North East Lincolnshire Clinical Commissioning Group Adult Social Services and Health Statutory Complaints Annual Report April 2013 to March 2014
Contents Page Context 1 Complaints 1 Activity: Adult Social Services 3 Activity: Health 6 Patient Advice and Liaison Service (PALS) 9 Development 9
Context This report provides an overview of Adult Social Services and Health Service Statutory Complaints made during the twelve months between 1 st April 2013 and 31 st March 2014. Complaints and representations are made under the following established procedures - The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009. The Clinical Commissioning Group Complaints Policy forms a schedule to the Partnership Agreement between North East Lincolnshire Council and North East Lincolnshire Clinical Commissioning Group and is binding between both organisations. The Statutory Complaints procedure covering Adult Social Services and Health Services is administered by the Patient and Client Experience Manager within the Clinical Commissioning Group. This report covers both Adult Social Services and Health Service complaints, reported separately, to reflect the new legislation introduced on 1 st April 2009. In April 2013, as part of national changes, the Care Trust Plus ceased existence and the Clinical Commissioning Group was established. In line with these national changes the handling of Primary Care Health Complaints was transferred from local Primary Care Trusts and Care Trust Plus s to NHS England. An agreement was made locally that the Customer Care Team, within the Clinical Commissioning Group, would continue to handle Primary Care Complaints until the new system was fully established. Similarly, arrangements were put into place to ensure that primary care health complaints received before the 1 st April 2013 remained with the Customer Care Team for business continuity purposes. Any primary care health complaints referred to in this report are included for these reasons. The Patient Advice and Liaison Service (PALS) function continues to be provided by the Customer Care Team within the Clinical Commissioning and deals with informal concerns and complaints for both primary health and adult social care. 1. Complaints 1.1 What is a Complaint? A complaint may be generally defined as an expression of dissatisfaction or disquiet about a service that is being delivered or failure to deliver a service. The Complaints Procedure gives those denied a service or dissatisfied with the proposed level or type of service an accepted means of challenging the decision made.
1.2 Who can make a Complaint? The statutory complaints procedure is available for service users/patients or their representatives who wish to make any sort of comment. Some service users/patients may wish to make their views known by raising a concern, but not have them dealt with as complaints. Anyone who expresses a view, verbally or in writing, which can reasonably be interpreted as a representation of their views will have those views acknowledged. People can make a complaint or representation about the actions, decisions or apparent failings covering Adult Social Services and Health Services commissioned, or provided, by the Clinical Commissioning Group 1.3 Complaints Procedure The Complaints procedure puts the patient/service user, and/or their representative, at the centre of efforts to resolve the issues they have raised. The Clinical Commissioning Group recognises the importance of listening to the experiences and views from the public about our services particularly if they are unhappy and we want to make it as easy as possible for them to let us know their views. The procedure ensures that representations are dealt with in a way that is: Open information gathered about the issues raised and the way in which they have been handled is shared in full. Clear the representation and the way in which it will be handled is agreed at the start with the complainant. Responsive the needs of the complainant and/or patient/service user is taken into account in determining the method of addressing their concerns. Flexible the complaint/representation handling is determined by the nature of the complaint and views of the complainant. Proportionate the efforts to resolve and time taken in addressing the issues raised reflects the significance of those issues. Accessible the procedure is easy to get access to and to use. Timely complaint handling is conducted in a timely way rather than subject to preset timescales. Focussed on resolution at all points through the process we look to using our best efforts to achieve resolution. Complaints will be dealt with in a way that is most suitable to the issues raised rather than according to a set procedure. The means of addressing the complaint takes into account: The complainant s views. The nature of the complaint. The potential implications for the complainant. The potential implications for the organisation.
We want everyone who is involved to feel confident in the process and will achieve this through a procedure that ensures: Concerns are taken seriously. Complaints are dealt with promptly and effectively. There is a full response and a clear outcome for complainants. Complaints are dealt with fairly and even-handedly. All those involved in the process are treated with dignity and respect. There is equality of access and standard of service for all complainants, with particular consideration for those people who may find it more difficult to use the process e.g. people with disabilities, those whose first language is not English. Using the outcomes from complaints and concerns to improve services. 1.4 Response times The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009, introduced in April 2009, removed previous timescales for responses to complaints and replaced this with timescales agreed with the complainant or their representative. In 2013-2014 100% of timescales agreed with the complainant, or their representative, were met. 2. Involvement of the Ombudsman A further option for complainants is either the Local Government Ombudsman (LGO) if the complaint is about Adult Social Services or the Parliamentary Health Service Ombudsman (PHSO) if the complaint is about Health Services. The Ombudsman is empowered to investigate where it appears that an organisation s own investigations have not resolved the complaint. Complainants can refer the complaint to the Ombudsman at any time, although the Ombudsman normally refers the complaint back to the Clinical Commissioning Group if it has not been considered under the local complaints procedure first. 3. Activity: Adult Social Services Between 1 st April 2013 and 31 st March 2014, the Complaints Service recorded 57 Adult Social Care complaints, compared with 34 last year. This indicates an increase of 59%. The majority of complaints received related to finance and care charges, and varied from concerns raised about the financial information provided by staff, to changes in direct payments and care packages. Complaints regarding contracted residential care were also high and referred, in the whole, to concerns about the care provided by staff. This increase in complaints does however demonstrate that the on-going awareness campaign delivered by the team is productive and a flexible, accessible complaints service is being provided to the population of North East Lincolnshire. All the complaints were responded to in the timescales agreed with the complainant.
Service Area Complaints Contracted Homecare 8 Contracted Residential Care & 13 Respite Social Care Assessment 10 Finance & Care Charges 15 Learning Disability Services 3 Safeguarding 1 Corporate 4 Direct Payments 1 Other 2 16 14 12 10 8 6 4 2 0 3.1 Concerns A concern is an expression of dissatisfaction where the service user, or their representative, does not wish to make a formal complaint but wishes the incident/failure in service to be logged. During 2008-2009 a process was developed and agreed to feedback any concerns regarding contracted homecare and residential services to the Clinical Commissioning Group Contracts Team. The process is intended to cover concerns identified by Adult Social Care Services staff employed by the Care Trust Plus and relates to contracted Social Care Service provision.
This information is used by the Contracts Team to inform contract monitoring visits to ensure improvements have been made and implemented in response to concerns raised. During 2013-2014 the Customer Care Team received 62 concerns regarding contracted homecare and residential services. This is compared to the 85 concerns which were logged during 2012-2013. 3.2 Compliments A compliment is recorded when a member of the public expresses their gratitude for a member of staff performing well, often above the person s expectations. The majority of these compliments are received in writing but a few are relayed via a line manager or to the Customer Care Team verbally. During the year 2013-2014 the Customer Care Team received 13 compliments for Adult Social Care and Health Services. It is essential that all teams delivering services (including Contracted Services) formally capture and record complaints and compliments. It is only by doing so that complaints can be tracked and, where things have gone wrong, managers can ensure that matters are put right and that lessons are learnt. Senior management therefore regularly encourage teams to recognise and record complaints and compliments and report these to the Customer Care Team. 3.3 Ombudsman referrals As far as the Customer Care Team are aware, there were 2 referrals during 2013 2014 to the Local Government Ombudsman regarding complaints about Adult Social Care. The Ombudsman determined that no further action was required in either cases and thus were not upheld. 4. Service Improvements for Adult Social Care As a direct result of formal complaints and concerns throughout the year the following service improvements include: Case Workers within the A3 Team (Single Point of Access) will identify and agree a single point of contact with carers and family members to avoid any miscommunication. In the cases concerning dementia clients, a Homecare Agency now asks that the carers call or texts the office on arrival in the person's home. If the office does not receive the call, they will then look into what has happened and if there are been any delays or a missed call, for example. Carers within a Homecare Agency have received further dementia awareness training as a result of a complaint.
It has been identified that, on occasions, there is a lack of communication between social workers and families. Staff have been reminded of the importance of returning phone calls in a timely manner and the importance of briefing colleagues in full before commencing their leave. A Care Home is reviewing in-house procedures regarding medication administration. They are also introducing closer monitoring of carers attending to personal care of residents and to ensure the checking of room and its contents are to become part of standard procedure. A Care Home has introduced a new system for recording and monitoring of all room service meals. This will ensure that residents, who are eating in their own rooms, are not missed. Two carers from a Homecare Agency were asked to prompt/administer controlled medication to a service user. This should have been part of the re-enablement service provided by Care Plus Group, but was shortfalled to A3 as the Care Plus medication policy does not allow for controlled medication to be given by Care Plus staff. As a result of this complaint Care Plus Medication Policy has been reviewed and updated. To further improve communication to service users, Community Care Finance have introduced improvements to supervise visiting officers whilst carrying out financial assessments to ensure consistency in undertaking financial assessments and information provided. A new process has been introduced by focus to ensure that when a Keysafe is to be removed from a home, a family member or other named person is contacted prior to removal. This is to ensure that an agreement can be made as to where any spare keys will be left or collected. As a result of a complaint, members of the public can now present any questions at the beginning of the North East Lincolnshire Clinical Commissioning Group Board Meeting, rather than just at the end. 5. Activity: Health Between 1 st April 2013 and 31 st March 2014, the Complaints Service recorded 25 Health complaints, compared with 71 last year. This indicates a 64% decrease in health complaints. As advised previously, in April 2013, the handling of Primary Care Health Complaints was transferred from local Primary Care Trusts and Care Trust Plus s to NHS England. Whilst arrangements were put in place to ensure a continuity of service was provided locally, the national changes naturally resulted in the decrease and demise of the health figures reported on.
All complaints were responded to in the timescales agreed with the complainant or their representative. Service Area Complaints Dental 0 GP 18 GP Out of Hours 2 Individual Funding Requests 2 Prescribing 1 Other 2 18 16 14 12 10 8 6 4 2 0 Complaints 5.1 Service Improvements for Health Services As a result of a complaint regarding incorrect dispensing of medication more checks have been introduced to the process and medication has been split on to different shelving. A Locum GP will now liaise with the Practice GP to ensure that correct information is passed to the DVLA. This will prevent patients being inconvenienced by unnecessary removal of their driving licence.
A GP has learnt lessons about how he deals with prescriptions when he is the Duty Doctor. He will now take patients comments on board and will endeavour to use the comments during his future dealings with repeat prescriptions for patients. A GP Practice has introduced a new system so that if a patient is unable to see a doctor they can have a telephone consultation. As a result of a PALS enquiry, GP Out of Hours (GP OOH) will be placing an order for a scanner, so that results from scans carried out at A&E and GP OOH can be sent to GP Practices straight away rather than having to wait for results to be sent by post. A GP practice unfortunately had problems with their telephone provider over the Christmas Period, meaning patients were unable to get through. The Practice provided patients with an alternative number on New Year s Eve to ensure that they still had contact with the practice. 5.2 Ombudsman referrals 3 complainants referred their complaints to the Parliamentary Health Service Ombudsman. The Ombudsman confirmed that they would not be investigating 2 of these complaints further, however they did investigate and uphold the third. The Ombudsman upheld the complaint on both the part of the GP Practice involved, referring to the clinical advice and service provided, and also the response provided by the CCG advising that it was poor, lacking information and was inconsistent with the medical record. In line with the current statutory Complaints Legislation (2009), complainants have the right to go to the commissioner or the provider with their complaint and, either way, the team would have no part in the investigation nor would they have sight of the medical records. The response would thus be based on the information provided. This process has been followed since 2009 by the CTP, and CCG, and similarly by other commissioners in the locality. The team solely rely on the good faith relationships with their providers that the information being provided is accurate and consistent with the medical record. Both the GP Practice and the CCG were asked to submit an action plan and letter of apology to the complainant which has been completed. The Customer Care Team are currently working on the Action Plan as follows: A review of the Complaints Policy to ensure it is in line with National and statutory requirements, and reflects organisational and operational changes within the Clinical Commissioning Group (CCG).
Review of the Complaints Procedure to ensure that complaints are appropriately handled, including the paperwork. Complaints reliant on evaluation of clinical records will be reviewed by a professional Practitioner when required. Training to be provided to the Customer Care Team on their roles and responsibilities in respect of complaints handling under the amended policy. 6. Patient Advice and Liaison Service (PALS) The Patient Advice and Liaison Service (PALS) is a public enquiry service which provides an informal and impartial service that helps service users/patients, carers, relatives or staff who use the services provided, or commissioned, by the Clinical Commissioning Group. As a core service, PALS provides a focal point to enable the organisation to learn from service users and patients experiences of using services. PALS also provides feedback to commissioners on common themes and concerns which service users and patients, their carers and families bring to our attention. Where trends are identified PALS, with service users, patients and other staff, where appropriate, explore solutions and make recommendations for improvements to service delivery. This can include the receipt of timely and suitable information to enable the patient to be an active partner in their care and treatment. During 2013/2014 the Clinical Commissioning received 933 PALS Enquiries compared with 1008 during 2012/2013. 7. Developments Gemma Mazingham was appointed as Patient and Client Experience Manager and started in her new role on the 1 st April 2014. The priorities over the coming year are to: To continue to provide a professional, front facing PALS and Complaints service on behalf of the CCG. To promote PALS and Complaints locally to ensure we provide an accessible service for all. To develop the joint working with the Service Triangle s to gather more data on the patient experience which, in turn, will result in better informed commissioning decisions To start to engage with the local health and social care providers to inform our local market The Customer Care Team are not just about PALS and Complaints and are increasingly branching out into the broader remit of patient experience. The team use their expert
knowledge of the local area in conjunction with their positive working relationships across the market to gather soft intelligence on a variety of services. The Customer Care Team are very much part of the commissioning process and by using the wealth of information gathered and working more closely with the Service Triangles within the CCG, will play a vital role in the shaping of future services that the CCG commissions.