SUMMARY REPORT Meeting Date: 28 July 2016 Agenda Item: 8.1 Enclosure Number: 7 Meeting: Title: Author: Accountable Director: Other meetings presented to or previously agreed at: Board Meeting Complaints and PALS Annual Report Mark Crisp, Complaints Manger, Soma Moulik, PALS Manager Julie Thornby, Director of Corporate Affairs Committee Quality and Safety Committee Date Reviewed 23 rd June 2016 Key Points/Recommendation from that Committee Purpose of the report This report details the complaints and PALS enquiries that have been received between April 2015 and March 2016. The report looks at services, subjects and key lessons learnt. The summary of the report at the start of the document also aims to put complaints in a broader context of other data and metrics about patient experience and incidents, to see if there is a wider story behind, for example, areas with the highest number of complaints. Consider for Action Approval Assurance Information Strategic goals this report relates to: To deliver high quality care To support people to live independently at home To deliver integrated care To develop sustainable community services 0
Summary of key points in report The number of complaints has increased slightly from 75 in 2014/15 to 88 in 2015/16 This increase is largely due to prisoners not being content with the medicine they have been prescribed. The complaints system at Stoke Heath has been improved, with better information available to prisoners and increased monitoring of concerns The highest number of complaints continues to be from CAMHS CAMHS issues relate to staff changes, waiting times, assessment and diagnosis and communication The issues related to CAMHS also feature with PALS Monitoring of actions related to complaints has been improved in the year. At the beginning of 2016 the PALS service started to receive a significant number of enquiries relating to TeMS appointments The top areas for PALS enquiries is appointments, followed by access to services and queries relating to clinical care. Key Recommendations Note the profile of Complaints and PALS enquiries and whether any additional assurance is required. Is this report relevant to compliance with any key standards? YES OR NO State specific standard or BAF risk CQC Yes Complaints management is included in CQC regulations IG Governance Toolkit Board Assurance Framework No Yes Impacts and Implications? Patient safety & experience Financial (revenue & capital) OD/Workforce YES or NO Y Y Clinical Quality and Safety If yes, what impact or implication Complaint act as an indicator, and acting on complaints will impact on patient care Potential claims Legal N Complaints regulations N 1
COMPLAINTS & PATIENT ADVICE AND LIAISON SERVICE ANNUAL REPORT 1 April 2015 to 31 March 2016 1
CONTENTS PAGE Shropshire Community Health NHS Trust Complaints Content Page Complaints and PALS The Bigger Picture 3 1 Introduction 6 2 Complaints 6 3 Themes and actions from complaints 8 3.1 Child and Adolescent Mental Health Service (CAMHS) 8 3.2 Stoke Heath Prison 8 3.3 Dental Service 9 4 Subjects 11 5 Parliamentary and Health Service Ombudsman (PHSO) 12 5.1 CAMHS 12 5.2 Health Visiting 12 5.3 South Staffordshire and Shropshire Healthcare NHS Foundation Trust and South West Interdisciplinary Team 12 6 Review of the Trust s Complaints Procedure 13 7 Future Plans for 2016/17 14 8 Compliments 14 9 Patient Advice and Liaison Service (PALS) 16 10 Profile of PALS enquiries since the formation of the 16 Trust in July 2011 11 PALS by Services 17 12 Breakdown of enquiries in each Division 18 12.1 Community Hospitals and Outpatient Services 18 12.2 Children and Family Services 19 12.3 Community Services 20 12.4 Telford Musculoskeletal Service 20 13 The top 5 Services comparison, year on year April 21 2012 to March 2016 14 Top 10 PALS Subjects across all Areas 22 14.1 Podiatry 22 14.2 CAMHS 22 14.3 Ludlow Hospital 23 14.4 MIU Oswestry 23 15 Data on Prison local resolution June 2015 to March 23 2016 16 Changes and Improvements 24 17 Changes through PALS 25 18 Conclusion 27 Appendix 1 Glossary 28 2
Compliments Shropshire Community Health NHS Trust Complaints Complaints and PALS The Bigger Picture All NHS organisations are required by law to collate and publish an annual report in relation to complaints and submit complaints data nationally to The Health and Social Care Information Centre which is then used for comparative analysis of performance in England by the Department of Health. Our fifth Complaints and Patient Advice and Liaison Service (PALS) annual report covers the period 1 April 2015 to 31 March 2016. The report provides an analysis of the complaints received, and the concerns raised with the Trust s PALS. The report that follows is specifically about complaints and PALS, but this covering summary aims to put complaints and PALS into the wider context of other data and metrics about patient experience and incidents, to see if there is a wider story behind, for example, areas with the highest number of complaints. It aims to do some triangulation. The link between incident and complaints: Top areas of Complaints Profile of issues Patient Incidents Staffing CAMHS (15) Stoke Heath (14) Wait for assessment (2) Consultant attitude/decisions (3) Lack of service provision (1) Communication (2) Diagnosis and Treatment (2) Multiple issues (1) Prisoners not happy with prescribed medication (11) Diabetes care (1) General care (2) Dental (7) Advice (2) Response (3) Standard of care (1) Staff attitude (1) Bridgnorth Hospital (4) South Telford Community Team (4) Waiting time for OP appointment (1) Radiography misdiagnosis (1) OP appointment cancellation (1) Care on Ward (1) 3 relate to care provided by team, one relates to communication 29 25 patient incidents were reported, the largest category relates to treatment (8) and medication (7). There are some similar issues e.g. concerns about clinical decisions, assessments and general care. The medication incidents relate to prescriptions e.g. lost prescriptions, wrongly dispensed medication and errors. 23 are categorised as no harm or minor harm. 2 are rated as Moderate, these relate to medication/confidence of parent and environmental concerns with clinical area 21 140 patient incidents reported. The highest areas are Medication (53) and Treatment (59). With medication these do not relate to changes, the areas are prescription errors with System 1, errors in dispensing with external pharmacy and accounting errors or problems 8 40 patient incidents reported. Categories were low numbers (less than 10) with the exception of equipment where 12 incident s were reported. These related to problems with the SOEL computer system. 43 351 Patient incidents: highest areas are Omitted medication (131) Falls (85) Pressure ulcers (38) 2 incidents were reported related to outpatients, 1 cancelled clinic and 1 lost 3 staffing incidents reported: High workload Concerns that parents concerns were not being followed up Shortfall on admin support One incident reported, a shift was not filled. None 41 incident, all relate to ward sample 5 41 patient incidents, 31 pressure ulcers. One incident reported. One understaffed shift resulted in the cancelling of patients Podiatry (4) Appointment problems (2), attitude 2 2 Patient incidents, one of these related to None 3
of worker (1). Failure to refer (1) appointments Conclusions: There may be some correlation between some CAMHS complaints, incidents and staffing, although the numbers of staffing incidents are small to draw conclusions from, and consistent themes across the different types of data are not strong. Reported incidents have not led to significant harm. For the other areas there are no obvious link with the types of complaints, incidents and staffing The Child and Adolescent Mental Health Service (CAMHS) remained the top service area in terms of numbers of complaints and PALS contacts received with delays in getting appointments, access to and clarity about the service being features of the issues and concerns raised. Similar issues relating to CAMHS were also received through the Trust s Feedback and Intelligence Group (FIG); the role of FIG is to monitor and oversee the information we receive from a range of different feedback methods. This should though be considered in the wider context of increase in demand on the service over recent years and the national problem in recruiting Consultants into CAMHS. During the year we have recruited new Consultants to the service and we are working with our Commissioners to increase our capacity to undertake assessments. The Trust is responsible for healthcare provision at HMPYOI Stoke Heath and this year saw a significant rise in the number of complaints received. During the year we reviewed the complaints process and availability of information to prisoners about how to raise complaints which led to clearer information being provided to prisoners. This combined with the newly formed Patient Forum at HMPYOI Stoke Heath are significant factors with regard to the increase in complaints received. A large number of the complaints raised by prisoners related to changes made in prescribing a specific medication; we explained that these changes had been made to ensure that we complied with the current guidelines for prescribing medication in prisons. Our responses to these complaints have been reviewed by another clinician within the Trust (not employed within the prison) to offer an independent clinical view; this has helped to provide reassurance to us that the care we have provided and our responses to complaints about this has been appropriate. The Telford Musculoskeletal Service (TeMS) is a new service provided in partnership between the Trust, The Shrewsbury and Telford Hospital NHS Trust (SaTH), The Robert Jones and Agnes Hunt Orthopaedic NHS Foundation Trust (RJAH), Pain Management Solutions and Maddocks Physiotherapy. We received a considerable number of contacts through PALS about the service which included issues about access and delays in appointments and referrals; these were in part affected by a higher level of demand for the service than had been anticipated, recruitment issues and communication issues with regard to the telephone system in place. Positive 4
action has been taken on all of these areas and the service is also very progressive and proactive in terms of gathering feedback from patients which will help to ensure that it continuously learns from their experience. During the year 3 complaints about the Trust were considered by the Parliamentary and Health Service Ombudsman (PHSO). None of these complaints were upheld by the PHSO; further information about the cases can be found in section 5 of the report. A glossary of the abbreviations used throughout the report is provided at Appendix 1. 5
1. Introduction Complaints/PALS Annual Report This report provides an analysis of Complaints and Patient Advice and Liaison (PALS) enquiries received from 1 April 2015 to 31 March 2016. The report meets the annual complaints report requirements of the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009. The table below shows the difference in numbers of complaints and PALS enquiries between 2013/14 and 2014/15 2014/15 2015/16 Difference Complaints 71 88 +24% Compliments 596 482-19% PALs enquiries 394 368-6% There has been little difference in the number of PALS enquiries received though there was a rise of 24% in relation to the number of complaints received during 2015/16 when compared to the previous year. 2. Complaints Complaints by Divisions: Chief Executives Office, 3 Corporate Affairs, 1 Community Services, 16 Child and Family Services, 36 Community Hospitals &Out Patient Services, 32 Complaints by services: 6
Service Total Child and Adolescent Mental Health Services (CAMHS) 16 Stoke Heath Prison 14 Shropshire Dental Services 7 Bridgnorth Hospital 4 Podiatry 4 Team 1 (Dawley, Stirchley, Wellington Community Team) 4 School Nursing 3 Ludlow Hospital 3 Administration 3 Child Health 2 Health Visiting 2 Therapies 2 Clinic Physiotherapy 2 Substance Misuse 2 Musculoskeletal Services 2 Respiratory Services 2 Shrewsbury North Community Team 2 Community Paediatrics - MEDICAL 1 Children s Community Nursing 1 Advanced Primary Care Service (APCS) Shrewsbury 1 Bishops Castle Hospital 1 Whitchurch Hospital 1 Diabetes Nursing 1 Shrewsbury South Community Team 1 Community Neuro Rehabilitation Team (CNRT) 1 Telford Enablement Team 1 Team 2 (Newport, Oakengates and Rapid Response Community Team) 1 Occupational Health 1 North Integrated Care Services 1 South West Integrated Care Services 1 Central Integrated Care Services 1 Totals: 88 Similar to the previous year CAMHS received the most complaints during 2015/16. The table below shows the top 5 areas for 2014/15: Service Total CAMHS 18 Shropshire Dental Services 6 Stoke Heath Prison 6 Health Visiting 4 Ludlow Hospital 4 The number of complaints received about CAMHS in 2014/15 was 18, this slightly decreased to 16 in 2015/16. Both Stoke Heath Prison and Shropshire 7
Dental Services again featured in the top 3 services with regards to the number of complaints received with each receiving 14 and 7 complaints respectively. 3. Themes and actions from complaints 3.1 CAMHS 16 complaints A total of 16 complaints were received about CAMHS during the year under the following areas: Time taken to get appointments and the referral processes (5) Unhappy with the type or content of treatment given (6) Communication issues with clinicians involved in care; this includes clarity of information about treatment/diagnosis and on occasions manner (5) The complaints relating to CAMHS may be directly related to the increase in demand on the service over recent years coupled with the national problem in attracting consultants to the service. During the year the service has been working with the recruitment Team and successfully recruited 2 new consultants into one of the teams. The following provides a flavour of the action taken where complaints about CAMHS were either upheld or partly upheld: Apology was given for confusion about the correct care pathway which caused delay. Protocols were discussed with the administration team to prevent recurrence and the form used to gather appropriate information was improved. Training and support was also provided to the school. A clinician was asked to reflect on a comment made to a parent; the parent requested a change of clinician and this was arranged. An apology was given for the length of time taken to reach a diagnosis. Reassurance was given that work was being undertaken with the teams to try to reduce the time it takes to reach a diagnosis. Regular appointments were arranged with a newly appointed clinician. An apology was given for the lack of continuity of clinician involved in the child s care. 3.2 Stoke Heath Prison 14 complaints A review of the complaints process and availability of information to prisoners about how to raise complaints relating to their health care was undertaken in 2015. This led to revised leaflets being produced, staff complaints training and clearer arrangements for the overview of complaints being dealt with directly by staff. 8
The Patient Forum at Stoke Heath Prison was set up in October 2015 with prisoners attending as representatives from the individual wings to share and raise any concerns relating to the provision of health care to prisoners. The complaints process and information has been explained and publicised through this mechanism with the prisoner representatives. The Complaints Manager continues to regularly attend the Patient Forum meetings. The 14 complaints received about Stoke Heath Prison during the year related to the following areas: Changes in medication (10) Unhappy about care/treatment (3) Communication issues with clinician (1) Similar to the previous year several of the complaints about changes in medication related to the changes in medication practice to reduce the use of opiate based and other medications. We will continue to review prisoners individual cases to ensure that appropriate care and treatment is being provided to them and that their concerns are addressed with regards to any changes to their medication. 3.3 Dental Service 7 complaints 7 complaints were received about the Dental Service in relation to the following areas: Treatment and advice (4) Delay in receiving appointment (1) Delay in treatment (1) Manner of dentist (1) The complaints received about the Dental Service related to different aspects of care with no single common theme across these. Our responses to complaints that were either upheld or partly upheld included: An acknowledgement that it would have been helpful if x-rays had been taken earlier in the patient s care an apology was given for this. An apology was also given that an appointment had to be cancelled aand rearranged due to staff sickness. The sedation service provided had been stopped due to concerns about the use of anaesthesia and its safety in relation to the fire evacuation arrangements at the clinic. The patient s dentist was asked to refer the patient to hospital for treatment. An apology was given for the oversight in arranging the patient s dental treatment under general anaesthesia. An appointment was arranged for the patient and staff were reminded of the process for arranging these appointments. 9
The cause of the patient s dental pain was misdiagnosed. An apology was given together with reassurance that the dentist had reviewed this as part of learning. An apology was given for how a parent and child had felt at an appointment. Reassurance was given that the dental team would review how and when the best time would be to share important preventative advice. The table below shows all complaints by areas, and whether the complaints were upheld or partly upheld. (The concepts of upheld or partly upheld are used by the Parliamentary and Health Service Ombudsman and we therefore report in that way, but recognise that we learn from all complaints). Service Complaint Not Upheld Complaint partly upheld Complaint Upheld Total Administration 1 2 0 3 APCS Shrewsbury 1 0 0 1 Bishops Castle Hospital 1 0 0 1 Bridgnorth Hospital 3 1 0 4 Central Integrated Care Services 0 1 0 1 Child and Adolescent Mental Health 8 7 1 16 Child Health 1 0 1 2 Childrens Community Nursing 1 0 0 1 Clinic Physiotherapy 0 2 0 2 Community Neuro Rehabilitation Team (CNRT) 1 0 0 1 Community Paediatrics - MEDICAL 0 1 0 1 Diabetes Nursing 1 0 0 1 Health Visiting 1 1 0 2 Ludlow Hospital 1 1 0 2 MSK Therapies 1 0 1 2 North Integrated Care Services 0 0 1 1 Podiatry 2 1 1 4 Respiratory Services 2 0 0 2 School Nursing 0 1 2 3 Shrewsbury North Community Team 1 0 1 2 Shrewsbury South Community Team 1 0 0 1 Shropshire Dental Services 2 2 3 7 South West Integrated Care Services 0 0 1 1 Stoke Heath Prison 12 2 0 14 Substance Misuse 2 0 0 2 10
Team 1 (Dawley, Stirchley, Wellington Community Team) 2 0 2 4 Team 2 (Newport, Oakengates and Rapid Response Community Team) 0 0 1 1 Telford Intermediate Care and Treatment 1 0 0 1 Therapies 0 2 1 3 Whitchurch Hospital 0 0 1 1 Occupational Health 1 0 0 1 Total 47 24 17 88 At total of 41 complaints were either upheld or partly upheld during the year. This is comparable to the previous year 2014/15, where 40 complaints were upheld or partly upheld. 4. Subjects 50 45 40 35 30 25 20 15 10 5 2013 2014 2015 0 There are variances across most subjects between the three years which are probably due to the differences in the services being complained about, particularly CAMHS and Stoke Heath Prison. There is a marked rise in the subject area Clinical Treatment/Error this year when compared to the two previous years. A proportion of this was due to the 11
rise in complaints received in relation to Stoke Heath Prison as described earlier in this report. 5. Parliamentary and Health Service Ombudsman (PHSO) All complainants can refer their complaint to the PHSO if they are dissatisfied with the response. In 2015/16 a total of 3 complaints relating to the Trust were considered by the PHSO s Office as follows: 5.1 CAMHS (1 case) A complaint was received about the care received by a child from CAMHS and specifically delays and difficulties experienced securing a referral to CAMHS and the time taken for CAMHS to formally support a referral to a specific service. The Trust provided a copy of the complaints file and the relevant CAMHS records to the PHSO s Office. The complaint was not upheld by the PHSO. 5.2 Health Visiting (1 case) The complaint related to an alleged breach of confidentiality by a Health Visitor in the context of an Initial Child Protection Case Conference. A copy of the complaints file and the relevant records were provided by the Trust to the PHSO s Office. The complaint was not upheld by the PHSO. 5.3 South Staffordshire and Shropshire Healthcare NHS Foundation Trust (SSSFT) and South West Interdisciplinary Team The response to this complaint was led by SSSFT and related to mental health care provided for a patient by SSSFT and services provided by our Trust which included the provision of equipment and assessment of continence needs under the South West Interdisciplinary Team (IDT). A copy of the relevant records and the report sent by the Trust to SSSFT were sent to the PHSO. The complaint was not upheld by the PHSO. 6. Review of the Trust s Complaints Procedure We held a workshop in September 2015 involving patient representatives and members of staff who investigate complaints to review our complaints process 12
and how we deal with complaints. Prior to the workshop we undertook a survey of all the people who had made complaints to the Trust during the previous year asking three simple questions: On a scale of 1 to 10 how effectively did we manage your complaint? If the answer to the first question is not a 10, what do we need to make it a 10? What was the one thing you particularly valued about the way we handled your complaint? The information from the surveys was shared and considered within the workshop and helped us to understand their views of how we handle and deal with complaints. The workshop and the information from the surveys informed our revised Complaints Policy and Procedure which is available on request from the Complaints Manager by contacting 01743 277616 or by visiting the following link on our website at http://www.shropscommunityhealth.nhs.uk/content/doclib/10302.pdf We plan to undertake similar surveys throughout the next year to ensure that we continue to learn from and improve the experience for people who raise complaints with us. As part of our review we also identified the need to ensure that a system is in place to record and track any actions required following our investigations of complaints. We now have a system in place where recommendations are recorded on our risk management system which allows us to track when they have been implemented. 7. Future Plans for 2016/17 The following provides a flavour of our plans for the forthcoming year to enhance how we deal with and learn from complaints: 7.1 Training and sharing learning on complaints During the year we provided training sessions for investigating managers to develop their skills and to share learning from complaints. In the forthcoming year we will be holding Root Cause Analysis challenge meetings. These meetings will involve a selection of complaints that have either been upheld or partly upheld where managers of the service will be asked to present what happened and any action taken to prevent recurrence; this will help to ensure that learning from complaints is shared across our different services. 7.2 Feedback Intelligence Group The Trust s Feedback and Intelligence Group (FIG) has now been established for just over a year. The purpose of FIG is to oversee, monitor and action information from all the feedback methods and have 13
reassurance that improvements have been identified, carried out and fed back to our patients. We provide reports to FIG relating to complaints and the contacts that we receive under PALS and we will be looking at ways in which this information can be better integrated into the broader information provided to FIG to ensure that we maximise the opportunity to learn from patients experiences of our services. 7.3 Provision for Children to make complaints We will be developing information for children about complaints which will include leaflets specifically designed for children. This will help us to hear and learn from children directly about their experiences of our services. 8. Compliments Top 10 areas receiving compliments 2014/15: Whitchurch Hospital, 32 Team 2 (Newport, Oakengates and Rapid Response Community Team), 27 Bishops Castle Hospital, 64 South West IDT, 28 Bridgnorth Hospital, 42 Shrewsbury South Community Team, 26 Shrewsbury DAART, 58 Ludlow Hospital, 75 Shrewsbury North Community Team, 27 Oswestry Minor Injuries Unit, 25 Top 10 areas receiving compliments 2015/16: 14
Therapies, 21 Whitchurch Hospital, 19 Bridgnorth Hospital, 43 Stoke Heath Prison, 21 Child and Adolescent Mental Health, 29 South West IDT, 22 Community Neuro Rehab Team, 21 Shrewsbury South Community Team, 33 Ludlow Hospital, 60 Shrewsbury DAART, 32 Shrewsbury North Community Team, 19 Ludlow Hospital remained at the top of the compliments list again this year with a total of 60 compliments received. Also featuring in the top 10 services again this year were Bridgnorth Hospital (43), Shrewsbury South Community Team (33), Shrewsbury DAART (32), South West IDT (22), Whitchurch Hospital (19) and the Shrewsbury North Community Team (19). Whilst CAMHS and Stoke Heath Prison featured in the top 3 service areas for complaints both services also featured in the top 10 services for compliments receiving 29 and 21 compliments respectively. 9. Patient Advice and Liaison Service (PALS) The PALS service deals with a significant number of enquiries each year. The majority of these are concerns related to our services, resolved through PALS which would otherwise be investigated as complaints. The types of enquiry and actions required are varied, including signposting patients to services, comments about services and liaising between patient and services to solve service delivery problems. The service frequently helps patients through processes, improving the quality of the service delivered but most importantly in identifying patterns or trends from ongoing issues to improve services by learning from mistakes. The management and learning from PALS helps to demonstrate that the Trust is listening to our patients, acting on the feedback and making changes to services. 15
10. Profile of PALS enquiries since the formation of the Trust in July 2011 The number of enquiries has increased year on year with an increase of 33% last year and very similar this year in 2015/16, with a total of 368. 11. PALS by Services Table 1 - the table below provides a breakdown of enquiries by Services. PALS by Service grouped by Directorate Numbers All Directorates 52 General 52 Children and Family Services 74 Child and Adolescent Mental Health 42 Children s Community Nursing 2 Community Paediatrics - MEDICAL 7 Child Psychology 1 Shropshire Dental Services 6 16
Health Visiting 9 School Nursing 3 Therapies 4 Community Hospitals &Out Patient Services 108 APCS Oswestry 3 APCS Shrewsbury 2 APCS Telford 2 Bishops Castle Hospital 3 Bridgnorth Hospital 3 Podiatry 34 Ludlow Hospital 24 Oswestry Minor Injuries Unit 13 Clinic Physiotherapy 2 Stoke Heath Prison 8 Whitchurch Hospital 14 Community Services 73 General 2 Community Equipment Stores 4 Continence Nursing 2 Diabetes Nursing 3 South West IDT 23 North East IDT 4 North West IDT 3 Respiratory Services 3 Shrewsbury North Community Team 5 Shrewsbury South Community Team 6 Community Neuro Rehab Team 2 Single Point of Referral 3 Team 1 (Dawley, Stirchley, Wellington Community Team) 3 South East IDT 2 Wheelchair Services 8 Corporate Affairs 3 Workforce and Occupational Health 2 HR 1 Integrated Care Services 4 North Integrated Care Services 2 Central Integrated Care Services 2 Telford Musculoskeletal Service 24 Maddocks Physiotherapy 1 Community Orthopaedics 6 Pain Management 2 MSK Therapies 2 Trauma and Orthopaedics 2 17
Community MSK 11 Other Organisations, CCGs/Acute 30 Totals: 368 12. Breakdown of enquiries in each Division: 12.1 Community Hospitals and Outpatient Services - 108 in comparison to 164 in 2014/15; 137 in 2013/14 and 84 in 2012/13 The top 3 services that received the highest number of enquiries were: Podiatry 34 Decrease in podiatry issues from 54 in 14/15 and 37 in 2013/14 Majority of issues relate to access, communication and appointment. Some of the access issues have now been addressed through recruitment of new administrative staff. This service has seen noteworthy improvement in patient experience following changes made to the service. Ludlow Hospital 24; Whitchurch hospital 14 Ludlow Hospital - increase from previous year, 7 in 2014/15 and 16 in 2013/14 Issues are varied ranging from quality of clinical/medical care, discharge and access to physiotherapy as an inpatient. Whitchurch Hospital - increase from previous year, 5 in 2014/15 and 11 in 2013/14 Issues relate to discharge and communication Oswestry MIU 13 Decrease from previous years, 64 in 2014/15 and 39 in 2013/14. X-ray provision (opening time) and quality of X-ray interpretation are the main issues raised Car parking continues to remain an issue 12.2 Children and Family Services 74 in comparison to 55 in 2014/15; 35 in 2013/14 and 39 in 2012/13. CAMHS - 42 Steep increase in issues relating to CAMHS, 23 in 2014/15 and 9 in 2013/14 CAMHS concerns rose significantly in the 4 th quarter with a total of 21 issues mostly relating to access to services/appointment and poor communication. 18
12.2.1 Why this sudden increase of CAMHS contacts? Termination of locum consultant s contract end of December 2015 leaving families concerned that there would be a gap in service for children who were under his care. Limited communication/engagement with families from the service leading to anxiety and concern about continuing provision of service New substantive post started in April 2016 12.2.2 Actions taken Key members of staff including the Medical Director and CAMHS consultant met with Jigsaw (a group representing more than 100 families), parents, MP representative and representatives from school/ education to discuss issues and explain service provision going forward Letters sent to families whose children were under the care of the locum consultant explaining the situation and providing assurance Appointment of a proactive CAMHS Manager providing leadership to the team 12.3 Community Services 73 in comparison to 54 in 2014/15; 24 in 2013/14 and 52 in 2012/13. The top 2 services that received the highest number of enquiries were: South West IDT 23 These are mainly compliments about the efficiency and quality of care received. Wheelchair Services 8 Remain same to previous year, mainly on communication and delay in getting appointment/equipment 12.4 Telford Musculoskeletal Service (TeMS) this is a new service, no previous data available for comparison. Some key points are: A total of 24 contacts received since its inception Issues raised relate to access, delay in appointments/referrals 19
12.5 TeMS background and progress made so far TEMS is a recently launched service and as a new service has experienced some initial difficulties. The Service is a partnership of the Shropshire Community Health NHS Trust, Shrewsbury and Telford Hospital NHS Trust (SaTH), Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust (RJAH), Pain Management Solutions and the Maddocks Physiotherapy. There were some recruitment issues at first and also the building from where the service was being offered did not have enough telephone line capacity to match with the expected demand of the service. The process is very complex as it involves clinicians from the Acute sector, primary care and also CCG involvement. The number of referrals into the Service has been far higher than what was expected. The Trust has been working with their partners to explore how capacity could be increased to ensure that patients can be seen in a timelier manner. This is particularly the case with the Consultants as some are only available as little as 2 clinics every 8 weeks. 12.5.1 Actions going forward: Process examined, service is trying to streamline the appointment process for patients Recruitment successfully completed, no longer have temporary staff The administrative team have now been fully trained in all aspects of the role and have regular team meetings to reinforce learning The administrative function as a whole has moved to a single location which has improved communication Vacancies have been filled and more administrative staff appointed to balance the demand of the service Invested in an automated mailing system and increased the number of administrative staff Service has relocated and significant investment made for a new telephone system Further discussion with a Supplier regarding the purchase of an enhanced Call Centre package which will significantly improve the experience of patients when they are accessing our service 20
13. Table 2 - Top 5 Services comparison, year on year April 2012 to March 2016 2015/16 2014/15 2013/14 2012/13 CAMHS - 42 Oswestry MIU - Oswestry MIU - 39 Podiatry - 32 64 Podiatry - 34 Podiatry - 54 Podiatry - 37 Ludlow Hospital - 15 Ludlow - 24 CAMHS - 23 Ludlow Hospital - CAMHS - 15 16 Whitchurch - 14 Continence Nursing - 16 Whitchurch Hospital - 11 Shrewsbury IDT - 13 Oswestry MIU - 13 Stoke Heath Prison - 10 CAMHS - 9 Whitchurch Hospital - 12 CAMHS and Podiatry feature within the top 3 service areas in all the 3 financial years except 2013/14 followed by Oswestry MIU and Ludlow Hospital. 14. Chart 1 - Top 10 PALS Subjects across all Areas Appointment and access accounts for 50% of enquiries, this is the same as 2014/15 and 2013/14 This is followed by Quality of care/treatment, exactly the same as the previous financial years. Staff attitude and behaviour/communication is an area that continues to remain high both in PALS and Complaints. 21
14.1 Podiatry - related to appointments and difficulty in accessing the service. A significant proportion of these are difficulties in reaching the service by telephone and no option of leaving a message when lines are engaged. This has now been addressed through employment of a new administrative member of staff and patients now have the option of leaving a message when lines are engaged if they need to cancel their appointment. 14.2 CAMHS mainly about delays in getting appointments, access and lack of clarity about the service provision. Poor communication with parents, staff not resolving issues when they are raised and parents not receiving any communication back from the service came out to be the trend across all contacts raised through PALS. This follows the pattern seen in complaints. 14.2.1 Steps taken Following the actions set last year good progress have been made through closer working with commissioners, to improve processes and free up clinical capacity through the recruitment to specific posts such as eating disorders and deliberate self-harm. Waiting times for Tier 3 services remain a pressure due to limited capacity within community Tier 2 services. However, as part of the local CAMHS Transformation Plan current service redesign will see a greater emphasis on early help provision to support increased emotional health and wellbeing resilience. The largest demands on CAMHS resources are referrals for a neurodevelopmental assessment which remain high. In order to address this a revised neurodevelopment pathway has been developed that will see increased partnership working across the wider health economy to ensure timely intervention and better communication for parents and carers along the pathway. In addition, further resources have been identified to enable CAMHS to work in partnership with other providers to reduce the waiting ensuring the successful implementation of the new pathway. 14.3 Ludlow Hospital issues mainly related to quality of clinical/medical care, Communication/staff attitude and discharge where family members felt that they were not consulted but informed and were given very short notice to plan any support at home. 14.4 MIU Oswestry majority of the cases were about: Provision of X-ray opening time and quality of interpretation of images. Commissioners have been made aware of this issue and have the information for their work in relation to Urgent Care Centres 22
Parking at MIU continues to remain an issue. The Trust s landlord at Oswestry is now NHS Property Services who are responsible for resolving parking issues. Currently they are inviting expressions of interest from car parking firms to assist them in devising a solution to the car parking problems. They could range from a full automated parking eye type of solution to car parking attendant and with a number of other permutations between the two. The new car parking sign, erected by the local authority on the main road from Gobowen towards Oswestry, incorrectly directs the public into our car park. NHS Property Services have been asked to take this up with the Local Authority. 15. Data on Prison local resolution June 2015 to March 2016 A review was completed of the prison service s local resolution process following an early CQC inspection last year and a number of improvements were made. Easily accessible PALS/Complaints information on wings Easy read version of leaflets Simplified forms for prisoners to record their concerns Prompt written response by trained staff including the Manager Response letter and concerns recorded on Datix, automatically alerts PALS/Complaints for approval. Table 3 Number of local issues raised and resolved within prison Month and Year Total June 2015 1 July 2015 19 August 2015 16 September 2015 16 October 2015 19 November 2015 40 December 2015 28 January 2016 31 February 2016 28 March 2016 18 Total 216 We are working to streamline the data in line with PALS and Complaints in order to be able to report on Subjects/themes in future. 23
Majority relates to dissatisfaction on medication prescription, mainly pain relief. Medication relates to the regime to reduce opiate and other medications within the prison environment. Access, particularly dental has been raised several times. Additional sessions have been secured to reduce dental waiting time. 16. Changes and Improvements PALS act as a catalyst for driving quality improvement by encouraging a change in culture, existing practices and behaviour. The following table provides examples of the changes, improvements and lessons learnt which provides assurance that our key objectives of listening, changing and learning remain at the heart of our service. 17. Changes through PALS Description Service Changes/Learning/Improvements -Delay in getting appointments -Repeated and last minute cancellation of appointments to see consultant -Communication issues Telford Musculoskeletal (TEMS) -Process reviewed with partners, streamlining appointment process -Triage criteria amended -Teams briefed as staff working across different Trusts -Consultants to give 6 weeks notice of planned cancellations via email so that contact with patients could be made -Partners like Shrewsbury and Telford Hospital NHS Trust (SaTH) will be asked for a replacement clinic -Staff made aware of the importance of ensuring that patients are given accurate information 24
-Concerns about the availability of on-site parking and disabled parking at Shrewsbury Dental Clinic -Family not involved and unaware of assessment and outcome as patient suffers from dementia -System takes too long to process and deliver lifesaving equipment (ex. suction catheters for tracheotomy) to patients -Order needs signing off from Manager but as the Manager was on leave, automatically got redirected to cover who was off sick at that time -Order got cancelled after 7 days as part of process Shrewsbury Dental Continence Interdisciplinary team -Several years ago it was proposed to relocate the clinic to a site that would have better access for patients but sadly the proposal was not able to be supported -Trust to re-visit proposal and ask Commissioners for support in developing a long term plan for re-locating -Council allowed parking on double yellow lines with a blue badge -Steps to forewarn patients and carers of the parking issues at Castle Foregate by including this information in their appointment letters, change to take effect immediately -Explore if a simplified note with outcome of assessment could be handed to patients following review so that family members and patients are aware of the outcome -Staff to be proactive in involving next of kin in the assessment process -Process reviewed in particular where nonstandard equipment is being ordered through Oracle and system changed -Urgent orders will be flagged up with Managers -Nurses made aware of urgency of equipment and not to rely on carers to alert them of the need -Information disseminated by the managers to both clinicians and administrators for future orders -Staff who place orders advised to follow up anything urgent with a phone call or email to ensure it is authorised on Oracle by Manager -Reviewed sickness reporting and out of office arrangements to ensure a vacancy rule is put in place on Oracle when any Manager is off for any length of time. 25
-Carer/family not aware of care package from ICS (ex. frequency/time and days of visits) following discharge from hospital. -No written documentation left for family -Difficulty in accessing health visiting team -Poor communication with patients providing inaccurate information -Delay in referrals being processed and passed on Whitchurch hospital/ics Health visiting TEMS -Greater involvement of family in discharge planning -Information sheet with time and frequency of visits from carers to be handed to family - Large scale review of the procedures and work-load arrangements within ICS is underway -North Shropshire have centralised all their telephone calls from parents to one number -This is staffed from 9am - 5pm Mon Friday -Comprehensive and robust processes have been put in place around follow-ups, allocation of referrals and feedback -Administrative staff have now been fully trained in all aspects of the role and have regular team meetings to reinforce this learning -We no longer have any new temporary staff -The administrative function as a whole has moved to a single location which has improved communication 18. Conclusion This annual report reflects the activity of the complaints and PALS team throughout 2015/16. The report shows that there have been 88 complaints during the year which is a 24% increase on the number of complaints received during the previous year (71). PALS received 368 contacts during the year in comparison to 394 received between 1 April 2014 to 31 March 2015, this is a very slight drop of 6%. CAMHS remained the top service area in terms of numbers of complaints and PALS contacts received. The themes of delay in getting appointments, access and clarity about the service were common to both complaints and PALS in relation to CAMHS. The theme of communication/staff attitude and behaviour continued to feature through both PALS and complaints contacts either as primary or secondary issues. This has been highlighted in reports to the Trust s Quality and Safety Committee throughout the year. 26
Both the complaints and PALS services continue to ensure they remain visible and accessible to patients and to welcome feedback about our services. We value and recognise the opportunity that feedback provides in helping us to learn lessons from patients experiences and in turn developing and improving the services that we provide to them. GLOSSARY APPENDIX 1 Abbreviation APCS CAMHS CCG CNRT DAART HMPYOI ICS IDT MIU NHS PALS PHSO RJAH SaTH SSSFT TeMS Definition Advanced Primary Care Services Child and Adolescent Mental Health Service Clinical Commissioning Group Community Neuro Rehabilitation Team Diagnostics, Assessment and Access to Rehabilitation and Treatment Her Majesty s Prison and Young Offenders Institution Integrated Community Services Inter Disciplinary Team Minor Injuries Unit National Health Service Patient Advice and Liaison Service Parliamentary and Health Service Ombudsman Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Foundation Trust Shrewsbury and Telford Hospital NHS Trust South Staffordshire and Shropshire Healthcare NHS Trust Telford Musculoskeletal Service 27
If you have any questions or queries about anything in this report please contact Complaints and PALS on 0800 032 1107 For further information about the Trust please visit our website: www.shropscommunityhealth.nhs.uk 28