Patient Experience Annual Report 2015-16 including Complaints and Patient Advice and Liaison Service
Contents Page No. 1 Contents 2-3 Introduction Progress towards the Key Milestones: 4-7 Ambition 1 Improve the whole journey 8 11 Ambition 2 Improve communication 12-16 Ambition 3 Meet care needs 17 19 Measuring our success 20 Conclusion 21 37 Appendix 1: Facts and Figures Word cloud generated from Trust s Patient and Carer Experience Strategy Patient Experience Annual Report 2015-16 Page 1
Introduction East and North Hertfordshire NHS Trust has as its vision to be amongst the best performing NHS Trusts in the country, with high quality care and excellent patient experience at the heart of all we do. We aim to provide our patients and their carers with the best possible experience whilst they are using our services. This combined patient experience, complaints and Patient Advice and Liaison Service (PALS) annual report demonstrates how the Trust measures progress towards the ambitions set out within the Patient and Carer Experience Strategy. It includes a summary of patient and carer feedback and actions and initiatives to improve patient experience during 2015-16. The Trust s Patient and Carer Experience Strategy 2015-19 was developed using feedback from discussions with patients, families, carers, public Trust members and staff as well as a review of national policy and guidance. The strategy focusses on three key ambitions for the Trust:- Ambition 1: We want to improve the experience of our patients and carers from their first contact with the Trust, through to their safe discharge from our care. Ambition 2: We want to improve the information we provide to enhance communication between our staff, patients and carers. Ambition 3: We want to meet our patients physical, emotional and spiritual needs whilst they are using our services, recognising that every patient is unique. The Trust s Patient Experience Committee (PEC), a sub-group of the Risk and Quality Committee, provides the direction to deliver the strategy. PEC is chaired by a non-executive Director of the Trust and includes representation from the Medicine, Surgery, Cancer, Women s and Children and Clinical Support Service Divisions, Director of Nursing and Patient Experience, Patient Experience Project Manager, Facilities Manager, Chaplain, Head of Engagement, Complaints Manager, Health Liaison team and six patient representatives. The committee met ten times during 2015-16 and received regular updates on the Trust s patient experience survey results and updates on the Divisional patient experience action plans. Five new members have recently been recruited to the committee from the Trust s membership and a workshop was held in April 2015 with new members to review the way forward for the committee. In future, alternate formal meetings and workshop sessions will be held each month to enable the committee to monitor progress towards achieving the three ambitions contained within the Trust s Patient and Carer Experience Strategy. Patient Experience Annual Report 2015-16 Page 2
Patients and carers are able to provide feedback and raise questions or concerns about their hospital experiences in a variety of ways: Talking to staff in the ward or department Completing one of our local patient experience surveys which includes the Friends and Family Test question (how likely are you to recommend our ward/department to friends and family if they needed similar care or treatment?) Completing one of the national patient experience surveys Writing or e-mailing the Trust Sharing their patient or carer experience story Participating in one of our focus groups (e.g. Carers Focus Group) Posting comments on social media (e.g. Twitter/Facebook) Posting comments on NHS Choices or Patient Opinion Contacting the Patient Advice and Liaison Service Making a formal complaint All feedback is shared with the relevant ward or department to enable teams to share positive feedback and consider suggestions for improvements made by patients and carers. Each ward/ department has a learning from your experience poster which is updated monthly to share the actions that have been taken as a result of patient feedback. The response to key questions from the inpatient experience survey are monitored and reported monthly by ward in the Nursing and Midwifery Quality Indicators. Wards produce action plans to address any areas of concern identified by patients. Each Division has a patient experience action plan which is discussed and monitored by the Trust s Patient Experience Committee. The Trust participates in the national mandatory patient experience surveys co-ordinated by the Care Quality Commission and Department of Health. This feedback is valuable as it enables the Trust to compare performance with other Trusts throughout the country. Last year the Trust received feedback from the national inpatient, maternity and children s inpatient and day case surveys. A summary of results from these national surveys is included in Appendix 1. Appendix 1 also shows the full breakdown of patient experience survey responses during 2015-16. This wealth of feedback has helped the Trust prioritise areas for improvement and influenced the actions included in this report. The Trust received feedback from over 79,000 patients in 2015-16. This feedback informs the Trusts improvement plans and is vital to help us on our journey to be amongst the best performing NHS Trusts in the country. Angela Thompson Director of Nursing and Patient Experience Patient Experience Annual Report 2015-16 Page 3
Patient and Carer Experience Strategy update The Patient and Carer Experience Strategy sets out the Trust s key milestones for each of the three ambitions. The following information summarises the progress made to date towards achieving the milestones in this four year Strategy. The Strategy sets out how the Trust will measure its success either by achieving improvements in our patient experience survey responses, reducing complaints regarding specific areas or by improving our scores and number of responses to the Friends and Family Test survey. Key Milestones Ambition 1 We want to improve the experience of our patients and carers from their first contact with the Trust, through to their safe discharge from our care. Engage with users to review the appointment system. Business case for administrative support for outpatient team. The Trust is committed to improving the accessibility of our outpatients appointments team. Through the introduction of our netcall service we recognised that calls coming through to the Trusts Contact Centre required significant improvement. Through the commissioning for quality improvement (CQUIN) process we have been able to secure some additional investment to increase the number of call handlers in 2016-17. The average percentage of calls answered in 2015-16 was 60.6%, this has now increased in the first part of 2016-17 to 82.8%. We have also seen a significant reduction in the average time to answer, from 13.38 minutes in 2015-16 to 4.95 minutes in the first two months of 2016-17. The graphs below show the monthly performance. Percentage of calls answered 100.0% 50.0% 15/16 16/17 0.0% Apr 15 Jun 15 Aug 15 Oct 15 Dec 15 Feb 16 Average time to answer in minutes 30.00 20.00 10.00 0.00 Apr 15 Jun 15 Aug 15 Oct 15 Dec 15 Feb 16 15/16 16/17 We are also working ensure our netcall text reminder service is rolled out across all of the Trust s outpatient departments as this gives patients the opportunity to confirm their attendance or alert the Trust if they are unable to attend an appointment. Patient Experience Annual Report 2015-16 Page 4
Actively engage with patients and carers when developing Trust services via the Engagement Team. The year to March 2016 has seen significant growth in patient and carer involvement. Our growing involvement programme has had patients and carers participate in strategy development through to service design. For example, our patients have shaped our Sustainable Development Strategy as well as contributing to our Patient Access Policy. Public membership of the Trust has grown by over 20% in the three years to March 2016 and the range and quality of involvement has continued to improve. In August 2015 we opened our Community Hub at the Lister hospital from which our Carer Lead delivered support to carers. Looking forward, the Trust has a new Engagement Strategy for 2016 2019 which prioritises patient and public involvement with service delivery, development and transformation. Specifically we will actively seek to involve the public and patients, and patient support groups in all our significant patient pathway developments. Establish Voluntary Services Steering Group and further develop links with the local community to provide services and entertainment for patients. The Voluntary Services Steering Group was established in July 2015 to develop a coherent approach to volunteering across the Trust, focussing on the Lister, QEII and Hertford County Hospitals. The remit of the group is: To ensure that the volunteer policies are fit for purpose and that all volunteers, including third party organisations, adhere to them. To establish the focus and priorities of the service, to identify projects and commission volunteer support. We have supported the palliative care team s pilot of the Butterfly Project, whereby volunteers offer companionship to patients who are nearing the end of their lives. On completion of the pilot, the steering group will be instrumental in considering the impact and the next steps to embedding the project across the Trust. We have also been working with the local community to develop a team of TLC volunteers. These are people with special skills like hairdressers, singers, beauticians, craft-makers and PAT dogs, who are able to offer uplifting and enjoyable sessions that provide a little distraction and pleasure for patients. By doing this we can give patients, their family and friends some comfort and good memories. Patient Experience Annual Report 2015-16 Page 5
Develop and implement End of Life Strategy for the Trust. Support on-going education and training regarding end of life. Implementation of individualised end of life care documentation. The Trust s End of Life Care Strategic Plan 2015-2018 was published in March 2015 and the End of Life Strategy Group is chaired by a Consultant in Palliative Care. The Strategy sets out the Trust s ambitions to raise the profile of palliative and end of life care, for all patients to receive individualised end of life care, for clinical staff to receive appropriate training around end of life care, partnership working and providing a quality service. The Strategy Group oversees implementation of the Trust s ambitions for end of life care; in conjunction with the NICE Quality Standard recommendations. The role of the strategy group will be to identify and oversee key areas for improvement through quarterly meetings with representatives from relevant key areas. In addition there will be several task and finish groups which will be responsible for delivering elements of the strategy and will report to the main strategy group. The strategy group will provide an annual report to the Risk and Quality Committee and the Clinical Commissioning Group End of Life Forum. Individual Plan of Care for the Dying Person Education on priorities for care of the dying person is now mandatory for all clinical staff including selected non-clinical staff such as porters, ward clerks and housekeepers. The training sessions are delivered by the Palliative Care Clinical Nurse Specialists and on average 2-3 sessions are delivered each month. Alongside this, the Palliative Care link doctors and nurses on the wards also ensure the priorities for care of the dying patient are implemented when it is identified that patients are in the last few days and hours of life. All new members of staff undergo this training as part of their induction. The Individual Care Plan for the Dying Person is in use on all wards. This has been developed with the aim to ensure maximum comfort, dignity, compassion and sensitive communication at all times. The Trust has also been selected to be a pilot site for Building on the Best programme. This is a national programme working with ten pilot sites across England to deliver compassionate end of life care. Patient Experience Annual Report 2015-16 Page 6
Launch Trust-wide values-based customer care training programme building on the work already undertaken. Launch monthly staff recognition scheme. A customer care training programme was developed for clinical and clerical staff working in outpatient clinics, supported by a separate training programme for managers and supervisors. This was launched in October 2015 and has been delivered to staff at the Lister, Hertford County and New QEII sites. Customer care training has also been delivered to Lister main reception and Facilities administration staff. It is anticipated that this work will continue during 2016-17. Local recognition schemes are in development within the clinical divisions and work will continue during 2016-17 to improve how we share success and good news stories across the Trust. Information available on Trust website to reflect changes in department locations and new signage A comprehensive review of signage has taken place at the Lister Hospital site in line with the Department of Health Wayfinding Guidance (2005). The hospital has been separated into different coloured zones and, when reaching the correct colour zone, patients and visitors are directed to departments within the zone. Maps are clearly displayed at the hospital entrances and patient correspondence has been reviewed to include directions to the new colour zones. The Trust s website has been updated to include the new site map and directions to wards, departments and outpatient clinics. Lister Hospital map Patient Experience Annual Report 2015-16 Page 7
Key Milestones Ambition 2 We want to improve the information we provide to enhance communication between our staff, patients and carers. Review patient information leaflets and develop new information as required. Expand on the information available in alternative formats e.g. easy read. There are over 300 patient information leaflets available for patients to access via the Trust s website. Each Division has a patient information lead responsible for the review and development of patient information for patients supported by the Trust s Patient Information Co-ordinator. Information is offered to patients and carers to meet their individual needs both verbal and written. A wide variety of information is available via the Trust s website. All patient information leaflets state you can request this information in a different format or another language and a policy is in place for staff to access information in alternative formats. Translations of small documents can be arranged via Languageline. For larger documents the department would consider using the services of a translation company. When new patient information is developed authors are asked to consider the need for developing an easy read version. The Trust uses the British Sign Language Interpreting Agency to provide language service professionals to facilitate effective communication with patients who are deaf, deaf-blind or hard of hearing. A Comments, Concerns, Compliments and Complaints easy read information leaflet has been developed with the help of the Health Liaison Team and is available on the Trust s website. #hellomynameis included in divisional patient experience action plans. Improvements in communication categories in patient experience survey responses. The Trust has actively promoted the #hellomynameis campaign at public events and all divisions are encouraged to include this within their patient experience action plan. The number of complaints throughout the Trust regarding communication increased from 197 in (2014-15) to 216 (2015-16). This is disappointing but the Trust has also seen a significant growth in activity during this period, particularly in emergency medicine. The national CQC inpatient survey asks patients if staff contradict each other, if patients have confidence in decisions made about their condition and treatment and about the information given on their condition or treatment. The scores on all three questions remained the same or higher in the 2015 inpatient survey compared to the previous year and we are determined to continue to make improvements. Patient Experience Annual Report 2015-16 Page 8
Develop ward information booklets A number of wards have developed ward information booklets and the Trust s Patient Information Co-ordinator is working on producing a template for other wards to use. A short ward information leaflet has been developed for each ward and copies are to be provided to all inpatients. This leaflet provides a short summary of the key information patients may need to know and has been developed with input from staff and patients and the Patient Experience Committee membership. Key information includes: Ward contact details Ward Sisters name and photograph Visiting and protected mealtimes Meals and snacks Ward routine mealtimes, visiting times, times of doctors rounds Who to talk to about questions/concerns Contacting the Chaplains Reducing noise/use of mobile phones How to hire a TV Free Hospital Wi-Fi Personal belongings Discharge from hospital Medication Providing feedback/how to make a complaint Patient Experience Annual Report 2015-16 Page 9
This is Me booklet available for patients with dementia and purple folder for people with a learning disability. This is me is a booklet that people with dementia can use to tell staff about their needs, preferences, likes, dislikes and interests. It enables health and social care professionals to see the person as an individual and deliver person-centred care that is tailored specifically to the person's needs. It can help to reduce distress for the person with dementia and their carer. It can also help to prevent issues with communication, or more serious conditions such as malnutrition and dehydration. Nursing staff offer the This is me booklet to all patients with a diagnosis of dementia and encourage relatives/carers to help the patients complete the information supported by staff where necessary. People with a learning disability living in Hertfordshire are encouraged to complete their own Purple Folder with information about their health. The folder is shared with healthcare professionals and enables them to care for the patients and provide any support that they need. The healthcare professional will complete the Health Action Plan part of the folder to summarise what has been discussed and agreed with the patient. The Health Liaison Team promote the use of the Purple Folder and are able to provide copies free of charge to patients. Patient Experience Annual Report 2015-16 Page 10
Carers Lead in post providing support for carers and promotion of Carers Policy and Carer s Agreement. Ward staff recognise importance of role of carer The Trust recognises its responsibilities to support the needs of all carers of patients who access and use Trust services. In particular through access to information, advice on health and social care or ensuring the necessary support services are in place. Carers are often the people who know and understand the needs of a patient best and they have an invaluable role to play. The Trust appointed a Carers Lead in April 2015 and key actions during the year included: Review of the Trust s Carers Policy which sets out standards for supporting carers to care for their relative or friend in hospital. It includes a Carer s Agreement for carers to complete with a member of ward staff setting out expectations from the staff and the carers whilst their relative or friend is in hospital. The Policy includes details of benefits for carers e.g. discounts on car parking, catering and the Health Shuttle service. Increasing awareness of the role of carers. A dedicated Carers Corner providing information for carers, visitors and staff is available. Working closely with individual carers to help co-ordinate and expedite discharge. Identifying carers and signposting them to support and information including referrals to Carers in Hertfordshire/Bedfordshire. Updating the Trust s carers leaflet. Providing dedicated carer information boards in ward areas Providing a carer s welcome pack to all new carers. Fundraising to purchase three carer s beds which can be used by carers staying overnight with their relative or friend. Providing carer awareness training to 50 members of staff across the Trust. Informal carer awareness talks to 60 staff at team meetings with social services, matrons and sisters and individual departments. Information displays supported by Carers in Herts providing carer passports on the spot for carers Patient Experience Annual Report 2015-16 Page 11
Key Milestones Ambition 3 We want to meet our patients physical, emotional and spiritual needs while they are using our services, recognising that every patient is unique. Patient safety elements monitored and information displayed at ward level. Each ward displays a poster which is updated monthly with information about patient safety and the quality of care on the ward. The poster includes the numbers of infections, pressure ulcers and falls as well as hand hygiene and ward cleanliness audit scores. This poster was developed in conjunction with patients to ensure that it included the information that patients wanted to know. The Trust continues to monitor the number of MRSA and Clostridium difficile infections, falls and pressure ulcers each month by ward and this information is included in the Nursing and Midwifery Quality Indicators which are updated monthly. Patient Experience Annual Report 2015-16 Page 12
Reduce number of hospital acquired pressure ulcers and new Catheter Associated Urinary Tract Infections (CAUTIs) reported in the Safety Thermometer audit In 2015-16 the Trust had a target to reduce the number of new CAUTIs reported in the Safety Thermometer audit by 25%. This target was exceeded: The number of new (hospital acquired) pressure ulcers recorded in the safety thermometer audits continues to decrease year on year: Patient Experience Annual Report 2015-16 Page 13
Protected mealtimes in place on all wards and patients receiving assistance at mealtimes Protected mealtimes are in place to ensure that our patients have a dedicated mealtime, free from as many interruptions as possible, so they can enjoy their meal in a quiet and relaxed atmosphere. Nursing staff, clinical support workers and volunteers will help patients with their meals and monitor food intake. Visitors are welcomed on the ward at mealtimes if they are helping their relative or friend to eat their meal. In 2015 the Trust reviewed and re-launched the Policy for Protecting and Managing Patient Meals, the key messages are to ensure: that there is a calm, quiet environment on the ward to help patients have a pleasant mealtime experience. that patients are properly prepared for their meal before it arrives. the identification of patients who need help with their meal (red tray and red lidded jug) and that help is provided to patients who are unable to eat independently. that non-essential visitors leave the ward and there are no non-urgent interruptions. that family, friends and carers of patients who may wish to participate in the positive meal time experience are welcomed to the ward. that regular audits of protected mealtimes are undertaken and an action plan developed if improvements are needed. A review of meal trolley delivery times to all wards was undertaken and protected mealtimes adjusted where necessary. Each ward displays a poster on the door showing the visiting and protected mealtimes along with an explanation of protected mealtimes so that those visitors who wish to help their relative or friend know that this is supported. The CQC Inpatient survey report asks patients if they received help from staff to eat their meals. The score has significantly improved from 6/10 in 2014 to 7.5/10 in the 2015 survey. The Trust s Meridian inpatient survey has also shown an improvement in responses to this question from 89.41% in 2014-15 to 91.08% in 2015-16. Patient Experience Annual Report 2015-16 Page 14
Introduce new menus on inpatient wards In the past our patients rating of hospital food has not been as good as we would have liked. A new catering manager was appointed and a review of catering services undertaken. New menu booklets have been produced with a variety of options to meet regular, lower fibre, lower fat, low potassium, high calorie/high protein, dairy free, gluten free, vegetarian, diabetic, halal and kosher. These were introduced to the wards during July 2015 and include a mid-afternoon snack for patients. Texture modification diet options for patients with swallowing difficulties have also been reviewed. Ward sisters have been updated on the new menu options and it is hoped that offering a good selection of appetising meals will increase patient satisfaction. The Food and Drink strategy 2015-19 was published in 2015. This was developed by a multidisciplinary team consisting of nursing, medical, catering and allied health professionals and identifies the Trust s key ambition to provide high quality effective nutrition and hydration care for our patients: Providing healthier food choices for our patients, staff and visitors The sustainable procurement of food and catering services throughout our Trust Patient Experience Annual Report 2015-16 Page 15
Maintain improvements in cleanliness of hospital The Trust s Meridian inpatient survey asks patients about the cleanliness of the ward and the overall Trust score decreased from 91.04 (2014-15) to 88.51 (2015-16). The Facilities Team continue to monitor ward cleanliness and a nursing environmental audit has been introduced to enable ward staff to monitor cleanliness on their ward. PLACE is an annual assessment of non-clinical aspects of patient care including the environment, food, privacy and dignity. All teams include at least two patient assessors. The Trust s PLACE scores for 2013-2015 were: Cleanliness Food Privacy, Dignity and Wellbeing Condition, Appearance & Maintenance 2013 97.26% 76.20% 87.86% 87.16% 2014 98.54% 79.93% 83.34% 89.64% 2015 95.65% 69.88% 68.65% 83.03% Re-check results 2015 98.51% 87.55% 86.57% 89.49% The scores achieved by the Trust during the 2015 assessment process show the Trust s position worsened since the 2014 assessment. An action plan was developed and presented to the Care Environment Committee in July 2015. A re-check assessment was conducted at Lister Hospital in September 2015 to audit improvements/changes since the original assessment took place. Although this did not change the Trust s scores for the year it did demonstrate that improvements had already been made. The Trust expect to see significant improvements in the 2016 PLACE assessment. Clinical areas display information for patients on support groups and advice available. The Trust s Patient Information Policy advises that it is good practice to use patient information produced nationally or by clinical networks where this is available. Staff are also encouraged to review information on the NHS Choices website and adapt this where appropriate for local information leaflets. Many departments distribute information from support groups, national organisations or charities, This is a positive way to inform patients about such groups, to use resources well and make use of specialist information. The PALS office and the Trust s Carers Lead are also able to provide information and contact details for other healthcare services that are available for patients and their carers. Patient Experience Annual Report 2015-16 Page 16
Measuring our success Key: On, or exceeding, target Maintaining or limited progress made Not on target to achieve Ambition 1 2014-15 2015-16 Progress towards target 2019 Target National Inpatient Survey response to admission date to hospital not changed National Inpatient Survey response to patients knowing when their discharge will be 9.2/10 9.2/10 9.4/10 6.9/10 6.6/10 7.5/10 National Inpatient Survey response to delayed discharge from hospital 5.0/10 5.1/10 6.5/10 Proportion of outpatients who would recommend our Outpatients to their friends and family 92.75% 94.57% 94.00% Number of complaints regarding delays in treatment/appointment 343 [0.050%] 255 [0.040%] 300 Number of complaints received regarding cancellation of appointments/clinics 29 [0.005%] 29 [0.005%] 20 Patient Experience Annual Report 2015-16 Page 17
Ambition 2 2014-15 2015-16 Progress towards target 2019 Target National Inpatient Survey response to patients understanding answers to questions from doctors 7.8/10 8.1/10 8.5/10 National Inpatient Survey response to patients understanding answers to questions from nurses 8.310 8.0/10 8.8/10 National Inpatient Survey response to patients being involved as much as they wanted to be in decisions about their care and treatment. Number of responses to the Friends and Family Test survey 7.3/10 6.8/10 7.8/10 53,141 77,707 65,000 Patient Experience Annual Report 2015-16 Page 18
Ambition 3 2014-15 2015-16 Progress towards target 2019 Target National Inpatient Survey response to patients having enough emotional support from staff 6.7/10 6.8/10 7.2/10 National Inpatient Survey response to patients having enough help from staff to eat their meals 6.0/10 7.5/10 8.0/10 National Inpatient Survey response to patients overall rating of their experience National Inpatient Survey response to patients feeling well looked after by hospital staff 7.8/10 7.6/10 8.3/10 8.5/10 8.5/10 9.0/10 Number of complaints regarding medical care 151 [0.022%] 166 [0.023%] 125 Number of complaints received regarding nursing care 63 [0.009%] 58 [0.008%] 55 Patient Experience Annual Report 2015-16 Page 19
Conclusion 2015-16 has been a challenging and exciting year for the Trust. The Care Quality Commission visited the Trust in October 2015 and the report was published in April 2016. Overall the CQC rated the Trust as requiring improvement with four of the five key areas rated as requires improvement (safe, effective, responsive and well led). Overall the Trust was rated as good for caring. See Appendix 1 for breakdown of CQC ratings by hospital site/service. The Trust was recognised at the annual Patient Experience Network national awards and won the Access to Information category. The award was presented for the suite of posters developed with patients and staff. These contain important information that our patients and visitors want to know when they walk onto a ward. This report shows that there are many successes and areas of good practice to be celebrated but that we still have much more work to do. The Trust is now well placed to deliver real improvements not only in the quality of services provided by our staff, but also in how those services are experienced by our patients and their families/carers. We will continue to strive to improve the care and treatment that we provide to our patients and look forward to the challenges ahead. Angela Thompson Director of Nursing and Patient Experience John Gilham Chair of Trust Patient Experience Committee Carolyn Fowler Deputy Director of Nursing Education, Research & Patient Experience Jenny Pennell Project Manager Nursing & Patient Experience Kim Clarke Complaints/PALS Manager Patient Experience Annual Report 2015-16 Page 20
Appendix 1 Facts and Figures 2015-16 Care Quality Commission inspection - October 2015: Patient Experience Annual Report 2015-16 Page 21
Patient Experience Annual Report 2015-16 Page 22
National Patient Experience Surveys National Inpatient Survey The annual survey of adult inpatients is undertaken in all NHS acute hospitals and results published by the Care Quality Commission. The inpatients were asked what they thought about different aspects of the care and treatment they received. Survey month Report received Response rate No. % July 2012 April 2013 342 42 July 2013 April 2014 320 38 July 2014 April 2015 333 40 July 2015 June 2016 509 42 Note: In 2015 the national survey sample size increased from 850 to 1250 patients. The survey is divided into sections and a score out of 10 allocated for each question and section. Each Trust is assigned a category showing whether their score is better, about the same or worse than most other Trusts. In 2012-15, ENHT was worse than other Trusts in one section each year and about the same as other Trusts in all other sections. Section 2012 2013 2014 2015 1 Emergency department Same Same Same Same 2 Waiting list and planned admissions Same Same Same Same 3 Waiting to get a bed on a ward Same Same Same Same 4 The hospital and ward Worse Same Worse Same 5 Doctors Same Same Same Same 6 Nurses Same Same Same Same 7 Care and treatment Same Same Same Same 8 Operations and procedures Same Worse Same Worse 9 Leaving hospital Same Same Same Same 10 Overall views and experiences Same Same Same Same 11 Overall experience Same Same Patient Experience Annual Report 2015-16 Page 23
National Inpatient Survey 2015 The Trust scored about the same as other Trusts for 53 questions in the 2015 inpatient survey. There were nine questions where the Trust scored worse than other Trusts:- Were you offered a choice of food? In your opinion, did the members of staff caring for you work well together? Were you involved as much as you wanted to be in decisions about your care and treatment? Did a member of staff explain what would be done during the operation or procedure? Did a member of staff answer your questions about the operation or procedure? Were you given enough notice about when you were going to be discharged? Discharge delayed due to wait for medicines/to see doctor/for ambulance. How long was the delay? Overall experience. The table below shows performance in the 2015 inpatient survey against the five areas that were shown as performing worse than other Trust s in the 2014 inpatient survey: Questions performing worse than other Trusts in 2014 Inpatient Survey Were you ever bothered by noise at night from hospital staff? 2014 2015 Comments 7.2 7.8 Score improved and now the same as other Trusts. How would you rate the hospital food? 4.4 5.2 Score improved and now the same as other Trusts. Did you get enough help from staff to eat your meals? Did doctors talk in front of you as if you weren t there? Discharge delayed due to wait for medicines/to see doctor/for ambulance. 6.0 7.5 Score improved and now the same as other Trusts. 7.9 8.4 Score improved and now the same as other Trusts. 5.0 5.1 Score improved slightly but remains worse than other Trusts. The Divisional patient experience action plans will be reviewed in light of these results and presented to the Patient Experience Committee (PEC). The PEC review the Divisional patient experience action plans and make recommendations for improvements where indicated. National Maternity Survey 2015 A random sample of 347 women who gave birth at the Trust during February 2015 were sent the maternity survey; the response rate was 49% which was above the national average response rate of 41%. Compared to other Trusts ENHT was in the best performing Trusts category for one question: Labour and birth: If your partner or someone else close to you was involved in your care during labour and birth, were they able to be involved as much as they wanted? Compared to other Trusts ENHT was in the worst performing Trusts category for one question: Labour and birth: If you needed attention during labour and birth, were you able to get a member of staff to help you within a reasonable time? The Trust was about the same as other Trusts for the remaining questions. Patient Experience Annual Report 2015-16 Page 24
Compared to the 2013 survey the score was significantly higher for one question: Care at home after the birth: When you were at home after the birth of your baby, did you have a telephone number of a midwife or midwifery team that you could contact? Compared to the 2013 survey the scores were significantly lower for two questions: Labour and birth: Did you have skin to skin contact with your baby shortly after the birth? Staff: Thinking about your care during labour and birth, were you involved enough in decisions about your care? There was no significant change for the remaining questions. The Women s Division have reviewed these results and agreed actions for inclusion in their patient experience action plan which is monitored by the Trust s Patient Experience Committee. National Children s Inpatient and Day Case Survey 2014 The results of the 2014 national children s inpatient and day case survey were published by the Care Quality Commission in July 2015. Young patients aged between 0-15 years who were admitted to hospital in August 2014 were asked to take part in the survey which involved 137 acute and specialist NHS Trusts. 75 patients responded to the ENHT survey, a response rate of 25% (27% nationally). Three questionnaires were used to target different age groups: a parent/carer version for 0-7 year olds, and versions for 8-11 year olds and 12-15 year olds which had a section for the young person to complete and a separate section for their parent/carer to complete. Young people and their parent/carer were asked what they thought about different aspects of the care and treatment they received. The survey is divided into nine sections: going to hospital, the hospital ward, hospital staff, speaking with patients and providing information, facilities for parents and carers, pain, operations and procedures, being prepared to leave hospital and overall experience. There were two questions where the Trust performed worse than other Trusts: Parents and carers: Staff answered their questions about the operation or procedure, in a way they could understand. Parents and carers of 0-7 year olds: They were told what to do or who to talk to, if worried about their child when home. The Trust scored about the same as other Trusts for the remaining questions. The Children s Division have reviewed these results and agreed actions for inclusion in their patient experience action plan which is monitored by the Trust s Patient Experience Committee. Patient Experience Annual Report 2015-16 Page 25
Meridian Surveys The Trust continually monitors feedback from patients and uses this feedback to make changes and improvements to the services it provides. An electronic patient survey system is in place called Meridian which enables patients to complete surveys by the use of a simple electronic device (ipad) whilst they are in the hospital, or on a paper survey if preferred. During 2015-16, 19,605 patients completed one of our surveys (excluding the Friends and Family Test survey). This is an increase from 16,148 surveys completed in 2014-15. Meridian Surveys No. completed 2015-16 Inpatient 9685 Maternity 2946 Day Case 2374 Outpatients 1993 Renal Dialysis Unit 1016 Discharge 903 Accident and Emergency 349 Assessment 174 Neonatal Unit 150 Critical Care 15 TOTAL 19605 Each month around 900 patients complete our inpatient survey whilst on the ward. This comprises questions included in the national inpatient survey and enables the Trust to monitor feedback month by month and address any areas of concern. In 2015-16 there was a decrease in satisfaction from patients who were bothered by noise at night from other patients. There were significant improvements in patients reporting there were enough nurses on duty and that they knew their named nurse. The following chart shows a comparison of the inpatient survey results between 2012-13 to 2015-16: Questions added 2014 Patient Experience Annual Report 2015-16 Page 26
Friends and Family Test The Friends and Family Test question is asked of inpatients/day case, maternity, accident and emergency and outpatients. Patients are asked how likely are you to recommend the ward/department/service to friends and family if they needed similar care or treatment. The question must be asked at or within 48 hours of the patients discharge from hospital. The Trust s FFT results for all elements are reported as the percentage of patients who would/would not recommend the service. The NHS England Friends and Family Test (FFT) guidance has been updated to meet the new Accessible Information Standard which places a legal responsibility on providers of NHS funded services to ensure that people with a disability, impairment or sensory loss get information they can access and understand, and any communication support that they need. Changes were made to the children s and easy read/large print FFT survey forms used in the Trust to meet the new FFT guidance. The easy read version of the FFT survey is offered to people (with appropriate support if needed) who have dementia, learning disability, are profoundly deaf, deafblind, blind/vision loss, have little or no English or low levels of literacy. Guidance is available for staff offering the FFT survey to patients with dementia or a learning disability. The FFT survey is also available on the Trust s intranet and website as a short video clip translated into British Sign Language and translated into different languages. Summary of Trust FFT results and response rates (2015-16): In 2015-16, 77,707 patients responded to the Friends and Family Test question: Breakdown of patient responses to the Friends and Family Test question Patient Experience Annual Report 2015-16 Page 27
For each element of the Friends and Family Test question, the Trust monitors the percentage of patients who would recommend, the percentage of patients who would not recommend and the response rate. The charts below show this information with a comparison to the national average where available. Inpatients and Day Case Accident and Emergency Patient Experience Annual Report 2015-16 Page 28
Outpatients Maternity Each woman is asked the FFT question at four stages: Antenatal service (at 36 week antenatal appointment) Ward/birthing unit/homebirth Postnatal ward Postnatal community service (at discharge from care of community midwifery team) Antenatal Patient Experience Annual Report 2015-16 Page 29
Birth Postnatal Patient Experience Annual Report 2015-16 Page 30
Community Midwifery. Patient Experience Annual Report 2015-16 Page 31
Complaints and Concerns This report provides a summary of formal complaints received in 2015-16 in accordance with the NHS Complaints Regulations (2009). Complaints and concerns provide valuable information to monitor the experience of patients, carers and relatives. Users of the service are encouraged to discuss their concerns with staff at the time the problem arises. However, it may be the case that patients feel unable to do this, or perhaps staff have tried to resolve the issue but have not achieved this. The Patient Advice and Liaison Service (PALS) provide on the spot advice and support with the aim of timely resolution. In the event that this has not been achieved, PALS will give advice on the formal complaints process. In October 2015, the Care Quality Commission (CQC) undertook a review of the complaints process and they were satisfied that there were systems and processes in place to inform patients and relatives how to make a complaint. They visited wards and clinics and saw you said, we did posters which highlighted themes in patient feedback and complaints, and detailed actions that had been taken to rectify the issues. Complaints data assists with measuring the success of our learning and the Strategy sets out targets to reduce complaints regarding delays in treatment/appointment, cancellation of appointments/clinics and complaints regarding medical and nursing care. Formal Complaints by Subject 2012-13 2013-14 2014-15 2015-16 Attitude of staff 43 64 84 97 Cancellation of appts / clinics 0 20 29 29 Choose & Book 1 0 0 1 Communication 149 149 197 216 Confidentiality 14 4 9 16 Consent Issues 2 1 0 0 Delay in treatment/appointment 294 251 344 255 Delayed discharge 3 5 5 9 Discharge 39 35 57 35 Discrimination allegations 1 0 0 0 DNAR decisions/concerns 0 0 3 2 Equipment failure 0 2 5 5 Essence of Care 1 5 7 5 Catering/Facilities 14 4 6 16 Infection Control 2 1 1 3 Information 1 3 9 4 Medical Care 5 48 152 166 Miscellaneous 0 5 5 1 Nursing Care 31 37 63 58 Overseas patient issues 0 0 0 1 Pain control issues 0 5 1 2 Medication error 2 2 5 8 Policy and procedures 8 8 7 7 Patient's property 5 8 7 9 Medical records issues 13 10 52 29 Staffing issues 2 2 1 1 Transfer arrangements 1 1 0 0 Transport issues 23 18 10 11 Treatment received by patient 318 189 123 87 Totals: 972 877 1182 1073 Patient Experience Annual Report 2015-16 Page 32
The graph below compares the number of complaints received in the last four financial years. Number of Complaints by Division per Financial Years 2014-15 2015-16 Division No. % replied to within agreed timeframe No. % replied to within agreed timeframe Cancer Services 33 47% 40 71% Clinical Support 220 77% 160 55% Medicine 345 53% 316 57% Surgery 421 51% 386 53% Women & Children s 139 64% 137 53% Trust Wide 1158 59% 1039 55% Recommendations from The Clwyd/Hart report outlined the importance of negotiating a timeframe for completion of an investigation with the complainant. There is currently no national mandatory timeframe. The Trust has set a timeframe of 80% of complaints are replied to within an agreed timeframe. We recognise that we are not currently achieving this and continue to work with the Divisions to do so. There is a mandatory requirement to acknowledge all formal complaints within three working days of receipt. In 2015-16, 90% of complaints were acknowledged in three working days which is a significant improvement on the previous year of 75%. The table on the following page shows the number of complaints received by site. It is of no surprise that the number of complaints for the New QEII Hospital has gradually been deminishing as more services have transferred to the Lister site. There has been a decline in complaints during 2015-16 for the Lister site which could be attributed to transferred services successfully integrating after a period of adjustment. Patient Experience Annual Report 2015-16 Page 33
The table below details the outcome of formal complaints following the investigation. 60 Complaint Outcomes 50 40 30 20 10 0 Apr 2015 May 2015 Jun 2015 Jul 2015 Aug 2015 Sept 2015 Oct 2015 Nov 2015 Dec 2015 Jan 2016 Feb 2016 Mar 2016 Complaint Not Upheld Complaint Upheld Local Resolution Complaint Partially Upheld Incident Requiring Investigation Withdrawn by complainant Patient Experience Annual Report 2015-16 Page 34
Learning from complaints and concerns Analysis of the themes from complaints and concerns is used to identify areas of the Trust that need additional resources or support to improve patient experience. In addition the information gathered is compared with other patient experience feedback. The table below provides some examples of measures taken to improve patient experience: More sensors installed across the Trust to assist with locating medical records. Communication sheets designed to ensure relatives are given updates on patient care and treatment. An alert system implemented on the electronic patient record for patients with learning disabilities. This will ensure that any special requirements to support the patient are in place. Introduction of a reference board in the kitchen on Ward 6a to ensure that patients nutrition and hydration needs are met. In addition special dietary needs are included in each handover. This initiative is now being explored in other ward areas. New templates for completing discharge letters to eliminate inaccuracy on discharge reports. Training in place from the Motor Neurone Disease Association to support nursing staff care for patients who have a hospital admission. Concerns The table below shows the number of concerns received by the Patient Advice and Liaison Service (PALS) in 2015-16. Attitude of staff, communication and delays in treatment/appointments (both inpatient and outpatients) continues to be the main subject of concern, which is in comparison to the formal complaints. Patient Experience Annual Report 2015-16 Page 35
The table below is a sample of concerns received in PALS relating to specialties. Prior to April 2015 PALS data was not robust and, as a result, reporting of the last four financial years is not possible. 2015-16 Mount Vernon Cancer Services 9 Lister Cancer Services 22 Contact Centre 54 Emergency Department 49 Emergency Department (Paediatrics) 2 The Pathology Partnership 23 Pharmacy 4 Radiology 103 PALS 1 Critical Care 2 Estates 6 Facilities 17 Gynaecology 96 Obstetrics 43 Paediatrics 72 Cardiology 107 Renal 18 Rheumatology 12 Neurology 41 Endocrinology/Metabolic 46 Respiratory Medicine 30 Stroke Medicine 4 Medical Services Transport 8 Acute Medicine 32 Dermatology 30 Endoscopy 10 Gastroenterology 66 Elderly Care 44 Oncology 6 Outpatient Services 69 Haematology 10 Medical Records 34 Anaesthetics 25 Orthopaedics 320 Plastic Surgery 54 Urology 89 Audiology 18 ENT 44 General Surgery 105 Ophthalmology 282 Oral/Maxillofacial 19 Patient Experience Annual Report 2015-16 Page 36
Parliamentary and Health Service Ombudsman (PHSO) The bi-monthly aggregated reports to the Trust s Risk and Quality Committee (RAQC) gives details of all activity and outcomes related to PHSO investigations. In 2015-16 the PHSO accepted 21 complaints investigations compared with 10 in the previous financial year. Of the PHSO determinations received in 2015-16, 1 was upheld, 10 partly upheld, 5 not upheld and 5 are awaiting a decision. Three of these cases relate to investigations by the PHSO in the previous year. The table below shows the outcome of those cases that were partly upheld: Specialty Subject Outcome Elderly Care Family felt insufficient pain relief given prior to patient passing away. Partly upheld - Further letter to complainant acknowledging the failings, and further apology for impact on patient and General Medicine Emergency Department Delay in cancer diagnosis. Left with scarring on face from stitching, feels this would not have been so evident had the Plastic Surgery Team seen patient. Ophthalmology Failure to diagnose eye condition Poor record keeping. Elderly Care General Medicine Family feel that death could have been avoided if treatment had been better. family. Partly upheld - Apology for the distress caused, assurance that Trust recognises impact of its actions. Partly upheld - 250 redress as failure to conduct sensitivity test. Trust will never be able to confirm that patient would have had a better outcome. Partly upheld Acknowledge that referral should have been made at the pre-operative assessment. Apology for delay and distress. Partly upheld Further apology. No recommendations made as appropriate actions had been taken. Care and treatment, pressure sores. Partly upheld - 700 redress. Plastics Care and treatment. Partly upheld - 175 redress. General Surgery Lack of dignity shown to patient. Partly upheld - 500 redress, further apology for distress. ENT Grommets inserted into wrong ear Partly upheld - 750 Surgery Urology Surgery for fistula was in the wrong place, suffered pain as a result. Date for removal of bladder not given within appropriate timescales. redress and further apology. Partly upheld - 500 for complaints handling. Upheld Action plan to address failings in 31 day maximum wait for cancer treatment. Patient Experience Annual Report 2015-16 Page 37