Patient Experience & Complaints Report 216/17
Contents Introduction... 3 Complaints... 3 Patient Experience... 4 Key findings... 4 Emerging themes... 4 Key area of focus and development during 216/217:... 5 Patients Experience... 1 Central London Community Healthcare NHS Trust... 1 Trust Overview... 1 Patient Reported Experience Measures (PREMS)... 11 Number of PREMS received... 11 Patient Advice and Liaison Service (PALS)... 13 Complaints... 17 Friends and Family Test (FFT)... 21 Hounslow and Richmond Community Healthcare NHS Trust... 22 Trust Overview... 22 Patient Survey... 23 Compliments... 24 Patient Advice and Liaison Service (PALS) & Complaints... 25 Friends and Family Test (FFT)... 28 Chelsea and Westminster Foundation Trust... 29 Trust Overview... 29 In-Patient Survey 216... 3 Patient Advice and Liaisons Service (PALS)... 31 Complaints... 33 Friends and Family Test (FFT)... 34 Imperial College Healthcare Trust... 38 Trust Overview... 38 Patient Advice and Liaisons Service (PALS) & Complaints... 39 Friends & Family Test (FFT)... 43 West London Mental Health Trust... 46 Trust Overview... 46 Page 1 of 58
Patient Opinion... 47 Compliment and Complaints... 48 Compliments... 49 Patient Advice and Liaisons Service (PALS)... 5 Complaints... 51 Friends and Family Test (FFT)... 54 London Northwest Hospital Trust (Community Services)... 55 Friends and Family Test (FFT)... 55... 55... 55 Summary Conclusion... 56 Glossary... 56 Page 2 of 58
Introduction The annual report provides a summary of themes and trends emerging from the Patient Experience and Complaints data across CWHHE CCGs. The Quality, Nursing and Patient Safety Directorate have a dedicated Complaints and Patient Experience resource to enable the provision of a complaints service and review of patient and carer experience across commissioned providers and CCG provided services. A glossary has been developed to provide definition and explanation of all terms and acronyms in the document. To note that the Complaints Section of the report is a statutory requirement and requires Governing Body formal sign off. The Patient Experience Section although not a statutory requirement - provides an overview of the CWHHE CCGs themes and trends emerging from key CCG commissioned services. More specifically the data reviewed relates to the following providers: Central London Community Healthcare NHS Trust Hounslow and Richmond Healthcare NHS Trust Chelsea and Westminster NHS Foundation Trust Imperial College Healthcare NHS Trust London North West Healthcare NHS Trust (Community Services). Data presented in this section only highlights Friends and Family Test response rate and percentage recommend for the period of April 216 March 217. As patient experience reports provided by the Trust cover the organisation as a whole rather by division. The quality and presentation of the data included in this report varies due to the quality of available data relating to the Trusts, it also reflects the quality of the data outlined in the providers Quarterly Patient Experience Reports. Complaints CWHHE CCGs Collaborative manages complaints under its Complaints Policy, which reflect the legislative requirement outlined in the NHS Complaints Regulations 29. This means that all complaints should be acknowledged within three working days and that complainants should be provided with a response within a mutually agreed time-scale. CCGs are responsible for investigating and responding to complaints about the commissioning decisions they make and any services they directly provide; it is providers though that have the statutory responsibility to investigate and respond to complaints about service provision. From 1 April 216-31 March 217 there were 395 complaints across the 5 CCGs within CWHHE CCG Collaborative, 13 of these complaints related to the commissioning decisions taken by the CCGs and were investigated and responded to under the NHS Complaints Procedure. 82 complaints were about Primary Care Contractors and were forwarded to NHS England for investigation and response. 184 complaints related to other providers and with the complainants consent were forwarded to the appropriate organisations for investigation and response under the NHS Complaints Procedure. Where appropriate, the CCGs requested a copy of the final response for quality monitoring purposes. Of the complaints investigated and responded to by the CCGs the majority related to commissioning decision taken, however 4 related to Individual Funding Requests; 21 related to NHS funded Continuing Health Care and 2 related to Personal Health Budgets. Page 3 of 58
Themes emerging from complaints received overwhelmingly related to care received and appointments, other themes include staff attitude and the time took for referral to treatment. In terms of provider complaints,, higher numbers were received relating to Imperial (Charing Cross and St Mary s sites) and at Chelsea and Westminster (West Middlesex site). For a detailed analysis of the data by CCG and themes relating to providers please refer to Complaints Section of the full report. Patient Experience The patient experience section is a resource to help CCGs to have an overview of areas of focus and priority to: Inform commissioning plans and decisions Identify areas of priority for improving patient experience and access across all commissioned services and providers The information used relied on existing data from numerous sources in particular, Friends and Family Test (FFT), and data used to produce Provider Quarterly Patient Experience Reports and Annual Quality Accounts. Key findings The types of patient experience data currently captured take place within healthcare settings. This does not systematically capture access to and experience of self-care, self-management, peer support and advocacy programmes; the quality of health and care information as well as experience of services provided by 3rd sector organizations at community level. In order to address this, work is already underway to build an integrated infrastructure - in collaboration with the London Quality Observatory - to enable for a wider range of datasets and qualitative community insights to capture experience and feedback in realtime. Further details are outlined in the section below. There is a wide range of data currently available and while this is helpful in uncovering insights into patient experience more generally, there are no datasets that have been generated specifically for measuring and evaluating patient experience (PE) across different contexts and over any period of time. Also there is a lack of agreed standardised structure and contents among trusts in their periodical Patient Experience Reports which makes it very challenging to analyse data into comparative themes. However, the data available points to key persistent touchpoints and themes that require system wide improvements. Emerging themes The report highlighted key touchpoints i.e. points of interaction between service users and staff, healthcare environments and digital resources, service users that affect the quality of the overall patient experience across providers and services. These include, Contact & Information: knowing who to contact and how, finding information on condition, healthcare facility, advice and support; Appointment: making appointments, what to do if delays and cancellation of appointments occur Arrival: knowing where to report, who to speak with, interaction with (reception and other) staff; Page 4 of 58
Consultation: interaction with healthcare professionals, GPs, doctors, nurses, specialists; Care: quality and effectiveness of care provided (including examination, treatment, and management of a condition); Discharge: knowing what to do next, how to take medication, danger signs and who to contact if needed. Key area of focus and development during 216/217: Development of Patient, Service User, Carer and Community Experience & Insights System In last year s Annual Complaints and Patient Experience Report, it was highlighted that order to be able to use data to better understand and improve patient experience, three separate but interrelated components are required: Design of a commonly agreed (and co-produced) PE framework that includes indicators for both measuring and evaluating patient experience and complaints data (over time and across different healthcare settings) Develop a Survey/Questionnaire Bank Infrastructure for the data bank to be accessible to a range of organizations and services with the ability to: o Link to existing surveys o Export questions and datasets o Import validation questions and surveys o Access to meta data Publish survey / feedback outcomes in accessible formats for use by patients, the public and partner organisations. Monitor patient and carer experience of care through provider quarterly patient experience and complaints reporting. Through discussions with CWHHE CCG Engagement Leads and local organisations it emerged that there is an opportunity to bring two systems together that are already commissioned in different locations. Currently, there is annually licenced portal to a national database of Patient Experience data, which the CCG are mandated to report to NHS England: NHS Choices Patient Opinion Safety Thermometer NHS Friends and Family Test (+ GP FFT) PROMs/PREMs Social Media (Facebook, Twitter) CQC Data GP Survey (useful for delegated commissioning) Separate to the above, there is a software house provider, which automates CCG customisable and editable questionnaires, which two of the five CWHHE CCGs have already used to support: Service redesign Community patient experience Equality Impact Assessments through real time collection of patient experience questionnaires Customisable questionnaires for local engagement Page 5 of 58
Supply and support questionnaire on tablets for CVS orgs to use with housebound and hard to reach less mobile cohorts of patients Images: Example of questionnaire used for service redesign. Images show real-time collection and reporting of data, which will be used for the completion of EIAs. These questionnaires can also be edited after consultation with CCG staff and presentation at relevant boards & committees. Using Better Care Fund investment, the two pieces of software highlighted above have been integrated to provide a patient experience framework for the 3 CCGs (WL, CL, and HF) initially and then will expand to incorporate all CWHHE CCGs. The software house provider has provided a trainer and analyst who will be responsible for collating and analysing all data and displaying it within a centralised location so that in 217/18 all staff across CWHHE CCGs can access best practice and real-time data, which will enable them to have shape and influence development of the key CCG commissioning plans including transformation programmes. CWHHE CCGs Complaints Following graphs show complaints data broken down by CCG. It is important to note that as a complaint may cover more than one issue the numbers presented below may total more than the overall number of complaints received. The data highlights that number of complaints have increased from the previous year. Complaints Broken Down by Area Complained About 12 11 1 9 8 7 6 5 4 3 2 1 Acute CCG CLCH Gp IFR CNWL CHC LA Other CL CCG 215/16 4 6 3 12 3 3 Number of Complaints CL CCG 216/17 12 8 5 9 2 4 2 3 Figure 1: Central London CCG Page 6 of 58
Overall complaints have decreased from 145 to 97 this year. Complaints Broken Down by Area Complained About Number of Complaints 6 55 5 45 4 35 3 25 2 15 1 5 CHC IFR GP Pharm acist Dentis t Acute Ealing UCC CCG RFS Ealing ICO Phlebo tomy Pae Phalbo tomy 111 Svc Local Autho rity Ealing CCG 215/16 3 4 31 2 6 1 17 5 6 7 Ealing CCG 216/17 14 4 19 2 24 4 13 2 1 1 2 4 7 Other Figure 2: Ealing CCG Page 7 of 58
Overall complaints have increased slightly from the previous year. Complaints Broken Down by Area Complained About Number of Complaints 16 14 12 1 8 6 4 2 IFR CHC GPs CCG Acut e MSK CLC H Pres cribi ng LA NHS Engl and H & F CCG 215/16 1 1 7 1 15 8 1 6 4 1 H & F CCG 216/17 1 6 12 12 12 4 3 1 1 3 2 Othe r Figure 3: H & F CCG Overall complaints have increased slightly from the previous year. Complaints Broken Down by Area Complained About Number of Complaints Figure 4: West London CCG 22 2 18 16 14 12 1 8 6 4 2 IFR CCG CHC MSK CLC H GPs Acut e NHS Engl and WL CCG 215/16 1 3 5 8 12 18 1 4 4 WL CCG 216/17 3 3 3 2 5 21 18 3 1 3 9 LAS CN WL Oth er Page 8 of 58
Overall complaints have increased from the previous year Complaints Broken Down by Area Complained About Number of Complaints 18 16 14 12 1 8 6 4 2 Acute HRCH CLCH GPs CHC IFR CCG Commsi ssioning RFS Medicin es Mangem ent Nurishin g Home Hospital Transpor t Hounslow CCG 215/16 18 7 1 9 13 3 3 1 2 1 2 3 Hounslow CCG 216/17 18 5 1 12 11 3 8 4 1 12 Other Figure 5: Hounslow CCG Page 9 of 58
Patients Experience Trust Overview Central London Community Healthcare NHS Trust The following narrative and associated data has been extracted using the provider s quarterly patient experience report submitted to the CCG as part of the requirement in the quality schedule. The reports use data gathered from the following Surveys: Friends and Family Test Patient Reported Experience Measures (PREMs) Patient opinion PALS / Complaints / Compliments data Areas where the Trust has demonstrated overall improvements Patient Reported Experience Measures There were approximately 4 responses to the PREMs Survey which focused on 4 key areas: Overall experience the Trust asks patients to rate their overall experience of care, The Trust has exceeded its target of 9% where respondents have scored the trust as good or excellent Dignity & Respect patients were asked if they feel they were treated with dignity and respect. The overall score remains above target at 95.4%. However, the data also shows decrease in positive responses and a downward negative trend. Areas where the Trust requires improvement Involvement in care patients was asked how involved they have been in planning their own care. Overall, the trust did not meet its target of 85% of patients who reported that they were involved as much as they wanted to be in planning their care. However, improvements are being made and that there is an upward trend towards meeting the target. Explaining Care - patients were asked if their care was explained to them in a way they could understand. The trust did not meet its target during the final quarter of the year however; the data below shows that there is an upward trend towards a more positive response. In order to address this, the Trust has prioritised involvement in and Explaining Care in their217/18 Annual Quality Account; more specifically, they launched A Positive Patient Experience Campaign highlighting the following target outcomes: o Maintenance of 9% and above of proportion of patients whose care was explained in an understandable way o Achievement of 85% of proportion of patients who were involved in planning their care Themes emerging from PALS, Complaints and Compliments during 216/17 There were 858 queries logged by the Patient Advice and Liaison Office - these included both issues for resolution and compliments - 49 formal complaints made across the Trust. Overwhelmingly the themes from both PALS queries and Complaints relate to the following: o All aspects of medical care and treatment o Appointment (including cancellations) Page 1 of 58
o o Communication and access to information Staff attitude In terms of service areas, Podiatry across the 3 Borough CCGs and Soho Walk in Centre was most logged Issue for resolution See below for further details on Complaints and PALS data. Summary of data relating to FFT Overall, data highlighted a 92% Positive and 4.5% Negative in terms of recommending the Trust this is below the London Average. The response rate is slightly higher than the London Average overall. The Charts below provide a detailed overview of both response rate and likelihood recommend for the Trust. Figure 6: Captured from Patient Voice Stories 215/16 & 216/17 Patient Reported Experience Measures (PREMS) Number of PREMS received It fluctuated over the year hence towards the end of the year in March, there has been continued increase in the number of PREM s received from 312 in February to 384. Figure 7: Number of PREMS received Page 11 of 58
Dignity & Respect Although there has been a slight decrease in positive responses, the overall position remains above target at 95.4%. Figure 8: Proportion of the patients responded "yes definitely" Overall Experience The Trust continues to exceed this target. Figure 9: Proportion of patients who rated their overall experience as good or excellent Involvement in Care In March, the Trust target was not met however, there has been significant improvement in positive responses (Feb=75.8%, Mar=83.2%). To address this, the trust is working to develop and implement Always Events, in particular, the Patient Experience Facilitator will be working with the division to identify areas of targeted engagement to continue this improvement. Figure 1: Proportion of patients who were as involved in planning their care as they would like Page 12 of 58
Explaining Care There has been a significant improvement in January then sharp fall however from the February started to climb up. Figure 11: Proportion of patients whose care was explained to them in an understandable way Patient Advice and Liaison Service (PALS) Most of the logged contact for the first half of the year was dominated by Issue for Resolution however from quarter three compliments and Issue for Resolution was in similar in ratio. PALS Logged Contacts 216/17 Number of Logged Contacts 3 25 2 15 1 5 255 221 24 178 176 152 13 87 79 69 11 91 Q 1 Q 2 Q 3 Q 4 PALS logged contacts Issue for Resolution Compliments Figure 12: PALS logged contacts Page 13 of 58
PALS (Issue for resolution & Compliments) by CCGs Number Raised 4 3 2 1 PALS "Issue for resolution" & "Compliments " Central London CCG CL CCG Issue for resolution CL CCG Compliments Figure 13: Towards the 2nd half of the year compliments was dominant Number Raised 4 3 2 1 PALS "Issue for resolution" & "Compliments " H&F CCG H & F CCG Issue for resolution H & F CCG Compliments Figure 14: Towards the last quarter of the year compliments was dominant Number Raised 4 3 2 1 PALS "Issue for resolution" & "Compliments " West London CCG WL CCG Issue for resolution WL CCG Compliments Figure 15: At the beginning & 2nd half of the year compliments was dominant Page 14 of 58
Issue for resolution by Service Following graphs show Podiatry areas across tri-borough and Soho Walk in Centre was most logged Issue for resolution Number of Issue for resolution 2 15 1 5 Top 6 service areas "Issue for resolution" was logged - Q 1 Number of Issue for resolution 2 18 16 14 12 1 8 6 4 2 Top 6 service areas "Issue for resolution" was logged - Q 2 Number of Issue for resolution 14 12 1 8 6 4 2 Top 6 service areas "Issue for resolution" was logged - Q 3 Figure 16: Issue for resolution by service by quarter Number of Issue for resolution Page 15 of 58 14 12 1 8 6 4 2 Top 6 service areas "Issue for resolution" was logged - Q 4 Podiatry (H & F) Podiatry (West) Podiatry (Central) Soho Walk in Centre St Charles Urgent Care Centre Falls Triborough
Issue for resolution by Subject Appointment Issues, Communication/information, Attitude of Staff and Access to Service area have the most logged contacts Number of Issue for Resolution 65 6 55 5 45 4 35 3 25 2 15 1 5 Top 5 themes associated wtih "Issue for resolution" was logged - Q 1 Number of Issue for Resolution 65 6 55 5 45 4 35 3 25 2 15 1 5 Top 5 themes associated wtih "Issue for resolution" was logged - Q 2 Number of Issue for Resolution 65 6 55 5 45 4 35 3 25 2 15 1 5 Top 5 themes associated wtih "Issue for resolution" was logged - Q 3 Number of Issue for Resolution 65 6 55 5 45 4 35 3 25 2 15 1 5 Top 5 themes associated wtih "Issue for resolution" was logged - Q 4 Figure 17: Issue for resolution by subject per quarter Page 16 of 58
Complaints Complaints has started to rise in July through August then started to fall sharply in October and then raised again in January however toward the end of the year finished in downwards trend. 9 8 Complaints Number of Complaints 7 6 5 4 3 2 1 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar CL CCG H & F CCG WL CCG Combined Figure 18: Number of complaints received over the year per month. Page 17 of 58
Complaints by Service Community Nursing and Podiatry services have received most complaints. Complaints by Service Community Nursing Podiatry St Charles Urgent Care Centre Urgent care/walk in Soho Walk in Centre Parsons Green Walk in Centre Sexual Health Services Dermatology Wheelchair Services Inpatient Rehabilitation Worls End (DN K&C Princess Louise/Alexandra Unit Hammersmith Bridge (DN H&F) Emperors Gate(DN K&C) Dental Service Belgravia - Team 2 south (DN CL Bedded Rehab(Athlone) Parkview White City and Wesway(DN H&F) Health Visiting Community Rehab Podiatric Surgery ICT/Inreach/Spor Tissue Viability Service Learning Disability 1 2 3 4 5 6 7 8 Number of Complaints Figure 19: Complaints by service are across tri-borough Page 18 of 58
Complaints by Subject Most complaints received in the subject area of All Aspect of Clinical Treatment and then Attitude of Staff. 2 18 16 14 12 1 8 6 4 2 Complaints by Subject Figure 2: Complaints by Subject across tri-borough Page 19 of 58
Complaints Response times by CCG Most of the complaints responded within <25 working days with very few exceptions Q 1 Response Times by CCG Q 2 Response Times by CCG 6 4 2 5 CL CCG 4 1 1 H & F WL CCG 8 6 4 2 7 1 1 CL CCG H & F 8 1 1 WL CCG <25 working days >25 working days Agreed Timescale Re-opened <25 working days >25 working days Agreed timescale Re-opened Q 3 Response Times by CCG Q 4 Response Times by CCG 4 3 2 1 1 CL CCG 3 H & F 1 4 WL CCG 4 3 2 1 2 1 CL CCG 3 H & F 5 1 WL CCG <25 working days >25 working days Agreed timescale Re-opened <25 working days >25 working days Agreed timescale Re-opened Figure 21: Response times by CCG per quarter Page 2 of 58
Friends and Family Test (FFT) The average figure of 91.18% service Recommendation for the Trust is below the London average figures of 93.98%. 98% FFT Service Recommendation Service User Percentage 96% 94% 92% 9% 88% 86% 4.2% 4.3% 3.8% 4.8% 3.3% 3.4% 3.5% 5.6% 5.1% 5.2% 5.5% 4.9% 9.1% 9.5% 9.6% 9.1% 9.% 91.9% 92.1% 91.8% 92.1% 91.1% 91.6% 92.2% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar M1 M2 M3 M4 M5 M6 M7 M8 M9 M1 M11 M12 Recommended Not Recommended Figure 22: Service user Recommended & Not Recommend The average response rate for the year is 3.5% compares favourably with the London average of 2.71%. 5% FFT Service Response Rate Service User Percentage 4% 3% 2% 3.4% 2.5% 3.2% 2.3% 2.4% 3.8% 4.1% 3.5% 2.4% 3.4% 2.8% 2.9% 1% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar CLCH London Average Figure 23: Service user Response Rate in comparison with London Average Page 21 of 58
Hounslow and Richmond Community Healthcare NHS Trust Trust Overview The following narrative and associated data has been extracted using the provider s quarterly patient experience report submitted to the CCG as part of the requirement in the quality schedule. The reports use data gathered from the following Surveys: Friends and Family Test HRCH Patient Survey (data submitted by the CCG does not show number of responses but only shows percentage score) PALS / Complaints / Compliments data Areas where the Trust has demonstrated overall improvements Patient Survey is one of the mechanisms that HRCH uses to capture patient feedback; as we do not have the number of responses overall we cannot assess how representative the sample response is. The survey is also a local survey so data cannot be compared to results from elsewhere. However, it does present useful feedback that correlates with PALS and Complaints feedback. Dignity & Respect patients were asked if they feel they were treated with dignity and respect. The overall score remains above target at 97% by Quarter 4 which is higher than the London average. Being Listened to patients scored the Trust consistently high against this theme throughout the year at 95% Right Care being provided with the right care also scored consistently high with a peak at 96% by Quarter 4. Areas where the Trust requires improvement Access making appointments and access to services has scored particularly low across the year with patients scoring access only at 75%. Confidence - patients were asked about confidence in care and treatment. The trust scored comparatively low with 89% as the highest scored achieved in all quarters. Decisions involvement in decisions about care and treatment. The trust also scored comparatively low in relation to other questions at 89%. Themes emerging from PALS and Complaints and Compliments during 216/17 There were 61 queries logged by the Patient Advice and Liaison Office, 151 compliments and 37 formal complaints made across the Trust. Overwhelmingly the themes from both PALS queries and Complaints relate to the following: o Medical care and treatment ability o Appointment /delay and cancellations o Staff attitude o Communication and access to information To improve experience in these areas, the Trust has introduced Always Event in the following clinical priority areas: o End of Life Care o Inpatient Services o Community Nursing o Urgent Care Page 22 of 58
Hounslow Community Recovery, Learning Disability Team and MSK were services that received most compliments. Whereas Urgent Care Centre, Musculoskeletal (MSK) Service and Feltham & Bedfont Team were most logged for enhanced PALS and Complaints See below for further details on Complaints and PALS data. Summary of data relating to FFT Overall, data highlighted a 95% Positive and 2% Negative in terms of recommending the Trust this is above the London Average. The response rate of 4% is higher than the London Average overall of 3%. The Charts below provide a detailed overview of both response rate and likelihood recommend for the Trust. Figure 24: Captured from Patient Opinion Stories 216/17 Patient Survey All the indicators are either have increased or stayed same in positive direction Patient Survey Service User Percentage 1% 95% 9% 85% 8% 75% 78% 78% 85% 87% 94% 97% 89% 89% 95% 95% 91% 96% 7% Access Confidence Dignity and Respect Q 1 Q 2 Q 3 Q 4 Decisions Listening Right Care Figure 25: Inpatient survey result by Quarter Page 23 of 58
Compliments 151 compliments were received over the year of which Hounslow Community Recovery Service 19, Learning disability 16, Musculoskeletal Service 13, Paediatric Therapies 13 and Urgent Care Centre has received 12 compliments. Number of Compliments 5 4 3 2 1 Compliments Received 48 26 3 Q 1 Q 2 Q 3 Q 4 47 Figure 26: Compliments received over the year by quarter Compliments by Service 2 Compliments Received by Team Family Nurse Partnership Dietetics Chiswick Team Hounslow Adults Speech & Language therapy Health Visitors Health Promotion Smoking Cessation Tissue Viability Team Podiatry Integrated Community Response Services Brentford & Isleworth Team Feltham & Bedfont Team Speech and Language Therapy Wheelchairs & Posture Management Service Urgent Care Centre Paediatric Therapies Musculoskeletal Service Learning disabilities Hounslow Community Recovery Service 2 2 2 3 3 3 4 5 5 7 7 8 9 1 12 13 13 16 5 1 15 2 Number of compliments 19 Figure 27: More than 2 compliments received by a team Page 24 of 58
Patient Advice and Liaison Service (PALS) & Complaints Compliments have increased and PALS have decreased from previous year. Number of Complaints & PALS 24 22 2 18 16 14 12 1 8 6 4 2 Complaints & PALS Overview 18 18 17 17 14 13 12 Q 1 Q 2 Q 3 Q 4 24 Enhanced PALS 15/16 Enchanced PALS 16/17 Complaints 15/16 Complaints 16/17 Figure 28: Complaints & PALS Overview per quarter PALS by Service 61 PALS were received across following Service areas. Other represent where only one PALS received in a service area. Others, 14 Urgent Care Centre, 12 Whitton & Twickenham, 2 Phlebotomy Services, 2 Paediatric Medical Team, 2 Central Hounslow Team, 2 Brentford and Isleworth, 2 Continuing Care Centre, 3 Chiswick team, 3 Heart of Hounslow, 5 Musculoskeletal Service, 9 Feltham & Bedfornt Team, 5 Figure 29: Enhanced PALS received over the year by Service area Page 25 of 58
PALS by Subject 61 PALS queries were received across following Subjects area. Others represent where only one PALS received in a subject area. Please note that certain PALS queries cover more than one subject. Others, 1 Continuing Care, 2 Treatment/Ability, 11 Equipment/appliances /aids/premises, 3 referrals, 3 Access to services, 4 Attitude - Staff, 9 Lack of Communication, 6 Length of time waiting for a response, 7 Appointment/delay/ca ncellation, 7 Figure 3: Enhanced PALS received over the year by Subject areas Complaints by Service 38 complaints were received across following service area. Others represent where only one complain received in a service area. Others, 9 Paediatric Medical team, 2 Urgent Care Centre, 15 Podiatry Service, 2 Health Visitors, 2 Integrated Community Response Service, 3 Musculoskeletal Service, 5 Figure 31: Complaints received over the year by Service area Page 26 of 58
Complaints by Subject 39 complaints were received across following subjects. Others represent where only one complain received in a subject area. Others, 12 Staff attitude, 9 Treatment/Ability, 7 Communication standards - written, 2 Diagnosis, 4 Appointments/, 5 Figure 32: Complaints received over the year by Subject areas Page 27 of 58
Friends and Family Test (FFT) The average figure of 95.44% Recommended for the Trust compares favourably with the London average figures of 93.98 Recommended. Service User Percentage 1% 99% 98% 97% 96% 95% 94% 93% 92% 91% 9% FFT Service Recommendation 2.1% 2.2% 2.3% 1.4% 2.4% 2.2% 1.8% 1.4% 1.2% 1.6% 1.7% 2.2% 96.3% 96.4% 95.6% 95.5% 95.5% 94.7% 96.1% 94.8% 93.5% 95.3% 95.5% 96.1% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar M1 M2 M3 M4 M5 M6 M7 M8 M9 M1 M11 M12 Recommended Not Recommended Figure 33: FFT service Recommended & Not Recommended. The average response rate for the year is 3.56% compare to London average of 2.71%. FFT Response Rate 5% Service User Percentage 4% 3% 2% 3.1% 3.9% 3.6% 3.7% 4.2% 3.7% 2.2% 3.3% 3.5% 3.7% 3.4% 4.2% 1% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar HRCH London Figure34: FFT Response Rate compare to London average Page 28 of 58
Trust Overview Chelsea and Westminster Foundation Trust The following narrative and associated data has been extracted using the provider s quarterly patient experience report submitted to the CCG as part of the requirement in the quality schedule. The reports use data gathered from the following Surveys: Friends and Family Test In-patient Survey 216 Patient Opinion PALS and Complaints Areas where the Trust has demonstrated overall improvements The Trust scored significantly better than national average in 1 questions while WMUH scored significantly better in 3 questions these relate to the following areas: o Care and treatment o Trust and Confidence in doctors o Environment in particular cleanliness of the wards and hospital o Having privacy when being examined Areas that require improvement The Trust scored significantly worse in the following areas: o Quality and choice of food o Help to wash or keep clean (WMH) o Noise levels at night o Cleanliness of the toilets o Time waiting for staff to answer call button o Involvement in Decision Making (WMH) o Discharge in particular information about who to contact, information on medication and danger signals Themes emerging from PALS and Complaints and Compliments during 216/17 There were 149 Informal concerns reported to the Patient Advice and Liaison Office and 676 formal complaints made across both sites. Overwhelmingly the themes from both PALS and Complaints relate to the following: o Clinical Treatment, o Communications and appointments, (delay, cancellations and lack of access to the appointment office. o Patient Care. Summary of data relating to FFT Data from responses of 85896 (Chelsea patients) 41657 (West Mid patients) highlighted a 91% Positive and 5% Negative in terms of recommending the Trust. The trust did not achieve the targets of over 3% overall Response Rate. A deep dive analysis has identified why this has not been achieved and targets for 217/18 have been set to reflect this. Further analysis highlighted that the A&E showed a decreasing A&E recommendation rate and response rate. FFT trends show that the decreasing recommendation rate at Chelsea coincided with the extensive building works. Since the work has been complete the recommendation rate has risen Page 29 of 58
to over 9% patient satisfaction in A&E at Chelsea. The building works which started at the West Middlesex Hospital have also negatively affected the FFT recommendation rate. Both A&E departments are proposed to have kiosks installed and volunteer support to ensure the increase in response rate. Figure 35: Captured from Patient Opinion Stories 216/17 In-Patient Survey 216 Compared to the previous year, Chelsea and Westminster and West Middlesex sites performed significantly better in 1 and 3 questions respectively. Areas of improvement include the hospital environment (in particular, choice and quality of food as well as cleanliness of the ward); Care (involvement in decision making and confidence in the decision made); Discharge (involvement in discharge decisions). Compared to other trusts the Chelsea and Westminster site performed significantly better than average in 5 question whereas West Middlesex site performed significantly better than average in 3 questions. Number of Responses 6 5 4 3 2 1 Progress since 214 Survey 58 52 1 3 1 Significantly BETTER Significantly WORSE No significant difference ChelWest WestMid Figure 36: Improved since 214 survey by site Page 3 of 58
Numbar of Responses 6 5 4 3 2 1 Compared to other Trusts 46 5 2 Significantly BETTER than average Significantly WORSE than average 58 19 Same as average ChelWest WestMid Figure 37: How do both sites compared to other Trusts Patient Advice and Liaisons Service (PALS) PALS by Subject and by Division Communication and Appointments (delay, cancellation, scheduling or inability to communicate with the Appointments office) make up most of the concerns raised by patients. This is dominant in all Divisions. Figure 38: Emergency & Integrated Care Division Page 31 of 58
Figure 39: Planned Care Division Figure 4: Women's, Children's, HIV/gum, Dermatology and Private Patients Division Page 32 of 58
Complaints Complaints by Subject and by Division Clinical Treatment (General Medicine), Communication, Values and Behaviours, Patient Care and Admission, discharge are the top most concern areas. Figure 41: Emergency and Integrated Care Division Clinical treatment Surgical, Communication, Values and behaviour and Appointments are the top most concern areas. Figure 42: Planned Care Division Page 33 of 58
Clinical treatment (Obstetrics & Gynaecology), Communication, Values and behaviours and patient care are the top most concern areas (Please refer to the narrative on page 29 for actions taken by the Trust to address this). Figure 43: Women's, Children's, HIV/gum, Dermatology and Private Patients division Friends and Family Test (FFT) Inpatient FFT The percentage Recommend is slightly below the London Average. The Response Rate is on a par with the London Average. Inpatient Service Recommendation & Response Rate Service User Percentage 1% 8% 6% 4% 2% % Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar CWHFT Recommended London Average Recommended London Average Response Rate Not recommended Response Rate Figure 44: Service Recommended and Not Recommended along with Response rate in comparison with London Average. Page 34 of 58
Outpatient FFT Outpatient Service Recommendation & Response Rate Service User Percentage 1% 8% 6% 4% 2% % Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar CWHFT Recommended Not Recommended Response Rate London Average Recommended London Average Response Rate Figure 45: Service Recommended and Not Recommended along with Response Rate in comparison with London Average A&E FFT A&E Service Recommendation & Response Rate Service User Percentage 1% 9% 8% 7% 6% 5% 4% 3% 2% 1% % Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar CWHFT Recommended Not Recommended Response Rate London Average London Average Response Rate Figure 336: Service Recommended and Not Recommended is on a par with Response Rate in comparison with London Average Page 35 of 58
Birth Service FFT 1% Birth Service Recommendation & Response Rate Service User Percentage 8% 6% 4% 2% % Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar CWHFT Recommended Not Recommended Response Rate London Average London Average Response Rate Figure 47: Service Recommended and Not Recommended along with Response Rate in comparison with London Average Page 36 of 58
Positive and Negative Data of responses from 85896 (Chelsea and Westminster Site) patients and 41657 (West Middlesex Site) patients respectively. Positive 91% Negative -5% Staff Time Care Waiting Friendly Doctor Service Appointment Received Staff Time Wait Good Hours Helpful Care Efficient Seen Professional Long Positive 91% Negative 5% Staff Attitude Staff Attitude Implementation of Care Waiting times Environment Environment Waiting Time Implementation of Care Clinical Treatment Communications Communication Clinical Treatment Patient Mood/Feeling Patient Mood/Feeling Admission Admission Staffing levels Staffing levels Catering Catering Page 37 of 58
Trust Overview Imperial College Healthcare Trust The following narrative and associated data has been extracted using the provider s quarterly patient experience report submitted to the CCG as part of the requirement in the quality schedule. The reports use data gathered from the following Surveys: Friends and Family Test In-patient Survey 216 Compliments, Complaints and PALS Patient Opinion Areas where the Trust has demonstrated overall improvements National inpatient survey the 216 national survey of adult inpatients was published on 8 June. Overall, performance in the survey was consistent with previous years and comparable to similar trusts in London. The trust scored significantly better than most for 1 question which relates to the following area o Information on medication: more specifically in response to question Were you told how to take your medication in a way you could understand? Areas that require improvement The Trust scored significantly worse in response to the following questions: o Did hospital staff take your family or home situation into account when planning your discharge? o Did hospital staff discuss whether additional equipment or adaptions were needed in your home? Themes emerging from PALS and Complaints and Compliments during 216/17 There were 2719 queries reported to the Patient Advice and Liaison Office and 137 formal complaints made across the Trust. Overwhelmingly the themes from both PALS queries and Complaints relate to the following: o Appointments o Communication o Clinical Treatment See below for further details on Complaints and PALS data. Summary of data relating to FFT Overall, data highlighted a 94% Positive and 3% Negative in terms of recommending the Trust. A&E, though still not meeting the 2% target it is worth noting that results are amongst the highest in England and London both in terms of response rates and likelihood to recommend. The Charts below provide a detailed overview of both response rate and likelihood recommend for the Trust. Page 38 of 58
Figure 48: Captured from Patient Opinion Stories 216/17 Patient Advice and Liaisons Service (PALS) & Complaints Both PALS and Formal Complaints have declined in numbers over last two years. 4 PALS & Complaints 379 Number of PALS & Complaints 35 3 25 2 15 1 5 1145 137 2719 215/16 216/17 Formal Complaints PALS Figure 49: PALS & Complaints over two years Page 39 of 58
PALS & Complaints Overview PALS & Complaints Overview 35 312 Number of PALS & Complaints 3 25 2 15 1 5 224 229 221 26 186 237 271 167 199 197 216 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 PALS Formal Complaints Figure 5: PALS & Formal Complaints overview per month Page 4 of 58
PALS and Complaint by Division PALS and Formal Complaints have reflected a very similar pattern of percentages in Surgery, Cancer & Cardio the highest followed by Medicine & Integrated Care. PALS by Division Complaints by Division W & Children & Clin Supp. 13% Corporate 1% Medicine & Integrated Care 34% W & Children & Clin Supp. 19% Corporate 13% Medicine & Integrated Care 31% Surgery, Cancer & Cardio. 43% Surgery, Cancer & Cardio. 37% Figure 51: PALS & Complaints by division Page 41 of 58
Complaints by Subject Most of the complaints related to Appointments followed by Communication and Clinical Treatment. Complaints by Subject Appointments Communication Clinical treatment Access to treatment or drugs Patient care 2 4 6 8 1 12 14 Number of Complaints Figure 52: Complaints by category Complaints acknowledged and response times The Trust has performed 1% for most of the months in acknowledging a complaint within 3 working days. However, in terms of response within agreed timescales the Trust did not achieve its target in the first quarter of the year. Acknowledgement Number of Complaints 12 1 8 6 4 2 Complaints Acknowledgement Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Due for acknoledgement Acknowledged within 3 working days Figure 53: Complaints acknowledged within 3 working days Page 42 of 58
Response Times Number of Complaints 12 1 8 6 4 2 Complaints Responded Within Agreed Timescales Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Due for response Responded in agreed timescales Figure 54: Complaints responded within agreed timescales Friends & Family Test (FFT) Inpatient FFT Willingness to recommend and the response rate is higher than the London average. Unlikely to recommend is very low. Inpatient Service Recommendation & Response Rate Service User Percentage 1% 9% 8% 7% 6% 5% 4% 3% 2% 1% % Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar ICHT Recommended London Average Recommended London Average Response Rate Not recommended Response Rate Figure 55: Service Recommended and Not Recommend along with Response Rate in comparison with London Average Page 43 of 58
Outpatient FFT Willingness to recommend has remained around 9% and continues to be on a gradual upward trend. Response rate is higher than London Average Response rate. Unlikely to recommend is low. Outpatient Service Recommendation & Response Rate Service User Percentage 1% 9% 8% 7% 6% 5% 4% 3% 2% 1% % Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar ICHT Recommended Not Recommended Response Rate London Average Recommended London Average Response Rate Figure 56: Service Recommended and Not Recommend along with Response Rate in comparison with London Average A&E FFT Willingness to recommend is higher than London average and the response rate around the London average response rate. Unlikely to recommend is low. A&E Service Recommendation & Response Rate Service User Percentage 1% 9% 8% 7% 6% 5% 4% 3% 2% 1% % Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar ICHT Recommended Not Recommended Response Rate London Average London Average Response Rate Figure 57: Service Recommended and Not Recommend along with Response Rate in comparison with London Average Page 44 of 58
Maternity (Birth) FFT The maternity FFT result for touch point 2 (birth) shows willingness to recommend is around London average and the response rate is well above London average. Unlikely to recommend remain low. Service User Percentage 1% 8% 6% 4% 2% % Birth Service Recommendation & Response Rate Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar ICHT Recommended Not Recommended Response Rate London Average London Average Response Rate Figure 58: Service Recommended and Not Recommend along with Response Rate in comparison with London Average Page 45 of 58
Trust Overview West London Mental Health Trust The following narrative and associated data has been extracted using the provider s quarterly patient experience report submitted to the CCG as part of the requirement in the quality schedule. The reports use data gathered from the following Surveys: Friends and Family Test Patient Opinion PALS / Complaints / Compliments Patient Opinion The total number of stories posted from 1st April 216 to 31st March 217 increased substantially from the previous year to 11 compared with the same period last year where 4 stories were posted The main themes for what is good within the trust is staff and care The main themes for areas for improvement are communication and more time Themes emerging from PALS and Complaints and Compliments during 216/17 Compliments have increased to 187 from previous year s 17 as a result complaints have decreased from 56 to 466. Cognitive Impairment and Dementia Service and Developmental, Child and Adolescent Mental Health Service have received more compliments than complaints. High Secures Service have received most compliments (41) at the same time most complaints (166). Overwhelmingly the themes from both PALS queries and Complaints relate to the following: o All aspects of Clinical Treatment o Staff Attitude o Communication / Access to Information See below for further details on Complaints and PALS data. The Trust has put in place a range of activities and programmes to improve experience across services and in particular improve experience in the areas highlighted above. This includes: o Introduction of the Triangle of Care to improve communication and engagement between staff, service users and their carers. o Services working collaboratively with service users to reduce the use of restrictive interventions including physical restraint, seclusion and long-term segregation o Implementing a patient centred workforce planning approach across the services and support transformation programmes Summary of data relating to FFT Overall, data highlighted a 8% Positive and 9% Negative in terms of recommending the Trust. Response rate is very low in comparison to London average almost all year round ranging from.5% to 3%, this is against the London average rate of 4% response rate. The Charts below provide a detailed overview of both response rate and likelihood recommend for the Trust. Page 46 of 58
Figure 59: Word Cloud courtesy by the Trust Patient Experience Annual report 216/17 Patient Opinion Stories posted on patient opinion have increased from previous year. The stories have been viewed on Patient Opinion 24,35 times in all. Number of Stories 16 14 12 1 8 6 4 2 Stories Posted on Patient Opinion 15 11 215/16 216/17 Figure 6: Patient Opinion over last two years Page 47 of 58
Most of the stores are not critical (total positive) with only one is identified as strongly critical. Number of Stories 9 8 7 6 5 4 3 2 1 82 : not critical (totally positive) Stories on patient opinion by criticality score 14 13 1:Minially ciritical (e.g. phone system/car park) 2:mildly critical (e.g. waiting time) 11 1 3:Moderately critical (e.g. problem with treatment) Not rated 1 4. Strongly ciritcal (e.g. serious problems with treatment) Figure 61: Stories on patient opinion by criticality score Compliment and Complaints Compliments have increased to 187 from previous year s 17 hence complaints have decreased from 56 to 466. Number of Complaints & Compliments 18 16 14 12 1 8 6 4 2 Compliments & Complaints by Service - 15/16 & 16/17 166 148 High Secures 93 77 Primary and Planned Care 72 68 Access and Urgent Care 84 76 Liaison and Long Term Condition 3 Cognitive Impairment and Dementia Service 15 9 1 Developmental, Child and Adolescent Mental Health Service 57 94 West London Forensic Service Complaints 16/17 Complaints 15/16 Compliments 16/17 Compliments 15/16 Figure 62: Compliments & Complaints by Service area for 215/16 & 216/17 Page 48 of 58
Compliments Compliments have significantly increased from previous year. Compliments Number of Compliments 2 15 1 5 215/16 216/17 Figure 63: Compliments 215/16 & 216/17 Compliments by Service High Secures Service area has received most compliments closely followed by Liaison and Long Term Condition. Compliments Developmental, Child and Adolescent Mental Health Service 12% West London Forensic Service 11% High Secures 22% Cognitive Impairment and Dementia Service 12% Primary and Planned Care 1% Liaison and Long Term Condition 21% Access and Urgent Care 12% Figure 64: Compliments by Service area Page 49 of 58
Patient Advice and Liaisons Service (PALS) This is a difference of 123 contacts compared with the same period the previous year. This shows a decrease of 9% of PALS enquiries. Number of contacts 16 14 12 1 8 6 4 2 PALS Contacts Received 1496 1246 214/15 215/16 216/17 1377 Figure 65: PALS contact received over last three years Top three PALS complaints themes. Number of PALS complaints 3 25 2 15 1 5 Top Three PALS Themes 291 284 Any other issue Access to services Any aspect of clinical tratment/care received 174 Figure 66: PALS complaints top three themes Page 5 of 58
Due to the fact that PALS concerns are varied and often come from members of the public who seek general advice it is difficult to identify trends. The following graph highlights the majority of themes identified from the PALS enquiries received. The graph highlights that the highest number of enquiries received are from patients and are relating to access to services PALS by Subject Figure 67: PALS theme by subject Complaints Complaints has fluctuated over the last three years and are showing a decrease in 216/17 5 45 Complaints Over Three Years Number of Complaints 4 35 3 25 2 15 1 5 214/15 215/16 216/17 Figure 68: Complaints over last three years Page 51 of 58
Complaints by Service Like compliments High Secures Service areas received most complaints. Primary and Planned Care Service areas are the 2 nd highest closely followed by Liaison and Long Term Condition. Complaints by Service Developmental, Child and Adolescent Mental Health Service 3% Cognitive Impairment and Dementia Service 1% Liaison and Long Term Condition 16% West London Forensic Service 12% High Secures 36% Access and Urgent Care 15% Primary and Planned Care 17% Figure 69: Complaints by Service area Complaints by Subject Of the total 472 complaints raised from 1st April 216 to 31st March 217, the main theme was related to all aspects of clinical treatment followed by attitude of staff. Complaints By Subject All aspects of clinical treatment Attitude of staff Communication/information to patients(written and Appointments, delay/cancellation(outpatient) Patients property and expenses Admissions, discharge and transfer arrangements Other Failure to follow agreed procedures Personal records(including mediacl and/or complaints) Aids and appliances, equipment, premises(including Patients privacy and dignity Hotel Services(including food) Complaints handaling Patients status, discrimination(eg. Racial, gender, age) Transport (ambulance and other) Policy and commercial decisions of trusts Consent to treatment 36 29 26 26 23 15 11 11 8 8 3 2 1 1 1 114 157 2 4 6 8 1 12 14 16 Number of Complaints Figure 7: Complaints theme Page 52 of 58
Complaints Outcome During 216/17, a total of 441 complaints were closed, of those 58% (n=254) were closed in time and 42% (n=187) were closed over the agreed timescale. Further work is needed to ensure all complaints are closed in time. Over the last three years the number of complaints closed over the agreed time scales has increased. In 214/15 15% (n=45) were closed over the agreed timescale, 33% (n=123) during 215/16 and 42% (n=187) during 216/17. Outcome of Complaint Investigation Number of Complaints 12 1 8 6 4 2 19 Not Upheld 14 Partially Upheld 41 68 88 Upheld Not Upheld Partially Upheld 31 Upheld Closed intime Colsed Overtime Figure 71: Outcome of Complaints Investigation Complaints Withdrawn Number of complaint withdrawn has significantly increased year by year. 7 Complaints Withdrawn 65 Number of Complaints 6 5 4 3 2 1 27 45 214/15 215/16 216/17 214/15 215/16 216/17 Figure 72: Number of complaints withdrawn over last three years Page 53 of 58
Friends and Family Test (FFT) The overall annual percentage breakdown of the results highlights that the majority, 61% of responders would be extremely likely to recommend services to friends and family. Percentage of responses to the question'how likely are to recommend the service' Extremely Unlikely, 72, 8% Unlikely, 13, 1% Don't Know, 43, 5% Neither, 58, 6% Likely, 18, 2% Extremely Likely, 545, 6% Figure 73: Service users recommend the service Given that the Response Rate is very low in comparison to the London average across the year. The Trust decided to end the contract with Quality Health and Set up a provedcces of tthe FFT survey in house and have set up a Response Rate 4% 4.% 3% 2.7% 2% 1.8% 1% %.6%.5%.5%.6%.7%.5%.1%.2%.2% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar WLMHT London Average Figure 74: Response Rate in comparison with London Average Page 54 of 58
London Northwest Hospital Trust (Community Services) Friends and Family Test (FFT) Data presented in this section only highlights Friends and Family Test Response Rate and Percentage Recommend for the period of April 216 March 21 7. This is due to the fact that published patient experience survey data and reports are analysed and presented by the Trust so that they cover the whole organisation rather than by given an overview of experience by division. LNWHT service Recommended is in average 96.7% which is higher than London Average of 93.9% 99% 98% 97% 96% 95% 94% 93% FFT Service Recommendation.% 1.1%.6%.3% 1.2%.9%.5% 2.%.5% 2.% 1.3%.7% 96.5% 97.4% 97.7% 95.9% 97.1% 96.9% 96.4% 95.5% 96.1% 96.5% 98.5% 96.5% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar M1 M2 M3 M4 M5 M6 M7 M8 M9 M1 M11 M12 Recommended Not Recommended Figure 75: Service user Recommendation Response rate is higher than London average of 2.7% 9% 8% 7% 6% 5% 4% 3% 2% 1% FFT Service Response Rate 8.7% 6.4% 4.4% 4.7% 3.7% 3.1% 3.2% 2.7% 2.9% 2.4% 1.2% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar LNWHT London Average Figure 76: Service user Response Rate Page 55 of 58