West London Mental Health NHS Trust

Listening to Service Users & Carers & Learning from their feedback

Complaints & PALS Annual Report April 2010 to March 2011

Taking action and demonstrating improvements

1.0Purpose of the Report

1.1The purpose of this paper is to update the Quality and Risk Committee on the number and nature of PALS contacts and formal complaints received during the reporting period April 2010 to March 2011. This report will provide comparative data for numbers of complaints received and themes and trends, alongside lessons learnt and actions taken.

1.2The report provides a summary of complaint & PALS information for each Service Delivery Unit for the reporting period.

2.0 Complaints Received from Service Users & Carers

2.1224 formal complaints were received during the report period April to March which is a slight decrease on complaints received in 09/10 which 243 were received. The distribution of complaints received across the five SDUs is noted in Chart 1.

2.2 In terms of the 224 complaints received, 133 relate to forensic services which represent 59% of the total complaints received. Local Services received 91 complaints within which the majority relate to adult services.

Chart 1

3.0PALS contacts received by Service Users and Carers

3.1The Trust received a total of 309 PALS contacts from Service Users and Carers during the reporting period 2010/11 which is a significant decrease on the previous year when 464 PALS contacts were received.

Chart 2

3.2In terms of the 309 queries received the distribution is in complete contrast to complaints data in that the highest number received are within local services who received a total of 197. This represents 64% of the total number of PALS contacts received. This is a good demonstration that service users, carers and families are aware of the service and are utilising it.

4.0 Complaints Received from the Parliamentary & Health Service Ombudsman

4.1During the reporting period a total of nine complaints were referred to the Parliamentary and Health Service Ombudsman for consideration, 8 of those have been closed with no further action required by the Trust and one is still under consideration. The Trust’s approach to resolving concerns is extensive and demonstrated by the feedback provided by the Parliamentary and Health Service Ombudsman, on individual cases.

5.0Responding to Complaints Received from Service Users & Carers

5.1With changes to the way complaints are managed being driven by parliament we are pleased that our efforts to engage with service users and carers have meant that during the year we responded to 98% of complaints within an agreed timeframe. The Trust considers that it is essential that we respond to and resolve concerns in a timely and high quality way. This will help improve the experience service users have of our services and also improve both patient safety, clinical effectiveness and the patient experience.

5.2.1Chart 3 below provides an overview of the performance of each SDU in terms of responding to complainants within an agreed timeframe.

Chart 2 [1]

5.3Of the 224 complaints received at the end of 10/11 only 4 were completed outside of the agreed timeframe. At the time of writing this report 6 complaints are still open and within the agreed timeframe for responding.

6.0Listening to Service Users & Carers

**** Each complaint raised and registered by the Trust may cover many individual items****

6.2224 complaints and 309 PALS contacts is a rich data source for listening and learning from the experiences of service users and carers. The table below illustrates the themes in which complaints are allocated and the trend analysis between each quarter. Themes noted are allocated by the Department of Health and are a broad categorisation across the NHS.

6.3Complaints Items

Complaint Themes / Q1 / Trend / Q2 / Trend / Q3 / T Trend rend / Q4 / Total
All aspects of care and treatment / 14 /  / 24 /  / 14 /  / 18 / 70
Other category / 8 /  / 18 /  / 10 /  / 12 / 48
Failure to follow agreed procedures / 1 /  / 3 /  / 4 /  / 3 / 11
Staff attitude / 10 /  / 5 /  / 6 /  / 10 / 31
Property and expenses / 6 /  / 7 /  / 5 /  / 3 / 21
Implementing Admission procedures / 2 /  / 3 /  / 1 /  / 2 / 8
Policy and commercial decisions / 3 /  / 1 /  / 0 / ↔ / 0 / 4
Communication / 1 / ↔ / 1 /  / 5 / ↔ / 5 / 12
Patients’ privacy and dignity / 1 /  / 2 /  / 0 /  / 1 / 4
Appointments delay, cancellation / 1 / ↔ / 1 / ↔ / 1 /  / 0 / 3
Hotel services / 1 /  / 3 /  / 2 /  / 0 / 6
Aids and appliances / 1 / ↔ / 1 /  / 0 / ↔ / 0 / 2
Waiting time to be seen / 0 / ↔ / 0 /  / 1 /  / 0 / 1
Personal records / 0 /  / 2 /  / 1 /  / 0 / 3
Total number of complaints / 49 /  / 71 /  / 50 /  / 54 / 224

6.4Many of our complaints fall into the 2 categories ‘all aspects of care and treatment’ and ‘other’.

All aspects of care and treatment includes:-

Medication, ward moves, home visits, detention, diagnosis, seclusion, transfers, progress of treatment, care pathway, treatment of physical injuries and general aspects of inpatient care.

Other categories include:-

Indecent assault, physical assault, verbal abuse, bullying, patient safety, breach of confidentiality, cultural issues, restraint, staff levels, fraud, fresh air, access to leave.

7.0 PALS Themes

7.1There are currently 149 separate PALS categories to choose from so any analysis would be difficult given the spread of issues, however described below are the top 19 forthe reporting period 2010/11.

7.2

In addition to the above the main types of actions required were:-

  • Information (written or electronic or oral) on the services which the Trust provides or signposting to other organisaions.
  • Clarifying issues regarding care, appointments and referrals.
  • Providing reassurance whilst encouraging a caller to review their options and choices.
  • Passing queries to appropriate staff or services.
  • Liaison between the service user and the relevant clinical team.

8.0 Learning from Complaints.

Learning has been placed in three categories:-

  • Discussion
  • Raising Awareness
  • Specific Action

Discussion relates to outcomes from complaints where meaningful communication and dialogue is required. We acknowledge that demands on staff are significant and therefore sometimes staff need reminding about policy, procedures and changes within the work environment. Specific actions relate to real changes that have been made to practice as a result of complaints made. These three categories have been noted for each SDU along with the outcomes and learning.

8.1High Secure Services

8.2Discussions

These included:-

  • Providing explanations regarding care and treatment, medication, care plans and policies to individual Service Users and their carers.
  • Talking to a Service User and thanking him for his vigilance at spotting and reporting a potential risk item left on the ward.
  • Discussions regarding food portions which involved the input of the hospital dietician.
  • Discussions took place regarding resumes, specifically about disclosures from Service Users in therapy being documented in MDT notes which would then be reproduced in CTM resumes and also for service Users to be encouraged to participate in the writing of their resumes.
  • Discussions took place with Service Users regarding the Risk to Children policy

8.3Raising Awareness

Staff have been reminded of the following:-

  • To ensure accurate information is communication to service users.
  • The importance of maintaining confidentiality.
  • The importance of having clear interactions with Service Users especially when highlighting to a Service User concerns staff have in relation to behaviour or attitude.
  • That bullying and harassment forms should be accessible to Service Users at all times.
  • To ensure non compliance forms are completed by catering staff when calls are received from wards regarding missing meals.
  • Water temperature should be checked by Hairdressing staff prior to each use.
  • To ensure there is a consistent application of the local policy around restricted telephone access during protected time.
  • To try wherever possible to discuss verbal concerns raised by Service Users
  • To ensure that when searching a Service User this takes place within a designated CCTV surveillance area and to ask the Service User if there are any difficulties (in terms of injury) they should be aware of.
  • To use appropriate channels of communication and to ensure private rooms are offered at all times for discussion
  • To be mindful of their language and content of discussion and to present in a professional manner at all times.
  • The importance of handling resumes correctly and that the allocation of a resume should take into account the Service User request to discuss any matters prior to it being completed.
  • To use clear language in their interactions with Service Users so that instructions are not mis-interpreted.
  • To communicate effectively and clearly about any changes to a Service Users treatment at the time when decisions are made and to record discussions regarding medication accurately
  • To ensure that positive information should be included in a Service Users report
  • To try maintain a good relationship with Service Users Carers.
  • To ensure that when Service Users have appointments every effort should be made to ensure that they are kept informed if there are any delays.
  • Members of staff to be reminded that the administration of prescribed medication has to be in accordance with trust policy and that any error must be treated and logged accordingly.

8.4Specific Actions

  • The Clinical Nurse Manager is to ensure that communication is improved between the Ward, Escorting and Creative Room staff.
  • Clinical Nurse Managers and Primary Nurses to work closely with patients in an attempt to resolve issues.
  • Clinical Nurse Managers to ensure that effective rostering is in place across the wards so that activities for Service Users can be facilitated.
  • Adequate time must be given to escorting staff who are collecting and delivering visitors from the visitors lounge to the visits centre to ensure that maximum visiting time can been facilitated.
  • Monthly water temperature checks within the Hairdressing Salon to be carried out by the estates department.
  • Reviewing storage facilities for service users.
  • Reviewing the procedures currently in place for booking official visits for Service Users from legal representatives.
  • Clinical Nurse Managers to ensure that staff are up to date with current policies and procedures
  • A review to take place regarding the methods of dealing with verbal abuse and intimidation between service users.
  • Compensation to be issued to a service user for loss of property.
  • Specific care plans/management plans need to be put into place after patients have undergone surgery in order to ensure that any special requirements are met.
  • Clinical bin to be relocated within the clinical room to an area out of reach of Service Users receiving medication at the medication hatch.
  • Dental care should be incorporated into nursing plan and reviewed regularly.
  • Recommendations for staff to attend both personal development and boundary training.
  • LOA forms to be kept in a central location for at least 6 months where they are easily accessible.
  • Chaplaincy service to ensure that a written record is kept of any possessions handed to them by Service Users or relatives along with details of how these can be returned.
  • Protocols to be developed as to how the trust manages or provides access to toilet facilities for Service Users on the terrace especially over the weekend when they can not access facilities in central hall.

9.0West London Forensic Services

9.1Discussions

These included:-

  • Providing information regarding care plans.
  • Discussion regarding the use of the laundry room, visits and town leave. Discussions took place with Staff regarding the importance of good communication with Service Users and how to respond to Service User requests.
  • The process which should be followed when a Service User reports an incident and the need for a consistent approach.

9.2Raising Awareness

Staff and Service Users were reminded of the following:-

  • Of the importance of ensuring Service User privacy and dignity, especially when carrying out a restraint.
  • The importance of following policy and procedure and specific issues raised relate to the direct contravention of practice when a solicitor was left alone to read a Service Users notes.
  • The importance of ensuring that visitors were not inconvenienced when arrangements were made for them to view RIO and to ensure they were informed in good time if RIO was not serviceable.
  • Access to fresh air was also featured and staff were reminded of the importance of ensuring that this was facilitated wherever possible.
  • To ensure compliance with protocol and procedure with regards to documenting personal affects on admission.
  • The importance of clear documentation with regards to Service User names for the facilitation of leave.
  • Service Users were reminded and leave and privileges can be affected when Trust policies and procedures are breached.
  • Staff reminded to present in a professional manner at all times.
  • Staff to be reminded that English is the only language to be spoken whilst on the ward.

9.3Specific Actions

  • A new process to be developed and implemented whereby a Senior Dr or Senior Manager will be called if a duty doctor fails to attend the ward in order to review a Service Users needs.
  • Service Users are to be provided with written information regarding medication side effects.
  • Consideration to be given for a workshop which would raise awareness regarding transsexuals and dual role transvestism.
  • Consideration to be given for having a set time for viewing DVD’s each Saturday
  • More effective communication systems to be implemented, including more effective use of the ward diary and communication book.
  • An action plan relating to changes on the ward to be devised.
  • Training to be provided to relevant ward staff regarding roles and responsibilities when facilitating visits on the ward.
  • Carer to be actively involved son’s care and will share their experiences with ward staff in order to highlight the difficulties faced.

10.0Ealing SDU

10.1Discussions

These included:-

  • Discussion with service user in order to provide support to stop smoking.
  • Discussions took place with staff regarding the structures of their ward reviews and how they inform Service Users that they are being seen at the ward review.

10.2Raising Awareness

  • Staff were reminded of the following:-
  • Admission property checks to be completed with as much detail as possible.
  • To ensure that times for escorted cigarette breaks are adhered to and a full explanation and apology is given if for any reason this can not be facilitated.
  • That risk assessments should be updated at all times reflecting current risk status.
  • To ensure that changes in a Service Users care needs are carefully assessed and care plans are written to reflect the changes
  • Entries on RIO are made promptly and accurately.
  • Staff to remind themselves of the Nursing & Midwifery council’s reporting and recording policies & procedures.

10.3Specific Actions

  • A review of IR1 forms to be carried out with ward manager and ward staff.
  • CAMHS to ensure that there is access to mandatory training for safeguarding children and all staff are upto date.
  • CAMHS staff to have access to and utilise clinical supervision
  • When a room is required for a Service User and the room still have the previous occupants belongings in two nurses should pack and label belongings and ensure that this is kept in a safe place until it is returned to the owner.
  • Providing Customer Care training to all staff to be explored.
  • Improvements in record keeping are to be made.
  • Staff are to improve communication with Service Users and increase one to one time.
  • The Trust are to work with Ealing Housing Options to develop a more Service User centred approach.
  • When an appointment is made to see a Service User staff are required to ensure that Service Users/Carers are kept upto date regarding any delays and after 30 minutes of waiting a Service User should be offered a new appointment date in order to avoid prolonged waiting time.
  • Practitioners should proactively follow up referrals made to other professionals or services where no response has been communicated back within a reasonable timeframe and any documentation and responses should be kept within the Service Users file.
  • CMHT Mental Health Doctors to be made aware of the operational/inclusion criteria of the Ealing Mental Health & Wellbeing Services and of any service that they endeavour to refer a Service User to in order to avoid any undue delays.
  • Experiences of complaints are to be fed back to a group who are developing protocols for the care of patients during the first 72 hrs of being admitted to a ward.

11.0Hammersmith & Fulham SDU

11.1Discussions

These included:-

  • The Trust smoking policy was discussed with staff in order to provide them with more clarity and the outcome of that staff will form a specific action and will be monitored via staff supervision.
  • Discussions took place with both staff and service users regarding taking ownership of the environment in trying to ensure it is kept clean at all times.

11.2Raising Awareness

Staff are reminded that:-

  • The Administration manager will also remind staff how important it is that information is recorded accurately.
  • Ward managers have reminded staff of the importance of being polite and courteous at all times.
  • Care Plans should be consulted at every contact with a Service User.
  • Letters received from patients to which a response is required are responded to within a suitable timeframe.
  • Staff to be reminded that if a clinician re-schedules a clinical appointment then it should be acted on promptly and where possible Service Users are offered an earlier appointment.
  • The importance of recording any attempts to contact Service Users should appointment queries arise.

11.3Specific Actions

  • Written literature regarding CPA information should be made available to clients in any language that is requested and staff should ensure that a translation process is in place if required.
  • The GIC will establish an alert system within the patient’s notes for unique information and instructions.
  • Staff should always indicate in the Service User Records when property is handed in.
  • Service User rights forms to be made available in bedrooms
  • Conditions of escorted leave should be made clear to Service Users and the first escorted leave from the ward should be limited to the Hospital Grounds.
  • Administrative process to be put into place whereby for a period of time all letters out should be checked for addressing mistakes and any correspondence should be clearly typed and clearly worded.
  • Crisis resolutions teams should ensure that they have processes in place whereby any scans/investigations that they are requested are followed up and the results are communicated, even if the Service User has been discharged.
  • A GIC website was developed to enable service users to have access to accurate information regarding the GIC and associated treatments.
  • Improvements to take place in the arrangements for contacting CRT staff, orientation for new service users on admission and for the promotion of a culture of compassion and understanding in supervision and staff meetings.
  • Recommendation for domestic time to be increased on the ward.
  • A local services policy is to be developed for the use of mobile telephones and cameras.

12.0Hounslow SDU