Annual Complaints Report April 1 2017-March 31 2018

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1 Introduction and Purpose

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2 Overview

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3 Analysis of Complaints Received in 2017/18

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4 Benchmarking Against Other Organisations

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5 Subject Analysis and Key Themes

Additional analysis for Queen Square Division

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6 Other Lessons Learnt from Complaints Monitoring

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7 Referrals to Parliamentary Health Service Ombudsman (PHSO)

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8 Complaint Management and Compliance in 2017/18

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9 Summary and Conclusions

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10 Glossary

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CONTENTS

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1. INTRODUCTION

The Trust receives and reviews a range of patient experience metrics. This report is focussed on an analysis of the formal complaints that the trust receives and is produced to comply with NHS Complaints Regulations (2009).

The purpose of this annual report is to: - provide assurance that the Trust follows its Complaints Policy and Procedures when investigating and responding to formal complaints addressed to the Trust. - identify opportunities to improve the patient experience - show examples of complaints which have been used to assist in learning lessons

Patients and their relatives are encouraged and able to provide feedback or make a complaint in a number of ways, there is link on the Trust website, leaflets in most areas or they can write in. Most contacts to the complaint team come by email (see p42/3). Whilst the term complaint may be used, we know that often the person just wants some immediate action taken e.g.to get through to change an appointment. Issues that can be resolved quickly are not reported through NHS Digital Complaint Report (KO41) but these contacts are monitored and trends noted. NHS Digital collects data from all NHS organisations and produces a quarterly national report on this data. The distinction between a ‘concern’ and a ‘complaint’ can be challenging, both are expressions of dissatisfaction and require a response. Formal complaints are those that require a degree of investigation and a written response. The manner in which the contact to the complaints department is handled is in accordance with the wishes of the individual raising the issue, and under the NHS Complaint Regulations (2009) should also be proportionate to the issues, with the aim to always resolve matters as quickly as possible. It is widely recognised that complainants worry their treatment or care will be adversely affected by making a complaint. It is important to recognise that making a complaint takes a lot of effort and to reassure patients that their care will not be adversely affected. The numbers of complainants making contact under represent those patients with a poor experience. Therefore it is essential that opportunities to improve patient experience and learning are maximised. We know from feedback following a complaint investigation that whilst the response does not affect the complainant’s own experience, they are grateful for an apology and to know that as an organisation we are keen to learn when we get it wrong. In order to ensure that any complainant has adequate access to appropriate support, they are also given information about NHS Complaint Advocacy Services. The principle on receipt of any complaint is to address the issues as soon as possible. Staff are encouraged to respond to concerns as soon as they become aware of them, rather than asking for these to be raised as a complaint. All trust staff are made aware of UCLH’s expectation for staff behaviours and values of ‘kindness’, ‘safety’, ‘team work’, and ‘improving’ during induction and the appraisal process. Information about dealing with complaints is also provided during induction, and a

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variety of teaching sessions / workshops on handling complaints and concerns have been held in 2017/18. At UCLH there are separate departments for complaints and a Patient Advice and Liaison Service (PALS) and the two teams work closely together. Our PALS focuses on working with our teams to resolve concerns quickly and escalate more serious concerns into the formal complaint process. The complaints team will also attempt to resolve concerns that can be addressed quickly, outside of a formal complaint response without passing patients back to PALS. Complaints are coded on receipt according to the NHS Digital categories and this allows analysis and identification of themes and trends. UCLH received 16.7% more formal written complaints in 2017/18 than the previous year. When activity is considered the complaint rate also increased slightly from 0.56 to 0.63 per 1000 contacts. This increase was mainly due to an increase in complaints about non-emergency patient transport service (NEPTS). This is explored further on p18. UCLH has a lower percentage of clinical and patient care complaints than both national and London wide NHS Digital figures show at the end of Q4 data. (The final year end data is not yet available). If for the purposes of comparative analysis we remove all transport complaints there is still an increase in complaints for 2017/18 but this decreases to 6.7%. How does the trust learn from complaints? Complaints will often trigger improvements to processes as staff try to learn from negative patient and relative experiences. Complaints data is shared internally with subject expert leads and committees such as medication safety, falls, pressure ulcers, nutrition, end of life steering groups amongst others so that Trust wide monitoring of these issues can take place and appropriate improvement actions can be identified and monitored by the relevant committees. Issues from complaints are also discussed at local departmental and divisional meetings and actions taken where appropriate to ensure learning takes place. Quarterly reports about patient experience, including complaints are discussed at the Improving Experience Group (IEG), the Trust’s Quality and Safety Committee (QSC) the Patient Experience Committee (PEC), and Complaints Monitoring Group (CMG). Issues and actions arising from complaints are also used and discussed within divisions and Boards to drive change and to reflect on where improvements are required. UCLH reports on patient experience quarterly to the Trust Board, and to the commissioners via the Camden Clinical Quality Review Group, and annually via this report and on request to the Care Quality Commission or other parties. Complaints and their responses are seen and signed off personally by the Chief executive (or his acting deputy) and are seen by several members of the Trust Board including the Medical Directors, Chief Nurse, Chief Executive and Chairman. Non-executive directors review complaint responses on a rotational basis. The trust board receives a regular performance report in which the number of complaints and response times met are noted. There is evidence from the trust board minutes that there are regular discussions about complaints e.g.) May 2017 Board minutes notes discussions about response times to complaints and the rise in transport complaints. What happens if complainants are not satisfied with the trust’s handling of their complaint?

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Patients unhappy with the outcome of our complaints processes can ask for their complaint to be reviewed by the Parliamentary and Health Service Ombudsman (PHSO). The PHSO received 108 contacts by patients or their relatives about care at UCLH. Most of these were considered premature by the PHSO; the complainant had either not made a complaint to us or their concerns were still under investigation. This is a slight increase on the previous year (96 for 2016/7). However of the contacts received by the PHSO, only 13 were accepted for investigation, compared to 21 in the previous year, a decrease of 38 per cent. Over the past year, 14 PHSO investigations (some relating to previous years) were closed with 6 partially upheld (partly agreed), with the outcome being an apology, an action plan to rectify the failures that were identified and in some cases a financial settlement.

Caveats to note for this report :

National figures for Ombudsman cases are not available at this time and this data is based on provisional data provided to the trust at the end of March 2018.

In 2015 /16 the categories and frequency of reporting changed from an annual to a quarterly return. At this point all subjects within a complaint became reportable not just the main subject, and this needs to be considered when comparing historic data.

Data is based on the content of the complaint and not on the outcome of the investigation, unless specifically stated.

Figures may change slightly over time as complainants may withdraw complaints or decide they have been resolved through other means, e.g.) a clinical appointment to discuss concerns.

2. OVERVIEW OF COMPLAINTS GOVERNANCE

The trust’s complaint policy was last fully reviewed and updated in 2016. Responsibility for handling and investigating complaints lies with the relevant divisional senior management teams. There is a central complaint team that receive and register complaints, triage them to the appropriate teams for investigation and review the responses. The lead division is responsible for contacting the complainant, unless agreed otherwise with the complaint team. Numbers of complaints and response times are part of the information pack that is produced by the trust’s performance team and is circulated and reviewed monthly by clinical boards and divisions. Divisions hold regular governance meetings in which learning from complaints (and other areas such as incidents) is discussed and shared.

In 2017/18 a monthly Improving Experience Meeting (IEG) was held, in which various sites at UCLH feedback on trends and actions noted from patient feedback, PALS and complaints.

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A quarterly patient experience report was produced in 2017/18 and this is circulated internally to the Improving Experience Group and to the Patient Experience Committee and externally to the Camden Clinical Quality Review Group (CQRSG). Representatives from complaints, PALS, patient experience and performance meet quarterly to review trends in data and identify any areas for further review. In 2017/18 The Patient Experience Committee (PEC) which met quarterly also reviewed our complaints and PALs data, this group reports into our Trust Board Committee.

3. ANALYSIS OF COMPLAINTS RECEIVED

In 2015 the national categorisation of complaint subjects changed, so this is why the description of the main subject changes at this point. Table 1. – Summary Table: complaints, response time and PHSO cases over time.

Year

Total No of Formal Complaints Received (change from previous year)

Response time for all complaints target met

Main Subject matter of original complaint

Complaints accepted for investigation by PHSO (change from previous year)

Number of Complaints Upheld by PHSO

2010/11

671 84 per cent

All aspects of clinical treatment

13 (↑1.9per cent)

0

2011/12 520 (↓22per cent)

85 per cent

All aspects of clinical treatment

30 (↑5.8per cent)

0

2012/13 677 (↑30per cent)

80 per cent

All aspects of clinical treatment

23 (↑3.4per cent)

2 partially upheld

2013/14 791 (↑17per cent)

78 per cent

All aspects clinical treatment

23 (↑2.9per cent)

2 partially upheld

2014/15 833 (↑5.3per cent)

73 per cent

All aspects clinical treatment

22 (↑2.6per cent)

2 partially upheld

2015/16 711 (↓15per cent)

72 per cent

Clinical Treatment (main) Communications (all subjects)

24 (↑3.3per cent)

6 partially upheld

2016/17 769 (↑8per cent)

75 per cent

Clinical Treatment (main)Communication (all subjects)

30 (↑3.9per cent)

12 partially upheld

2017/18 887* (↑16.7per cent)

77 per cent

Clinical Treatment (main) Communication (all subjects)

13 (↑1.4 per cent)

6 partially upheld

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*Complaints submitted at time of KO41 or the annual quality report return may be subject to slight variation as patients may withdraw a complaint

Number of Complaints As can be seen from the above table there was a significant increase in complaints in 2017/18, this is explored further over the next few pages. An increase in complaints may not in itself be cause for concern as it is also recognised that an open culture will encourage feedback and providing information on how to complain will make it easier for complaints to be made. However the increase from baseline over 2017/18 was noted and the numbers and subjects for complaints were reviewed as part of the quarterly patient experience reports. The most significant increase in complaints was linked to the provision of non-emergency patient transport service throughout the year and this is explored further on page 18. If complaints about transport is removed from the analysis then the number of complaints rises from 700 in 2016/17 to 747 in 2017/18 representing a 6.7% increase The NHS and UCLH faced a number of challenges in 2017/18, with significant bed pressures from emergency admissions related to a flu epidemic and outbreaks of norovirus. There were more cancellations of elective surgery and outpatients in Q3 and Q4 and this may account for some of the increase noted in Q3 /4. There was a decrease in the number and percentage of complaints accepted by the Ombudsman for investigation compared to overall complaint numbers, this is explored further on page 34 Fig 1: Number of complaints received by quarter over time

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50

100

150

200

250

300

2013/14 2014/15 2015/16 2016/17 2017/18

Quarter 1

Quarter 2

Quarter 3

Quarter 4

On review the increase in complaints in Q2 2017/18 was mainly due to an increase in communication issues such as not being able to contact staff, and delays in receiving letters. This is explored further in the thematic analysis section from p16. Formal complaints ranged from 55 – 92 per month with an average of 74 (compared to 64 for last year.) A reduction in complaints usually occurs during the summer period, but in 2017/18 there was a significant increase in complaints over this period.)

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Fig 2: Number of complaints by month, trend over time

Table 2: Comparison between Divisions over 2012 – 2018

Divisions 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

Queen Square 153 173 168 139 152 168

Emergency Services 78 92 64 75 84 98

Women's Health 77 80 87 79 94 89

Surgical Specialties 59 90 112 106 76 95

Gastrointestinal Services 51 54 66 59 38 43

Royal National Throat, Nose & Ear Hospital

56 53 50 46 49 41

Medical Specialties 35 37 41 31 40 43

Clinical Support 26 35 44 32 76 154

Eastman Dental 25 37 38 28 50 41

Heart Hospital * Transfer to Barts 21 37 35 16* n/a n/a

Cancer 16 21 31 29 34 28

Imaging 13 13 16 19 18 23

Infection 13 10 8 13 8 10

Theatres and Anaesthesia 11 16 15 6 11 9

Pathology 10 7 13 6 5 3

Estates and Facilities 9 8 14 4 7 10

Paediatrics 6 5 14 15 17 14

Integration n/a n/a 0 1 3 2

Critical Care 1 3 6 0 1 5

Corporate functions : medical records/ IT/ Finance/ PALS/ Chaplaincy/ Governance

7 5 6 6 6

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Totals: 667 791 830 712 772 887

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When the five divisions receiving the most complaints are considered, as Figure 3 shows –the most significant increase has been noted in clinical support. This was linked to a change in the provider for Non-Emergency Patient Transport Service (NEPTS). It is also important to note that although Queen Square Division receives the most complaints it is the division with the largest inpatient and out patent activity and when this is considered (Fig 4 page 9 the rate of complaints received is similar to other areas. Transport delays are categorised under the main subject of admissions, discharges and transfers but also feature in trust administration and communication themes. Patients were experiencing long delays in collection from home or returning from the hospital. This increase was discussed with the transport team, and the poor experience for patients was escalated to the division, various patient experience meetings and to Board level and was monitored through the monthly Quality Performance packs and quarterly patient experience reviews. There is now a recovery plan in place with a Transport Quality Improvement group monitoring a range of metrics including complaints and patient feedback. A range of measures are now in place, including financial penalty for poor patient experience and the number of complaints has begun to show a reduction since January 2018. Themes from complaints are explored further on page 18. Fig 3: Top five Divisions by number of complaints received

It was not possible to fully benchmark UCLH transport complaints against other organisations in the Shelford Group, as most trusts report that as transport is commissioned by Clinical Commissioning Groups any complaints would appear as CCG complaints rather than under the acute trust. However where trusts do manage their transport contracts UCLH is an outlier at present. Women’s Health Division saw a slight reduction in complaints, whilst Surgical Specialties Division, Queen Square Division and Emergency Services Division noted a small increase. In general, divisions with more surgical cases receive the largest number of complaints. This is linked to both administration issues such as waiting

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times, delays and cancellations, and clinical matters such as complications following surgery or outcomes as well as questions about clinical management such as surgical treatment versus a conservative approach. Activity can vary between divisions and across the trust, therefore it is important to also consider complaints against activity. This is based on the number of patient contacts for each division. Please note that transport journeys are not considered clinical activity and so fall outside the standard monitoring of complaints per 1000 patient contacts. This skews the data in Figure 4 and Figure 6. A patient contact can be a single outpatient appointment or an inpatient stay. Transport journeys are not considered ‘patient contacts’ but there were 96,220 patient journeys in 2017/18 and this gives a rate of 1.5 complaints per 1000 journeys for the year. This is being monitored but is at a higher rate than clinical patient contacts. Fig 4: Top Six Divisions receiving complaints per 1000 patient contacts

0

0.5

1

1.5

2

2.5

2014/15 2015/16 2016/17 2017/18

Clinical Support

Queen Square

Surgical Specialties

Emergency Services

Gastrointestinal

Services

Women's Health

The average rate of complaints per 1000 contacts for the year has increased in 2017/18 from 0.57 to 0.63 when all complaints are considered, and as stated above the increase in transport complaints is skewing this data. As Figure 4 shows, when activity is considered the rate of complaints for Queen Square is comparable with other areas for the trust. Fig 5: Complaints per 1000 patient contacts for whole Trust

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*Transport journeys are not captured as patient contacts so the increase in transport complaints for 2017/18 has had a more significant effect on number of complaints per 1000 contacts. There were 96,220 patient journeys in 2017 / 18 giving a rate of 1.5 complaints per 1000 journeys. Complaint Response Times There was a slight improvement in meeting response times from 75 per cent to 77 per cent for the year however there is still significant room for improvement. Performance was better in Quarter 1 and Quarter 2 when 82% of responses were sent within the negotiated target. Fig 7: Complaint response times against target

Whilst there may sometimes be a delay in providing a written response, other actions may occur promptly e.g. organising a clinical appointment to assess the patient, if they are raising clinical concerns that need more immediate attention. We recognise that some written responses are still taking too long. There are multiple reasons for

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this: transport experienced considerable delay in receiving information from the NEPTS provider (which has now been resolved), sometimes medical records may not be available eg when patient is still receiving active treatment, key staff may be on leave and not be available for interview, there can be competing priorities for staff involved in investigating complaints as this is only part of their role, especially when clinically based. When delays occur this has been escalated to the divisions and medical directors over the course of the year. The importance of a timely response and of keeping the complainant updated if delays occur, for example when key staff are on leave or medical records are not available has been emphasised during complaint handling training sessions over the year. Response times are monitored through the clinical boards and also forms part of the monthly quality performance reports and the Chief executive’s performance pack that is reviewed by the trust board. Grading of Complaints Complaints are triaged on receipt in the complaint department and graded, with red being the most serious. Grading is based on the content of the complaint and not on the outcome of the investigation. Figure 8 shows complaints by grade that entered the formal complaints process. Improving Patient Safety: Triage of complaints containing potential safety issues Complaints are triaged on receipt as to the seriousness of the issues raised. One of the trust’s quality objectives is to improve patient safety, with a number of clinical objectives sitting under this aim: improving safety linked to radiology reporting, improving detection and treatment of sepsis and acute kidney injury. In 2015 /16 a safety huddle were introduced, in which complaints, risk and safeguarding teams looked at significant issues raised in the complaints. As part of the triage process, complaints that highlight potential clinical incidents are reviewed against the clinical incident database and shared with the subject matter expert / clinical lead, e.g. any complaints highlighting a delay in treatment for infection are shared with the lead for sepsis. This allows triangulation of data and can highlight where there are learning opportunities. Anonymised first person accounts can also be used as powerful messages in educational sessions. In 2016 /17 a total of 61 complaints were reviewed in safety huddles with six being managed under complaint and safeguarding processes, four utilising the Trust’s serious incident process and 19 being both an incident and a complaint. In 2017/18 75 complaints were reviewed as a safety huddle and two were managed under safeguarding processes in addition to complaint response. Four were treated as serious incidents and 12 as both a complaint and clinical incident. Complaints monitoring is a standing agenda item for each divisional governance meeting, and there is evidence to support this from Divisional meeting minutes. Clinical boards have also used complaints as an example for learning across their divisions. Trust wide issues are also highlighted as part of the monthly Quality and Safety Newsletter.

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More serious complaints are shared with medical directors and heads of nursing, with clinical amber 4 and red 5 complaint responses requiring review from clinical directors before they are sent to complainants. Fig 8: Complaints by Grade and Quarter

Learning from Deaths NHS England issued guidance on ‘Learning from Deaths’ in March 2017, in which trusts were required to develop a policy to monitor and learn from deaths. From 1st April 2017 all complaints received following a death in which relatives raise concerns about clinical care have received additional review. Fifty three complaints were received in 2017/18 in which the patient was noted to have died. Thirty nine of these raised concerns about clinical care provided. Nine identified areas where clinical care could have been improved and were partially upheld, two remain open. Clinical care in the remainder was considered to be appropriate and an explanation for the rationale for the treatment given was provided in the complaint response, but there were opportunities in eleven cases for improvement in communication to the patient or their family. The rest were not upheld but explanations for treatment given were provided. Benchmarking data for this is not available at present. Themes identified from a review of these complaints include communication with the patient and their relatives, decision making around ceilings of treatment or resuscitation, whether more could have been done for the patient and other issues such as receiving communication about appointments after the death, or why a post mortem has been requested (which may be outside the scope of UCLH to investigate if it is at the request of the coroner). For several cases there may be a request for information form UCLH when the complaint is primarily about care at another organisation. Clinical complaints that are partially upheld are taken to the Mortality Surveillance Group that reviews and triangulates data from a variety of sources and considers whether death is judged more likely than not to be due to problems in care. There were no complaints following a death that met the criteria of ‘death due to problem in care’ but other opportunities for improvement and learning were noted.

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Complaints about care at the end of life are also shared with the ‘End of life’ senior team, who use anonymised data in their teaching sessions on ‘Excellent care in the last days of life’ An increase in red complaints was noted in quarter 4, several of which were received after a death. All ‘red’ complaints were subject to an initial safety huddle, four cases underwent a 72 hour review and two complaints were managed under the serious incident process, one was also subject to a safeguarding investigation. There was no single area or reason identified as a concern.

4. BENCHMARKING AGAINST OTHER ORGANISATIONS

NHS Digital (which produces annual statistics on complaints) states that caution should be taken when interpreting basic quantitative data on complaints. An organisation that has good publicity about how to make a complaint or raise a concern, and that welcomes complaints as an opportunity to learn and to improve services may be expected to receive a higher number of complaints than an organisation with poor publicity and a defensive approach in responding. It is important that organisations are open about the number of complaints received, but these figures should not be read in isolation. Nationally complaints about the NHS appear to have increased by roughly 1%, (based on Q4 position as figures for this year not fully released at time of report) whilst UCLH saw an increase of 16.7 per cent compared to the previous year. However as can be seen from Table 3, figures varied considerably between organisations. Caution needs to be taken when looking solely at the overall number of complaints, as organisations may have improved ways to complain, may have taken over new divisions, departments or organisations or just increased activity. We also know that several trusts do not include transport figures as they are not run by the trust but by the local CCG and some organisations require all complaints to be reviewed by PALS before being formalised which is not the case at UCLH. Table 3: Comparison of UCLH complaints to other key London trusts and members of the Shelford Group for 2017/18 using K041 data ** :

complaints 2016

complaints 2017

Complaints 2018 Percentage difference

Birmingham 680 779 660 ↓15.3 per cent

BARTS health 1396 2206 1814 ↓17.8 per cent

Cambridge 519 503 590 ↑17.3 per cent

Chelsea & Westminster 344 628 569 ↓9.4 per cent

Central Manchester 1152 1026 ***

Changes in trust in 2017/18 so direct comparison not possible

Frimley Park 772 921 956 ↑3.8 per cent

Kings 823 1034 821 ↓20.6 per cent

GSTT 1122 1198 1233 ↑2.9 per cent

Imperial 1164 1166 1136 ↓2.6 per cent

Oxford 1047 1093 991 ↓9.3 per cent

Sheffield 1148 1163 1080 ↓7.1 per cent

Newcastle 627 541 603 ↑11.5 per cent

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St George's 975 903 964 ↑6.8 per cent

Royal Free 1440 1545 1519 ↓1.7 per cent

UCLH 721 769 897 ↑16.7 per cent

** Please note the K041 data is submitted in April and may vary from data produced for the Trust’s main annual report and this data collection due to the withdrawal of some complaints. As can be seen from Table 3 UCLH saw a larger increase in formal complaints than many of its peers in complaints in 2017/18. This upward trend was noted and monitored through CMG and IEG meetings and the performance reports. As already outlined the single main reason for this increase is linked to non-emergency transport provision.

A new experimental statistic was introduced by NHS Digital in 2017/18 to look at activity across organisations. Figure 9 shows a comparison of complaints per 10,000 finished consultant episodes (FCEs). This allows a more accurate comparison against organisations that are of different sizes, or reflect a single specialty such as the Royal Marsden, but this data should be viewed with caution, and seen as ‘experimental’ as it is the first year such data has been produced. It does show that by only considering the number of complaints in isolation, a different picture emerges as UCLH then appears less of an outlier when activity is concerned, with 48.6 complaints per 10,000 FCEs compared to the highest at 80.1 and the lowest at 39.4 for the same organisations as above.

Fig 9: Complaints per 10,000 FCEs (Experimental Data)

0.010.020.030.040.050.060.070.080.090.0

NHS Digital also produces data on the number of complaints that are upheld, partially upheld or not upheld on investigation.

National figures for the upheld status of complaints in England for 2017/18 showed an overall upheld percentage of 33.7% (greater than UCLH), partial 30.4% (lower than UCLH) and not upheld of 35.9% (higher then UCLH). However due to the variation in determining upheld status, further comparison and analysis of this data is challenging.

Fig 10: Percentage of UCLH Upheld Status over time

15

25 27 23

4347

48

32 25 29

0

10

20

30

40

50

60

70

80

90

100

2015/16 2016/17 2017/18

Upheld

Partially upheld

Not upheld

UCLH upholds or partially upholds about 77% of formal complaints received following investigation. This categorisation clearly remains subjective and should be based on the overall complaint not the main or most significant element to it. It is also not possible to differentiate data or benchmark clinical issues from administrative issues with the data that is released by NHS Digital.

UCLH is not an outlier in its complaint outcomes but as the figure below shows there remains considerable variance, e.g. George’s NHS University Hospitals NHS Foundation Trust and Great Ormond Street Hospital upholds 100 per cent of complaints it investigates, whilst Royal Free NHS Foundation Trust upheld about 9 per cent, this variation is probably related to a lack of robust national guidance in determining whether a complaint is upheld or not following a complaint investigation.

Figure 10: Comparison of Percentage of Upheld, partially upheld and not Upheld for 2017/18

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5. SUBJECT ANALYSIS AND KEY THEMES

Prior to 2015 all complaints had been categorized and reported under a single main subject. Since 2015 the subjects have changed slightly and data is now produced by looking at all subjects within a complaint, not just the main issue. Prior to 2015 there were 12 subjects and since 2015 there are now 18.

As has already been described, many trusts no longer manage their transport contracts and so do not report on such complaints. As UCLH has seen a large increase in transport complaints, this in turn has skewed results for UCLH in admissions / discharges and transfers, and trust administration when overall percentage is considered (as transport issues fall under these two subject headings). Table 4 compares England wide data (national) with London and UCLH. Unfortunately it is not possible to access individual Trust data to this level from the released data set. It should also be noted that ‘other’ is used more by many organisations, whereas UCLH aims to ensure the subjects are captured rather than using other as a default.

Table 4: Comparison of all subjects within a complaint as a percentage of the total Subjects for that organisation / area

National London UCLH

Clinical Treatment 26.7% 24.4% 15.9%

Patient care 11.5% 9.9% 6%

Other 4.8% 5.2% 0.5%

Access 3.5% 2.4% 1.9%

Admissions / discharges 4.8% 4.9% 11.6%

Appointments 5.8% 7.0% 6%

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Commissioning 1.5% 1.3% 0.04%

Communication 15.3% 17.1% 25.4%

Consent 0.3% 0.3% 1.4%

EOL 0.7% 0.3% 0.08%

Facilities 1.7% 2.2% 2.2%

Integration 1.2% 1.9% <0.08%

Privacy Dignity 2% 2.3% 2%

Restraint 0.1% 0.2% 0.17%

Staffing 0.4% 0.3% 0.65%

Trust admin 1.9% 2.9% 6.2%

Values & behaviours 10.1% 10.5% 13.5%

Waiting 2.3% 2.5% 3.5%

Please note UCLH figures based on provisional KO41 data as end of year full

validated data was not released at time of this report.

The following graphs show the main and sub subjects of all formal complaints at

UCLH. Whilst clinical treatment is triggered as the main reason a complaint is made,

it remains below the London and national average and when the elements of the

complaint and all of the sub areas are considered communication becomes the topic

featured most within complaints.

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Fig 11: ALL subjects within a complaint (more than one per

complaint)

0

20

40

60

80

100

120

140

160

180

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

16/17 16/17 16/17 16/17 17/18 17/18 17/18 17/18

Communications

Values and behaviours (Staff)

Clinical Treatment

Admisssions and discharges

Appointments

Trust admin/policies

Patient care

Waiting times

Prescribing

Privacy Dignity Wellbeing

Facilities

Access to treatment or drugs

Consent

Staff Numbers

other

end of life

restraint

Integrated care

commissioining

As already mentioned the reason for the increase in admission and discharge related complaints is primarily due to delayed transport collection, which is a sub category under this heading.

Further Analysis of Complaints related to Queen Square Division Camden Quality Review Group asked us to provide additional information in relation to complaints for Queen Square Division, which is the largest division within UCLH and comprises National Hospital for neurology and Neurosurgery, Pain Clinic at Cleveland Street, Gowers ward at Chalfont Centre and the Royal London Hospital for Integrated Medicine.

Queen Square receives the most complaints for a division within UCLH but also has the greatest activity. When activity is considered the rate of complaints for Queen Square is comparable with other clinical areas for the trust (see p8 and 9

Table 5 : Complaints by Main Subject

Queen Square Division Rest of Trust

Main Subject for Complaint 17/18 16/17

Main Subject for Complaint

17/18 16/17

Clinical Treatment 52 45 Clinical Treatment 185 193

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Values and behaviours (Staff) 26 21

Values and behaviours (Staff) 95 83

Communications 25 26 Communications 85 81

Appointments 19 27 Appointments 45 48

Patient care 9 6 Patient care 21 27

Admissions and discharges 7 10 Admissions and discharges 171 73

Facilities 6 1 Facilities 0 6

Trust admin/policies/procedures 6 0

Trust admin/policies/procedures 25 21

PDW 5 0 PDW 6 10

Prescribing 4 5 Prescribing 12 10

Waiting times 4 0 Waiting times 21 19

Access to treatment or drugs 3 10

Access to treatment or drugs 14 12

Commissioning 1 0 Commissioning 0 1

Integrated care 1 0 Integrated care 0 0

Restraint 0 1 Restraint 0 0

Staffing levels 0 0 Staffing Levels 0 2

Consent 0 0 Consent 6 7

Other 0 0 other 5 8

Totals: 168 152 Total 691 600 Sub group : Transport (complaints led by Clinical Support)

Transport related to QS sites 13 50

Transport All other sites

88 53

As a tertiary centre, many patients are referred to Queen Square Division for a diagnosis or specialised treatment and UCLH can be asked for input into broader complaints that cross organisational boundaries. This happened in two cases in 2018

Complaints by Location : Queen Square Division This is similar to other divisions within the trust, with the majority of complaints linked to out patient care rather than in patient experience 25 per cent of Complaints were linked to an in patient stay at UCLH, compared to . All complaints relating to nursing care are shared and monitored by matrons. Complaint themes are also shared with Improving Care Rounds. Wards within Queen Square Division that have seen an increase for 2017/18 are HASU, David Ferrier and Nuffield ward. Gowers Ward has also seen a small number of complaints after receiving no complaints for a couple of years.

Table 6 : Complaints by main specialty within Queen Square

Specialty 17/18 16/17

Neurology 45 29

Neurosurgery 43 44

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Pain Management 13 9

RLHIM 10 5

Stroke services 9 5

Neuro-radiology 8 2

Autonomics 5 5

Uroneurology 5 14

Pt Bookings 5 13

Out patient 5 5

Headache 4 8

Private patients 4 1

Epilepsy 3 0

Neuro-pschiatry 2 1

Neuro-rehab 2 3

Facilities 2 1

Therapies 2 5

Neuro-ophthalmology 1 0

Neuro-metabolics 0 1

Pharmacy 0 1

Total 168 152

The largest increase is noted in Neurology– this relates to out patient not in patient care, with several concerns linked to administration processes rather than clinical care – delays in receiving letters after clinic, coordination of multiple tests and delays if one is postponed, waits for specialised neurology appointments and an increasingly common theme for this year – disputes about diagnosis and accuracy of medical entries in records or out patient letters. The latter may be linked to change in policy in relation to disability allowances, as outcome of medical assessments may have significant financial implications for patients. Therefore patients are more likely to challenge entries that patients consider do not accurately capture the impact of their condition on their daily lifestyle. Stroke has also seen an increase in complaints for this year, mainly linked to the hyper acute part of the stroke pathway. The majority of complaints are from patient’s relatives asking if more could have been done, for example asking why they had not been given thrombolysis. None of these clinical concerns have been upheld and the responses have explained why the patient was not a candidate for additional treatment. There have been a few complaints about concerns linked to transfer after admission and this has often been linked to bed capacity within HASU or the local stroke unit. Neuroradiology has also seen an increase in 2017/18 with two patients unhappy at using a mobile scanner rather than being seen in the main department. The other issue is delays in getting an MRI could be performed. For example when a patient has an implant, additional information may be needed from other hospitals or the manufacturer before an MRI can be safely performed There has also been an increase in contacts related to funding concerns for homeopathic or herbal preparations in line with NHS changes in funding, which come under Queen Square Division. There were also 13 compliments noted about staff within complaints about other aspects of care.

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Fig 12 Trend over time of all subjects within complaints (more than one per complaint)

Trends are monitored by the central complaints team and discussed at CMG. When numbers or types of complaints change significantly over time, the relevant division is asked to account for the variation. Key themes are now explored in more detail :

TRANSPORT COMPLAINTS Transport delays and performance fall under the subjects- admission and discharge arrangements, communication and trust policy and procedure. As a trust, we were very concerned to see this increase, which included some very poor patient experiences. This was linked to the new transport provider taking longer than expected to deliver the full service to the quality we required. We are working closely with them to improve the quality of this service. Measures already taken have included working with clinical areas to reduce transport bookings at short notice. The transport team has also been proactive in talking to patients who have had problems and trying to ensure future travel plans have been checked to avoid similar problems occurring. The performance of the transport provider and the number of complaints is being monitored closely at Board level and has also been the main subject of a governors meeting. A new contract was negotiated to improve response and waiting times, with financial penalties for poor patient experience.

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Actions taken by the transport provider include an increase in the number of stretcher vehicles available, improving patient facing staff in key waiting areas and plans have been developed to improve the environment in key waiting areas. Trust staff have tried to reduce on the day bookings as this improves planning, and ensure patients are given access to drinks in waiting areas. COMMUNICATION It is disappointing to see communication issues rose in 2017/18 (especially in Q2) despite a number of initiatives. Patients report that staff, especially doctors, do not listen to them. Other significant areas for complaint are being given conflicting information either within the trust or across organisations. Some of the communication complaints are linked to the overall increase in transport delays. There has also been an increase in complaints from patients who have upset by questions they have been asked during appointments. They are either upset by the nature of the questions or feel that by being asked such questions the doctor has not read their file. Patients may not appreciate that some questions are used as an assessment of their memory and it is not possible for a doctor to read multiple volumes of notes for a short appointment. Therefore by asking the patient their concerns they are checking on their understanding of the referral and establishing what is the most significant concern to them. Fig 13 Comparison of all subjects relating to Communication

Many complaints linked to communication are also closely linked to administration issues, such as cancellation of appointment at short notice, rather than consultations with clinical staff. The situation is then not helped when patients cannot access the phone numbers provided on the appointment letters.

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Examples of Learning: A review of issues linked to administration and communication from complaints and PALS cases was taken to the Improving Experience Committee and shared with the Improving Access patient team (APA) for developing an improvement strategy. As part of the APA programme appointment letters have been reviewed and most divisions have reviewed their patient facing telephone numbers to try to improve coverage of these. The contact centre is developing a training programme for staff in dealing with enquiries and who to escalate issues to when it is not possible to reschedule an appointment The RNTNE and EDH in conjunction with the complaint team identified that a larger number of their complaints in 2016/17 were linked to communication and administration issues. This data was shared with their teams and their senior team made this a key priority for their teams to review all patient facing numbers and the quality and detail of their appointment letters. This appears to have had an impact as both divisions saw a reduction in complaints for 2017/18 when compared to the previous year. The trust is also planning to introduce a faster turnaround in 2018/19 for letters following clinics, with greater use of digital dictation. It is also hoped that the trust’s commitment to the introduction of an electronic health care record for patients in 2019 will improve communication between medical teams, GPs and patients. Following feedback from patients, the Women’s Health Division have developed a designated room for holding difficult and upsetting conversations. It is hoped that this will allow patient’s privacy and time to process what has happened when, for example, they are told that they have miscarried.

VALUES AND BEHAVIOURS

There has been an increase in complaints relating to values and behaviours in 2017/18 with 314 complaints featuring a concern about values or behaviours compared to 276 for the previous year. Values and behaviours is a broad category and covers several sub subjects in addition to attitude or unprofessional behaviour:

When staff groups are considered there has been an increase in complaints relating to non-clinical staff over the year and for nursing staff in Q3 and Q4. Analysis shows the increase in nursing complaints in Q3 and Q4 is linked to outpatient rather than inpatient support and in some areas was linked to absences of clinical nurse specialists. Where gaps have been identified divisions are reviewing arrangements for cover when key staff leave or are unexpectedly absent and to ensure out of office messages are in place. After a period of increase in medical staff attitudinal complaints there has been a reduction in Q3 and Q4.

Fig 14: Value and behaviour complaints by staff group

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Learning from complaints

Following an upward trend for complaints about attitude and behaviour for administrative staff in Q1 and Q2, the complaint manager met with the trainers who were creating a development programme for administrative staff. Anonymised examples of complaints were then used to highlight the key role of effective and empathetic communication for non-clinical staff. It is hoped that this will show a reduction in similar complaints in 2018/19

What does further analysis of complaints at UCLH tell us?

Complaints about attitude or behaviours can be difficult to investigate, it may be one

person’s word against another. Often the perceptions between individuals can be

very different – we know that some patients may have been confused, have mental

health problems or be under the effect of medications. A small number of patients or

relatives may have unrealistic expectations about how much time staff can spend

with them on an individual basis and a very small minority of contacts appear to be

vexatious but it is still concerning that the overall numbers have increased.

The majority of complaints UCLH receive are about a single encounter with a

member of staff that has left the complainant affected enough to write in, often with

the intention of avoiding it happening to someone else. Far less common are

complaints about multiple care failings accompanied by a series of unsatisfactory

staff encounters. Many complaints about a single staff member will acknowledge that

care from other staff has been very good. What do we do with these? Are they held

on the staff’s file to understand if there is a trend?

Although complaints by their very nature are negative, many will contain positive

comments about care or consideration from other members of staff to the issue being

complained about. In 2017/18 we received 78 ‘compliments’ about the behaviours

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other staff members within a complaint letter but this should be seen as only a small

snapshot of the positive comments that the Trust receives via thank you cards and

letters to wards and departments, and positive feedback to PALS and NHS choices.

Fig 15: Compliments within a complaint about staff attitude

Contributory Factors from Analysis of Value and Behavioural Complaints:

Staff not introducing themselves or not wearing a visible ID badge.

Staff not robustly checking and changing patient address, GP and next of kin details – often adds to a complaint when errors are passed on – patient then feels not listened to by staff.

Lack of rooms for private discussions in some areas.

Patients do not understand why some patients are ‘seen ahead of them’ – e.g. in ED and multiple clinic waiting rooms and may see this as deliberate behaviour rather than streaming or triage in line with multiple appointment streams.

Not being able to contact staff– patients report voicemails as full, no one answering or getting transferred to lots of people.

However some patients do expect an immediate email response, even when they have not been given an email as a point of contact. Complainants are often not aware that clinical staff are not office based and usually require three days or more to respond. These types of complaints are on the increase.

Being given a complaint leaflet rather than staff giving the patient time and escalating their concerns. This has reduced for 2017/18 with many patients noting the efforts staff had made to address their concerns in their contact to the complaint team.

Contributory factors and how to deal with concerns effectively is explored

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within teaching sessions run by the complaint team for hospital staff.

Appropriate attitude and behaviour of staff, and their responsiveness to patients are part of our values. This message is reiterated to staff from recruitment, through induction to development and leadership programmes. New recruits have to complete and pass a values based assessment before they are allowed to apply for a post at UCLH. Existing staff have an annual appraisal in which they consider their performance against the trust values of kindness, teamwork, safety and improving. Several caveats need to be applied to the data about values and behaviours as far more subject and sub subjects were added to the complaint framework when the subjects were changed in 2015. At UCLH it is also practice to capture all issues in a complaint so there may also be more than one behavioural issue noted from a single complaint received.

CLINICAL TREATMENT AND PATIENT CARE

The most significant change is that clinical care had previously been one category but it now falls within a number of main subjects :

Clinical treatment

Patient Care

Prescribing (medication safety)

Values and behaviours

Privacy and dignity

It is also possible for any subject to apply to multiple staff groups. Although NHS Digital data allows some degree of comparison of the subjects raised in complaints, the lack of a robust guide on classification can lead to differences between organisations.

Complainants usually have a year to bring a complaint but there may be times when discretion is used, eg) following a bereavement or after a birth. However the passage of time may affect the ability to provide a detailed response due to time passed and staff turnover.

Clinical complaints are reviewed closely for trends and emerging concerns. There is a slight increase in complaints about clinical care for this year.

This year all complaints that were received after a death were also subject to additional review as part of the Trust’s Learning from Deaths Policy.

Fig 16: Clinical Treatment and Patient Care Complaints by Division (there may be more than one issue and division per complaint)

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Example of good practice in trying to resolve concerns at earliest opportunity:

If contact is made to the complaints team from a patient or relative whilst they are admitted, this is referred to the ward sister, matron or a consultant to arrange a meeting to try to resolve any concerns at the earliest opportunity and this usually resolves the concern.

‘Thank you so much for putting me in touch with the ward sister, she called me and was able to arrange a meeting with the consultant and this resolved all my worries about my mother’

General learning points from clinical complaints: When a complaint is about an individual then this is used by their line manager to direct their development and training needs. When the issue has been noted for more than one individual then the whole team will usually discuss the care provided and the complaint, and consider how they can learn from the issues raised. Anonymised versions of complaints have been used for the senior staff nurse development programme throughout 2017/18. Staff have been split into smaller groups and given scenarios based on issues from a number of complaints and asked how they would manage the clinical situation and handle the complaint. Approximately 100 nurses have attended these workshops. When complaints are received teams utilise handover to address immediate actions following complaints or incidents, and more significant learning is discussed at local governance meetings. Clinical cases studies have also been used for junior doctor training or discussion at local governance groups e.g. unusual / atypical presentations, X-ray review and teaching. Where a lack of or conflicting information about a procedure or the potential complications has been identified as an issue this has been shared with the patient

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information lead and new leaflets have been developed or existing information reviewed. Examples for 2017/18 include: updating ante natal leaflets about thyroxin replacement.

Clinical themes: Medical staff

The main reason for a complaint about medical care continues to be when surgical outcome is not as expected - either through development of a complication, or that the outcome of the operation on their quality of life has not been as good as the patient expected. There may be elements relating to the consent process, but the response usually demonstrates that consent has included the development of the complication after surgery, suggesting that communication and patient understanding may be a root cause. The Ombudsman has commented in a couple of cases that the documentation about the consent process can be strengthened. A slight increase in complaints relating to consent was noted. This was fed into clinical audit programme, who conducted an audit into consent process. The Trust plans to review its consent process further when the electronic healthcare record goes live.

Communication is the main concern about medical staff when all subjects are considered, with many patients being upset by the manner in which they have been spoken to, especially during questioning about their medical history. Complaints may also be about conflicting information or insufficient information from medical (and other) staff.

Some patients may have done their own research into their condition and believe that a specific treatment or surgical procedure is indicated or that the diagnosis they have been given is incorrect.

When complainants do not agree with their clinician’s view, they may seek further clarification through the complaints process. Such complaints appear to be on the increase compared to previous year. The complaint team will also try to explain to complainants that clinical decisions that are made via a multi-disciplinary process will not be changed due to a complaint, but in such cases the offer of a second opinion can often be arranged via the clinical team caring for the patient.

Missed diagnosis, such as not identifying a fracture is not an uncommon issue for

any emergency department that sees 100,000 patients a year, but when this

happens clinical teams have used them as anonymised case studies for junior

doctor’s education programme.

There was also a slight increase in concerns raised by relatives about whether

diagnosis could have been made earlier. In most cases a thorough explanation of the

rationale of the care provided and the communication with the patient is sufficient to

resolve the family’s concerns. This may be followed up with a meeting. For one

family the combination of a letter and the opportunity to ask questions of the clinical

team brought closure after their relative had died after only a short illness. The family

subsequently wrote to the chief executive to thank the medical and nursing staff for

giving them the answers they were seeking and for the closure this brought.

Fig 17: Comparison of complaints involving Medical Staff

(there can be more than one issue per complaint)

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Examples of learning from clinical complaints :

A complaint was received from patients’ next of kin about the death of their

relative shortly after being readmitted following discharge from the emergency

department.

Action: the clinical care was thoroughly investigated and an explanation was provided to the next of kin, about why certain tests had been performed or not undertaken prior to the patient’s initial discharge. The rare nature of their relative’s condition (which only became evident at the post mortem stage) was explained in detail. The family were asked if they had any other questions following the response and were offered a meeting. A coroner’s inquest was also held. The family thanked the consultant for explaining the care in such detail (the relative had not been to see the patient at the hospital). The consultant explained how they had anonymised the case and presented this as a teaching session to staff within the emergency services division. The family thanked the consultant for his review of the care and for his ‘thoughtful and considerate response’ The family were also grateful to read that the staff had tried to learn from such a tragic event. An overview of complaint themes was held by the theatre and anaesthetic division, and Communication with patients was identified as an area to improve on. Sometimes anaesthetists are the ones who have to cancel or postpone operations at the last minute. This cancellation can be for safety reasons, e.g. when they identify that the patient may need to undergo further tests or change medication to ensure they are fit enough to undergo the anaesthetic and cope with the procedure. This decision is never reached at lightly but sometimes the patient may not appreciate all the issues that have been considered in reaching such a decision. The session was very useful in reflecting on how to best communicate this to patients, who have usually made considerable arrangements in order to come to hospital and prepare for their operation and recovery period. Building on this, the anaesthetic staff also invited a relative to speak to them about their experiences in dealing with a number of different staff groups over a long admission.

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Clinical themes: Nursing Staff

This can vary from a single nurse’s attitude or behaviour to more complex complaints indicating failure in the overall care and support offered across an admission but this is rare. A six monthly review of complaints is shared with the Trust’s Nursing and Midwifery Board.

Data on themes from complaints in used to triangulate with other sources such as incidents, patient feedback and PALS cases, and is used as part of the ward safety data and the ‘Improving Care’ rounds. Each ward records the number of complaints on their local quality boards. Many wards are part of the exemplar ward programme which is being rolled out trust wide. The senior nursing team and complaint manager monitor nursing complaints for any areas of concern such as clusters of complaints by location or any similar clinical themes. Agency / Bank staff can be perceived to be less caring / knowledgeable and recruitment has focussed on replacing temporary staff with permanent trust employees. There has also been a focus on having the right patient in the right place through the development of the centralised Coordination centre and tele tracking in 2017/18, as patients who are cared for on a ward different to their admitting speciality appear to be more likely to have questions about their care. Table 5: Number of Complaints in which Nursing features Trend Over time

All complaints

Nursing Complaints Percentage

Q1 15 16 171 30 17.5%

Q2 15 16 205 48 23.4%

Q3 15 16 197 41 20.8%

Q4 15 16 139 32 23.0%

Q1 16 17 184 32 17.4%

Q2 16 17 183 32 17.5%

Q3 16 17 180 22 12.2%

Q4 16 17 225 26 11.6%

Q1 17 18 185 25 13.5%

Q2 17 18 254 31 12.2%

Q3 17 18 216 29 13.4 %

Q4 17 18 226 41 18.1%

Complaints featuring nursing increased in Q3 and Q4, on review this was linked to outpatient issues with contacting Clinical Nurse Specialists (CNS) rather than in patient care. Such complaints highlight the key role Clinical Nurse Specialists play in supporting patients in the community, so that when a CNS is unexpectedly unavailable e.g. when off sick , having a clear plan for covering calls and emails may be challenging in very small teams. Reminders to ensure cover is in place have been circulated across the trust via the quality and safety newsletter. Although there is a slight increase in the number of nursing complaints for the year, there was a reduction in complaints linked to communication for nurses over the whole year. Fig 18: Comparison over time for all Nursing Complaints (can be more than one subject per complaint)

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In 2015/16 the NHS in patient satisfaction survey suggested a potential problem at UCLH with care at night. Examination of complaints showed that patients were more likely to be disturbed by other patients, rather than staff noise. Several complaints contained praise for day staff but outlined concerns with the support offered by some staff at night. Care and noise at night was therefore monitored through the improving experience committee. In 2017/18 there were only three complaints specific to care at night. One of these was related to noise disturbance from another patient, the other two were about individual staff members one of whom was a temporary member of staff employed via the staff bank.

Examples of learning from complaints about nursing care

Following a complaint about inadequate discharge arrangements the ward sister ordered additional stocks of catheter stands for use by patients at night after their discharge home. These can be brought back at follow up appointment but avoid delays or distress when equipment orders are held up in the community.

Following a complaint about a lack of care and support during an admission, the ward sister shared an anonymised version of the complaint with her team. Ward handover was used to stress the learning points in relation to monitoring food intake and referral to a dietician and the importance of working with family members in identifying food preferences when patients are not able to communicate this. There have been no further complaints about this aspect of care since for this ward and the complaint and response were also shared with the nutritional steering group chair.

Trust Wide learning

There are many committees that receive data on complaint issues that are related to clinical complaints. For example:

Falls – any complaints featuring falls are shared with the falls group and falls leads and cross checked with incident reports. In 2017/18 there were two complaints relating to falls, one of these was reported as an incident and one occurred outside

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the trust and does not appear to have been reported at the time (as it was unknown). In 2016 /17 two complaints featured falls and both had been reported as incidents at the time.

Pressure ulcers – any complaints featuring these are shared with the tissue viability team. There was one complaint related to a pressure ulcer in 2017/18 compared to zero complaints about pressure ulcers in 2016/17 but advice was sought regarding wounds for two complainants.

Nutritional Committee

All complaints featuring nutritional concerns are shared with the Head of Dietetics who chairs the trust’s Nutrition and Hydration Steering Group. A quarterly report of themes and key issues has been shared with this committee and is being used to drive improvements.

Fig 19: Trend of themes relating to Nutritional Issues over year

Learning to have come out of joint working with the trust nutrition and hydration steering group includes a review of ‘snack box’ content, with a particular emphasis on whether this is suitable for diabetic patients. A variety of new options for content has been considered and this will be implemented in 2018.

The Trust’s nil by mouth policy is also currently under review, in part due to a small but steady number of complaints that have been anonymised and shared with this committee. In the mean time a number of areas have reviewed the time they ask patients to come in to hospital for proceures and tests and have used posters and regular ‘small amounts of water’ rounds to try to ensure patients are not left nil by mouth for excessive periods.

Medication safety – (Appears as ‘prescribing’ under national datasets)

Any complaint mentioning medication issues is shared with the trust’s medication safety lead and a quarterly report is shared with the medication safety committee to cross reference themes from complaints with incidents and ensure learning. Complaints can be related to medical, nursing or pharmacy staff or combinations.

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A couple of complaints were received as UCLH and other NHS organisations reduced routine provision of minor analgesia on discharge. A review of information given to patients identified an area that had changed its practice without fully updating patients. Patients now receive information on stocking up with over the counter medication ready for discharge as part of their preoperative information and there have been no further complaints in Q4 related to this.

Fig 20: Medication Related complaints 2017/18

Example of Learning to have come out of medication safety reviews

Following a complaint in which a patient felt unprepared for how they felt during an infusion and after discharge from the department, the process has been evaluated. Patient information reviewed and guidelines for administration are currently under review.

Maternity / Obstetric Complaints

Complaints for Women’s health services increased slightly for this year, therefore further review of these have been carried out by Maternity Services and the complaint manager to identify themes and develop improvement plans.

Learning and development

A specific development day for all Senior Midwives was held in 2017/18. A number of scenarios were developed using issues from complaints and staff were asked how they would manage the clinical scenario, communicate with the patient and her family and then how to handle the complaint. A number of improvement projects were developed following this session.

Fig 21: Maternity and Obstetric related care complaints (There can be more than one issue per complaint)

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Ante Natal Care There is a slight reduction for ante natal complaints in 2017/18 and further analysis shows that 4 of these complaints were related to administration issues rather than clinical concerns. The matron for ante natal services has worked with the team to improve flow through the clinic and phlebotomy delays have also been reduced over the course of the year. Complaints about experiences in the scanning department remain steady and generally relate to how patients are supported when receiving bad news about scan results. The team are currently exploring whether different colour referral slips might alert staff to patients who are referred with possible miscarriage from those who are having routine monitoring scans so that additional support can be given at the earliest possible stage Latent Phase Latent phase is the long period when labour is not fully established but can be very painful as the uterus contracts in preparation for birth and the cervix starts to dilate 0-3cm. Complaint themes about this stage of labour are often about not being admitted or offered somewhere to rest as they not in established labour (and this phase may last from many hours to a couple of days), and a lack of empathy from staff. A slight reduction is noted in complaints for this year following the formation of a working group last year to look at improving communication during this challenging phase when women may be very distressed but are not in established labour. Staff have also been encouraged to offer alternatives to women during this stage rather to advise to ‘go home until labour is more established’. Care during Labour There was an increase noted in complaints about care and treatment during active labour in 2017/18. One of the themes that was discussed with the senior midwifery team is the apparent difference in experience for some women compared to the expectations that are set in ante natal classes such as those run by the NCT. An increase in concerns about not following birth plans was noted for the year. On review the deviation from the original birth plan was linked to changing clinical status

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but the workshops explored how important effective communication was to explain why the management plan has changed. This increase has been noted and remains under review in the Women’s Health Division but women are offered the option to attend a birth reflection meetings (midwife and obstetric) as this may resolve their concerns. One of the themes identified in relation to complaints about care during labour is pain control. In 2017/18 there were 11 complaints about inadequate pain control, two of these related to care after delivery and one related to care some years before. This represents a slight reduction to 12 complaints about pain control during labour in 16/17. There was also more evidence of alternatives to epidurals being offered by midwives to women in labour from the complaints received. Post Natal Care Overall complaints about post natal care reduced in 2017/18. Following additional training for staff and strengthening the role of the breast feeding coordinator, complaints about lack of support in breastfeeding have reduced from 5 in 2015/16 to 3 in 2017/18. Follow up after discharge However there was an increase in concerns about community or follow up after discharge, and sometimes this aspect is not managed by UCLH or is dependent on other services such as physiotherapy.

STAFFING LEVELS (ALL STAFF)

Relatively small numbers of complaints feature concerns about staffing. There was a slight reduction in such complaints in 2017/18. UCLH has focused on improving its recruitment in past years and staffing complaints are closely monitored alongside vacancy and sickness data.

ADMINISTRATION COMPLAINTS Administration related complaints can be due to a wide number of reasons, a few of which are outlined below: Unable to contact the trust by telephone, conflicting information in letters about appointments, letters not received or going to an incorrect address, cancellation or changes to appointments, tests or surgery dates. The access and patient administration programme has worked on the following over the last year: Updating contact numbers for patients, developing email options, reviewing content of clinic letters to ensure appointment data is clearly displayed and working with divisions to ensure outpatient information sheets are clear to understand, especially if relating to preparation for tests. Cancellations Concerns and complaints about cancellations of theatre on the day were noted to be increasing. This was discussed at the Improving Experience Group and best practice was identified and shared throughout the trust (see p 32).

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Example of shared learning : Consider best practice checklist for cancellations on the day. Divisions need to work closely with theatre / day surgery staff and senior staff should be involved in decision making and communication

Ensure that patients are offered travel reimbursement for any ‘wasted’ journeys. Ensure an apology is given to patients for the late cancellation and provide an

explanation why the decision is being made so late. Ensure that the patient has a new appointment / date for surgery given before

they leave or know that a date will be sent to them by a set date. Ensure that it is recorded that they were cancelled on the day, this should enable

them to be booked again as a priority. Give the patient a point of contact for questions about the rescheduling. Offer the patient some food and drink before they leave. Ensure that they can get home and update their family. Offer to supply a letter if this is needed for work or any other reason. Consider why they have been cancelled, and whether they could have been

notified earlier – (after action review AAR – to seek continuous improvement).

6. OTHER LESSONS LEARNT FROM COMPLAINT MONITORING

This section considers further how the trust learns from the complaints it receives. Complaints provide valuable feedback, and should be viewed by staff and the trust as positive agents for change. This may arise from review of themes or trend analysis but on occasion issues can be identified from individual complaints which have implications for other patients, their relatives and carers, as well as the services provided by the Trust. Some of these lessons have already been shared in section 4. Improving response times: The trust met 77 per cent of agreed response times in 2017/18 and although this is an improvement compared to 72 per cent in 2015/16 and 75 per cent in 2016/17 it is short of the 85 per cent Trust target. It should be noted that performance does vary, and this is reported monthly via the quality scorecard. Winter pressures saw a reduction from 82% in Q2 to 72% in Q3 and 4. Some divisions consistently meet their targets and keep the complainants updated whilst others struggled. The increase in transport complaints and the need to seek information from the provider led to a backlog in responses for clinical support. The provider has now provided a named manager and has a regular meeting with the trust to ensure a more rapid and effective response. This has enabled the backlog to be cleared and the focus is now on providing a quality service and dealing with any concerns in a timely manner at the time. The number of complaints is reducing but is still being closely monitored.

Action taken in year: Divisions that are not meeting response deadlines have been asked to review their local complaint handling processes and develop an action plan.

One division has recognised the nature of their complaints has changed over the

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last few years and is in the process of recruiting a quality and safety officer with one of the main aims for the new post being to improve their complaint response times and ensure complainants are kept updated.

Quality checks by the division and the central complaint team and an improvement in the quality of initial responses to complainants has reduced the number of complainants sending further concerns following their complaint response (8.1 per cent in 2017/18 compared to 8.5 per cent for 2016/17 and 10 per cent in 2015/16).

Learning from PHSO feedback Following feedback that as an organisation we sometimes took too long to close the local complaint process, further contact following an initial response are now reviewed and direction is provided by the central complaint team to divisions on the areas to respond to. If there is nothing more to add and it is not thought appropriate to offer a meeting then a letter explaining that local resolution has concluded and information about contacting the Ombudsman is provided.

7. REFERRALS TO THE PARLIAMENTARY HEALTH SERVICE OMBUDSMAN (PHSO)

The Parliamentary and Health Service Ombudsman (PHSO) is a free and impartial organisation that makes final decisions on complaints that have not been resolved by the NHS in England and UK governments and other public organisations. At the time of this report their annual data is not available but in 2016/17 they received 8000 complaints a year and go on to investigate about 50 per cent but will ask for medical records and complaint files on many more. They will not usually investigate unless the organisation has completed their own investigation. In deciding to investigate they will consider:

Whether the person been personally affected

Whether they complained to the PHSO (or MP) within a year of the matter becoming known**

Whether they have had the option of a legal route**

Whether there are signs that the organisation potentially got things wrong that has had a negative effect on the complainant that has not yet been put right.

Overall the PHSO upholds or partially upholds approx. 37 per cent of the cases it investigates nationally, and finds that in:

• 1 in 5 of the complaints is due to poor communication. • 1 in 4 show failures in decision making. • 1 in 5 the organisation has arrived at the wrong conclusion or used incorrect

guidance. The PHSO periodically releases papers to try to share learning across the NHS. In 2017 they reviewed complaints across the NHS linked to eating disorders (UCLH had no complaints linked to this theme), but their reports also focussed on developing a longer term strategy for improving complaint handling. As part of the Shelford group UCLH provided feedback on their vision

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Complaints to the Parliamentary and Health Service Ombudsman In 2017/18 there were 108 contacts by patients or their relatives with the PHSO. Most of these were considered premature by the PHSO; the complainant had either not made a complaint to us or their concerns were still under investigation. This is a slight increase on the previous year (96 for 2016/7). Of the 108 contacts received by the PHSO, 13 were accepted for investigation, compared to 21 in the previous year, a decrease of 38 per cent. If the PHSO accept a case they may consider no further action is needed, or may partially or fully uphold the complaint and may request an action plan, apology and possible compensation. Over the past year, 6 PHSO investigations (some relating to previous years) were partially upheld (partly agreed), with the outcome being an apology, an action plan to rectify the failures that were identified and in some cases a financial settlement. Table 6: PHSO cases Comparison across Shelford Groups (based on data shared by PHSO as of March 2018)

PHSO referral

Accepted for review

Closed in year

Upheld Partially upheld

Not upheld

Percentage upheld/ partly upheld

Birmingham 68 15 21 0 8 11 38 per cent

GSTT 124 18 24 1 5 15 25 per cent

Cambridge 45 13 9 2 4 2 66 per cent

Imperial 90 13 14 0 3 8 21 per cent

Newcastle 55 21 22 0 11 9 50 per cent

Central Manchester 191 30

16 1 6 7 44 per cent

Oxford 59 10 12 2 7 1 75 per cent

Sheffield 112 16 19 0 3 15 16 per cent

Kings 93 14 17 0 6 10 35 per cent

UCLH 108 13 14 0 6 6 43 per cent

At the time of this report the PHSO has not yet released its official figures, the data above is based on that shared by the PHSO with the Shelford group in March. The columns do not add up as some cases may be withdrawn in year as the investigation progresses or have alternative outcomes such as mediation. In 2016/17 UCLH had a large number of cases partially upheld (12) but this has reduced in 2017/18. As the table above shows about 25-30% of cases relative to PHSO contacts proceed to a full investigation. It can still take over a year for the Ombudsman to reach a conclusion from their investigation but the numbers are low to draw definite conclusions and there can be quarters in which more reports are released than others.

Thematic review of PHSO cases:

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No single division is an outlier for cases that are upheld, and many PHSO cases have spanned several divisions. Main Themes from review of partially upheld complaints by the Ombudsman

Inadequate communication to patient or relatives (in most cases).

Inadequate or missing documentation (in a small number of cases)

Consent process has not included documented risk / benefit or various treatment options including option for no treatment (in some cases).

Pathway delays (in some cases).

Inadequate complaint investigation, failure to cover all issues in complaint response (in a few cases).

Complaint Maladministration (in some cases) – responses took too long and the complainant had not been kept updated (also see p32).

Financial redress was recommended in 2 out of the 6 cases partially upheld cases. Action plans may be requested by the PHSO in response to the outcome of their investigations. Examples of Learning from Ombudsman’s cases A relative complained to the ombudsman about their family member’s clinical care and were concerned that they had suffered post operative complications from ‘poor care’. The PHSO investigated and concluded that the clinical care provided had been appropriate and agreed with the trust’s initial response that the family had been given opportunity to discuss their concerns with appropriate clinical staff during their admission and had been given an explanation from staff at the time. However after providing an initial written complaint response the division took too long to advise the complainant that they had no more to add and to refer them to the Ombudsman. The complaint was therefore partially upheld Outcome: An apology was given and the division reviewed its procedures for reviewing initial responses and keeping complainants updated during the complaint process. A patient was unhappy with a number of aspects of their care, including consent. UCLH’s investigation had already partially upheld their concerns. The PHSO case concluded that the clinical care had been appropriate but made some recommendations about recording more information during the consent process, but they did not consider this had an impact on the patient. Outcome: The named doctor reflected on their practice in relation to consent with their clinical lead and the case was shared through local governance meetings. An apology was given. A patient had been referred for a specialist opinion, but it was not possible to give the patient a definitive diagnosis and their care pathway was prolonged as they required a number of tests to establish the best clinical option for them The department had been managing the patient’s frequent contacts as a clinical concern rather than a complaint. A clinical nurse specialist had been responding to

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the patient’s contacts and had escalated to the departmental manager when the number of contacts exceeded the volume the department could support. The ombudsman acknowledged the efforts taken to address the patient’s concerns but felt that the patient should have received a written response at an earlier stage as they had clearly said that they wanted their concerns treated as a complaint. The clinical care was acknowledged as complex and the concern about inappropriate clinical care was not upheld. Outcome: Learning from the complaint handling was shared in the quality and safety newsletter and also referenced in teaching sessions within the department and division. The department has reflected how they can respond to a complaint whilst the clinical care pathway is ongoing. A patient with a chronic medical condition was unhappy about a number of aspects of their care after their operation The PHSO did not uphold their concerns about medical care but recognised that the patient could have been given more support immediately after their operation, as staff had not recognised that the patient was not able to meet their care needs as a result of their anaesthetic. The department were not aware that the patient had been unsupported during their admission, but discussed the outcome of the PHSO review and a reminder was given to staff about offering support and assistance after surgery or anaesthetics.

8. COMPLAINT MANAGEMENT AND COMPLIANCE

Board engagement The medical directors, chairman and chief nurse have always played very active roles in the complaints process, in reading complaints and raising issues raised by complaints with their teams and in a variety of meetings. All complaints and responses are seen and signed off by the Chief Executive, complaints are shared with the chief nurse, chairman, and a non- executive director on a rotational basis. Significant complaints and all PHSO cases are also shared with the medical directors and heads of nursing. The non-executive director who chairs the Patient Experience Committee (PEC) has had regular contact with the complaints manager in 2017/18. UCLH is involved in the Shelford Complaints forum which is made up of 10 Trusts and explores best practice and shares learning from complaints management. The Shelford Group was formed in 2011 to benchmark and share best practice in key service areas across the membership through working groups, and constructively engage with Government, Parliament and industry to represent the interests of large tertiary centres and the wider National Health Service. The Shelford Group are dedicated to excellence in clinical research, education and patient care. We aspire to demonstrate system-wide leadership for the benefit of patients. External Reports and Visits There was no CQC inspection during this calendar year, but this is expected in 2018/19. Improving quality of responses

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Whilst the majority of the complaint responses appear to satisfactorily resolve the concerns raised, there are a number of complainants who return to the Trust with additional queries, follow up questions or re-contacts for areas that require clarification. In some cases a complaint may require a full reinvestigation, especially if new information is provided.

In 2010/11 UCLH had a 10 per cent reinvestigation/ recontact rate.

In 2011/12 UCLH continued to have a 10 per cent reinvestigation / recontact rate.

In 2012/13 UCLH experienced a drop in reinvestigation / recontact to 7 per cent

In 2013/14 UCLH had a 8 per cent reinvestigation / recontact rate

In 2014/15 UCLH had a 8.5 per cent reinvestigation / recontact rate

In 2015/16 UCLH had an 11per cent reinvestigation/ recontact rate

In 2016/17 this reduced to 8.5 per cent

In 2017/18 this reduced to 8.1 per cent A small number of complainants (5) have also re-contacted the department after receiving their response to thank us for the explanation provided and the actions the trust plan to take. Education and development The Complaint team have run a series of workshops on handling complaints. A series of teaching materials have been developed and shared with staff. Complaints team staff have presented data about complaint themes at audit days at Queen Square, Women’s Health and Theatre and Anaesthetics. The complaints team have also had input into the senior staff nurse development programme with sessions on dealing with concerns effectively and handling more formal complaints. A workshop was developed for all band 7 midwives to attend, that took scenarios from complaints received to assist staff in dealing with concerns and responding to complaints. The complaint manager was invited to present complaint data and discuss patient experience following an increase in complaints were noted within gynaecology. The reasons for the increase were multifactorial and the session explored how understanding the impact in delays that might fall outside the division’s control and effective and empathetic communication were key issues for patients accessing gynaecology services. How can we be reassured that patients and relatives know how to complain? A leaflet explaining the complaint process and also how to contact PALS has been in use since 2008, the last edition was released in February 2016. 7000 complaint leaflets were distributed in 2016/17 across the trust. More complaints and contacts were received in 2016/17.

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The patient’s reading group were asked to review the Trust’s complaint information leaflet and this is currently being printed for 2018. The Trust website has an on line complaints form. The complaints team assist patients in making a complaint and provide advocacy details when additional support is required. In 2017/18 we asked local health watch and complaint advocacy services to review the content of the complaint information leaflet and website and they had minimal comments. In 2015 /16 the website was checked and slight adjustments made to make it easier to make an on line complaint or raise a concern. In 2014/15 – stickers were added to the bedside for patients to be able to contact a senior member of staff if they had concerns about care. In 2013/14 a welcome pack was introduced for all patients undergoing an elective admission. This contained a section on how to raise a concern or make a formal complaint. Environmental walk-rounds involving wide selection of staff and governors take place, part of the checklist is to check availability of complaints forms and obtain feedback from patients. It is hoped that this would increase feedback and awareness of how to raise a concern or to complain. The complaints team work with divisions to ensure any matter that is raised is reviewed to see if prompt actions can resolve any concern without it needing to become a formal complaint. Fig 22: All Contacts to complaints department The overall number of contacts to the complaints department is increasing year on year, however these may not always be linked to patients or their representatives wanting to complain. The complaint team also receives contacts from trust staff seeking advice, or patients or NHS organisations or external staff wanting to contact someone at the trust and asking how best to do this. The trust’s complaint department also fields a number of contacts from patients wanting to complain about care not provided by UCLH and if this happens then the team will give information on local PALS or advocacy services as we are not able to investigate issues that are not related to UCLH care.

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Working with other organisations The 2009 Complaints Regulations require organisations to offer complainants the option of a joint response when their concerns cross the boundaries of NHS care providers. If UCLH receives a complaint which relates to care at UCLH and another organisation then the Trust currently asks the complainant for consent to share a complaint with another organisation. During 2017/18 the Trust received 17 complaints which required co-operation with another organisation. This is the same as the previous year. With 35 for 2015/16, after a large increase from 10 in 2013/14.

All the complaint files were reviewed against the following criteria:

Consent was obtained in all cases order to share information between organisations

Conclusion All complaints requiring joint working across organisations were managed in line with the policy, and joint responses provided either by UCLH or via another organisation. Compliance with Complaint Process:

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a) acknowledging a complaint 9 per cent of complaints from a random selection were acknowledged within 3 days, but sometimes more information was needed before investigations could take place. b) responding to a complaint

UCLH has a flexible approach to complaint response times, and seeks to negotiate the time period with the complainant wherever possible, in line with the revised NHS Complaints Guidance (2009) which removed the 25 day target. Many issues may be resolved during the initial phone call and all divisions are encouraged to involve the complainant in determining what they are hoping to achieve from their complaint, with many immediate actions being taken e.g. booking a clinical appointment, arranging a meeting. We recognise that some complaints may take considerably longer where multiple divisions or organisations are involved. Monitoring timescales is therefore based on whether the negotiated target is met. Table 7: response times

Response within 25 working days or negotiated target

Comments

2017/18 77 per cent Slight improvement but not meeting target

2016/17 75 per cent Slight improvement but not meeting target

2015/16 72 per cent Deterioration in performance

2014/15 73 per cent Deterioration in performance

2012/13 84 per cent Marginal deterioration in performance

2011/12 85 per cent Slight improvement in performance

2011/10 81 per cent Baseline

Adhering to the response date and providing a high quality response in the allocated time frame continues to present a challenge for some Divisions, with a reduction in meeting response times unfortunately noted for the last few years. The response time would have been higher for this year but due to the significant increase in transport related complaints, and the need to seek information from the transport provider, this had a significant impact on the overall response rate. The response time has been part of the new contract with the provider, and a penalty is now possible when responses are not received from the provider within the agreed timescale. Where performance within divisions consistently fell below target, this is escalated to the relevant division and then medical director for comment and action. The reasons for delay are multifactorial and may include difficulties contacting the patient to discuss their complaint, notes not being available to the investigator, general

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workload, especially when a clinical reviewer is needed or absence or changeover of staff. Although some of our patients indicate they are not concerned by how long their response takes, as they want to know that a thorough investigation has occurred and that we have learnt from the issues they have raised, for others a long response time may add to their distress and anxiety. A failure to update the complainant can be very distressing and is a common reason for dissatisfaction with the complaint process. A number of actions were taken within 2017/18 to improve response times with mixed success through the year. It was therefore disappointing that there was only a small improvement in overall performance for the year. However it should also be noted that a large number of contacts to the complaint department are able to be resolved quickly by the divisions to the satisfaction of complainants without the issue becoming a formal complaint.

Actions taken Training sessions have emphasised the importance of: * agreeing realistic deadlines for complex complaints when speaking to complainants * keeping complainants updated The weekly memo sent to divisions has highlighted complaint responses due in the next two weeks The contact sheet that captures information when the initial phone call is made was revised to ensure staff discussed response times with complainants A more formal escalation to senior staff for significantly overdue complaints

Ensuring Equal Access

The Trust endeavours to make the complaints process easy to access and equitable, in the following ways:

Support is provided to complainants who wish to make a complaint but for whatever reason are unable to write in to the Trust or make the complaint themselves. Approximately 30 complainants were supported in this way by a member of the complaints team in 2017/18, however this is probably an under representation due to data capture methods.

Easy read complaint leaflets are available on the website and also the trust’s Clinical Nurse Specialist has been involved in supporting complainants with learning disabilities when they have complained. This has included meeting them in their own home.

Complaints responses are translated on request and during 2017/18 only two requests for translation into another language was received and actioned.

The complaint leaflet is currently being translated into the five most common languages in use by patients at UCLH.

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All complainants are given information about accessing advocacy services via the complaint leaflet and acknowledgement letters.

Complaints data is found alongside other data within the Trust’s Equality and Diversity report and is only summarised briefly in this section to meet NHS Complaint report guidance.

A reduction in the provision of British Sign Language interpreters was noted in Q4 2017, this was due to a reduced number of interpreters being available. This was addressed by the provider of interpreting services in 2017 and by Q3 and Q4 this issue had been resolved. However confirmation to deaf patients about when an interpreter has been booked remains a concern. It is hoped that this will be resolved when the trust moves to an electronic health record in 2019.

Further analysis is provided and available in the Trust’s annual diversity report.

Fig 23: Complaints by Gender

Male34%

Female66%

Gender

Fig 24: Complainants by Age

0

50

100

150

200

250

300

350

400

450

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Ethnicity Ethnicity data is drawn from CDR / EPR and is linked to the patient not the complainant as per NHS guidance. This metric is now not included in KO41 returns. Please note that where a complainant is not a patient this data is not available, e.g. visitor, relative etc. It is not possible to separate out ‘not stated’ from those who do not wish to provide this data, but there was an increase where no ethnicity data was provided. Table 8: Ethnicity of patients as appearing on Carecast

2017/18

Not stated 300

White - British 332

White - other white 80

Other ethnic category 43

Black African 18

Indian 24

Black Carribean 14

Other Asian 16

White - Irish 19

Bangladeshi 10

Other Black 11

Pakistani <10

Other mixed <10

Mixed white and black Carribean <10

Mixed white and black African <10

Mixed white and Asian <10

Chinese <10

Methods of accessing the complaints process The Trust offers a range of options for raising complaints: leaflet, letter, email, in person, by phone. The vast majority of complaints are now made by email (see figure overleaf). The ongoing rise in emails brings challenges as some people may expect an instant response and often do not include enough information to start the investigation. An automated receipt has been developed informing patients that they should receive further contact within 3 days, although the aim is always to try to respond that or the next working day. Fig 25: Trend of method of contact for complainants

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The leaflet in 2016 was changed to be for information only, not to submit their complaint as this was felt to limit space for complainants to describe their experience, this partially accounts for the reduction in complaints made by leaflet. Complaints may come from advocates, solicitors, MPs, and GPs. All complaints are treated equally regardless of the source and consent is obtained when appropriate. Letters from GPs will be shared with the Trust’s GP Enquiries team and any learning will be anonymised and shared via the GP newsletters when relevant. Use of initial contact sheet / telephone contact, compliance with Trust Complaint’s Policy

As part of the monitoring of compliance with the Complaints Policy. Two elements were selected for the monitoring by ‘mini audit” which reviewed a selection of random complaints throughout 2017/18

Use/completion of the initial contact sheet

Making the initial telephone call to complainants Table 9: Complainant Contact Compliance

Qtr1 and 2 Qtr 3 and 4

Evidence to support contact call was made within 5 days

40 per cent 44 per cent

Call made but after 5 days 12 per cent 14 per cent

No evidence 34 per cent 30 per cent

patient had initially raised complaint to a member of staff or had requested written response or staff had tried but could not contact so letter sent

14 per cent 12 per cent

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There was an improvement in use of contact sheets or emails to the complaint team over the year. An increase in 2016/17 was noted in staff not being able to contact complainants to discuss their concerns. There are a number of challenges to making a call, many patients are not available during the day, trust phone numbers appear on mobiles as ‘withheld’, which can be off putting to some complainants and not everyone has a voicemail to leave a return contact. Staff may also not want to leave messages about complaints and would prefer to speak to the complainant. The complaints team have encouraged trust staff to let the central complaint team know if contact cannot be made, so that a letter can be sent offering them to re contact us. Complaint correspondence has also been adapted to advise complainants that numbers may appear as withheld.

9. SUMMARY AND CONCLUSIONS

UCLH has noted a 16.7 per cent increase in KO41 reportable complaints, and although this is against a backdrop of increased activity this is well above the overall national figure of around 1 per cent in provisional end of year data. Staff try their best to resolve concerns at the earliest opportunity and there has been an increase in the number of contacts to the complaints team that are resolved promptly without the need for investigation. The time taken to respond to some complaints remains too long in some cases. This is despite weekly data being sent to divisional staff about complaints that are due for a response. There is ongoing evidence that complaints are regarded by the organisation as a valuable gauge of the patient experience at UCLH. There is evidence that complaint responses regularly identify opportunities for individuals, departments, and the organisation to learn from complaints. There are a number of opportunities to improve the non clinical experiences for patients in terms of transport experiences, letter contact, returning phone calls and overall communication. UCLH has received more complaints that mention negative staff ‘values and behaviours’ but there are also a number of compliments for staff within a complaint about another staff member. The behaviour of individual staff members still acts as the main trigger for a number of complaints, with an increase noted for non clinical staff. It is hoped that the educational programmes planned for 2018/19 for key administrative staff will have an impact on this Complaints about staffing levels have reduced but this continues to be closely monitored UCLH receives less clinical complaints than many of its peers but there is a steady number of complaints in which patients dispute the treatment given or what has been written in either the medical record or clinic letters. Whilst the majority of such concerns may not be upheld by the organisation or the Ombudsman (PHSO) it still highlights the importance of clear explanations to patients and their families especially when a firm diagnosis cannot be reached.

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The incidence of contacts to the PHSO has again increased over the past year, but the number of cases accepted for investigation has reduced, and those cases being partially upheld has reduced after a notable increase in 2016/17. In conclusion the trust has complied with its complaint policy but there are still opportunities to improve patient experience.

GLOSSARY PALS – patient advice and liaison service KO41 – a quarterly data return on numbers and types of complaints made to NHS Digital NHS Digital – the organisation that collates data from organisations submitting KO41 returns CQRSG – Care Quality Review Steering group PHSO – Parliamentary and Health Service Ombudsman (reviews complaints that have not been resolved by local resolution) IEG – Improving Experience Committee (meets monthly, attended by site representatives, patient representatives, complaints, PALS, patient experience, performance staff and chaired by Chief Nurse) PEC – Patient Experience Committee (meets quarterly, Shelford Group – a group of acute foundation trusts that share quality NHS Complaint Advocacy Service – a free and impartial service provided to assist people to complain about NHS care and service 72 hours review – a meeting to share initial findings after an incident and to consider what immediate actions are needed and whether the incident meets the criteria for being managed as a serious incident Serious Incident – an incident which meets the specific criteria set out by the department of health, if it does then this is reported externally and an in depth investigation is carried out and actions identified to prevent recurrence. The report must be completed within 65 days CMG – Complaint Monitoring Group ( meets quarterly and reviews data from PALS, patient experience and complaints to identify themes or issues for escalation) Subject – Defined by the Department of health and used to submit quarterly data on complaints to NHS Digital Ward Safety Data – set of data that allows wards to monitor how they are performing and to compare their results to other similar areas Exemplar ward – the ward uses a set of standards and improvement projects to deliver the best possible care

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Improving Care Rounds – look at standards of care and patient experience Coordination Centre – this area assists in making the best use of resources across the trust. Controls admissions and discharges in relation to demand from emergency admissions and responds to unusual situations e.g. major incidents Teletracking – a method of knowing and showing which patient is admitted or ready for discharge using interactive electronic boards located on wards and in the coordination centre. FCE – Finished consultant episode Patient Contact – clinical contact either by an out patient appointment or an admission to a ward or day unit Birth Reflection Meeting – meeting for women and partners to come and discuss their experiences or concerns CQC- Care Quality Commission - is the independent regulator of health and social care in England. They monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and publish what they find, including performance ratings to help people choose care

Contact details Trust Complaints Manager Address 250 Euston Road Address London Address NW12PQ Tel No 0203 456 7890 Email address uclh.complaints @nhs.net Web address Additional details if required