Trust Board Agenda Item 12. Date: 30.11.16 Title of Report Purpose of the report and the key issues for consideration/decision Patient Relations Annual Report The Board are asked to note the annual report from Patient Relations / PALS. This has been reviewed and discussed at Q&S Committee. Prepared by: Name & Title Presented by:, Patient Relations Manager Pauline Law, Director of Nursing Action Required (please X) Approve Adopt Receive for information x Strategic/Corporate Objective(s) supported by this paper Safe, Effective and Caring Corporate Objectives Is this on the Trust s risk register? No x Yes If Yes, Score Which Standards apply to this report? CQC NHSLA BAF Objectives WWL Wheel X X X Have all implications related to this report been considered? Yes/No/NA Any Action Required Finance Revenue & Capital Na. Na. Equality & Diversity National Policy/Legislation Na. Na. Patient Experience Na. Na. Governance NHS Contract & Risk Management Human Resources Na. Na. Terms of Authorisation Consultation/Communication Na. Na. Human Rights Other: Na. Na. Carbon Reduction If action required please state: Previous Meetings Please insert the date the paper was presented next to the relevant group ECC Audit Committee Quality & Safety Committee Finance & Investment Committee Management Board IM&T Strategy Committee Yes/ No/NA Na. Yes Yes Na. Na. Na. HR Committee Any Action Required Na. Na Na 12.10.16 Na Na Na Na Na Na NED No No Na. Na. Na. Other
Patient Relations/PALS Department Annual Review 2015/2016 Susan
Summary Reflecting on the last year the Patient Relations/PALS Department is again in a position to report a fall in the number of formal complaints from the previous year (2014/15) by 4%. The department has continued their proactive role of the PALS service which is measurable against the increase in the number of concerns, requests for information and advice from the previous year (15%). Introduction In April 2009, a revised NHS Complaints System was introduced to create a simpler more flexible complaints process within the NHS and social care services in England. The aim of the new system was to support the development of locally led complaints services that were supported by more flexible processes. The driver behind the changes was the desire to create a culture of openness and transparency between service users and providers and to reinforce the requirement for organisations to learn lessons from complaints which would in turn drive service improvement and an improved patient experience. The Trust has a duty to adhere to The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009, which states that all formal complaints are required to be acknowledged within 3 working days. Data reveals that Patient Relations met the national target, as well as dealing with the many concerns that require immediate action. A requirement of the National Health Service Complaints (England) Regulations 2009 is the preparation and production of an annual report specifically defined as a period of 12 months ending 31 March. The Regulations require the report to include the following information; The number of complaints received The number which were upheld The number which were referred to The Parliamentary and Health Service Ombudsman (PHSO) Summary of the subject matter of complaints Highlight any matters of general importance Identify action undertaken to improve services as a consequence of these complaints. The Regulations are supported by PHSO Principles of Good Complaint Handling and the CQC Essential Standards, Regulation 16: Receiving and Acting on Complaints. The Trust met its statutory duty and has extended the Annual Report to include the number and nature of cases dealt with by the PALS Service. 2
The team has remained committed too the 6 C s and the Always Events. The Patient Relations Departmen nt has the heart to Care; The Compassion to understan nd; The Courage to take things forward; The Communic cation skills to get itt right; The Competency to make it happen and the Commitment to see it through.. The team are dedicated in working with the Divisions andd the Multi-Disciplinary ensure a positive patient Staff to work in collaboration and to have a mutual goal too experience Patient Relations/PALS Structure Patient Relations/PALS Manager Susan Heighway Deputy Patientt Relations /PALS Manager Vicky Bolton Patient Relations/PALS Officer Zoe Howarth Patient Relations/PALS Assistant Annmarie Haggerty Patient Relations/PALS Assistant Julie Fields Patient Relations/PALS Senior Administrator Suzanne Huntley Mission Statement The Patient Relations/PALS Department face many challenges on a daily basis providing accesss to the department via the Patient Relations e-mail address; Patient.Relations@wwl.nhs.uk, by thee Wrightington, Wigan & Leigh NHS Foundation Trust web site www.wwl.nhs.uk; here we also provide information about the 3
department and our leaflet Comments, Suggestions, Problems and Praise as well as contact details and a complaints form that can be down loaded if required. We are available for face to face contact in the department from 09:00 hours to 16:00 hours during the week, and by telephone on 01942 822176 which runs from 2 lines and 1 internal line. There is also an answer machine for out of hours. The Patient Relations/PALS are often perceived to be just about complaints when in fact our work and the support we provide is much broader. Everyone is welcome to contact the department whether they are a patient, relative, carer or member of staff, as a friendly welcome is given to all. We have a wide range of leaflets and access to information to help where we can and during the day we respond to many requests for information and advice and signpost all who access our service in the right direction. Our remit is if we don t know, we will find out who does. The team continue to attend the ward and clinic areas as and when required. In addition we provide support to the staff of the Trust to ensure that they are able to respond to concerns and complaints in a positive manner. For example; helping to resolve concerns as and when they happen; providing information to the patient with respect to internal processes, i.e. being involved in Multi-Disciplinary Team Meetings (MDT) and arranging attendance and guidance. In addition the Patient Relations/PALS team provide pastoral support and family liaison support to the complainant through the complaints process. Patient Advice and Liaison Service (PALS) The PALS service has continued to work closely with the Divisions to respond in a proactive manner to concerns received within the Trust. This entails immediate involvement of the Divisions as well as contacting nursing staff, clinicians and administration staff in any particular area, to liaise and respond to concerns in real time. By providing the link between staff, patient, relative or carer and offering the support to everyone involved leads to a greater degree of satisfaction for all concerned. 382 Concerns were recorded on the DATIX system during the period 1 April 2015 to 31 March 2016, as having the potential to escalate to a formal complaint. With a further 1124 known contact with the department in respect of enquiries and requests for information. In addition during the year the team provide signposting information, a listening ear, refreshments for distressed relatives which may not appear to be significant but are a key and essential part of the role in the Patient Relations/PALS Department. These 382 concerns from 2015/16 were distributed over the year within the divisions as follows: Medicine 142 Surgery 120 4
Specialist Services 89 Corporate Services 5 Estates and Facilities 21 Finance - 5 A selection of the subjects of concerns assisted with were: Access issues to various departments; admission arrangements; attitude; communication; discharge arrangements; delay in diagnosis; appointments; administration to name a few. Reflecting on the past year Working with the Divisions The Team continues to build on the relationships with the Divisions and encourage the empowering of staff to work with us proactively to resolve concerns at source. The team support staff, patients, carers and their relatives through difficult times without having to engage in the formal complaints process. This attains a speedy resolution and satisfaction to all concerned. Last year proved to be more positive in relation to working together with staff within the Divisions. Staff from all areas and levels have continually supported the department in resolving concerns at source which provides us with the confidence that we have been successful in the building of firm relationships with our colleagues. Working with the Patient Safety, Legal Teams and Adult and Children s Safeguarding Leads The Team maintains strong working relationships with the Clinical Risk and Legal teams and attend the Executive Scrutiny Team Meetings on a weekly basis providing the information on all complaints and concerns received each week as well as providing the more positive aspects of information received. These meetings assist in the triangulation of incidents, claims and complaints prior to the Executive Scrutiny Meetings. Any complaints risk assessed as HIGH (RED) are discussed on an individual basis to enable a more in depth discussion to assist with the decision making of how they are to be taken forward. These include complaints that are also reflected in a Serious Untoward Incident, complaints received from MPs, and any which may have the potential for media attention. This ensures prompt decision making regarding the progression of these complaints and, where appropriate, instigation of investigations through the Root Cause Analysis process or Independent reports from clinical and nursing experts externally. 5
The Department works alongside the Trust Solicitor to liaise with relatives who have any outstanding concerns following an inquest and acting on communication/instruction from the Coroner. We also work closely with the Adult and Children s Safeguarding leads to ensure that any potential cases are escalated as soon as possible to ensure that prompt action is taken where appropriate. Working with the PHSO The Team continue to maintain positive links with the PHSO case workers; providing the necessary information and advice for a speedy and thorough resolution to their investigations. The Trust will also continue to challenge any report that it is felt is not acceptable and evidence is provided in respect of this. Advocacy Forging links with Advocacy Services i.e. ICA and Healthwatch to ensure that the complainant is provided with independent advice and direction to an advocate that is right for them. Working with other organisations The Trust will, on occasion, act as lead investigator for a complaint liaising with the other Trusts or organisations to ensure that a co-ordinated response is completed if requested by the complainant. The Patient Relations/PALS team work and coordinate complaints with: Other NHS Acute Trusts Regionally and Nationally The Ambulance Service/Patient Transport Services Community Services Independent Nursing Homes Social Services Local Council The Police Complaints are graded in accordance to their severity using a risk management matrix that looks at consequence and likelihood. A Red (High) rating is given to the more serious complaints. The table below shows a breakdown of the initially graded Red (High) rated complaints and then the final grade allocated following investigation during 2015/16. Last year s figures are in brackets. 6
Total Number of Initially Red (High) Rated Complaints graded Number of Complaints to remain RED (High) Status Number of Red (High) Rated downgraded to Amber (Moderate) Number of Red (High) Rated Complaints downgraded to Yellow (Low) Number of Red (High) Rated Complaints Downgraded to Green (Very Low) Number resolved via meetings Number of Red (High) Rated Complaints outstanding at Year End 42 (81) 6 (13) 34 (41) 1 (1) 0 (10) 4 (14) 1(2) Formal Complaints In 2015/16 the Trust received 362 formal complaints compared with 376 complaints in 2014/15. By addressing issues raised at source, 15 less formal complaints were reported last year and this reduction, in part, has been achieved by the department having much closer working relations with the Divisions and the staff at all levels within the Trust. The following data is provided in line with the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 The number of formal complaints received - 362 The number which were upheld 361 The number of requests received from the Parliamentary Health Service Ombudsman: 15 The Trust welcomes the views of people using our services and in acknowledgement of any patient, relative or carer who has felt it necessary to contact the Trust, apologises, where appropriate, to each person who has expressed their unhappiness following their experience. During 2015/16, the Trust therefore upheld 361 out of 362 complaints received. Complaints by Gender and Age In the table below it is evident that we receive more complaints about the treatment and care of females overall and that the age group that is more prevalent is the 60-69 age group. 7
400 350 300 250 200 150 100 50 0 8 25 20 30 21 33 24 37 26 40 17 10 12 13 14 18 and under Complaints Received by Patient Gender and Age Group 47 50 97 59 2732 24 33 9 6 8 2 19 29 30 39 40 49 50 59 60 69 70 79 80 89 90 99 total 203 362 159 Female Male Total Statistical information in respect of complaints and concerns is collected and monitored to identify trends. The Trust continues to share its statistical information from formal complaints nationally (KO41a) which includes information on Subject of complaint and the Services Area (in-patient; out-patient; A&E and Maternity). This information is now collected quarterly. A summary of the subject matter of formal complaints is demonstrated in the table below and for comparison purposes also shows the 2014/15 data. Subject Total 2015/16 Total 2014/15 Admissions, discharge and transfer arrangements 24 30 Aids and appliances, equipment, premises (including access) 6 5 Appointments, delay/cancellation (out-patient) 27 19 Appointments, delay/cancellation (in-patient) 16 7 Attitude of staff 39 24 All aspects of clinical treatment 183 248 Communication/information to patients (written and oral) 50 31 Patients' privacy and dignity 5 1 Patients' property and expenses 1 0 Personal records (including medical and/or complaints) 4 7 Failure to follow agreed procedure 1 1 Patients' status, discrimination (eg racial, gender, age) 1 1 Transport (ambulances and other) 1 0 Policy and commercial decisions of trusts 2 0 8
Hotel services (including food) 1 1 Others 1 0 Totals: 362 376 The majority of formal complaint received fall under the category of All aspects of clinical treatment which encases a large number of sub-subjects to pin-point an actual issue. Communication will always play a large role in a complaint even if it is not the main category identified. Attitude of staff complaints represent just over 10% of the complaints received. This is an increase from last year s figure of 24. It should be noted that communication complaints increased in 2015/16 and represents 14% of the total complaints received. However complaints relating to the admissions and discharge process have decreased from the previous year and represent 6.5% of the total complaints received. From the 1 April 2016 the complaints information will be collated under new categories for subjects and sub-subjects which is hoped will provide more comprehensive information as there are specific subjects that were previously only collated under the more general category of All aspects of clinical care. Trends Of the 362 formal complaints received 14% of these specifically relate to communication, these, in concert with the increase in the Attitude of Staff complaints (11%) go hand in hand. The Trust is still taking forward training in respect of communication as it is an essential skill. Customer Care Training is provided through the department and the Training and Development team. It is proposed to purchase a new version of the Customer Care Board Game for the coming year s training schedule by the Patient Relations/PALS Department. Attitude of Staff complaints were further reviewed by the Divisions involved and discussed with the individuals concerned with actions undertaken where necessary. Whilst the number of complaints received in relation to Admissions and Discharge arrangements have gone down from last year, 21 of the 24 received were regarding the Discharge process in some form. To ensure that further learning is shared the Patient Relations/PALS Department now provide information to the Discharge Improvement Committee which is also reviewed by the Adult Safeguarding Lead to enable her to review any aspect of a complaint which could be a safeguarding risk. In addition a search on the Incident Reporting system is also undertaken to identify whether, as a Trust, we have recognised any failing in the discharge process and these have been reported. Learning from complaints is very important and the following lessons are a snap shot of the identified improvements and the action taken over the last year. 9
Admissions discharges and transfers: 1. Midwife should have discussed with the Paediatrician the discharge arrangements of new born baby, and mums request to go home. The ward manager is to review discharge process and how communication can be improved; to ensure that the multidisciplinary team write in appropriate sections of the hospital (orange) case notes any deviations from the normal, and a management plan for ongoing care. Immediate care of new-born and new-born examination guideline are under review to include discharge process and criteria for discharge; documentation to be improved by all staff and staff need to be aware of incidents that have happened in order to learn from events and help reduce further similar incidents from occurring. 2. Concerns raised with regards to a patient s discharge destination, and changes to medication. In addition the family were not given any information regarding parking. The area have fed back to staff regarding effective communication in respect of plans/discharge and changes to the medication. A welcome pack being developed which will include car parking advice etc. Communication: 1. Patient was brought by ambulance however information was incorrectly documented from the ambulance chart by WWL. Whilst this was not referenced throughout the patient s admission and did not alter the patient s treatment, the incorrect information was relayed to the Care Home, which led to confusion. An addendum will be added to the medical notes, and the incorrect information will be removed from the Electronic Patient Record. 2. Staff were unaware of a patient s arrival in the department and therefore the patient was left waiting in a cold area wearing only a gown. All staff to check with reception if there is any indication that the patient may not have attended. All staff have been e-mailed as a reminder of this and this issue was discussed at the daily communication cell for the department. 3. Patient required British Sign Language interpreter (BSL) which was not realised until theatre time resulting in a delay as they were not first on list. BSL interpreter not available on discharge and supporting arrangement not made. Patients who require the interpreter for British Sign Language to be first on list where medically possible within the Division of Specialist Services. Patient Passport to be used to support journey for patients with hearing difficulties and other disabilities during their stay. 10
Attitude of Staff: 1. Mum concerned regarding the lack of examination of her young son, and attitude of paediatric doctor in emergency care. The doctor has reflected (via discussion with his senior colleague) on his attitude, and to fully consider all aspects of examinations. Doctor will also shadow a paediatric consultant to improve his practice. Equipment Failure: 1. Patient fell from operating chair. Patients to be supervised when being seated on the operating chair. Staff to be given formal teaching sessions regarding seating positions. A Standard Operating Procedure is to be produced and poster communication to be displayed in the Anaesthetic room. Medication Error: 1. Patient was given medication which was not compliant with the current medication this set back the patient s treatment. The Doctor concerned has reflected on the error and provided a statement to the Consultant in charge of care. They will continue to be monitored and will need to contact Pharmacy when unsure regarding any medication. Patient s privacy and dignity: 1. Patient was having a scan when a nurse took her phone out and appeared to read a message, however patient is concerned that the nurse could have discretely taken a photograph of her during examination. Staff member received feedback and reminded of the Trust policies in place. Policy also reiterated to all staff as a point of learning Second Bites (Complainants who remain unhappy) When a complainant remains unhappy with the response from the Trust we ask that they let us know what they feel we have not responded to or what they do not agree with. These are known as Second Bites. The number of second bites has continued to demonstrate a reduction compared with the previous year. This confirms that the process of providing a comprehensive response in the first instance is being maintained. However the Team will continue to strive and work with the Divisions to eliminate or further reduce the need for a second bite by ensuring responses are thorough and cover all the concerns raised. 11
28 26 24 22 20 22 Second Bites 1 April 2015 to 31 March 2016 26 1 April 2014 to 31 March 2015 Concerns, Information and Advice Within the department we respond to a great many concerns, requests for information and advice. These are identified and dealt with in an appropriate manner. We also involve the Divisions allowing the opportunity to deal with a concern at the time and if successful stop this becoming a formal complaint as reflected in the number of formal complaints received this year. It is anticipated that if the amount of formal complaints reduce that the number of concerns should increase. This has been the case during 2015/16. To further demonstrate this, the table below reflects the number of formal complaints, concerns (which includes requests for information) and telephone activity that the team have received during the past year compared with the previous year s figures. 14000 12000 10000 8000 6000 4000 2000 0 Comparison of Formal Complaints/Concerns/Telephone Activity 2014/15 and 2015/16 362 376 381 337 11703 11113 Formal Complaints Concerns Telephone Activity 2015/16 2014/15 As a Trust we welcome comments both negative and positive to help make improvements to our services. This is rich and powerful information and is free market research that should be embraced. 12
Parliamentary and Health Service Ombudsman (PHSO) During the year 2015/2016 the Trust received 15 requests for files from the Parliamentary and Health Service Ombudsman the outcomes of which are as follows: Ombudsman Cases 2015/2016 Requests for Records Partially Upheld Fully Upheld Not Upheld Not Being Investigated Draft Report Only 15 5 0 7 1 2 The 5 cases that were partially upheld were also the subject of financial redress. Patient Satisfaction Survey During the last year the department sent out a patient satisfaction questionnaire to all complainants who had received a CEO response in that particular quarter. It was found that the first 2 questionnaires were not fit for purpose as it was felt that the questions may have been misinterpreted in that the answers did not reflect an opinion on the service. This led to a further survey being prepared with questions in line with the My Expectations for raising complaints and concerns published by the Parliamentary and Health Service Ombudsman. Out of 80 Questionnaires 32 were returned. The responses to the 14 questions posed are set out below: Question YES NO NOT APPLICABLE NOT SURE NO ANSWER 1 I was aware that I could make a complaint. 28 4 0 0 0 Q2 I knew how to make a complaint. 22 8 1 0 1 Q3 I felt able to raise my concerns with any member of staff. 17 14 1 0 0 Q4 There was information available to assist in the making of a complaint. 19 12 1 0 0 Q5 I knew that there was support to make a complaint 15 16 0 0 1 Q6 I received communication that my complaint had been received 32 0 0 0 0 13
Q7 I received a response in the timescale advised for my complaint 27 5 0 0 0 Q8 I was updated when my complaint was overdue 15 9 7 1 0 Q9 I was told the outcome of my complaint in an appropriate manner 29 2 0 0 1 Q10 I feel that my response was satisfactory 14 16 0 0 2 Q11 I felt that my complaint had been handed fairly 14 15 0 2 1 Q12 I would feel confident in complaining again 21 10 0 0 1 Q13 I am confident that complaints help improve services 18 12 0 1 1 Q14 I would happily advise and encourage others to make a complaint if they felt they needed to 25 7 0 0 0 On reflection on some of these results; as a department we feel assured that the majority of people were aware of the complaints process and how to make a complaint. This has been reinforced with recent visits to the different sites by the Patient Relations/PALS Manager and one of the Governors to ensure that information is available. In Q6 it is noted that every person advised that they had received acknowledgement of their complaint and it is evident that there is confidence in the complaint process with 25 out of the 32 responding positively to Q14 as we do, as a Trust encourage our service users to let us know when things go wrong so we can make changes to improve the services we provide. The response to Q9 was very positive in that the outcome to the complaint was told in an appropriate manner, which provides reassurance that the responses are written sensitively and are suitable for the audience they are intended. It is disappointing that the responses for Q10 and Q11 gave an element of dissatisfaction to what the complainant was expecting, however there is always going to be some difference in opinion following investigations and a personal acceptance of information that is provided is never going to be 100%. Some of Our Successes in 2015/16 The further reduction in formal complaints and the increase in the number of issues being resolved as concerns 14
A reduction in the number of holding letters sent out due to the collaborative working with the Divisions to respond to complaints in the agreed timescale. Involvement in the Quality Champions Programme Involvement in the Trust s Advance Communications Programme Involvement in Trust Induction Involvement in Bereavement Services training Involvement in the Ward Leadership Programme Involvement in the Caring for our Customers Programme The success of the patient experience video used in training; CEO Blog and incorporated in outside media. Facilitate and support a pre-employment candidate and a Cadet giving the experience to assist in finding permanent employment Vexatious Policy re-written and ratified Significant Assurance from the MIAA Internal Audit Report The writing of a in Investigating Complaints training package Completion of the CQC Fundamental Standard review CQC interview with the CQC in December 2015 and subsequent positive comments in the CQC reports Majority of PHSO investigations resulting in not upheld Professional Development Day attendance and presentation Attending the National NHS Complaints Managers Group Meeting in London giving the opportunity to share learning and good practice. As a department we have received positive feedback of our service which include thank you cards, comments relayed personally and gifts of chocolates. Looking Forward into 2016/17 The Patient Relations/PALS team are always looking for a better way to work to achieve our main goal to provide a better patient experience. To continue to be proactive on receipt of a complaint taking these forward for early resolution and to continue building the relationships with staff of all levels to deliver this. Ensuring up to date information is provided at the Executive Scrutiny Meetings each week, with the continuation of working closely with colleagues from Patient Safety and Legal Services and Adult and Child Safeguarding the sharing of information at an early stage is imperative for the Trust s reputation and early intervention with external bodies. Ensuring the complainant is kept informed of the progress of their complaint by either letter or personal phone call the need for this has reduced significantly in the last 12 months due to the Divisions responding in the agreed timescale, we will continue to strive for 100% compliance. 15
Continue to give prompt, appropriate information, guidance and advice to signpost patients, relatives and carers in the right direction. To continue to work successfully with other providers when a co-ordinated response is required, working together to ensure the correct information and actions are maintained. Keeping updated with the current information and working practice of other Trusts through the National NHS Complaints Managers Group to attend more meetings to share experiences and best practice. Being involved in projects to improve Patient Experience Forging ahead with the links already established in working groups throughout the Trust. Taking forward the Quality Champion projects that we are committed to: Conclusion Improving the patient experience through a more open and accessible entrance to the department. Looking at how we can learn from our patients, relatives and carers in a new project entitled What matters to you following the feedback from the Learning from IHI Seminar. This will be commenced in the New Year. Overall the Patient Relations/PALS Department have had a successful year with a strong team who work closely together to maintain that connection with our patients, relatives, carers and staff to ensure that there is help and support provided with empathy and sincerity. 16