Contents
Introduction
§ Central Complaints Team
§ Patient Advice and Liaison Service (PALS)
§ Cross Organisational Working
1. SECTION 1 FORMAL COMPLAINTS
1.1 Performance Monitoring of Formal Complaints
1.1a Trust wide Performance
1.1b Divisional Performance
1.2 Service Areas of Formal Complaints
1.3 Formal Complaints by Profession
1.4 Formal Complaints by Ethnic Category of Patient
1.5 Formal Complaint Categories
1.6 Analysis of Formal Complaints by Division
1.6a Division of Diagnostics and Therapies
1.6b Facilities and Estates
1.6c Division of Medicine
1.6d Division of Specialised Services
1.6e Division of Surgery Head and Neck
1.6f Division of Women and Children
1.6g Division of Trust Services
1.7 Independent Reviews by Healthcare Commission 2007/08
1.7a Independent Reviews concluded during 2007/08
1.7b Recommendations from the Healthcare Commission and action taken by the Trust
1.8 Review by Parliamentary & Health Service Ombudsman
2. SECTION 2 INFORMAL COMPLAINTS
2.1 Informal Complaints received centrally 2007/08
2.2 Patient Advice and Liaison Service (PALS) Activity 2007/08
2.3 Patient Advice and Liaison Service Reporting
2.4 Informal Complaints received by the central Complaints Team
2.5 Informal Complaints received by the Patient Advice and Liaison Service
3. SECTION 3 COMPLIMENTS
3.1 Compliments received by the Chief Executive
3.2 Compliments received about the performance of the Patient Advice and Liaison Service
4. SECTION 4 DEVELOPMENT WORK
4.1 Training
4.2 Improving Access
4.3 Service Improvement
4.4 Achievements during the year
4.5 Other important Development Activity
4.6 Future Development
7
Complaints/PALs Annual Report September 2008 – Final
Introduction
The University Hospitals Bristol NHS Foundation Trust, (formerly United Bristol Healthcare NHS Trust) Complaints and Concerns Policy (August 2007) sets out how the Trust will manage both formal complaints, as defined by the NHS (Complaints) Regulations 2004 and the NHS (Complaints) Amendments Regulations 2006, and informal complaints.
Central Complaints Team
During 2007/08, arrangements for the handling of complaints within the Trust remained the same as the previous year, with Divisions maintaining the responsibility for the investigation and overall management of complaints at the local resolution stage of the complaints procedure. The complaints team based at Trust Headquarters retained the responsibility for the central coordination of the formal responses for the Chief Executive and the collation of complaints case files for both The Healthcare Commission and The Parliamentary and Health Service Ombudsman’s Office.
Informal complaints are managed by the receiving service; either centrally by the complaints team, via the Patient Advice and Liaison Service or locally within the Trust’s Divisions. The Complaints Department has a staffing of approx. 2.5 whole time equivalents and the Patient Advice and Liaison Service 3.0 whole time equivalents.
Patient Advice and Liaison Service (PALS)
The central Patient Advice and Liaison Service is based in the main entrance of the Bristol Royal Infirmary, with information widely available throughout the Trust and officers also based in the main entrances of the Bristol Royal Hospital for Children and Bristol Haematology and Oncology Centre. The service has continued to support a large number of patients, their families and carers during 2007/08. The number of people who contacted the service was 2,146, which is a slight increase of 4% from the previous year. During the last quarter of 2007/08 the Patient Advice and Liaison Service had an open vacancy for a Patient Advice and Liaison Officer.
Cross Organisational Working
Both the Complaints team and Patient Advice and Liaison Service manage queries which cut across other NHS and non-NHS organisations.
The Complaints Team continued to work with Complaints Managers in local authorities to liaise about joint complaints that included issues relating to both health and social care. This actually refers to only a small number of complaints but the complaints that it does relate to are invariably complex to resolve.
The Patient Advice and Liaison Service continued to work closely with other local and National Patient Advice and Liaisons across organisational boundaries, on a regular basis.
The Paediatric Family Information and Patient Advice and Liaison Service Officer remains a member of the National Paediatric Patient Advice and Liaison Service Network, which has expanded this year to include the new Queen Alexandra Children’s Hospital in Brighton. The network has been involved with the National Children’s Bureau Research on providing Patient Advice and Liaison Service for children and young people and remains a central resource to acute and community services nationwide for guidance in this field.
The Chief Nurse and Director of Governance is the delegated Executive Lead for complaints.
This report provides an overview of all complaints received by the Trust during the period 1 April 2007 to 31 March 2008.
1. SECTION 1 FORMAL COMPLAINTS
1.1 Performance Monitoring of Formal Complaints
1.1a Trust wide
The Trust received 542 formal complaints during the year, a decrease of 37 cases (6.4%) on the previous year. The 542 complaints raised a total of 901 issues of concern. There have been fluctuations in the number of formal complaints received over the last 5 years as shown in Table 1 below.
07/08 / 06/07 / 05/06 / 04/05 / 03/04Number of Formal Complaints
Received / 542 / 579 / 533 / 567 / 549% Completed within target response time / 96.1 / 89.6 / 81.4 / 77.9 / 82.0
Table 1: Comparison of performance achieved within target response time - last 5 years
Quarterly analysis of performance for 2007/08 in Table 2 below shows a decrease in percentage of responses completed within the target time in quarter 4 to 90.3%. This is due to a high number of staffing vacancies within the central Complaints Department during this period with temporary arrangements being put into place.
Qtr 1 / Qtr 2 / Qtr 3 / Qtr 4Apr – Jun 2007 / Jul – Sep 2007 / Oct – Dec 2007 / Jan – Mar 2008
Number of Formal Complaints
Received / 136 / 126 / 136 / 144% Completed within target response time / 97.0% / 99.2% / 98.5% / 90.3%
Table 2: Number of formal complaints received each quarter during 2007/08
The Trust acknowledged 99% of all complaints within two working days of receipt. 96.1% were responded to within 25 working days, which is a significant improvement from the previous year. This improvement is in part due to the NHS Amendment Regulations for complaints, which came into effect on 1st September 2006, increasing the target timescales for responses from 20 to 25 working days. Year 2007/08 was the first full year in which the new timescales applied. Where timescales were not met, complainants were kept informed of progress wherever possible. Those complainants who remain dissatisfied with the response they have received from the Trust are advised that they may request an Independent Review of their complaint by the Healthcare Commission after informing the commission of their unresolved concerns. It is important, therefore that investigations are carried out thoroughly. The Trust must be able to demonstrate a good audit trail on how the outcome of an investigation was concluded should it be required.
The majority of complaints were resolved through Local Resolution. However 5 requests for Independent Review were received by the Healthcare Commission during the year.
1.1b Performance by Divisions against target timescales for responses
All divisions, apart from Facilities & Estates, showed a significant improvement on the previous year’s performance against the target timescale of 25 working days set by the NHS Complaints Regulations which, as stated previously, must still in part be deemed to be due to the increase in the timescales.
Division
/ Number received / Responded within target / NewIndependent
Review RequestsNumber / %
Specialised Services
/ 44 / 44 / 100Facilities & Estates
/ 22 / 20 / 90.9 / 1Surgery
/ 237 / 229 / 96.6Medicine
/ 113 / 110 / 97.3 / 2Diagnostics & Therapies
/ 15 / 15 / 100Women & Children
/ 104 / 96 / 92.3 / 2Trust Services
/ 7 / 7 / 100TOTAL
/ 542 / 521 / 96.1 / 5Table 3: Divisional performance of formal complaints handling 2007/08
The Trust received 5 new requests for Independent Review at the 2nd stage of the complaints procedure, in comparison to 29 the previous year. Although this appears a substantial decrease; it must also be seen in context, as many of the cases received during the previous year were part of a backlog at the Healthcare Commission and related to complaints initially received in previous years.
The Healthcare Commission concluded 12 Independent Reviews during this period and a further 1 was withdrawn as the complainant decided to instigate legal action. Details of the recommendations made to the trust appear later in this report (p12 - 13).
There were 23 Local Resolution meetings during the year. This is a reduction from the previous year when 33 were held. However meetings continued to be offered in all cases where there has been bereavement when the complaint is first received and in all other cases as part of the first written response.
Information on the service areas of complaints and the profession of those involved in the complaint is recorded on the complaints database and forwarded annually to the Department of Health as part of the KO41a return.
1.2 Service Areas of Formal Complaints
Patterns of service areas of complaints in 2007/08 remain largely the same as in 2006/07 apart for a slight increase in complaints in maternity services. Whilst the Trust is responding to the rise in birth rate, there has been an increase in the proportion of high risk deliveries to mothers with complex medical conditions requiring more midwifery time, and difficulty in recruiting sufficient numbers of experienced midwives to manage these patients.
The introduction of reporting complaints for Care of the Elderly services was new for 2007/08.
Service Area
/ Complaints Received07/08 / 06/07
Hospital
Acute
Services
/ In-patient / 211 / 245Outpatient / 229 / 260
Accident & Emergency Department / 52 / 47
Care of the Elderly* / 21 / n/a
Maternity / 20 / 13
Community / 9 / 14
Total
/ 542 / 579Table 4: Service Areas of Formal Complaints
* Data not collated in previous years.
1.3 Formal Complaints by Profession
The analysis of complaints involving members of staff in Table 5 shows an increase in those involving Dentists and those involving Maintenance & Ancillary staff. There appears to be no single explanation for these increases and this will continue to be monitored closely during 2008/09.
Profession
/ Complaints07/08 / 06/07
Medical / 413 / 443
Dental / 21 / 15
Professions supplementary to Medicine / 21 / 27
Nursing, Midwifery & Health Visiting / 21 / 23
Scientific, Technical & Professional / 1 / 2
Maintenance & Ancillary Staff / 24 / 10
Trust Administrative Staff / 36 / 53
Other
/ 5 / 6Total / 542 / 579
Table 5: Formal complaints involving staff by profession
1.4 Formal Complaints by Ethnic Category of Patient
Monitoring of ethnicity of complainants is conducted indirectly by recording ethnicity as entered against complainants’ details in the Trust’s Patient Administration System. Where this information is incomplete in the Patient Administration System or the complainant is not the patient, no ethnic data is available. Consequently, in Table 6 below, over half the complainants’ ethnicity is not known, therefore comparison of percentages of ethnicity with that of the local population of Bristol has not been made. The Trust has recently made significant improvement in recording patients’ ethnicity on the Patient Administration System, and action is being taken to ensure this information is recorded on the Complaints system whenever appropriate.
Ethnic category / Code / Total numberComplaints received / % of those stated
White: British
/ A1 / 204 / 94.4White: Irish / B1 / 2 / 0.93
Any other White / C1 / 4 / 1.85
White & Black Caribbean / D1 / 1 / 0.46
White & Black African / E1 / 0 / -
White & Asian / F1 / 1 / 0.46
Any Other Mixed / G1 / 0 / -
Indian or British Indian / H1 / 3 / 1.39
Pakistani or British Pakistani / J1 / 0 / -
Bangladeshi or British Bangladeshi / K1 / 0 / -
Any Other Asian / L1 / 0 / -
Caribbean or British Caribbean / M1 / 0 / -
African or British African / N1 / 1 / 0.46
Any Other Black / P1 / 0 / -
Chinese / R1 / 0 / -
Any Other Ethnic Group / S1 / 0 / -
Not Stated/Given / Z1 / 326
Total Received / 542
Table 6: Formal complaints by ethnic category of patient 2007/08
1.5 Formal Complaint Categories
The Trust records formal complaints by categories based on the main issue raised (primary category) and additional issues raised (secondary categories). The analysis of complaints by primary category for 2007/08 is shown in Table 7 overleaf.
Category / 07/08 / 06/07 / 05/06 / 04/05 / 03/04Accident Emergency– Length of Wait
/ 0 / 1 / 3 / 10Admission Arrangements
/ 3 / 6 / 2 / 9 / 2Aids & Appliances
/ 1 / 0 / 3 / 0 / 3Appointment (In-patient) Cancellation
/ 24 / 17 / 18 / 13 / 11Appointment (In-patient) Delay
/ 20 / 30 / 16 / 19 / 29Appointment (Out Patient) Cancellation
/ 30 / 30 / 23 / 20 / 37Appointment (Out Patient) Delay
/ 66 / 69 / 85 / 72 / 64Attitude of Staff (Administrative)
/ 11 / 8 / 14 / 9 / 7Attitude of Staff (Ancillary)
/ 3 / 4 / 7 / 7 / 2Attitude of Staff (Medical)
/ 17 / 30 / 27 / 25 / 32Attitude of Staff (Nursing)
/ 26 / 16 / 19 / 16 / 15Attitude of staff (Support To Medicine)
/ 4 / 2Clinical Care
/ 112 / 102 / 124 / 144 / 113Communication between Staff
/ 16 / 10 / 15 / 7 / 6Communication Information to patients
/ 77 / 98 / 64 / 72 / 73Complaints Handling
/ 1Consent to Treatment
/ 1 / 0 / 2 / 1Cross Infection
/ 2 / 5 / 7 / 3 / 0Diagnosis Missed
/ 23 / 21 / 12 / 2 / 3Diagnosis Wrong