Annual Complaints Report

2012 –2013

Prepared for:

The Trust Board

By: Sarah Bolton, PALS Unit Manager

S:\PALS Unit\CQC Evidence folder\Complaints Reports\AnnRep2012-2013.doc

Introduction

The Trust is committed to resolving complaints to the satisfaction of the complainant and, having learnt from what has happened, to institute changes that result in improvements to the service provided.

This report provides statistical information and commentary about the Trust’s complaints handling for the year 2012-13 including information required to be provided Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 (the 2009 Regulations). These regulations, and the Principles of Complaints Handling, Remedy and Administration laid out by the Parliamentary and Health Service Ombudsman, are reflected in the Trust’s Complaints Procedure.

Complaints Management.

Complaints are considered at a senior level in the Trust. The Chief Executive is the “Responsible Person” under the 2009 Regulations and he reviews and signs all the responses to the complaints. The Complaints Steering Committee, made up of representatives of all the directorates,is chaired by the chief executive and meets monthly to discuss the complaints report prepared by the PALS Unit and any improvements that may have been made as a result of complaints received.

Number ofComplaints Received Between April 2012- March 2013

Between 1 April 2012 and 31 March 2013 the PALS Unit received 549 written complaints of these 320(58%) were upheld.All of the complaints were acknowledged within 3 days and 430 (78%) of these complaints received responses within the time agreed with the complainant.

Within this period, the Trust recorded 1,066,542patient encounters which meant that 0.05% of such attendances resulted in a formal complaint.

The pattern of complaints received since April 2012 compared to those received in the years2011-2012 and 2010-2011is as shown in Fig.1. The monthly number of complaints received has varied from 35 in September 2012 to 74 in February 2013. The reason for the rise in complaints in February was unclear as no themes were identified. It is worth noting that there was increased press coverage regarding the NHS at this time and the publication of the Francis report recommendations.

Number of Complaints Received by Professional Group in 2012-2013

This is shown in Figure 2 below. The highest number of complaints received was for medical and surgical staff, although the highest number upheld, were for nursing midwifery and health visiting staff. This was also the same pattern in 2011-2012.

Number Complaints Received by Subject in 2012-2013

The largest number of complaints received (281) were about all aspects of clinical care, although attitude of staff (85) and communication issues (38) constituted a significant proportion of the total.

Number of Complaints Received for each Directorate in 2012–2013

These are shown in figure 4 below. It should be noted that the total of complaints allocated to each directorate amount to a larger number than the total number of complaints received. This results from the fact that each written complaint may contain several complaint issues. The complaints for the Emergency Department are included within the Acute and Elderly Care directorate.

Response Rates

The table below gives the number of complaints received for each directorate standardised for the number of patient encounters.

All Treatment Specialties / Women and Sexual Health / Specialist Medicine / Surgery / Children and Young People / Acute and Elderly Medicine
Patient Encounters / 1,066,542 / 122,703 / 247,405 / 85,110 / 194,586 / 331,034
Formal complaints / 654* / 87* / 100* / 145* / 50* / 272*
Complaints per 100
encounters / 0.05% / 0.07 / 0.04 / 0.17 / 0.02 / 0.08

* This figureis greater than the 549 total written complaints received as some letters will include areas of complaint which span across other directorates and require their input.

Independent Reviews

11 requests for an Independent Review of our complaints were receivedby the Parliamentary and Health Service Ombudsman (PHSO) between 30 April 2012 and 31 March 2013.

The outcome for those cases was as follows:

Number / Outcome
8 / PHSO decided not to investigate
2 / PHSO recommended further action after preliminary examination, following which, no further investigation was deemed necessary.
1 / Still under consideration

Service Improvements Resulting from Complaints.

The following list provides a brief description of some of the service improvements made during the year as a result of feedback received from patients and relatives.

A complaint was received about a patient who was referred for a chest X-ray with suspected cancer. As a result the directorate are now looking at systems in ED in relation to how information from the Dr goes back to the GP, and reviewing with the cancer team the information sent to the patient
As a result of a concern about information available on MRSA on the neonatal unit, the directorate have devised a leaflet on infection control and a ‘child friendly’ leaflet with a short quiz.
On discharge from Mat 5 or the birth centre, women are given a leaflet on infection and what signs to look out for. This will reduce the risk of patients developing sepsis.
A new leaflet developed for patients due to attend for surgery which details the risks and benefits (EIDO).
A nurse has been employed to look after patients who are waiting for transport home
Refurbishment of the labour ward
Change to the location of samples within dermatology
A new protocol was introduced in Endoscopy to ensure that all patients are booked in appropriately.
New whiteboards in the UCC which include the details of the named nurse
Token/pound coin operated wheelchairs purchased and introduced
Dedicated phone line for incoming calls only introduced onto labour ward
Local visiting policy for NICU has been revised
All new doctors to be given the palliative care symptom control guidelines
Consultants to see all follow up patients after surgery in Orthopaedic clinics, registrars to see new patients
‘C’ sign introduced to highlight that a patient has a specialist communication need
Hospital passport introduced to assist patients with learning disabilities

Case Studies of some of our formal complaints received this year

a)A patient received a letter from the Women’s Health Department inviting her for a first antenatal appointment with a Midwife. The patient stated that the letter had caused her distress as she had undergone a scan in the last week so knew she was not pregnant.

The patient also noticed that the appointment itself was in Suite 9 so she wondered if the appointment should relate to her diabetes.

The patient requested an explanation as to how she was sent the letter and if it should relate to a diabetic appointment that an amended one be sent out so she could show it to her employer and obtain time off.

The Trust investigated and was able to confirm that the patient was not pregnant and that the letter had been sent in error. Appointment letters are ‘created’ via the Trust’s Patient Information System (PIMS) using a clinic format together with merged fields. Unfortunately, it was discovered that if a format is not selected by the operator/user, the default is the antenatal clinic letter format, hence the letter received by the patient.

As a result of this complaint an alert has been placed on the system to ensure that the user has to select a clinic rather than use the default.

b)An inpatient was asked by a nurse post-surgery if she had received some compression stockings. The patient answered – No, however nothing happened until the following day when she was asked again and responded – No again, this time she was given some.

Anti-embolism stockings are now prescribed on the medication chart and have to be signed for by a nurse when they are measured and placed. If this has not been done, it becomes a medication error and individual staff will be spoken to.

c)A patient informed the Trust that she had been left alone in the waiting area of the labour ward and felt as though she had been forgotten.

On investigation it appeared that this patient’s experience was not an isolated one. The Trust acknowledged that the current layout is unwelcoming and poses a risk if women are not assessed immediately on arrival. As a result a refurbishment of the labour ward has been approved which will improve the admission and reception area, and remove the waiting room.

(The refurbishment was undertaken in the summer of 2013)

Excerpts from some of our compliments received this year

“I visited your radiology department today for a Barium enema X-ray, I was very nervous of such procedure but I must say your radiographer, Miss S and her assistant put me at ease. Everything was explained and I was made to feel comfortable at all times”

“I can say with 100% conviction that I have never received such a helpful, willing and dedicated service from any other hospital in my life. You’re A&E department should be used as a model to show how to care for patients and a bereaved family”

“ My Mother passed away whilst on the HDU and I just wanted to write to let you know that my family and I were very heartened by the interaction, help and information that were shown to us by the doctor and nurses on the night/early morning when she died.”

“I should like also to praise the catering staff, we had a choice of menu and the food was excellent”

“I just wanted to say that the care X has received has been of the highest quality at all times, from her outpatient’s on 15th January 2013, where she was first placed on the waiting list, to the timely manner in which she received a date for surgery”

“I am so touched by the care and attention that I received; your kindness shown to me was genuine. You showed me respect and gave me privacy and dignity”

“X was extremely kind and supportive when I was upset about the prospect of an induction of labour.

Y was kind enough to examine me during a very long latent phase and then supported me through the second half of active labour the following evening. She provided first rate care, filling me with confidence and helping to a first baby in 6.4 hours of active labour”

“I have private medical insurance through work and have gone private before but nothing can beat the NHS or in fact Lewisham Hospital”

“It has not been easy helping staff and those who come into contact with X, understand his communication difficulties, but thanks to Y’s clear report and the time she has given to come and meet to discuss it with key members of staff, it has started a very positive transition for my con to move from school to college”

Francis Report

On the 6 February 2013 Robert Francis QC, Chairman on the Mid Staffordshire NHS Foundation Trust public inquiry published his final report. The report makes recommendations to the Secretary of State for Health based on the lessons learnt from Mid Staff’s.

Chapter 3 of the report relates to: Complaints - Process and Support.

The report advised that patients raising concerns about their care are entitled to: have the matter dealt with as a complaint unless they do not wish it; identification of their expectations; prompt and thorough processing; sensitive, responsive and accurate communication; effective and implemented learning, and proper and effective communication of the complaint to those responsible for providing the care.

The key themes of chapter 3 are:

The reluctance of patients and those close to them to complain, in part because of fear of the consequences, and other barriers to organisations receiving complaints need to be addressed.
Support for complainants, whether or not they are specifically vulnerable, with advice and advocacy still requires development: in particular it should be made clear that advocates can offer advice on the substance of the complaint that is required, and information should be provided on available support organisations
The feedback, learning and warning signals available from complaints have not been given enough priority
Information about the content of complaints should, where permissible, be made available to and used by commissioners and local scrutiny bodies; the CQC should use material from complaints more widely
There is a case for independent investigation of a wider range of complaints

A summary of the recommendations in relation to complaints – process and support are:

Recommendation No. / Recommendation
109 / Methods of registering a comment must be readily accessible and easily understood. Multiple gateways need to be provided to patients, both during their treatment and after its conclusion, although all such methods should trigger a uniform process, generally led by the provider of the Trust.
110 / Actual or intended litigation should not be a barrier to the process or investigation of a complaint at any level. It may be prudent for parties in actual or potential litigation to agree to a stay of proceedings pending the outcome of the complaint, but the duties of the system to respond to complaints should be regarded as entirely separate from the considerations of litigation.
111 / Provider organisations must constantly promote to the public their desire to receive and learn from comments and complaints; constant encouragement should be given to patients and other service users, individually and collectively , to share their comments and criticisms of the organisation
112 / Patient feedback which is not in the form of a complaint but which suggests cause for concern should be the subject of investigation and response of the same quality as a formal complaint, whether or not the informant has indicated a desire to have the matter dealt with as such.
113 / The recommendations and standards suggested in the Patients Association’s peer review into complaints at the Mid Staffordshire NHS Foundation Trust should be reviewed and implemented in the NHS.
114 / Comments or complaints which describe events amounting to an adverse or serious untoward incident should trigger an investigation
115 / Arms-length independent investigation of a complaint should be initiated by the provider Trust where any of the following apply:

A complaint amounts to an allegation of a SUI
Subject matter involving clinically related issues is not capable of resolution without an expert clinical opinion
A complaint raises substantive issues of professional misconduct or the performance of senior managers
A complaint involves issues about the nature and extent of the services commissioned

116 / Where meetings are held between complainants and Trust representatives or investigators as part of the complaints process, advocates and advise should be readily available to all complainants who want those forms of support
117 / A facility should be available to independent Complaints Advocacy Services advocates and their clients for access to expert advice in complicated cases
118 / Subject to anonymisation, a summary of each upheld complaint to patient care, in terms agreed with the complainant, and the Trust’s response should be published on its website. In any case where the complainant or, if different the patient, refuses to agree, or for some other reason publication of an upheld, clinically related complaint is not possible, the summary should be shared confidentially with the Commissioner and the CQC.
119 / Overview and Scrutiny committees and local Healthwatch should have access to detailed information about complaints, although respect needs to be paid in this instance to the requirement of patient confidentiality.
120 / Commissioners should require access to all complaints information as and when complaints are made, and should receive complaints and their outcomes on as near a real time basis as possible. This means commissioners should be required by the NHS Commissioning Board to undertake the support and oversight role of GP’s in this area, and be given the resources to do so.
121 / The CQC should have a means of ready access to information about the most serious complaints. Their local inspectors should be charged with informing themselves of such complaints and the details underlying them
122 / Large-scale failures of clinical service are likely to have in common a need for:

Provision of prompt advice, counselling and support to very distressed and anxious members of the public
Swift identification of persons of independence, authority and expertise to lead investigations and reviews
A procedure for the recruitment of clinical and other experts to review cases
A communications strategy to inform and reassure the public of the processes being adopted
Clear lines of responsibility and accountability for the setting up and oversight of such reviews

Such events are of sufficient rarity and importance, and requiring of coordination of the activities of multiple organisations, that the primary responsibility should reside in the National Quality Board.

As a result of the Francis Report (chapter 3)recommendations an action plan for the financial year 2013/2014 was created by the PALS Unit Manager and will form a key part of ongoing work. The results and improvements made will be published in the 2014/15 annual report.

Future Plans

The PALS Unit works in an integrated manner to offer people the choice of how their concerns and complaints are handled;whether through a rapid intervention as a PALS case or through a more thorough investigation using the formal complaints procedure. Our aim continues to be to ensure that feedback and comments received from complainants are used to improve the service provided by our Trust.

In 2013/14 the PALS team will be working closely with both the PALS and Complaints department of Queen Elizabeth Hospital Woolwich to ensure a seamless service is provided during the merger.