients to raise concerns or provide feedback through many communication mediums; for example, all patient letters and patient information all now provide details for the PALS service. We provide an online form for submitting an enquiry, concern or feedback and PALS is located in an accessible location at both the Denmark Hill and Princess Royal University Hospital sites. We signpost patients/carers to free NHS advocacy services where support may be required, and Easy Read literature and translations are also available. The percentage of a patient ethnicity which is captured when recording complaints, is fairly consistent with previous years, on both sites. However comparing the profile of the age of patients who are affected by concerns raised with the Trust, there are differences between Denmark Hill and Bromley sites. At Denmark Hill, there is a relatively constant representation of concerns relating to patients aged between 20 and 80, whereas on the Bromley sites, complaints relating to patients aged 60 and over are higher. Ethnicity Denmark Hill % of complaints Bromley sites % of complaints White - British 46% 66% White - Irish 1% 3% White - other white 5% 1% Mixed white and black Carribean 1% 0% Other mixed 1% 0% Indian 2% 1% Black Carribean 5% 3% Black African 6% 0% Other Black 12% 3% Other ethnic category 3% 3% Not stated 16% 20% Age Denmark Hill % of complaints Bromley Sites % of complaints under 20 38 (8%) 21 (6%) 20-40 124 (27%) 62 (18%) 40-60 130 (29%) 69 (20%) 60-80 114 (25%) 87 (26%) 80+ 47 (10%) 98 (29%) Complaints sent by Email were the predominant method of contact on both sites (46% and 47%). 11% of complaints relating to Bromley sites were passed to patient complaints when local resolution opportunities were either rejected or unsuccessful. Complainants who submitted a Complaint Form (Denmark Hill 11% - Bromley sites 13%) have first sought advice from PALS about making a complaint as these forms are provided by the service as a convenient method to raise a concern. 20 King s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16

Method Denmark Hill Bromley Sites Email 212 (46%) 158 (47%) Letter 93 (20%) 87 (26%) Complaint Form 52 (11%) 45 (13%) Telephone call 67 (14%) 8 (2%) Escalated from PALS 36 (8%) 38 (11%) Parliamentary and Health Service Ombudsman The Parliamentary and Health Service Ombudsman (PHSO) investigate complaints where an organisation has not been able to resolve the complaint at a local level. The PHSO have broadened their review process and have considerably increased the numbers of cases that they consider. In 2015/16, they handled 29,000 enquiries, of which 6,815 cases were looked at in depth and of these, 5,058 were investigated. In 2015/16, the PHSO have recorded 124 complaints against King s College Hospital of these 17 cases went forward for investigation; a decrease from 22 in 2014/15. This represents 2% of the total complaints received. This highlights that a high number of enquiries are made to the PHSO prematurely (i.e. before making complaint to the Trust, or the complaint is open and awaiting a response). The PHSO have reported that of the cases investigated in 2015/16, 10 complaints were either upheld or partially upheld, with recommendations to provide an apology, and/or an action plan to put things right. Seven complaints were not upheld. The following table details the outcomes and actions from the 17 cases investigated. 21 King s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16

Division Date Complaint concluded PHSO received PHSO concluded Decision 1 Dental Dec-13 Dec-14 Apr-15 Partly upheld 2 Corporate affairs Dec-13 Mar-15 Apr-15 Upheld Outcome Dental anaesthesia insufficient to aid pain control Department of Oral Surgery discussed the case at a monthly departmental audit meeting for shared learning. NOK w ere not located/identified before a hospital contract funeral w as arranged. Shared complaint w ith local Council. Checklist put in place, volunteer recruited to help with enquiries, next-of-kin tracing service now used in all similar cases. 3 Dental Sep-14 Dec-14 Jun-15 Not upheld Patient feels they w ere not given continuity of treatment betw een 2011-2014 4 Dental Apr-14 Nov-14 Jul-15 Not upheld Care planning & communication betw een w ard and Theatre Recovery 5 Obsetrics - PRUH Jun-14 Aug-14 Jul-15 Partly upheld Patient w ith high BMI. Patient had still-birth at 39w eeks but there w as a failing to discuss a possible admission at 37w eeks and a change to planned rescheduling of caesarean section. Post natal care was appropriate and in line with national guidance. The still-birth was unavoidable. The original planning of C-Section was however too early and contrary to NICE guidance. Failure to communicate timing changes caused parents to believe something could have been done sooner to have prevented the still birth. Doctor met with Clinical Supervisor to discuss case. Staff reminded of the guidance that women with high BMI have a re-weigh at 36 weeks. Case anonymised and used for cross site medical learning. 6 Medicine Mar-14 Jul-14 Jul-15 Not upheld 7 Neurosciences Aug-14 Dec-14 Sep-15 Partly upheld Medical and nursing care appropriate and Trust response considered reasonable to all issues. Consent - up-to-date MRI should have been offered before Surgery w as scheduled to allow for all risks to be discussed w ith patient to give informed choice. Doctors will be prompted to state date of previous scans on waiting list form - made mandatory. 8 Liver Mar-14 Aug-14 Sep-15 Partly upheld Failure to consider clinical significance of the patient's presentations w hen referred from another NHS Trust. Failure to treat urgently w ith suspected cancer from the outset, meant the patient's condition became inoperable. Delayed complaint handling. Case discussed with clinicians involved to improve management of patients. Robust patient level tracking completed and improved monitoring of patients on cancer pathways - both monitored through the Trust's Cancer Waiting Times meeting. Training for coordinators completed to ensure appointments are booked appropriately. A MacMillan Cancer Helpline was been set up for when the clinical nursing team are unable to take calls from patients. 9 Surgery Oct-13 Jan-15 Nov-15 Not upheld Surgical outcome - no service failure identified 10 CCTD Jul-14 Feb-15 Nov-15 Not upheld 11 TEAM May-14 Mar-15 Dec-15 Partly upheld Legacy care complaint - The patient's balance and hearing problems w ere not caused by inappropriate treatment. Excessive delays in March 14 in ED & delay in doctor treating; cold cubicle; documentation of fluid charts and updates on treatment plan to be more regular. Significant changes within the ED since complaint was made; e.g. increased clinical establishment, opening of a Clinical Decision Unit, new ED nursing documentation, rapid assessment of patients who attend by ambulance during peak time (12 noon - 5pm). 12 Surgery Jun-14 Apr-15 Dec-15 Not upheld Communication w ith family - no failings identified 13 Neurosciences Nov-14 Feb-15 Jan-16 Partly upheld 14 Liver Feb-15 Aug-15 Feb-16 Partly upheld 15 Surgery - legacy Sep-14 Jan-15 Feb-16 Partly upheld 16 TEAM Nov-13 Sep-15 Feb-16 Partly upheld 17 Neurosciences Feb-15 Sep-15 Feb-16 Not upheld Distress caused by poor communication and updates on treatment plans Consultant rounds have improved communication and consultant of the week introduced to ensure a point of referral for any concerns. Poor provision of information before sigmoidoscopy and inadequate monitoring of patient during procedure to assess and top up pain relief. Nursing documentation improved to include monitoring and recording of pain. Care shared for learning. Post-operative care and rehabilitation information New Trust rehabilitation guidelines for patients who are undergoing micro fracture surgery of the knee. Missed opportunity to admit patient to hospital on second presentation to the ED, for investigations. The Clinical Decision Unit (CDU) has improved its clinical rota and cover - Actions completed since 2014 include: Daily ward round, including weekends by an ED consultant for decision making and support of junior staff. All ward rounds are documented on the electronic patient record. Locum doctors are not placed on CDU (unless regular and with CDU experience at KCH). Consultant support is available from 8am midnight 7 days a week. Transfer to another NHS hospital and lost property - no failings identified 22 King s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16

Learning from feedback Complaints present an opportunity to review patient care, our services, and the way we interact and provide information to our patients. Once we have investigated a complaint, we tell the complainant where we will be taking action to ensure the events leading to their experience, are put right. Often this may involve individual staff members reflecting on the way they have provided care, team discussions for wider group learning, staff training or use of the complaint as a case study. If complaints are investigated as a Duty of Candour, the final report is shared with the complainant and will include an action plan. Complaints monitoring is a standing agenda item for each divisional governance meeting and a 6-month complaints report is provided for discussion and shared learning. This includes any specific actions and required monitoring/audit. Trust-wide issues are highlighted in the integrated Quarterly Patient Experience Report and all complaints which refer to end of life care are shared with the Trust s End of Life Committee where they are reviewed for themes. Below are some examples of the actions that have been taken as a result of the complaints presented to the Trust in 2015/16. Suture glue entered a head wound causing pain and distress to the child Teaching sessions arranged for clinical staff in the paediatric Emergency Department on wound assessment, closure and tissue adhesive use. A paediatric sedation policy is to be written for use within the paediatric Emergency Department. A new formulation of adhesive glue is being used for paediatric patients. Patient attending Neurophysiology arrived on stretcher transported by hospital transport service. Presented difficulties for the treating clinical team and resulted in patient not undergoing the procedure. Neurophysiology drafting a procedure for managing stretcher patients. Hospital transport service reviewing the use of trollies to take stretcher patients to clinic. Patient with dementia attending the Emergency Department (DH) fell and sustained an injury. A special or Healthcare Assistant will be allocated to provide 1 on 1 care. We are developing dementia distraction techniques for patients that are admitted onto our Clinical Decision Unit. A meeting with the Trust s falls team was held to discuss bespoke falls prevention training and falls sensor mats. 23 King s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16