COMPLAINTS, COMPLIMENTS, CONCERNS AND COMMENTS PATIENT EXPERIENCE REPORT 2012/13 PERFORMANCE AND PATIENT EXPERIENCE DIRECTORATE

COMPLAINTS, COMPLIMENTS, CONCERNS AND COMMENTS PATIENT EXPERIENCE REPORT 2012/13 PERFORMANCE AND PATIENT EXPERIENCE DIRECTORATE July 2013 1

1. Contents Section Title Page 2 Purpose of the Report 3 3 Executive Summary 3 4 Handling Complaints, Concerns, Comments and Compliments 4 5 An Analysis of Complaints, PALS Data and Compliments 5 5.1 Annual Data 5 5.2 Complaint Consequence Data 7 5.3 Patient Transport Service Complaints 12 5.4 Patient Transport Service PALS 13 5.5 Paramedic Emergency Service Complaints 15 5.6 Paramedic Emergency Service PALS 18 6 Method of Referral 20 7 Parliamentary and Health Service Ombudsman Review 21 8 Ethnicity Monitoring 21 9 Complaint Outcomes 21 10 Comments Received 22 11 Compliments 23 12 Learning and Service Improvement 24 12.1 Specific Lessons Learned - Paramedic Emergency Service 24 12.2 Specific Lessons Learned Emergency Control Centre 25 12.3 Recurrent Themes - Paramedic Emergency Service 26 12.4 Specific Lessons Learned - Patient Transport Service 27 12.5 Specific Lessons Learned - Patient Transport Service Control 27 12.6 Recurrent Themes - Patient Transport Service 28 13 Patient Experience 29 13.1 Community Events 29 13.2 Patient Survey Programme 30 13.3 Engagement With Local Involvement Networks 33 14 Making Experience Count Team Progress and Improvement 35 15 Publication of the 4C s Report 36 16 Conclusion 36 2

2. Purpose of the Report The purpose of this report is to inform the Board of Directors of the formal complaints, compliments and PALS contacts and comments (the 4 C s) received by the Trust from 1 st April 2012 to 31st March 2013. The report also contains details of lessons learnt as well as the Patient Experience programme undertaken over the last financial year and feedback obtained from LINks and the Critical Friends Network Core Group. The Trust has been collating consistent data since 2008 allowing for comparison reporting as well as detailed analysis of the work ongoing for the year ending March 2013. 3. Executive Summary i. The Trust manages the complaints, comments, concerns and compliments process in a robust fashion. The Trust also continues to receive relatively low numbers of complaints and concerns when taken in the context of over activity (0.09% of overall activity). ii. Complaints rose during this reporting year, by 86, in comparison to 2011/12 back to a similar level reported year ending March 2011. The top three reasons for complaints remain consistent with previous reporting: Delay in 999 response Inappropriate care Delay in PTS transport iii. PALS enquiries however decreased by a total of 301 in comparison to 2011/12, however the overall trend over the last five years shows a steady increase. The top three reasons for PALS enquiries were: Delayed 999 response Delays with PTS transport Delays out of hospital iv. The number of compliments received has decreased slightly by 16 in comparison to 2011/12. v. The Trust continues to meet all the requirements of Outcome 17 Care Quality Commission essential standards. vi. This year twelve complaints have been reviewed by the Parliamentary and Health Service Ombudsman. One is currently under investigation and none were upheld during the year. 3

vii. viii. ix. The Trust completed over 1000 patient surveys during the year, including 97 individual interviews, 87 observed patient journeys and had over 2500 staff contributions from two campaigns. Patients were asked to give the Trust an overall rating out of 10, 96.2% A&E patients, 89.2% UCD patients and 89.6% of PTS patients surveyed rated Trust a mark of 8 or above. The patient experience team and complaints / PALS team continue to triangulate the overall experience of using the Trust using both the proactive and reactive data sets. The lessons learnt process continues to strengthen with a combination of individual staff feedback and the identification of general trends and themes so that a wider programme of improvement can be implemented. 4. Handling Complaints, Concerns, Comments and Compliments i. The responsibility for managing the 4C s process rests with the Making Experiences Count (MEC) Team The team acts as a point of contact for patients, relatives, carers, other NHS providers and members of the general public to share their opinions, thoughts and concerns on their experiences of the service. ii. iii. iv. All contacts with the Trust have an assigned point of contact in the MEC Team who is responsible for ensuring the investigation is appropriately completed and maintaining contact. All complaints are risk assessed to guide the level of investigation and management approval. Throughout this year, the MEC team changed the roles of the PALS officers to create the role of the MEC Case Worker. This allowed a review of how lower level complaints were handled and recorded. All records were also moved over to one Datix module to ensure more uniformity of recording the reporting. Data from complaints and PALS along with trends are collated on a monthly basis for the service lines and reported through the Senior Management Teams. Data is also reported to the Clinical Governance Management Group (bi-monthly) and to the Quality Committee and Board of Directors (every six months). The Trust s Incident Learning Forum (chaired by the Director of Performance and Patient Experience) monitors the lessons learned from complaints and PALS with any associated action plans. v. Compliments are received and recorded in the area offices. They are acknowledged and shared with the individual/teams concerned together with their Managers. The information is also used to inform the overall patient experience programme and examples of compliments are highlighted internally through the Regional Bulletin. vi. During this reporting year, the MEC Team moved to using Datix web which will allow for more detailed and accurate reporting of the cases received and investigated. The move to Datix web allowed for a review of how complaints and PALS were recorded. This will mean a more significant change in the reporting year ending March 2014. 4

5. Analysis of Complaints, PALS and Compliments 5.1 Annual Data i. The Trust received a total of 472 complaints, 2267 PALS contacts and 787 compliments between 1 April 2012 and 31 March 2013. A monthly breakdown for complaints and PALS are shown at Figures 1a-c and a comparison graph is shown at Figure 2a below. ii. Complaints received rose in year, however both compliments and PALS contacts show a decrease in numbers. There has been a year on year increase in the number of PALS received by the Trust since April 2008. The trends since 2008 are depicted in Figures 2b-d. iii. The number of complaints increased over this reporting year by 22%. iv. Whilst the overall number of PALS enquiries did reduce over the year Figure 2a demonstrates the fluctuations in the numbers reported to the Trust with a significant increase in the winter months. Such dramatic increase in new cases naturally does impact on the Trust s ability to answer queries in a timely manner. v. PALS enquiries over the last year were evenly split between A&E operations and PTS. The overall increase in operational activity impacted on the number of complaints and queries received, especially for lower acuity calls. COMPLAINTS Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total 2008/2009 27 32 33 37 20 41 37 32 31 34 26 22 372 2009/2010 31 27 39 51 41 34 40 51 41 47 73 78 553 2010/2011 42 41 40 43 30 50 35 46 43 36 33 44 483 2011/2012 48 27 37 30 28 19 32 33 36 35 28 33 386 2012/2013 44 38 32 41 41 49 44 40 24 41 45 33 472 Figure 1a PALS Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total 2008/2009 121 124 102 139 106 129 147 104 110 136 137 160 1515 2009/2010 145 99 144 174 111 151 184 152 116 134 187 213 1810 2010/2011 159 140 195 155 161 130 112 173 150 173 185 274 2007 2011/2012 194 215 162 198 197 211 212 253 212 249 246 219 2568 2012/2013 207 234 197 190 176 174 240 241 163 171 128 146 2267 Figure 1b COMPLIMENTS Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total 2009/2010 63 41 62 57 73 45 53 67 35 62 47 65 670 2010/2011 62 67 66 62 56 66 61 67 46 68 50 77 748 2011/2012 55 47 77 67 74 78 81 60 62 78 71 53 803 2012/2013 45 74 52 36 39 35 99 107 45 150 48 56 786 Figure 1c 5

Figure 2a 3000 PALS Enquiries 2008-2013 2500 2000 1500 1000 PALS Enquiries Linear (PALS Enquiries) 500 0 2008/09 2009/10 2010/11 2011/12 2012/13 Figure 2b 6

600 Complaints 2008-2013 500 400 300 200 Complaints Linear (Complaints) 100 0 2008/09 2009/10 2010/11 2011/12 2012/13 Figure 2c 900 800 700 600 500 400 300 200 100 0 Compliments 2009-2013 2009/10 2010/11 2011/12 2012/13 Compliments Linear (Compliments ) Figure 2d 7

5.2 Complaint Consequence Data i. All complaints are assessed on receipt using an agreed 1-5 matrix. The scoring follows the consequence section of the Trust s Risk Management matrix. The scoring may change following the investigation though any amendments to the risk scoring must be agreed with the Head of Risk and Safety or Making Experiences Count Manager. Greater Manchester area had the higher number of high level complaints (Figure 3). ii. No complaints were categorised at Level 5, however 65 were categorised as Level 4 (Figure 4). Level 4 complaints cover those that raise issues around sub-standard care, general misconduct, patient injury or delayed response resulting in injury or harm. Most complaints scored at this level were recorded within PES however 8 were recorded against PTS. iii. iv. For the complaints categorised as major, response times (including delay in emergency transfer) was the most common reason for complaints in this category (n=26). Of these 26 cases, 11 were in Cheshire and Mersey, 10 in Greater Manchester, and 5 in Cumbria and Lancashire. Complaints have included both the primary response and delays for the conveying ambulance further to RRV attendance. For the complaints categorised as major, care and treatment was cited as the second main reason for complaining (n=25). Of these 25 cases, 14 were in Greater Manchester, 7 in Cheshire and Mersey and 4 in Cumbria and Lancashire. The common themes in this category are where a patient had been injured in the crew s care. These injuries are mainly due to patient falls, inappropriate application of moving and handling techniques including incorrectly walking the patient, non-conveyance of serious underlying condition and lack of immobilisation when indicated. v. Those complaints categorised as moderate mainly arose from the PES service line. Delays in emergency response was the main cause of complaint (n=159) with complaints about care provided the second reason for complaint (n=45). Cumbria and Lancashire received most complaints for delays in emergency response (n=58) with Cheshire and Mersey receiving 53 and Greater Manchester 48. Reporting was evenly spread over each month, with October and November with the lowest number reported. vi. vii. viii. The common themes for inappropriate care with the moderate risk rating (n=44) included complaints for inappropriate patient moving and handling (including both PES and PTS), non-recognition of condition, inappropriate medicines management, patient fall in care, carrying patient upstairs following discharge, lack of appropriate handover at hospital and concerns that patients were inappropriately left at home. For the complaints categorised as a 1 or 2, the three main reasons for complaint are issues with PTS transport (n=33), issues with emergency response (n=26) and staff attitude, including staff conduct and comments, (n=18). The majority of PTS delays continued to be handled through the PALS process, the ones referred through the formal complaints process have included excessive waits for transport, end of life care discharge and reported repeated failures of transport. These complaints were more evenly spread across each of the three areas, in comparison to previous years data however most were still received for Greater Manchester (n=17). 8

This more even spread however was not reflected in the PALS records with Greater Manchester receiving 56% of all PTS transport related PALS. ix. Delays in emergency response for this category were most frequently reported for Cumbria and Lancashire, with Cumbria receiving the most complaints (n=10). Figure 17 provides a wider overview of all complaints received for emergency response times. x. Staff attitude complaints for this severity were reported in all areas for this reporting year with no area particularly standing out. xi. xii. xiii. xiv. xv. The lowest level of complaints common themes include questions about referral to UCD, response times, delays within PTS, queries about eligibility, lack of care by attending staff and complaints about how people have been spoken to. The Greater Manchester area continues to generate the highest number of complaints and PALS contacts for the past year (Figures 5a&b, 6 and 7 below). Although Greater Manchester consistently received more complaints and PALS, there were individual months where both areas received higher number of complaints and PALS. Of complaints closed in the year ending March 2013, 260 were found to be not upheld, 132 were upheld and 19 were partly upheld. The way in which complaints and PALS are recorded was changed during the year with different categories introduced. This will be reflected in how the figures below are presented below. The amendments were made ahead of the move to recording all records on Datix web within one module. The amendments were also to lay the foundation of the cessation of PALS with all records either being classed as a complaint or as a general enquiry and to measure complaints at the end of their investigation rather than at the front end. COMPLAINTS BY AREA AND SEVERITY 2012-2013 Minimum Minor Moderate Major Serious Total CAL 12 30 90 15 0 147 CAM 0 27 99 21 0 147 GMA 3 37 109 29 0 178 Figure 3 9

Complaints by Primary Category and Risk Score Minimum Minor Moderate Major Total Emergency Response 4 22 160 26 212 Care and Treatment 0 3 45 25 73 Staff Conduct 2 9 22 6 39 PTS Transport 1 20 11 2 34 Staff Attitude 1 10 12 1 24 Failure to Transport (PTS) 1 11 6 0 18 999 Call triage 0 2 12 1 15 Failure to Convey (PES) 1 2 9 1 13 Communication and Information 3 2 4 1 10 Delay in emergency transfer 0 0 8 1 9 Transport Other 0 4 2 1 7 Other 1 3 2 0 6 Driving Skills 1 0 2 0 3 Driving Standards 0 1 1 0 2 Policy/Procedure 0 2 0 0 2 Medical Records 0 2 0 0 2 Safeguarding 0 0 1 0 1 Damage or loss to property 0 0 1 0 1 Staff Comments 0 1 0 0 1 Totals: 15 94 298 65 472 Figure 4 COMPLAINTS 2012-2013 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total CAL 14 12 8 10 12 22 14 13 10 14 10 8 147 CAM 10 12 9 10 12 16 17 9 8 13 20 11 147 GMA 20 14 15 21 17 11 12 19 6 14 15 14 178 Figure 5a PALS 2012 2013 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total CAL 57 84 49 48 57 61 71 78 46 48 46 43 688 CAM 51 54 56 67 44 54 78 64 42 63 42 48 660 GMA 99 96 92 75 75 59 87 99 75 60 40 55 912 Figure 5b 10

Figure 6 Figure 7 11

5.3 Patient Transport Service - Complaints i. The percentage of complaints about PTS against the overall total reduced in this reporting year to 20.9%, down from 32.9% in the previous year (Figure 8). The Trust received an average of 8 new complaints for PTS a month. ii. The main areas of concern (detailed in Figure 9) continue to be delays within the provision of transport both in and out of hospital. The areas of concern however were more evenly distributed throughout the three areas than in previous years. After an overall increase in complaints month by month until July, there was a steady decrease over the rest of the year. PATIENT TRANSPORT SERVICES COMPLAINTS Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total 2009/2010 11 7 15 14 12 10 8 14 16 15 41 23 186 2010/2011 16 11 12 15 13 21 8 12 15 14 12 22 172 2011/2012 26 6 11 11 6 4 12 9 13 13 8 8 127 2012/2013 10 9 9 15 11 5 9 8 3 6 9 5 99 Figure 8 PTS Complaints by Area and Role 2012-13 CAL CAM GMA Total PTSCON PTSCP PTSOPS VCS PTS Transport 7 11 18 36 23 0 12 1 Delay in PTS Transport 2 4 10 16 15 0 1 0 Care and Treatment 0 6 6 12 0 0 12 0 Staff Attitude 3 1 4 8 3 0 5 0 Staff Conduct 3 0 4 7 0 0 7 0 Transport Other 1 3 3 7 5 1 1 0 Driving Standards 3 0 1 4 0 0 4 0 Other 0 3 1 4 1 0 3 0 Communication and Information 2 1 0 3 3 0 0 0 Policy/Procedure 0 0 1 1 1 0 0 0 Staff Conduct 0 0 1 1 0 0 1 0 Totals: 21 29 49 99 51 1 46 1 Figure 9 12

Figure 10 5.4 Patient Transport Service - PALS i. There was a noticable reduction in the number of PALS recevied by the Trust in relation to PTS for year ending March 2013, receving 378 less than the previous year taking the level back to that experienced in 2010/11. There were an average of 97 new PALS queries for PTS each month. ii. iii. iv. With the residual high activity from the end of 2011 onwards, the start of this reporting year was an exceptionally busy one in terms of PALS queries recevied. With the exception of October however, there is a notable decrease in the number of incoming queries in comparison to the same months in the previous year (Figures 11 and 12). Figure 13 details the types of PALS enquiries by area and role. The new general category of PTS transport along with delays out of hospital were the most common reasons for raising concerns in this reporting year. The continued application of the eligibility criteria continues to give rise to concerns being raised and delays into hospital along with non arrival of ambulance remain consistent reasons over recent reporting years. PATIENT TRANSPORT SERVICES PALS 2009-2012 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total 2009/2010 47 33 64 55 41 53 49 64 51 67 90 122 736 2010/2011 77 60 103 66 82 64 52 92 83 103 110 199 1091 2011/2012 137 125 89 116 106 114 122 160 137 148 155 128 1537 2012/2013 128 141 111 107 89 74 105 95 58 89 76 86 1159 Figure 11 13

Figure 12 PTS PALS Categories by Area and Role 2012-13 CAL CAM GMA Total PTSCON PTSCP PTSOPS VCS PTS Transport 65 58 83 206 84 3 119 0 Delays out of Hospital (PTS) 49 39 116 204 193 0 11 0 Eligibility Criteria 85 38 20 143 134 0 9 0 Delays into Hospital (PTS) 29 25 68 122 111 0 11 0 None Provision of Ambulance 11 20 58 89 86 0 3 0 Problems with transporting 14 21 42 Patients 77 53 1 23 0 None arrival of Ambulance 13 13 42 68 58 0 10 0 Attitude Staff 23 13 17 53 10 1 41 1 Communication and information 15 12 16 43 33 0 10 0 Expression of Concern 11 10 20 41 19 0 22 0 Driving Standards 16 4 9 29 0 1 27 1 Staff Conduct 11 4 5 20 2 0 18 0 Damage or loss to property 7 7 5 19 7 1 3 0 Vehicle issues 6 7 0 13 4 0 9 0 Care/ Treatment Given 4 4 4 12 2 0 10 0 Early arrival of Ambulance 3 3 3 9 7 0 2 0 Other 2 2 4 8 4 0 4 0 Discrimination 0 1 0 1 1 0 0 0 Failure to Transport (PTS) 0 0 1 1 0 0 1 0 Navigation 1 0 0 1 0 0 1 0 Totals: 280 216 419 1159 720 2 191 2 Figure 13 14

5.5 Paramedic Emergency Service - Complaints i. There was an immediate increase in the complaints received from April 2012 onwards, reaching a peak in September which resulted in an overall increase of complaints for the year. This reporting year therefore reversed the trend of decreasing complaints that has been witnessed over the last four years. ii. iii. iv. There was an average of 31.08 complaints received for PES per month with September being an outlier. PES, including Emergency Operations Centres and CFRs, accounted for 79.1% of the complaints received for the year. Figure 16 details complaints primary category by area and role (Figure 16) and shows that delays in emergency response was significantly the most common reason for complaint. These complaints also significantly increased in comparison to previous years with an increase of 103% since year ending March 2012. There were significant increases for all three areas for emergency response complaints which was particularly reflected in Cumbria and Lancashire where n=77 complaints were recorded in year, up from n=24 in the previous year (Figure 19). v. Complaints regarding care and treatment (n=61) increased since 2011/12 (n=55). Cheshire and Mersey received the same number of complaint (n=22) with the other two areas showing a slight increase. vi. vii. Staff conduct complaints increased this year, becoming the third most common reason for complaints for this service line; a comparison with previous years complaints is included in Figure 19. This increase can partly be explained as a result of the changes made to Datix categories with the introduction of Datix web. Staff attitude complaints have also continued to decrease this year, from n=23 to n=16. Attitude however is often a secondary feature of complaints that are primarily categorised as emergency response or care and treatment, this is often cited where the patient or their family perceive that the attending staff lack appreciation or urgency for the situation. Given the nature of ambulance work, it can be difficult to resolve attitude complaints, as the accounts can differ greatly. Paramedic Emergency Service Complaints Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total 2009/2010 20 19 24 36 28 24 32 37 25 32 32 55 364 2010/2011 26 29 28 28 17 28 27 34 28 22 21 21 309 2011/2012 22 21 26 19 22 15 20 24 23 22 20 25 259 2012/2013 34 29 23 26 30 44 34 33 21 35 36 28 373 Figure 14 15

Figure 15 PES Complaint Categories by Area and Role 2012-13 CAL CAM GMA Total EOC PESOPS CFR Emergency Response 77 71 64 212 176 36 0 Care and Treatment 14 22 25 61 0 61 0 Staff Conduct 13 6 8 27 0 27 0 Staff Attitude 6 4 6 16 5 11 0 999 Call triage 5 4 6 15 15 0 0 Failure to Convey (PES) 3 5 5 13 12 1 0 Delay in emergency transfer 3 1 5 9 6 3 0 Communication 3 2 2 7 4 3 0 Other 1 1 0 2 0 2 0 Medical Records 0 0 2 2 0 2 0 Staff Comments 1 0 0 1 0 1 0 Damage or loss to property 0 1 0 1 0 1 0 Driving Skills 0 0 1 1 0 1 0 Policy/Procedure 0 0 1 1 0 1 0 Safeguarding 0 1 0 1 0 1 0 Totals: 126 118 129 373 218 155 0 Figure 16 16

Figure 17 Figure 18 Figure 19 17

5.6 Paramedic Emergency Service - PALS i. As can be seen in Figure 20, there was another increase in PALS enquiries for this reporting year, with 93 more enquries. ii. The Trust recevied a steady number of enquries at the start of the year with an expontential increase through both October and November. The Trust recevied an average of 87 enquiries per month, an increase of 8 from the previous year. Paramedic Emergency Service PALS Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total 2009/2010 21 10 31 35 14 15 31 13 20 34 59 78 361 2010/2011 69 73 83 78 66 56 46 68 60 52 64 65 780 2011/2012 44 75 64 74 79 89 86 88 74 97 87 90 947 2012/2013 78 89 81 80 85 95 121 131 95 75 50 60 1040 Figure 20 Figure 21 iii. For the year ending March 2013, the main area of concern continues to be our response to 999 calls, particularly with an emphasis with the Trust s response to Green 3 and 4 calls. Care and treatment raised considerably more concerns within Greater Manchester, though this uneven split was not reflected in care and treatment complaints. 18

PES PALS Categories by Area and Role 2012-13 CAL CAM GM TW Total CFR ECC PESOPS Emergency Response 82 111 76 0 269 0 192 77 Care and Treatment 24 27 109 0 160 0 1 159 Damage to / Loss of Property 35 43 42 0 120 0 0 120 Communication and information 47 29 40 4 120 0 47 73 Attitude Staff 38 40 41 0 119 0 12 107 Expression of Concern 13 16 24 0 53 0 19 34 Driving Standards 18 15 17 0 50 0 0 50 Staff Conduct 6 21 10 0 37 0 2 35 Other 12 16 5 0 33 1 8 24 None Provision of Ambulance 10 8 5 0 23 0 21 2 999 triage 5 5 4 0 14 0 11 3 Misuse of Sirens 5 4 5 0 14 0 0 14 None arrival of Ambulance 5 3 6 0 14 0 12 2 Navigation 1 2 1 0 4 0 1 3 Access to Health records request 1 2 1 0 4 0 1 3 Problems with transporting Patients 0 2 1 0 3 0 2 1 Vehicle issues 0 1 2 0 3 0 0 3 Totals: 302 345 389 4 1040 1 329 710 Figure 22 19

6. Method of Referral i. Figures 23 and 24 details how complaints and PALS are received by the Trust, with e-mail becoming an increasing method for communication both to and from the Trust.. ii. As reported last year, telephone reporting for both types of records remains the most common method of communication. Figure 23 Figure 24 20

7. Parliamentary and Health Service Ombudsman Review Of the 472 complaints received by the Trust in 2012/13, twelve cases were subject to Parliamentary and Health Service Ombudsman assessment. One of the twelve cases has progressed to investigation stage. It should be noted that the one case being investigated was first received by the Trust in April 2011. 8. Ethnicity Monitoring The Department of Health specifies using 17 ethnicity monitoring categories for complaints. This information is rarely provided by complainants or those making PALS enquiries. A total of 5 forms were retuned for complaints and PALS, and in all but 5 cases, people categorised themselves as white British. 9. Complaint Outcomes For complaints closed within the reporting year, the breakdown of whether the complaints were upheld or not upheld is detailed in Figure 25. Some complaints have been classified as partly upheld; this is where there are multiple aspects to a complaint with varying answers. The breakdown for the PTS and PES service lines are detailed in Figures 26 and 27. Figure 25 21

Figure 26 Figure 27 10. Comments Received The Trust also received a number of comments during the year where the person contacting the Trust does not require any feedback. Comments have received on the following topics:- Driving standards Flags on addresses to note specific allergies and access information Vehicle driving off before patient could make themselves known Staff conduct Misuse of service 22

11. Compliments (NWAS Library photo) detailed below:- Patients, relatives and other healthcare professionals continue to praise staff members for their actions, kindness and attitude which are recorded and shared with the staff involved. Common themes from these remain similar to previous years and include care and professionalism, patience, kindness, efficiency and communication explaining what is happening and what is being done. A selection of compliments are shared with all staff through the regional bulletin and are PES Compliments The patient s family contacted the Trust to pass on their thanks to the crew for all they did to try to save their father, though the patient sadly passed away. Thank you email received for the care provided to an 89 year old father in December 2012, when he had fallen in his bedroom. "The staff were really reassuring and ensured that his dignity was preserved as he was not dressed. Their response and treatment could not have been better." Commendation received via telephone call amongst a complaint. Paramedic who attended was said to be "excellent". Patient fell and suffered a cracked femur and broken wrist. She contacted the Trust to thank the crew for their care and for making her laugh whilst she was in pain. Patient contacted the Trust to thank the crew who attended her and her partner when they were involved in a road traffic collision; she was humbled by their help. Thanks were received from a family member after the patient collapsed, and was having a heart attack. The paramedic who attended commenced CPR and defibrillated the patient which saved his life. PTS Compliments A patient contacted the Trust to express their thanks for how their daily transport was handled saying that all the staff were very kind, caring and courteous Thanks were received from a patient s family member, stating that the crews were very professional, a credit to the service and were very highly praised by the patient 23

For both the PTS Service and the car driver service, a patient wrote to say that the driving was excellent, the care was exemplary and how much they enjoyed the good conversation Thanks were passed onto the various crews who providing a service to the patient over the past 12 months. Car driver from the Voluntary Car Service were thanked, the patient stated that all the drivers were kind and considerate, there were some very pleasant journeys, laughing all the way home. The patient could not praise the drivers enough as they made what was quite a long period of treatment into a more enjoyable experience and they were not sure how they would have managed without them. A friend of the patient contacted the Trust after the patient passed away. The patient had tumour on their spine and various crews had attended over the years. During the funeral service thanks were given for the Ambulance Service as the family expressed a deep appreciation for staff who attended over the last few years. 12. Learning and Service Improvement i. During the investigation of complaints and PALS queries, where appropriate lessons to be learnt are identified. Both individual and Trust wide learning is identified however in the majority of cases the learning was linked to individual behaviour or practice, or requires reinforcement of an existing procedure. ii. Learning is captured both on Datix and through the Service Line Action Trackers. The Service Line Action Trackers are managed through the Quality Business Groups and overseen by the Incident Learning Forum. Detail of both general learning and recurrent themes are shown below. Images used are library photographs and do not reflect actual staff involved in individual examples of service learning. 12.1 Specific Lessons Learnt Paramedic Emergency Service (NWAS library service) Concerns raised about the care provided to the patient who was disabled, vulnerable and frightened including how the patient was handled and the handover information provided to the receiving hospital. A formal incident learning review was completed for the staff involved covering professional accountability, standard of documentation and the application of the pre-hospital early warning score. Full apologies were given. Concerns raised about the care provided to the patient when they fell from the stretcher. The crew were referred through the Trust s incident learning process for this 24

complaint as they had not ensured that the patient was secure during transport and the patient was also administered a drug that was not indicated for their presenting condition. A full explanation, apology and assurance that the matters are being addressed were provided. Patient did not attend following attendance of an RRV, the patient later died of a Pulmonary Embolism. Following investigation it was clear that whilst the staff member had acted appropriately at the time, more guidance was published to ensure that staff are aware that hyperventilation and Pulmonary Embolism can present with very similar symptoms and therefore other underlying health conditions causing hyperventilation should be excluded. The paramedic completed period of supervision and reflective practice with Advanced Paramedic A full explanation, apology and assurance that the matters are being addressed has been provided. Lack of immobilisation at scene. The patient was involved in a road traffic collision where they suffered a head injury. The investigation concluded that the patient should have been immobilised and the staff completed reflective practice with a senior clinician. A full apology was given and the complainant contacted the Trust to advise that they were very happy with the investigation and had only required an apology. 12.2 Specific Lessons Learned Emergency Control Centre Delay in attending a 999 call. The patient was a child who had sustained an injury at school though suffered from another long term condition that meant that treatment was needed as soon as possible. The parents felt they could not wait for an ambulance and so took the patient to hospital. Apologies were given and a local Advanced Paramedic contacted the family to instigate a mobile care plan in order to minimise any risks in the future. (NWAS Library photo) Delay in attendance. The caller had fallen and suffered a fractured femur. The call was correctly coded however the dispatcher incorrectly failed to dispatch a vehicle waiting for the UCD assessment. An assessment was not required in this case as a 60 minute response time was applied as the patient was on the floor. The subsequent calls were not handled appropriately and a reminder was sent to all staff about the application of UCD assessments. A full explanation, apology and assurance that the matters are being addressed was provided. Delay in getting through to the Emergency Operations Centre. A local MP contacted the Trust regarding the experience of one constituent who experienced difficulty in getting the operator to understand where they were to put them through to the right ambulance service (area borders with West Midlands Ambulance Service). The Sector Manager 25

contacted BT to ensure that they had to correct information ensuring that the area was noted for NWAS to attend as necessary. 12.3 Recurrent Themes Paramedic Emergency Service The level of demand for emergency ambulance attendance has proved to be a common theme arising from complaints in this reporting year. This has been particularly felt by patients with lower acuity conditions. Some investigations have shown a lack of application of the second call procedure in Emergency Control Centres and staff have been reminded of the importance of this procedure, which can be particularly relevant in times of high demand Staff have been reminded, through an article in Clear Vision, of the importance of ensuring that the most appropriately qualified staff member attends to the patient when driving to the receiving hospital. Other vehicle issues have also included consideration when driving, parking and use of warning lights and sirens. There were a number of complaints regarding patient injury whilst in the care of the ambulance crew and staff have been reminded of the importance of appropriate and accurate dynamic risk assessment ensuring the safety of the patient, so far as possible. Some investigations have identified the lack of RESG in the CAD incident log. All dispatchers/performance managers and duty managers have been reminded of their responsibilities when attempting to identify resources to dispatch to incidents. Instances where there was a lack of appropriate or accurate patient assessment resulting in inappropriate care were identified. Four themes are recurrent; lack of spinal immobilisation, lack of differentiating between hyperventilation and more serious conditions, inappropriate manual handling decisions such as walking the patient to the ambulance and inappropriate pain management. All four remain causes for complaint. Appropriate documentation has been identified one issue particularly in terms of the varying standards of Patient Report Form completion but also the lack of completing incident report forms when indicated. Individual staff have reminded of their duty to ensure appropriate record keeping through the Clinical Leadership structure. The importance of communication and how staff are perceived by patients and their families is a recurrent theme the use of appropriate language, how staff talk to each other and whilst on the phone have all played their part in the reason for complaints. Where identified staff have been reminded of this aspect of care and many have offered their apologies to complainants as causing offence was not their intention 26

12.4 Specific Lessons Learned - Patient Transport Service (NWAS Library photo) Staff displayed a poor attitude to a patient. The crew in question could not recall all the details of this journey showing the difficulty in reconciling different accounts of the same incident. Apologies were given and the crew explained it was not their intention to cause distress however they were reminded of the importance of empathy within their role. Patient had a lengthy wait after an appointment and then was conveyed by taxi causing distress. This investigation highlighted the importance of communication between crews and control. The crew were unable to accommodate this patient before the end of their shift however failed to let control know so that could make alternative arrangements. This was addressed with the staff concerned, apologies were given and no further problems have been reported. Patient caused discomfort during a journey. The patient was being transferred between hospitals and reporting being pushed too quickly into the ambulance and being jarred. The investigation showed that the crew should have been more careful during this transfer and that they should have completed an incident report form as per Trust policy. This was addressed with the staff member concerned and explained to the patient, with our apologies. Concerns raised about difficulty with a discharge home. A palliative care patient was taken home and the crew had difficulties in getting the patient into the house. This was a joint investigation with the local hospital and it showed that the hospital had not shared all the necessary information when booking the transport. A full explanation and apology was given to the family. 12.5 Specific Lessons Learned - Patient Transport Service Control Patient had different issues with different journeys. The investigation showed that different journeys were being booked by different providers and the information regarding the patient s needs was not uniform. Notes were therefore added to the Cleric system to ensure that the Trust s response remained the same regardless of booking source. Full apologies were offered. Ambulance did not arrive and patient missed the appointment. The patient telephoned on the day to advise that their transport had not arrived and felt that the call handler was rude. Apologies were given with the reassurance with customer care training was currently being reviewed. The investigation also found that the planning for this journey has been at fault, which was addressed with the staff member concerned. 27

Patient missed their appointment as the driver refused to carry the patient s walking aids. The patient was booked as needing an escort and walking aids, which the driver can refuse at their discretion however a memo was sent out to staff of the need to accommodate some walking aids where possible and to check with control as necessary. 12.6 Recurrent Themes - Patient Transport Service A lack of clearly defined procedures, particularly for control room staff, has led to some difficulty in answering some complaints and concerns as there was no standard by which the actions could be measured. The importance of good accurate record keeping remains an important component of learning from complaints. For PTS this was highlighted with Cleric records and journey sheets either inaccurate or not available as well as a lack of incident report forms and / or patient report forms being completed as necessary. On the day bookings remain an issue with bookers attempting to make bookings for patients when vehicles are already fully committed. Journeys are accommodated wherever possible and these matters are raised with hospitals at the time though this does not seem to always filter through to patients despite this being the responsibility of the bookers. Concerns regarding patient mobility and patient specific requirements are often raised through the complaints and PALS process and control room staff in particular have been reminded throughout the year of the importance of asking about any specific requirements so that the Cleric system contains accurate information on patients and their needs. Staff have been reminded about a number of issues including communication with patient, attitude and the use of heating on vehicles ensuring patient welfare and comfort. Control staff have also been reminded to contact patients when there are issues with their transportation. 28

13. Patient Experience The Trust obtains feedback from patients, their carers and families together with members of the public in many other direct and indirect ways which are used to shape and improve the services provided to our communities. (NWAS library photo) These include: Community events hosted by the Trust and/or other NHS organisations and emergency service partners Patient Survey programmes a patient experience programme was conducted using a variety of different methodologies including over 1,000 patient surveys and 97 one to one interviews during 2012/13. Patient journey observations 87 silent patient journey observations undertaken in 2012/13 Issues raised by LINks and the Trust s Core Group members (formerly part of the Critical Friends Network, now part of our Foundation Trust membership). 13.1 Community Events (NWAS library photo) Patient experience is obtained from the Trust s hosting of, or attendance at many community events throughout the year. In 2012/2013 major events included various Health Melas, the Disability Awareness Day, various PRIDE events, CODA, (Children of Deaf/Deaf Adults) SASCA Open Day (Somali Adult Social Care Agency) and the Trust s Annual General Meeting and Open Day at Ladybridge Hall. Experience is provided face to face through general conversation, dedicated engagement and consultation facilities using focus groups, message walls, written and touch screen surveys and the latest interactive survey software. Development of a bespoke ambulance service large scale board game proved a useful tool for the Trust to meet and engage with a further 10 community groups. As a result of the success the board game has produced, in bringing to life interesting and diverse dialogue, when played by members of the public, the patient experience team submitted it to the National Patient Experience Network (PEN Awards). We were delighted when the game won the 2012 National Outstanding Patient Experience Innovation award. Funding has also been invested in the development of another new bespoke Patient Experience Board Game. The new bespoke game enables us to both inform and educate patients of the services we provide as well as giving them the opportunity to provide feedback. Experience provided through these channels at community events during 2012/2013 has included: 29

Gaps in information and awareness of ambulance services and the preferred ways in which people would like to receive information Issues that may prevent people from calling 999 Ways in which the public would feel they have been treated with dignity and respect Understanding of the communication aids used by the Trust in respect of language, culture, learning difficulty and other special needs Opinions on the emergency service and patient transport service patient care provided by the Trust Who can access and how to access the patient transport service Understanding the work of the ambulance service and employment opportunities, particularly for black, mixed and ethnic (BME) community groups What constitutes an emergency and accessing the SMS service Understanding cardiac arrest, strokes and how to respond The value of reassurance, empathy, professionalism and care provided by the crews of the ambulance service. Lack of information in easy read format - including how to contact us to provide feedback. All of this experience has been recorded and analysed as part of the overall 2012/13 patient experience programme. Findings have been fed back to the Board of Directors together with individual Service Management Teams. This information has been used to inform service improvement plans and business plans. Initial improvements included the redesign of the dedicated PTS micro site, an easy read format describing PTS patient mobility categories, PTS flow chart for patient journey bookings, Increased Equality and Diversity training for staff and the launch of the There s more to your ambulance service than you think information campaign. 13.2 Patient Survey Programme Building on the findings and lessons learned from the 2011/12 patient survey programme, the Trust undertook a major patient experience programme utilising a number of different approaches to gathering feedback. The 2012/13 programme development was based on the outputs from the 2011/12 programme and consideration was placed on which methods had produced the best results in terms of volumes of patients surveyed and richness of feedback given. The 2012/13 programme has been supported by funding from CQUIN monies and has involved further rollout and testing of a number of methods to obtain patient feedback for our Paramedic Emergency Service (PES), our Patient Transport Service (PTS) and our Urgent Care Service (UCS). Real time face to face patient surveys were undertaken with 236 patients across 10 A&E hospital departments, following handover and triage. The Patient Experience Team used touch screen tablet devices to record survey responses using the externally provided specialist software from CRT Viewpoint. A new postal survey for patients accessing appropriate care via the Urgent Care Desk was undertaken. Users of the Urgent Care Desk service were asked by Urgent Care Desk Paramedics if they would consent to taking part in the postal survey. This survey had been previously conducted as a telephone survey and due to the difficulties with this method last year (numerous failed attempts to conduct the survey due to people not answering when called or not wanting to speak over the phone as it was inconvenient) a decision was taken to trial postal 30

surveys instead. A total of 351 surveys were dispatched, (along with a freepost return address) with 120 completed surveys being returned. This gave an average return rate of 34% The NWAS Talk To Us Forum during this year involved two campaigns, again using the Patient and Family Echo tool hosted by Clever Together. This staff engagement tool is known within our organisation as the Talk to Us online forum. The first campaign was targeted towards all staff members and they were invited to answer the following challenge question: Based on your knowledge, what elements of your work would you change in order to create the greatest positive impact on patient experience? As a result of the feedback given during the initial campaign, a more specialised campaign then followed which focused on the challenge question: What can we do to improve patient experience at the point of handover between NWAS and care institutions? The first campaign received 95 unique ideas, 365 comments and 1165 votes, altogether totalling over 1600 contributions. The contributions from the second campaign with a more specialised challenge question resulted in 54 ideas, which in turn generated 155 comments and attracted 731 votes, giving a contribution total of 940. Improvements introduced as a result of the staff feedback from the Talk to Us Forum included: Production of the new PTS Patient Charter outlining what a patient should expect when using the service. Launch of the information campaign There s more to your ambulance service than you think In addition 467 patient transport service patients were surveyed face to face in 12 hospitals, 87 silent patient observations were undertaken on patient transport ambulances, postal surveys were sent out to 266 patients who had used PTS when being discharged from hospital, with 67 being returned. A specialist survey was carried out face to face with 137 Oncology patients in total across The Christie Hospital and The Clatterbridge Cancer Centre. A total of 97 haemodialysis patients were also interviewed across five hospital sites about their experiences of using the Patient Transport Service. These patients were invited to suggest ways in which NWAS could improve their experience. At the start of the 2012/13 programme all survey questions were updated to reflect the NICE standards around patient centred care. These standards evolved from Picker s six dimensions of patient care. Almost all questions also allowed patients to provide context to their responses and this has provided the Trust with vast amounts of rich, qualitative data. The Department of Health Friends and Family Test question was updated to provide an answer scale of 1-10 instead of a simple yes or no used for 2011/12. The question read Based on your experience of our service, how likely are you to recommend the ambulance service to a friend or relative? The answer scale ranged from 1 (least satisfied) to 10 (most satisfied). This enabled a clearer calculation of our Net Promoter Score (NPS). As mentioned above the bespoke ambulance service patient experience board game proved very successful in engaging with hard to reach or seldom heard groups. During 2012/13 some of the 31

groups the Trust engaged with included several Mental Health Groups including Richmond Fellowship Blackpool and Remind Mental Health Support Liverpool. The game was used to engage with 10 groups in total that included two youth groups, Cumbria Young Farmers Group and Manchester Young Peoples Parliament. The main purpose of the events has been to play the game and to record feedback on varying topics relating to the trust. The feedback has then been analysed and service improvement recommendations made as a result. The events are usually supported by an operational staff member and an emergency vehicle. They have been held in community venues across the region. Objectives for the events included managing patient expectations, enabling us to give general information and discuss access issues and allowing us to listen carefully to service user experiences. As part of the patient experience performance measures, it was critical for us to monitor trends in complaints, concerns and compliments and align them with our work. It was important to ensure that specific engagement work focussed on some of the features being highlighted within the making experiences count arena. The patient experience team are in the process of adding another seven patient stories to their library of filmed patient stories. As in the past, the stories have come from patients who may have used our 999 emergency service or used our Patient Transport Service to get to their hospital or clinic appointments. The stories have been created as a result of listening to our patients through patient surveys, interviews in hospitals, compliments and complaints received and our work with community groups across the region. High levels of public satisfaction levels were demonstrated across all different approaches to gathering patient experience. 96.2% of patients surveyed in A&E s rated the overall service received from the ambulance service 8, 9 or 10 out of 10. 89.2% of respondents scored 8 or more out of 10 when asked how they rated the overall care they had received from the Urgent Care Desk. This figure dipped slightly (4.8%) compared to the previous year s results. More respondents graded their experience as 10 out of 10 this year and the sample size almost double that of last year. In terms of the Patient Transport Service face to face surveys; 89.6% rated the overall service received from the ambulance service 8, 9 or 10 out of 10. This is a slight increase on the previous year s result. The 2012/13 Net Promoter Score for patients of the Paramedic Emergency Service is 91%, Patient Transport Service 76.6% and Urgent Care Service 68.4% The Patient Experience Toolkit was successfully launched at the AGM in September 2012. The toolkit showcases some of the patient experience achievements the Trust has made. The toolkit has been produced in a limited number of printed copies mainly to allow individuals to see it at events, but primarily people are signposted to it on the Trust s website as an on-line flash book. To date the Trust has successfully been able to pilot and evaluate a number of ways in which to capture patient experience. A major challenge for an ambulance service, with a significant population to serve and across a large geographical footprint, is how to capture enough patient feedback so that the information is truly representative. In order to work towards fulfilling this challenge, it will be necessary to embed patient experience across the Trust and allow front line staff to facilitate the gathering of patient views. 32

13.3 Engagement with Local Involvement Networks (NWAS Library photo) The Trust invited all Local Involvement Networks (LINks) to two events during 2011/12; a conference on our proposals to deliver the Equality Delivery System and the Annual General Meeting and Open Day held in Knutsford, Cheshire. Feedback received on our progress against the Equality and Diversity characteristics was used in our assessment process and comments provided on a quick throw version of the patient experience game were included within the overall programme s findings. Many of the North West region LINks have been awarded pathfinder status for the transition to Healthwatch and the Trust has worked with them to assist this process. In particular the Trust has supported Blackburn with Darwen LINk attending workshops, taking part in one to one stakeholder and focus group interviews and also Blackpool LINk. Patient transport eligibility criteria has been raised by a number of LINks and visits involving Trust Officers and Commissioner representatives have taken place to answer questions. The Trust contributed to a new transport leaflet for Bury residents. Operational and support staff have provided presentations to LINks on the Quality Accounts, Hospital Arrival Screens, NWAS developments and localised issues. As important stakeholders LINks are provided with information and briefings on key topics including Foundation Trust progress, the 111 service and our patient experience work. Over the course of the year many other issues or questions have been raised with regard to experience of Trust services and written or face to face responses have been provided to all. Topics include: Patient transport to private hospitals Staff involvement in fleet and equipment design Night time operational activity in the Westmorland/Lancaster and Penrith to Carlisle areas Equality and Diversity, the SMS text service and other communication aids Training on specific conditions eg diabetic hypo training Estates and service redesign work Thrombolysis with regard to stroke Public involvement and use of social media Falls and dignity on discharge Re-categorisation of calls and the urgent care and 111 services Our response to mental health patients Hospital arrival Screens and the CMS Volunteer car drivers and availability of Community First Responders Flagging of addresses 33