NOT PROTECTIVELY MARKED Public Board Meeting May 2016 Item No 11 THIS PAPER IS FOR DISCUSSION PERSON-CENTRED HEALTH AND CARE UPDATE Lead Director Author Action required Key points Pat O Connor, Director of Care Quality and Strategic Development Sharon Hammell, Head of Corporate Affairs and Engagement The Board is asked to discuss and provide feedback on this update. This paper provides an overview of feedback, and complaints, concerns and compliments for the reporting period 2015/16. The Service has seen an increased preference for providing feedback as a concern. While concern volumes increased year on year by 52%, 67.5% of people raising a concern received a response within 20 days. Complaints compliance for the year was 51%. Complaints do tend to relate to more serious and complex cases of poor care, and therefore may take more time to resolve. Nevertheless, this is well below the 70% standard. A joint action plan has been developed between the Corporate Affairs Team and Operational Directorate with the intention of delivering a step change improvement to standard level. Patient Opinion continues to be a valuable source of feedback, including compliments. The paper provides assurance that Scottish Public Services Ombudsman (SPSO) cases are managed effectively. The paper shares ongoing development of Patient Focus Public Involvement (PFPI) governance arrangements, including the induction and support of patient and public representatives. Timing Contribution to the 2020 vision for Health and Social Care Benefit to Patients An update is presented bi-monthly to the Board. Person-centred care is delivered when health and social care professionals work together with people who use services, tailoring them to the needs of the individual and what matters to them.the Service s Person-centred Health and Care plan promotes patient and staff participation in the development of services and continuous improvement of the experience of patients and of staff. Patients and the public are easily able to share good care Doc: 2016-05-25 Person Centred Care Update Page 1 Author: Head of Corp Affairs & Engage Date: May 2016 Version 1.0 Review Date: July 2016
experiences, as well as those which highlight areas for improvement. They are also able to participate in service development, to co-design and co-produce improving the patient experience. Equality and Diversity Revised arrangements are being developed for PFPI governance arrangements to promote equality and diversity, as is participation in local community events. Doc: 2016-05-25 Person Centred Care Update Page 2 Author: Head of Corp Affairs & Engage Date: May 2016 Version 1.0 Review Date: July 2016
NOT PROTECTIVELY MARKED SCOTTISH AMBULANCE SERVICE BOARD PERSON-CENTRED HEALTH AND CARE UPDATE SHARON HAMMELL, HEAD OF CORPORATE AFFAIRS AND ENGAGEMENT SECTION 1: PURPOSE This paper provides an update on the Service s Person-centred Health and Care Delivery programme, feedback received via compliments, complaints, concerns and through Patient Opinion, as well as an update on Scottish Public Services Ombudsman (SPSO) cases. SECTION 2 : BACKGROUND The Service receives feedback from a variety of sources and actively encourages feedback from service users and their carers. We continue to test opportunities to build awareness with seldom heard groups, both about how to give feedback and how to become more involved with the Scottish Ambulance Service in volunteer roles such as patient and public representatives on programme boards and steering groups. SECTION 3: DISCUSSION 1. Person-centredness Update Enhancing Patient Focus Public Involvement (PFPI) Arrangements A follow up paper which outlines the detail of enhanced governance and diversity in relation to the Service s PFPI framework will be presented at the PFPI Steering Group meeting on 16 May. Changes include a revised Terms of Reference which would introduce tenure for Steering Group members, and introduce co-chairing of the Steering Group with patient and public representatives. In addition, the Head of Corporate Affairs and Engagement is in discussion with the new Head of Strategic Development and Quality Improvement to explore how person-centredness can be further aligned to strategy implementation. This includes enhanced PFPI capability across the Service s Improvement Adviser roles, as alignment with the Improvement Advisers and Divisional PFPI leads. Meeting with the Strategic Advisor for Person-Centred Care and Improvement at the Health Quality and Strategy Directorate, Scottish Government Doc: 2016-05-25 Person Centred Care Update Page 3 Author: Head of Corp Affairs & Engage Date: May 2016 Version 1.0 Review Date: July 2016
The Director of Care Quality and Strategic Development and Head of Corporate Affairs and Engagement met with Shaun Maher, Strategic Advisor, Person-Centred Team, Scottish Government on 31 March to explore opportunities to enhance focus on the Service s person-centredness priorities. Amongst the agreed actions were: exploring the opportunity to participate in training in the use of the Experience Based Co-Design (EBCD) methodology run by Health Improvement Scotland reviewing the presentation of Patient Opinion data in the context of all patient feedback received by the Scottish Ambulance Service. Engaging with Seldom Heard Groups The Service continues to engage with Minority Ethnic communities. The Equalities Manager has been supporting local staff in West Central Division in events which support Syrian refugees. Service representatives have provided information in Arabic to build awareness within the refugee community about how to access the Scottish Ambulance Service. The East Central Division s Patient Focus Public Involvement (PFPI) Lead has been working with the Equalities Manager to pilot an alert card through People First in Fife. People First support adults with learning difficulties. The alert card can be completed by, or on behalf of people who need support in communicating with others. The card holds key information, including telephone numbers of friends or family members who can help. Public Strategy Engagement Sessions The Corporate Affairs and Engagement team is finalising arrangements, in partnership with the Scottish Health Council, for further public engagement sessions across Scotland s remote, rural, urban and island communities to gather feedback and input on the development of services in May and June 2016. Confirmed meetings to date include Patient Public Forums in: Ayrshire and Arran, Borders, Inverclyde, Lothian and Shetland. 2. Patient Opinion During the year, there were 72 stories posted on the Patient Opinion website which related to the Scottish Ambulance Service. To date, these stories have been viewed 36,118 times. The tables below show the volume of posts per month, and the level of criticality. Doc: 2016-05-25 Person Centred Care Update Page 4 Author: Head of Corp Affairs & Engage Date: May 2016 Version 1.0 Review Date: July 2016
There were 11 posts in August. Seven were rated not critical, reflecting positive care experiences from the Scottish Ambulance Service. One post was rated minimally critical and also shared positive feedback about the Service. Two posts were rated mildly critical and highlighted frustrations with the Patient Transport Service. One post was rated moderately critical. However, the care provided by the Service, within the whole care experience, was praised by the person who posted the patient story. As highlighted in previous reports, posts routinely describe a patient journey where the Scottish Ambulance Service was one element of the end-to-end care experience. Criticality scores are aggregated across the whole patient experience and do not necessarily mean that a highly critical score reflects the care provided by the Service. For example, only one of the four posts graded a criticality level of three and two of the posts graded a criticality level of four were critical of the Scottish Ambulance Service. The remaining moderately or strongly critical posts were either not critical, or were positive about the care provided by the Scottish Ambulance Service. Where feedback was negative, the issues brought to the Service s attention were lack of flexibility with the Patient Transport Service, immobilisation of a patient and moving and handling of a patient. The people posting these experiences were invited to contact the Patient Experience Manager so he could gather more information in order to review the care of each patient in more detail. 31 of 33 people who looked at the three strongly critical and four moderately critical posts graded the response from the Scottish Ambulance Service as helpful. 3. Compliments This year, the Service logged 566 compliments on Viewpoint. For those compliments where themes were logged, attitude and behaviour was the most common theme, followed by clinical skills, then teamwork. Examples of good practice are highlighted in the Chief Executive s weekly bulletin, through local and national media, as well as through digital channels. The Service has also secured two spotlight sessions at this year s national NHS Scotland event in June, offering an opportunity to showcase progress in stroke and cardiac care. Patient stories which highlight good patient experiences as well as areas for improvement stories are filmed, often in the patient s own home, and are shared with staff to promote organisational learning. Doc: 2016-05-25 Person Centred Care Update Page 5 Author: Head of Corp Affairs & Engage Date: May 2016 Version 1.0 Review Date: July 2016
The comparisons by volume for 1 April 2014-31 March 2015 and 1 April 2015 31 March 2016 shows a 4.5% decrease in feedback received as a complaint, and a 52% increase in the volume of feedback received as a concern. During the year, we actively encouraged feedback and early resolution. Volume of Complaints and Concerns 2014/15 v 2015/16 01/04/2014 31/03/2015 01/04/2015 31/03/2016 +/- % Complaints 529 505-4.5% Concerns 516 783 + 52% The Pareto charts below highlight the principal complaints and concern themes. Doc: 2016-05-25 Person Centred Care Update Page 6 Author: Head of Corp Affairs & Engage Date: May 2016 Version 1.0 Review Date: July 2016
Complaint Themes 2015/16 Concern Themes 2015/16 Doc: 2016-05-25 Person Centred Care Update Page 7 Author: Head of Corp Affairs & Engage Date: May 2016 Version 1.0 Review Date: July 2016
The Pareto charts above highlight that the top three issues and hence the focus of our improvement actions in response to complaints and concerns, should be on attitude and behaviour, delayed response and cancellations. For the 2015/16 reporting period, attitude and behaviour features as the most common theme across both complaints and concerns (59 of 151 complaints and 151 of 783 concerns.) and this is a similar position to the previous year. A number of initiatives are in place to help address this, including the rollout of imatter and a review of the Developing Future Leaders and Managers (DFLM) programme, which is both developing management capability to help their team members learn from patient feedback and designed to free up manager capacity to spend more time with the staff who report to them. In addition, a campaign which highlighted the impact of alcohol misuse over the festive season not only highlighted the impact of alcohol misuse to the public, but demonstrated to staff that the Service was acting on the feedback they provided. The Service is working with Police Scotland and Scottish Fire and Rescue on a joint summer campaign which will highlight the impact of alcohol misuse on all three emergency services. Complaints and concerns about the Patient Transport Service have increased year on year. The biggest rise has been in relation to cancellations (57 complaints and 158 concerns) Three issues are creating increasing pressure on PTS resources. The number of complex patients has increased: e.g. patients who require bariatric support. More patients are travelling further distances outwith their local Health Board area in order to receive specialist care. In addition, there has been an increase in patients who are calling on the day of their appointment to seek support from the Patient Transport Service. At this point, journey planning is completed, with little or no capacity to meet the needs of these patients. Having identified the increasing trend in complaints and concerns about cancellations of Patient Transport Service bookings, a capacity management plan was approved by the Scottish Ambulance Service Board in November 2015. The plan is in place and continues to be refined in order to focus Patient Transport Service resources on the patients with clinical and mobility needs, which should drive a reduction in complaints and concerns. While complaints about clinical assessment are also to the left of the complaints Pareto chart, it is worth noting that complaints and concerns related to clinical assessment reduced during 2015/16. (48 complaints and 26 concerns in 2015/16 v 69 complaints and 20 concerns in 2014/15.) In the course of the year, there has been increased focus on learning from complaints and Significant Adverse Event Reviews (SAERs) with learning being shared across a range of staff communication channels. Anonymous case studies in Response magazine and webcasts on clinical care topics such as ECG Interpretation, Clinical Decision-making, Medicines Management, Stroke, Pre-hospital Paediatric Care and Out of Hospital Cardiac Arrest have been well-received by staff. There were over 2,500 views (i.e. devices such as PCs signed in to the webcast so more than one member of staff may have been viewing on one device) across all of these topics in the course of 2015/16. 4. Complaints Compliance Complaints compliance for the full reporting year is 50.9%, subject to validation by the Information Services Division (ISD) of National Services Scotland. All NHS Boards in Scotland are required to provide an annual submission to ISD of complaint volumes, themes and compliance data. Doc 2016-05-25 Person Centred Care Page 8 Author: Head of Corporate Affairs & Engagement
A number of mitigating actions were put in place in the course of the year, which were designed to improve complaints compliance. These included increasing the frequency of reporting to General Managers which flagged complaints within five days of the 20 day window, as well as a list of complaints over the 20 day threshold, and testing revised complaints review/investigation documentation, designed to simplify the complaints handling process. Given the compliance position however, a comprehensive complaints compliance recovery plan was approved at the Executive/General Manager development meeting on 26 April. The plan has seen complaints compliance being more prominent in divisional mid and full year appraisals, and further training and development is being provided for managers responsible for complaints handling, including a training session co-presented with the Scottish Public Services Ombudsman on 16 June. The Patient Experience Manager continues to work with our Improvement Advisers and is meeting with each Division s Business Support Managers to review local plans to improve complaints compliance and quality of response. For this reporting period, the average response time for a complaint was 33 days. The median was 23 days. This compares with 30 and 21 days respectively during 2014/15. As reported in the January and March 2016 Board papers, the longest number of days for a complaint response in this period was 132 days. In this case, there was lengthy correspondence with the complainant in relation to driving standards. The complainant was dissatisfied with our response and ultimately approached the Scottish Public Services Ombudsman, who took no action. 5. Improving Complaints Handling As a member of the National Ambulance Service Patient experience Group (NASPEG) the Scottish Ambulance Service has sought to benchmark complaints handling against other UK ambulance services. NASPEG members agreed to introduce a standard survey to complainants, to encourage feedback about what was working well in our complaints handling process and to identify areas for improvement. From November 2015, the Patient Experience Team began inserting the complaints handling survey with complaint response letters. To date, the response rate is lower than anticipated, at 8.5% (15 responses from 176 complaints handled between November 2015 and 31 March 2016.) From the 15 surveys received to date, feedback has indicated that communications related to complaints is easy to understand (14 of 15 surveys), but fewer than half of the people who responded (8 of 15 surveys) felt they had been taken seriously, and 11 of 15 respondents indicated that the time taken to respond was too long. We will continue to seek and share learning at the NASPEG forum in order to help increase the response rate to the survey and to respond to the feedback complainants have provided. The Complaints Handling Model Procedure Steering Group met on 15 April 2016. The final MCHP draft will be circulated more widely in June. Training and development plans and supporting documentation are also being finalised ahead of the roll out later this year. The new model will start at the beginning of the next reporting year, on April 2017 6. Complaints Benchmarking The tables below demonstrate the trends in the volume of complaints and concerns in relation to the number of patient touchpoints in areas of unscheduled and scheduled care delivery across the Scottish Ambulance Service. Patient touchpoint is defined as the Doc 2016-05-25 Person Centred Care Page 9 Author: Head of Corporate Affairs & Engagement
number of Accident and Emergency incidents and the number of journeys by the Patient Transport Service. Doc 2016-05-25 Person Centred Care Page 10 Author: Head of Corporate Affairs & Engagement
The bar charts above demonstrate that, overall, complaints and concerns have increased across each quarterly reporting period. While complaints relating to Accident and Emergency services decreased over the summer months, there was a subsequent increase during the last quarter of the year. During this time, the Service faced additional challenges through adverse weather conditions, which created additional pressures in maintaining services and reaching urgent and emergency patients quickly. The data also highlights that our Patient Transport Service is a driver of the overall increase in complaints and concerns. A capacity management plan was put in place at the end of 2015, and in response to patient feedback, continues to be refined in order to ensure PTS is focused on patients with clinical and mobility needs. Ongoing monitoring of the data above will show if the changes are delivering anticipated benefits to our patients. 7. Scottish Public Services Ombudsman (SPSO) Update Comparison of SPSO Investigation and Decision Reports 2014/15 and 2015/16 Investigation Reports 2014 2015 No investigation reports carried out. 2015-2016 One report laid before Parliament. Decision Reports Upheld Some Upheld Not Upheld 2014-2015 2 1 4 2015-2016 3 2 3 Doc 2016-05-25 Person Centred Care Page 11 Author: Head of Corporate Affairs & Engagement
A breakdown of the Decision Reports is below. SPSO Ref No Date Published Complaint Theme SPSO Outcome Action Status 2015405815 Jun 15 Failure/delay in sending an Upheld Complete ambulance Recommendations 2015405488 Oct 15 Clinical Treatment/Diagnosis Not Upheld N/A 201500671 Dec 15 Clinical Treatment/Diagnosis Some upheld, Complete Recommendations 201404381 Dec 15 Equipment Upheld Complete Recommendations 201502258 Jan 16 Admission/Discharge/Transfer Not upheld, No N/A Procedures Recommendations 201407184 Jan 16 Clinical Treatment/Diagnosis Not upheld, No N/A Recommendations 201502531 Feb 16 Clinical Treatment/Diagnosis Upheld, Complete Recommendations 201500443 Feb 16 Clinical Treatment/Diagnosis Some upheld, Recommendations Complete Doc 2016-05-25 Person Centred Care Page 12 Author: Head of Corporate Affairs & Engagement
SPSO Update: Breakdown of SPSO Cases Published during 2015/16 Date opened Date closed Description of Complaint Outcome Actions Status 16/03/2015 11/11/2015 201405184 (SAS upheld) 05/06/2015 26/11/2015 201500443 (SAS complaint outcome: not upheld.) the ambulance crew unreasonably failed to diagnose patient s condition the ambulance crew unreasonably failed to provide treatment for patient s condition the ambulance crew unreasonably failed to regard the situation as an emergency the Service s response to your complaint was inadequate Patient Deceased Not upheld N/A N/A Upheld Not upheld Upheld Upheld With four recommenda tions By 3 December: Apologise to complainant for failings By 17 December: a. SAS to ensure staff are aware of the signs and symptoms of leaking abdominal aortic aneurysms, including atypical presentations. c. SAS to ensure staff are aware that normal vital signs do not exclude serious and life-threatening medical and surgical conditions. e. SAS to ensure that, when making a decision not to transport patients to hospital, their staff document detailed history and examination findings which confirm the diagnosis of a minor illness. Documentation in these circumstances should demonstrate that more serious conditions which may be in the differential diagnosis have been considered and actively excluded. g. SAS to ensure that, when making a decision not to transport a patient, staff reference which see and treat guideline is being followed h. SAS to ensure that staff investigating complaints use appropriate reference material, such as clinical textbooks, when considering matters of clinical judgement. Recommendation: the Board apologise: that the ambulance crew unreasonably assumed that the patient s symptoms were due to sciatica or Doc 2016-05-25 Person Centred Care Page 13 Author: Head of Corporate Affairs & Eng Apology action complete. Consultant Paramedic and Critical Care Practitioner, Medical Directorate leading on rollout of actions a-g. (Timetable TBC) Patient Experience Manager, leading on action h.
18/06/2015 30/10/2015 201500671 muscular back pain that the crew failed to recognise that the patient was seriously unwell with a life-threatening condition that the crew failed to regard the situation as an emergency; and that the Service s response to the patient s complaint was inadequate. (SAS complaint outcome: not upheld.) Complete the ambulance crew failed to take a blood glucose reading appropriately the ambulance crew unreasonably took patient to hospital 24/07/2015 Open 2015001488 Upheld Not upheld SAS to apologise to complainant for failure to clean skin appropriately before taking reading. Crew to be made aware of requirement to clean skin before taking glucose reading. N/A N/A (SAS complaint outcome: not upheld.) Failure to properly assess patient Not upheld 27/07/2015 18/11/2015 201404381 Upheld Recommen dations Apologise for failure to transfer patient appropriately, and for distressed caused Apologise for failings in complaints handling. Complete 11/09/15 25/11/2015 201502258 (SAS complaint outcome: SAS complaint investigation identified that a hospital discharge had been booked through PTS, since patient was able to move from stretcher to chair. Not upheld. SPSO drew Doc 2016-05-25 Person Centred Care Page 14 Author: Head of Corporate Affairs & Eng
not upheld.) SAS did not take reasonable steps to ensure a transfer home for the patient. Not upheld When the crew arrived at the hospital they were advised that the patient was paralysed and would not be able to transfer. The crew carried out a Dynamic Risk Assessment and felt that the patient would need to be transferred by scoop stretcher. The discharge was therefore cancelled and rebooked. SAS attention to complaint timescales, updates, post-decision contact details. 22/09/2015 03/12/2015 201502531 (SAS complaint partially upheld.) SAS decision not to transport patient to hospital was unreasonable. Patient deceased. Upheld SAS complaint investigation was completed in relation to a patient who presented with multiple symptoms. The patient subsequently suffered a stroke and died. The complaint was partly upheld, with the following learnings to be followed up: Apologise to the patient and his family for the failings identified by 18 December 2015 Provide SPSO with the outcome of the service s own recommendations by 11 January 2016 Review the role of named contacts at the end of complaints letters by 15 February 2016 Remind non-prescribers of their role in advising patients on medications by 11 January 2016 Complete Complete Complete 12/10/2015 23/10/2015 201503509 (SAS complaint outcome: not upheld.) Failure to provide appropriate clinical treatment in view of patient presentation. No further action. SAS complaint investigation carried out in relation to cardiac patient who deteriorated and died shortly after handover in hospital. Investigation found the crew had carried out an appropriate clinical assessment and identified learnings in relation to eprf completion, JRCALC guidelines on Heparin and time on-scene awareness. No further action Doc 2016-05-25 Person Centred Care Page 15 Author: Head of Corporate Affairs & Eng
Patient deceased. 12/11/2015 26/01/16 201405815 (SAS complaint upheld) Upheld Apologise to patient for failure to ask appropriate questions re: abdominal pain. Training for Clinical Adviser Complete 28/11/2015 11/12/2015 201504415 (SAS complaint outcome: upheld.) SAS undertook remedial action (refresher driver training) as part of original complaint response. Complete Care during ambulance transport (discharge) No further action 27/01/2016 04/02/2016 201505935 (SAS complaint outcome: upheld.) No further action Failure to recognise the needs of escort for PTS patient. No further action. Attention drawn to providing updates to complainants. The Patient Experience Manager is developing a further training session for complaints handlers across the Service, which will take place on 16 June 2016. Doc 2016-05-25 Person Centred Care Page 16 Author: Head of Corporate Affairs & Eng