Executive Summary for Submission Of

Executive Summary for Submission of

Paper to tst Board

Paper No. NHST(13)013
Subject: Patient Experience Update: Qtr 1 & Qtr 2, 2012/13
Purpose: To update the Board in respect of patient experience activity and inform the Board about the requirements for the introduction of the Friends and Family Test.
Summary:
The report outlines Patient Experience Activity within the Trust and informs the Board about the Friends and Family Test.
Corporate Objectives met: Supports the delivery of 5* care.
Financial Implications: Failure to meet the patient experience and the Friends and Family CQUIN targets.
Stakeholders: Patients, staff, local partners and third sector organisations.
Recommendation(s): The Board is asked to receive and note the report.
Review Date:
Authors :
Report compiled by Annette Craghill, Head of Equality and Patient Experience
Presenting Director: Ms Chrissie Cooke, Director of Nursing, Midwifery & Governance
Board date: 30th January 2013

Patient Experience Update

1 April 2012 to 30 September 2012

1Introduction………………………………………….4

2The Friends and Family Test……...….…………...4

3Volunteers...………………………………………...5

4Managing Vulnerability …………..…………...…..6

5Complaints/PALS…………………………………..9

6Care Groups Reports:

Clinical Support Services………………….…15
Surgical Care Group……………………….…19
Medical Care Group……………………….….23

1.INTRODUCTION

The Operating Framework for the NHS in England 2012/13 puts patients at the centre of decision making with their experience of healthcare central to the drive for further improvements. The framework sets out four key themes, one of which is “putting patients at the centre of decision making in preparing for an outcomes approach to service delivery, whilst improving dignity and service to patients and meeting essential standards of care”. Government policy places emphasis on the personalisation of services and recognises patient experience as an equal partner to safety and effectiveness in achieving quality.

In addition, the mandate from the Government to the NHS Commissioning Board: April 2013 to March 2015, which was published in November 2012, requires the CommissioningBoard to introduce the “Friends and Family Test” for patients across the country.

The Trust continues to develop and improve quality activity in relation to the patient experience. Activity during this reporting period again demonstrates a number of areas of service improvement and lessons learned that have resulted in an improved patient experience.

2. FRIENDS AND FAMILY TEST

On 25th May 2012 the Prime Minister announced the introduction of the “Friends and Family Test” (FFT) with the aim of improving patient care and identifying the best performing hospitals in England. The FFT aims to provide a simple, headline metric and will be introduced across all Trusts with effect from 1st April 2013.

The question to be asked is “How likely are you to recommend our <ward / A&E department> to friends and family if they needed similar care and treatment?” A scale of answer options must be used from extremely unlikely to extremely likely. Trusts are also expected to ask follow-up questions, the number and wording to be determined locally.

The question must be asked at or within 48hours of discharge and the patients to be surveyed are:-

All adult acute inpatients (who have stayed at least one night in hospital

All adult patients who have attended A&E and left without being admitted to hospital or were transferred to a medical assessment unit and then discharged.

The guidance does not currently apply to:-

Day cases
Maternity Service Users (to be introduced in October 2013)
Outpatients
Patients under 16 years old
Palliative care patients are not exempt but there is a recognition that it might be inappropriate to survey some patients receiving palliative care.

There are no fixed requirements for response rates. However it is expected that responses will be received from at least 15% of the Trust’s survey group. Similarly, there is no preferred survey methodology and, initially at least, it is proposed to use postcard and ballot box solutions.

The results of the FFT will be published nationally on the NHS Choices website. The FFT Publication Guidance has not been published yet but based on draft guidance it is anticipated that a net promoter score will be used. The results will be ranked, the best and worst performing 20% of Trusts being highlighted.The first results will be published in July 2013 for Qtr 1 2013/2014 but thereafter they will be published monthly. Trusts are also required to report the results locally at individual ward level. The Department of Health is planning a communications launch for the FFT, week commencing 4 February.

A national CQUIN has been developed which has three separate elements:-

30% of the funding for phased expansion (the Trust will need to deliver the nationally agreed roll-out plan to the national timetable – maternity by the end of October 2013 and additional services (yet to be defined) by the end of March 2014. Missing any element of this will result in non-payment of the CQUIN.

40% of the funding for increasing the response rate in the acute inpatient and A&E areas. Achieving a response rate in the top 50% which also improves on the Q1 response rate

30% of the funding for increasing the score of the FFT question within the 2013/14 staff survey compared with the 2012/13 results.

Quality Health have been commissioned to carry out the FFT on behalf of the Trust.

3.VOLUNTEERS

3.1Recruitment

Volunteering at the Trust continues to grow, with the number of volunteers on the books currently exceeding 600. There are also a significant number of applicants at various stages of the recruitment process. Current figures indicate that the Trust benefits from more than 1500 hours of volunteering each week.

The Trust Induction and Recruitment training session for potential volunteers continues to attract large numbers, often in excess of 100. This is reflected in the number of ongoing applications being received by the Trust and further interest from potential volunteers.

3.2Developments

Volunteers are becoming more involved in qualitative issues within the Trust. For example, the recruitment of a number of volunteers has enabled the Delirium pilot on Ward 3 Alpha to commence in December. Work is progressing on devolving some non-clinical ward activity to volunteers (e.g. answering telephones) and a pilot is planned within Medical Care once the relevant criteria concerning Information Governance has been met. Volunteers continue to support Advancing Quality, undertaking patient surveys on an ongoing basis. More involvement with Patient Experience is planned.

Following the success of the recruitment of volunteers to the Nurse Bank, a number have now obtained substantive positions within the Trust, not only in Nursing but also in Pathology, Phlebotomy and Clerical Services.

3.3Local Engagement

Voluntary Services continues to engage with local colleges and have recently delivered further presentations to students at local Colleges and Schools. Voluntary Services has also been invited by RobyCollege to assist in mock interviews for students.

A series of “Careers Carousels” organised by Liverpool Compact are to take place early in the New Year and Voluntary Services, together with Human Resources, have been invited to participate.Liverpool Compact is Liverpool’s Education Business Partnership (EBP), one of over 100 EBPs under the national umbrella body of IEBE (Institute Of Education Business Excellence).

The Volunteers Newsletter which was introduced early last year provides important Trust information and activity and is sent to all involved in volunteering.

3.4Summary

Volunteers continue to provide an invaluable service throughout the Trust and their continuing support from within the Trust is delivering tangible benefits to those who use our services. The presence of the Chief Executive at the Volunteers Coffee Morning in October 2012 was testament to the recognition of volunteers.

4MANAGING VULNERABILITY

4.1Trust Safeguarding and Vulnerability Steering Group

The Trust Steering Group continues to be the vehicle for driving forward the agenda for safeguarding and vulnerability. The umbrella nature of the Group across all vulnerabilities demonstrates to patients that we see them as a person first rather than a label. The work plan provides a comprehensive view of activity and work in progress over the whole area of managing vulnerable patients but needs to be further embedded within the Trust’s day to day work.

4.2Mental Health Liaison Services

The Trust works with the 5 Boroughs Partnership NHS Foundation Trust (5BPFT) as the main provider of mental health liaison services. 5BPFT introduced their new model of care across the ‘acute care pathway’ on 11 June 2012. This effectively joined together two currently separate services provided to the Emergency Department and wards. Whilst the transition was not without problems5BPFT successfully bid for monies to enhance the liaison function and from 1 October a new enhanced service has been provided. This greatly increases staffing and an improved skill mix with two dedicated consultant posts being available. The funding is not recurring and is dependent upon a business case being presented for 2013/14.

This will provide some parity with the Older Peoples Mental Health Service which has already received significant recurring funding and is well established within the Medicine for Older People Team..

4.3Learning Disability: Access to Acute Care

This agenda has been dominated by the scandal of patients being abused in a private hospital. The Trust has been working closely with partners to learn lessons and to provide itself with assurance that the needs of people with a learning disability who access acute care are well managed.The further report published by Mencap “74 Deaths and Counting”, a follow-up to the report from 2007 “Death by Indifference”, provides evidence of 74 patients who allegedly died from avoidable harm within acute care. These have continued to provide a backdrop against which all health providers are judged. The Trust has made a significant contribution to the local services self assessment process which ends in September and requires validation by the Strategic Health Authority. The Trust is confident that much work has been completed within the Trust to provide its partners with clear pathways demonstrating reasonable adjustments and person centred care. The Trust looks forward to receiving feedback of its performance and contribution to the local self assessment framework.

4.4Supported Discharge

Approximately 20% of patients are discharged from hospital with a level of community, social and primary healthcare support. The Trust’s geographical situation is complex in that it is required to work in a collaborative manner with:

Four local authorities
Three primary care trusts (PCTs)
Two mental health providers.

The model developed through the Integrated Discharge Team (IDT) is based on localities working together doing each others assessments providing cross-cover. The model is working well developing towards a greater level of integration in the provision of intermediate care and housing services. This team ensures that the ward is provided with a level of expertise regardless of locality, reducing the number of assessments the patient will have the handovers of their care.

4.5Carers Support

The Carers Support Service, which is embedded within the Integrated Discharge Team, is now funded until March 2013 though its future continues to be unclear. It continues to provide dedicated support to ward staff and relatives, promoting wellbeing and a preventative approach. Patients can be confident that those who care for them and provide support are seen as separate, with needs of their own and separate services to meet those needs. The team sees patients and carers regardless of locality and routinely link in with local carers support services.

4.6Internet and Intranet Sites

To support patients, carers, families and staff the Trust has developed a number of internal and externally available web pages providing information about a number of areas of vulnerability. The following areas are included:

Mental Capacity Act
Deprivation of Liberty Safeguards
Improving The Access Of People With A Learning Disability To Acute Healthcare Services
Supporting Carers in Hospital
Advocacy Services
Accessible Information
Mental Health Liaison
A Housing page is shortly to be introduced.

Patients, their relatives and staff have access to information, tools and guidance round the clock.

4.7Managing Mental Incapacity

This continues to be a challenging area for theTrust. A local work plan has identifed key areas and staff are working to ensure that the priciples of the Mental Capacity Act and its statutory framework are embedded across the Trust. There looks to be an increase in the number of Deprivation of Liberty Safeguards authorisations reflecting an emphasis on ward staff improving awareness and understanding. The Trust continues to be involved in two locality networks. The Mental Capacity act is now included in mandatory training ensuring that all staff, both clinical and non-clinical, receive some awareness.

4.8Interpreter and Translation Service

There continues to be a fairly low level of activity which is well established and relatively stable. A new policy has been ratified and the Trust continues to develop good working relationship with its two providers.This service ensures that patients with communication needs are identified and provided with a safe, responsive, professional service which is person centred and which promotes the confidence and involvement in their care and decision-making. Plans are in place for one provider to introduce a web-based booking system which will assist the booking and management of referrals.

5.COMPLAINTS/PALS

5.1Complaints

Complaints and concerns are a very important measure for the Trust in relation to patient experience and as such they are essential aid in improving Trust services. The Trust is dedicated to listening and learning from complaints and concerns and implementing changes when necessary. For the reporting period of April-September 2012 St Helens & Knowsley Teaching Hospitals NHS Trust received 225 formal complaints, this number is low compared to the overall percentage of the thousands of patient contacts the Trust has each year.

The table below demonstrates a comparative number of complaints received in each quarter by each Care Group:-

Care Group / Q1 (2011/12) / Q2 (2011/12) / Q1 (2012/13) / Q2 (2012/13)
Apr / May / Jun / Jul / Aug / Sept / Apr / May / Jun / Jul / Aug / Sept
Medical * / 16 / 10 / 18 / 13 / 14 / 12 / 20 / 24 / 16 / 23 / 15 / 15
Surgical * / 15 / 22 / 17 / 11 / 21 / 9 / 17 / 21 / 15 / 16 / 15 / 12
Clinical Support / 2 / 1 / 3 / 1 / 2 / 0 / 1 / 1 / 2 / 1 / 2 / 0
Others / 4 / 0 / 5 / 3 / 3 / 1 / 1 / 1 / 3 / 4 / 0 / 0
Total / 37 / 33 / 43 / 28 / 40 / 22 / 39
(↑2) / 47
(↑14) / 36
(↓7) / 44
(↑16) / 32
(↓8) / 27
(↑5)
Overall Total / 203 / 225
↑(22)

*keynote – overall the volume remains fairly consistent for each of the two main Care Groups.

Complaints by Quarter and by the Main Subject identified:-

Top 10 highlighted by subject
Subject / Q1
(2011/12) / Q2
(2011/12) / 2011/12
Total / Q1
(2012/13) / Q2
(2012/13) / 2012/13
Total
All Aspects of Clinical treatment / 52 / 37 / 89 / 63 (↑11) / 52 (↑15) / 115 (↑26)
Staff attitude/behaviour / 11 / 11 / 22 / 12 (↑1) / 11 (→) / 23 (↑1)
Admissions/transfers/discharge procedure / 2 / 12 / 14 / 9 (↑7) / 10 (↓2) / 19 (↑5)
Communication (oral) / 10 / 5 / 15 / 10 (→) / 4 (↓1) / 14 (↓1)
Appointments Delay, Cancellation (outpatients) / 8 / 3 / 11 / 6 (↓2) / 8 (↑5) / 14 (↑3)
Appointments Delay, Cancellation (inpatients) / 6 / 4 / 10 / 4 (↓2) / 2 (↓2) / 6 (↓4)
End of Life Issues / 0 / 1 / 1 / 3 (↑3) / 2 (↑1) / 5 (↑4)
Aids/appliances/equipment/
premises / 0 / 2 / 2 / 2 (↑2) / 3 (↑1) / 5 (↑3)
Communication information to patients / 8 / 8 / 16 / 2 (↓6) / 2 (↓6) / 4 (↓12)
Patient privacy, dignity issues / 2 / 1 / 3 / 1 (↓1) / 2 (↑1) / 3 (→)
Test results / 3 / 1 / 4 / 0 (↓3) / 0 (↓1) / 0 (↓4)
Complaint handling / 0 / 0 / 0 / 0 (→0) / 3 (↑3) / 3 (↑3)
Safeguarding / 0 / 0 / 0 / 1 (↑1) / 1 (↑1) / 2 (↑2)
Staff competence / 1 / 1 / 2 / 2 (↑1) / 0 (↓1) / 2 (→)
Communication (written) / 0 / 0 / 0 / 2 (↑2) / 0 (→) / 2 (↑2)
Failure to follow agreed procedures / 4 / 1 / 5 / 2 (↓2) / 0 (↓1) / 2 (↓3)
Mortuary/post mortem arrangements / 2 / 1 / 3 / 0 (↓2) / 0 (↓1) / 0 (↓3)
Consent to treatment / 0 / 0 / 0 / 0 (→) / 2 (↑2) / 2 (↑2)
Patient, property/expenses / 1 / 0 / 1 / 1 (→) / 0 (→) / 1 (→)
Date for appointment / 1 / 0 / 1 / 1 (→) / 0 (→) / 1 (→)
Personal records (including health records) / 2 / 2 / 4 / 0
(↓2) / 1 (↓1) / 1 (↓1)
Other / 0 / 0 / 0 / 1 (↑1) / 0
(→) / 1
(↑1)
Overall Total / 113 / 90 / 203 / 122(↑9) / 103(↑13) / 225(↑22)

In the main the top 10 subjects remain fairly static compared to previous reports, with the addition of End of Life issues being identified.

The highest number of complaints is recorded against “All aspects of clinical treatment”. This subject covers a number of issues including, co-ordination of medical care, treatment not given, lack of medication, medication errors, wrong diagnosis, poor nursing care, poor aftercare, missed diagnosis, and will always feature high in reports.

The second highest number of complaints is recorded against “Staff attitude/behaviour”. The Trust has recently implemented ACE Behavioural Standards for all staff and it is anticipated that the Trust will see a decrease in complaints of this nature in future.

End of Life issues have been identified as a theme coming through complaints in relation to the Liverpool Care of the Dying Pathway, medication issues, communication, staff attitude, discharge arrangements, End of Life plan not adhered to by clinical/nursing staff.

In the majority of complaints the subject of Communication (oral and written) continues to be a theme. The importance of communication with our patients and their families is a priority and work needs to continue to address this by ongoing ward/departmental meetings and customer care training.

Top 10 highlighted by Subject and Care Group
By Quarter
Q1 / Q2 / Total
Subject / Medical Care Group / Surgical Care Group / CSS / Other / Medical Care Group / Surgical Care Group / CSS / Other
All Aspects of Clinical treatment / 30 / 30 / 3 / 0 / 30 / 21 / 1 / 0 / 115
Staff attitude/behaviour / 7 / 4 / 0 / 1 / 3 / 6 / 1 / 1 / 23
Admissions/transfers/discharge procedure / 6 / 3 / 0 / 0 / 8 / 2 / 0 / 0 / 19
Communication (oral) / 6 / 4 / 0 / 0 / 2 / 2 / 0 / 0 / 14
Appointments Delay, Cancellation (outpatients) / 2 / 3 / 0 / 1 / 3 / 5 / 0 / 0 / 14
Appointments Delay, Cancellation (inpatients) / 1 / 3 / 0 / 0 / 0 / 2 / 0 / 0 / 6
End of Life Issues / 2 / 1 / 0 / 0 / 1 / 0 / 1 / 0 / 5
Aids/appliances/equipment/premises / 0 / 0 / 0 / 2 / 0 / 0 / 0 / 3 / 5
Communication information to patients / 0 / 1 / 1 / 0 / 0 / 2 / 0 / 0 / 4
Patient privacy, dignity issues / 1 / 0 / 0 / 0 / 2 / 0 / 0 / 0 / 3
Complaint handling / 0 / 0 / 0 / 0 / 3 / 0 / 0 / 0 / 3
Safeguarding / 1 / 0 / 0 / 0 / 1 / 0 / 0 / 0 / 2
Staff competence / 0 / 2 / 0 / 0 / 0 / 0 / 0 / 0 / 2
Communication (written) / 1 / 1 / 0 / 0 / 0 / 0 / 0 / 0 / 2
Failure to follow agreed procedures / 2 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 2
Consent to treatment / 0 / 0 / 0 / 0 / 0 / 2 / 0 / 0 / 2
Patient, property/expenses / 1 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 1
Date for appointment / 0 / 1 / 0 / 0 / 0 / 0 / 0 / 0 / 1
Personal records (including health records) / 0 / 0 / 0 / 0 / 0 / 1 / 0 / 0 / 1
Other / 0 / 0 / 0 / 1 / 0 / 0 / 0 / 0 / 1
Total / 60 / 53 / 4 / 5 / 53 / 43 / 3 / 4 / 225

The following is an overview of developments in relation to the management of complaints and service improvements implemented as a result of complaints:

Mersey Internal Audit Authority (MIAA) Report action plan reviewed and changes implemented.
Complaints satisfaction survey being developed.
All formal complaints reviewed by Head of Equality & Diversity and Safeguarding lead.
Complaints Qlikview data available for all Care Group management teams and Executives to monitor complaints performance.
Clinical audit of complaints relating to End of Life issues.

Parliamentary & Health Service Ombudsman (PHSO)

Referrals received in Quarter 1, Quarter 2

The Trust received 9 PHSO referrals during the reporting period, cases identified in the tables below:-

QUARTER 1 - April-June 2012

Complaint Ref: / Care Group / Date of PHSO Referral request / Date of PHSO Decision & Outcome
19/2011 / SCG / 3/5/12 / 29/6/12 – No further action to be taken by the Trust complaint closed by PHSO.
D7169 / MCG / 26/6/12 / 3/10/12 - No further action to be taken by the Trust complaint closed by PHSO.
153/1010 / MCG / 27/6/12 / 14/8/12 - No further action to be taken by the Trust complaint closed by PHSO.

QUARTER 2 - July-September 2012