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Complaints Report
First Quarter April -June 2014/15
Presented by: Tracy Luckett
Director of Nursing and Allied Health Professions
Produced by:
Tim Withers, Practice Experience Manager
Board of Directors Meeting
4th September 2014
1.0 Complaints Q1 2014/5: Summary
This report provides an overview for the board complaints received by the trust between 1 April 2014 and 30 June 2014 (Q1 2014/15) and supports the information in the monthly performance report regarding complaints. This report will also be presented to the Clinical Quality Review Group (CQRG) where the trust discusses the quality of Moorfields services with our lead commissioners.
Part of the purpose of this quarterly report is to address one of the recommendations set out in the parliamentary report ‘A review of the NHS hospitals complaints system: putting patients back in the picture (2013)’ that suggests regular reporting of complaints issues to the trust board.
An average of 14 complaints a month was received by the trust during Q1. The reduction in complaints from December coincided with a change in process, with all complainants being contacted by telephone on receipt of a written complaint to discuss how the complainant would like to see their issue resolved to their satisfaction. This is in line with recommendations suggested by the Parliamentary Review of the NHS Hospital Complaints System. The purpose is not to reduce the number of complaints registered by the trust, but to try to reach a quicker resolution for the patient. Issues that require detailed investigation or a written response are still treated as formal complaints, as are all clinical issues. This is a change to the previous process led approach, in which the majority of issues raised by letter or email were automatically treated as a complaint. Importantly, it gives those patients who do wish to pursue a formal complaint someone to speak to, and feel supported by, at the start of the process.
Though the number of complaints has dropped over the past four quarters, the number of clinical complaints has remained the same, around 20 each quarter. This suggests that issues where there is potential risk to the patient are still being treated as formal complaints.Patients who raise concerns are given the opportunity to have their concern treated as a formal complaint should they wish. PALS enquiries are reviewed on a weekly basis and circulated to the management teams to ensure that concerns are being handled appropriately.
It is recognised in the parliamentary review and elsewhere, that many patients with a justifiable complaint do not pursue it, either due to lack of understanding of the process, feeling that nothing will be achieved or fear of prejudicing their care. Over the coming year, the complaints team hopes to encourage patients who have concerns and would not otherwise complain, to do so. This will be achieved through clear promotion of the process, new multi-language leaflets and posters, a video and guide to complaining on the trust website, publishing examples of what changes have been made in response to complaints, promotion of the independent advocacy service, and a greater presence at the satellite sites. It is possible that the number of PALS enquiries and complaints will increase as more people access the service.
2.0 Complaints received Q1 2014/5
(Fig. 1) Complaints received by quarter 2013/14 and 2014/15
Q2 2013/14 / Q3 2013/14 / Q4 2013/14 / Q1 2014/1584 / 63 / 35 / 41
Percentage of patients seen who went on to complain / 0.02%
(146,147 patients seen) / 0.02%
(147,198 patients seen)
Complaints per 10,000 patient contacts / 2.3 / 2.7
3.0 Complaints by type, directorate and service
(Fig. 3) Complaints received by type Q4 2013/14 and Q1 2014/15
Over quarter one, clinical complaints were, and continue to be, the most common cause of complaints and of these the majority focused upon the result of treatment not being as expected. The remainder concerned treatment that the patient felt they should have received but did not, perceived misdiagnosis, or conflicting information.
Of the five clinical complaints that were risk rated as ‘High’ (based on the risk matrix that measures the consequence of an event by its likelihood),the trust was found culpable in three. Two for drug (eye drop) errors and one for failure to treat appropriately (i.e. to admit rather than follow up in clinic).The latter was the only complaint referred to the serious incident panel (SI) in quarter 1, though upon review was not deemed to be an SI.All complaints are now copied in to the Risk and Safety team for review and PALS enquires are reviewed with them on a fortnightly basis.
The number of complaints regarding customer care and staff attitude increased, with two concerning information governance issues where an appointment letter and a GP letter were sent to the wrong patients. The remainder of customer care complaints were about staff attitude. These focused on what was perceived as unprofessional or insensitive behaviour on the part of the doctor or optometrist seeing them, and two concerned the perceived rudeness of reception staff.
Appointment issues that were dealt with as complaints were the result of patients having difficulty in arranging appointments, appointments being cancelled, or about appointment letters.
Other complaints,centered on communication around lost referralletters, one concern about not getting through on the telephone, waiting times and funding of treatment. There was one complaint about the delay in being collected by hospital transport.
(Fig. 4) Complaints received by type / Directorate Q4 2013/14 and Q1 2014/15
(Fig. 5) Complaints received by type / Service Q1 2014/15
4.0 Complaints handling
4.1 Re-opened cases
During Q1 there were three complainants who requested further information and for whom their case was re-opened.
4.2 Response time
Where the final response breached the 25 day limit, this was due mainly to further information being requested following the initial investigation or meetings being arranged beyond the time limit.
(Fig 6) 25 day response rate Q1
Complaints answered within 25 days Q1Apr-14 / 85%
May-14 / 87%
Jun-14 / 92%
Q1 average / 88%
4.3 Ombudsman referrals
Two complaints are currently with the Public and Health Service Ombudsman. One long standing referral involving the ability of a patient to consent to treatment, the other, registered during Q1, concerns whether the correct treatment was given in A&E.
They declined to investigate one case regarding a clinical outcome due to the length of time since the incident occurred.
5.0 Response to complaints.
Many of the issues raised in complaints during quarter onedo not allow for specific service change but are being addressed with trust wide initiatives aimed at addressing the underlying issues that give rise to them. The Moorfields Way project is bringing staff and patients together to identify shared beliefs and values that will inform future staff training, appraisal, recruitment and behaviors. The Transformation and Communication projects both review the operation of the trust in areas such as waiting times, appointments handling, accessing the right people and information etc. and will reduce the frustrations somepatients currently encounter.
Specific responses to the complaints received in quarters one and two included meetings with patients to better explain perceived misunderstandings or our processes and many of the final responses to patients clarified the reasons underpinning their treatment or care.
Other, specific changes included:
- A patient was not given a post op appointment: Review of the process for booking post op appointments is being undertaken.
- A patient felt their ECG should have been reviewed by an anaesthetist:guidelines will now be written for the staff nurses in the Pre-operative Assessment Clinic, to clarify the referral process of ECGs for anesthetic review.
- A patient had a piece of contact lens left in their eye in A&E: The medical staff involved have agreed to spend time with experienced contact lens practitioners, in order to improve their examination skills.
- A patient for whom there was confusion around his injection regime: A new referral form was created so that the injection administration team is better informed about the numbers of injections required and the interval frequency for their booking.
- There were problems with the funding for a patient requiring photodynamic therapy: The current procedure for processing individual funding requests (IFR’s) is being reviewed to ensure that in future the system is more robust.
- A patient had issues about their operation being cancelled at the last minute due to an overrunning list (St George’s): The consultant will speak to patients in future to explain. Alternative same day surgery will be offered if possible.
6.0 Complaint team activity
The complaint alert memo is now being used for all complaints. Following the initial conversation with the patient, the issues they seek to be addressed and the outcome they wish to see are clearly identified (not always clear from the letter) and are articulated for the directorate management team undertaking the investigation. The second part of the form, which is returned to the complaints team, includes what actions are to be takenin response to the complaint and the risk score (the decision of which now sits with the directorate team, who are in a better position to judge clinical and organizational risk, rather than the complaints manager).
Complaints training sessions are due to begin in September 2014. Though open to all, they are aimed at those who might be asked to investigate or make statements for a complaint. The training covers the national and local contexts of complaints handling, the process at Moorfields, and stresses the importance of trying to resolve issues for patients at the time.
The complaints team are in discussion with the NHS benchmarking service and the patients association to look at the possibilities of running an external survey of complainants in regard to how their complaint was handled e.g. did they feel supported and understand the process, did they feel the response was honest and addressed all their issues, what could improve the service, etc. In time this will be rolled out for the PALS service also.
Through a freedom of information request (polite requests having been unsuccessful) the trust is requesting other providers’ ophthalmic services statistics around the types and volume of complaints they receive and how they are handled in regards to risk assessments and SI reporting.
7.0 PALS enquiries.
The number of PALS enquiries in quarter1 (360) was down slightly on the previous quarter (380).
(Fig.7) PALS enquiries by broad category Q1 2014/15
A third of PALS enquiries regard appointment issues. These ranged from patients wishing to change the date, location, time, re-book, or cancel their appointment to concerns about cancelled or postponed appointments, the short notice given and patients feeling they should be seen sooner.
Half of communication issues were to do with callers being unable to get through on the telephone, though this was spread throughout the serviceswith between one and four each. There were nine for Optometry. Other communication issues regarded information about conditions, treatments or hospital services.
Of the medical and clinical enquiries a third are regarding the effects, availability, or appropriateness of their medication. Other enquiries are to speak to a doctor or consultant, diagnosis and treatment, poor care, insufficient information given at appointment or wanting to know the next part of their treatment.
Poor staff attitude was due to perceived rude, insensitive or difficult staff. In these cases the manager of the person involved would be contacted who in turn contacted the patient involved to appologise or explain.
Other issues were around administrative issues such as missing referrals, requests for notes of reports, and incorrect DNA’s. There were twelve concerns about waiting times and eight for transport, mostly around eligibility pick up arrangements or lateness. Optometry concerns were around contact lens and spectacle orders and entitlement to benefits.
Of the other issues, cashiers’ enquiries (checking that claimants are entitled to benefits) were the largest. Others, apart from questions about interpreter services, were fairly specific enquiries or concerns, examples being:fire escape signage, someonewanting the names of websites where they could get further information, someone without a home address wanting to know which services they could access and a patient want specialist equipment to help with their studies.
TPW/Com/Q1/7/14
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