Annual Complaints Report 2012/13

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Weston General HospitalGrange RoadUphillWeston-super-Mare BS23 4TQ

Tel: 01934 636363

www.waht.nhs.uk

1st June 2013

Contents Welcome and Introduction

1. 2. Complaints Process3. Number of Complaints Received4. Number of Complaints Resolved Within an Agreed Timescale5. Nature of Complaints Received6. Number of Complaints Upheld/Partially Upheld 7. Parliamentary and Health Service Ombudsman 8. External Monitoring – Care Quality Commission (CQC) Review9. Learning by Experience 10. Satisfaction Surveys11. Complaints Training 12. Policy 13. Staffing14. The Patients' Council15. Summary of Key Achievements16. Future Plans

1. Introduction and Welcome

This report reviews the complaints received by the Trust for the period 1st April 2012 to 31st March 2013 and describes how these complaints have been managed.

Complaints are important to the Trust. They can act as an early indicator that a system is not functioning effectively and can provide valuable insight into where service improvements may be required.

In responding to complaints firstly we aim to remedy the situation as quickly as possible and ensure the individual is satisfied with our response. It is important that individuals feel that they have been fairly listened to, treated with respect and any issues raised have been satisfactorily resolved within agreed timescales.

The Trust covers an overall population in North Somerset of around 202,000 people with a further 3.3 million day trippers and 375,000 resident visitors increase this base population each year. In 2012/2013 the total number of patients treated was 182,938. The number of these patients that contacted the Trust to raise a formal complaint was 262.

The top three themes described in complaints were:

unhappy with the medical treatment received, communication with patients, their families and carers and standard of the nursing care.

The complaints function is the responsibility of the Director of Nursing. Complaints are reported and monitored regularly by the Executive Team and the Board of Directors.

We continue to be proud of the number of compliments received about our staff and think it is important that this positive feedback is communicated across the organisation, ensuring that where we have got it right we share this approach across other areas.

The number of compliments the Trust receives annually far outweighs the number of complaints it receives.

The Trust continues to be proactive in its management of complaints and is currently reviewing our Complaints Policy and Procedures to ensure they are in line with the national review led by the Department of Health and Complaints Ombudsman.

This report will be presented to the Quality and Governance Committee and provided as information to the Trust Board before being circulated Trust-wide. It will then will be posted onto the internet site and distributed to external stakeholders.

2. Complaints Process

Weston Area Health Trust aims to provide the highest quality services, ensuring the experience individuals have while using our services is the best we can offer. For most people we fulfil this aim; however for some their experience falls short of this aim. We are always sorry when this is the case and welcome the feedback individuals provide about what went wrong.

We aim at all times to provide local resolutions to complaints and take all complaints seriously. We listen carefully, we are open, honest and transparent in our responses and welcome the opportunity

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to do all that we can to put things right. Our complaints system gives the opportunity for complainants to meet with managers to discuss their concerns and we ensure that staff are made aware if concerns are raised about them and encourage them to look at ways they can change their practice or behaviours where appropriate.

The time limit for making a complaint as laid down in the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 is currently 12 months after the date of the incident or 12 months after the date on which the matter came to the attention of the complainant.

An acknowledgement of the complaint is made within three working days, to verify the issues requiring investigation. The Complaints Team will contact the complainant to agree a realistic timescale in which the complaint should be resolved. This decision is based on the type and complexity of the complaint allowing a swift response to straightforward issues, whilst at the same time allowing an achievable response time to be set for complex and cross-organisational or cross-Trust issues.

The complaints legislation indicates that ‘the Trust must investigate the complaint in a manner appropriate to resolve it speedily and efficiently and keep the complainant informed’. When a response is not possible within the agreed timescale, a new completion date is agreed with the complainant, who, in addition, must be kept informed of progress throughout the investigation.

Although the legislation allows flexibility, the Trust aims to provide a response in as timely a manner as possible setting an internal target of 30 working days.

Under the current complaints legislation Trusts have six months in which to endeavour to resolve a complaint to the complainant’s satisfaction. However if the complainant remains dissatisfied they have the right to refer their complaint to the Parliamentary and Health Service Ombudsman (PHSO) as the second stage.

The Ombudsman may:

Refer the complainant back to the Trust to complete ‘local resolution’ Ask the Trust to consider if further local resolution is an option Request the case file for screening assessment Having assessed the case file, decide not to investigate further Having assessed the case file, appoint an Investigating Officer to carry out a review ‘on paper’

3. Number of Complaints Received

The Trust received a total of 262 formal complaints which represents a 6.5% increase on the total of 246 for 2011/2012 (Chart 1). The Patient Advice Liaison Service and Complaints Team have been integrated to enable increased choice on how to take forward concerns and complaints. For the last seven months of the year there was a decreasing trend in the number of complaints.

The Trust was pleased to receive and record over 1100 letters of compliment during the year.

The total number of patients treated in the period 1st April 2012 to 31st March 2013 showed a 1% increase on the previous year.

Chart 1

A number of factors have been identified as contributing to the increase;

Winter bed pressures and the need to open extra capacity to meet the demand for beds. A refurbishment programme which resulted in wards being closed and service disruption.

All complaints received were acknowledged within three working days.

4. Number of Complaints Resolved Within an Agreed Timescale

The Trust performance for resolving complaints within the timescale agreed with complainants improved this year. An average of 79% up from 61% was achieved in 2011/2012. The delays in responding were caused by the complexity of the case and prolonged investigation time.

Improving the quality and ability of staff to respond effectively within agreed timescales will be a key priority for the Trust in 2013. The Trust plans to review the complaints management process. Further training and education will take place to enhance the investigation process and to ensure lessons learned are translated into practice.

5. Nature of Complaints Received

Complaints data enables the Trust to determine if there are any trends in subject matter, location or personnel. The reporting of complaints has been developed over the past year to provide a more in-depth overview by ward and department within each Division.

The main themes of complaints related to medical treatment, nursing care, and communication. (Chart 2). Although the percentage of complaints linked to communication and medical treatment shows an increase on the previous year, the actual numbers of recorded complaints for each theme has decreased since 2011/2012. (Table 1)

An analysis of complaints is undertaken across the Trust each month and monitored by Trust at the Divisional Governance Meetings.

Chart 2

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April

Jun

Aug Oct Dec Dec Feb05

10152025303540

The number of formal complaint recieved over the past two years

1st April 2011 - 31st March 20121st April 2012 - 31st March 2013

Axis Title

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Complaints are often complex involving one or more concern. As you can see in table 1 people often introduce several themes into a complaint.

Table 1

Themes of complaints over the last 3 years

Theme2012/1

32011/1

22010/1

1Medical Treatment 120 302 197

Attitude 37 94 67Medication 39 90 16

Communication 105 266 182Nursing care 78 192 52

Discharge 36 74 70Dignity 12 28 53

Diagnosis 27 74 132

25%

8%

8%

22%

16%

7%

2% 6%6%

0%

Top 10 categories of complaints receivedMedical TreatmentAttitudeMedication CommunicationNursing careDischargeDignityDiagnosisDelay appontment/treatmentPersonal belonging

Delay appointment/treatme

nt 30 102 62Personal belonging 2 1 8

Environment 3 5 4Hotel Services 1 1 0Documentation 1 1 2

Theme Total 491 1230 845Complaint Total 262 246 182

Chart 3

The Clinical Services and Planned Care Divisions are responsible for outpatients and patients who come into hospital for booked operations, procedures and treatment. The Planned Care Division also treat patients who require emergency surgery. The Emergency Division is responsible for patients admitted without appointment and generally needing priority treatment.

The Emergency Division which is the largest Division and has the highest patient numbers continues to receive the majority of the Trusts formal complaints. There were 13,966 emergency admissions and 50,947 emergency department attendances in 2012/13, and 155 complaints. (Chart 3).

6. Number of Complaints Upheld/Partially Upheld

The decision to uphold or partially uphold a complaint is made following an investigation. If the complaint is found to be justified due to a failure to deliver an appropriate standard of care then the complaint will be upheld. If most elements are found not to be justified when a complaint has several issues raised, it is recorded as partially upheld even if one element is upheld.

Across all areas a total of 32% of the complaints received were upheld following an investigation. This is a much improved figure on 2011/2012 total of 49%.

7. Parliamentary and Health Service Ombudsman

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Emer-gency

57%

Planned Care 37%

Clinical Services 7%

Complaints received by Division

The Ombudsman received 13 referrals following complaints to us during the year. The Ombudsman has notified the Trust that it would be investigating one of these complaints and the outcome for this one has been confirmed as “partly upheld”.

The Ombudsman has confirmed that 10 complaints would not be investigated by themselves and no further actions or recommendations were made therefore these are considered not to be upheld. At the time of publishing this report, there are two active cases with the Ombudsman and notification is still awaited on these cases.

The annual NHS Complaint Handling report was published in October 2012 by the Parliamentary and Health Service Ombudsman. During 2013/14 the Ombudsman will be investigating every complaint referred to them.

The Trust continues to cooperate with the Ombudsman when required.

8. External Monitoring - Care Quality Commission (CQC) Review

The CQC’s Outcome 17 “People should have their complaints listened to and acted on properly” has not been reviewed in the past 12 months by the CQC. The Trust was meeting this standard when last reviewed by the CQC in January 2011. Since this date no concerns have been raised by the CQC regarding the Trust’s management of complaints.

9. Learning by Experience

Learning and improvement actions identified from complaints are logged to ensure that any recommendations are implemented. As a means of monitoring, a summary of the lessons learned is reviewed monthly by the Trust at the Divisional Governance Meetings.

The table below highlights a selection of some of the lessons learned from complaints over the past year.

What our patients said What we didA patient felt that the administration team were unhelpful when they contacted the hospital to seek information about an appointment and results.

Reception staff involved have completed customer service training to improve patient experience.

The care and information a mother received when she brought her child to the hospital for emergency treatment was not good enough.

The Trust’s specialist pediatricians have developed a protocol to ensure that a generic treatment will automatically be started whilst a patient is waiting for the definitive diagnosis.

A “higher risk’ patient criteria” has been developed. Out of working hours arrangements have been strengthened in partnership with the Pediatric Team in Bristol ensure our procedures are reflective of their current practice.

A husband wrote to the Trust to raise concerns about the care his wife received from the Orthopaedic Team. His wife was an elderly lady with memory loss.

To improve care, the Orthopedic department has been part of a national project to raise standards for the over 65’s with memory impairment.

A patient was unhappy that he was told that he was unable to take his carer into the cubicle to help him take his boot off for an MRI scan.

The appointment letter has been reviewed to give clarification to patients on the process if they are accompanied for a scan.

A patient was unhappy with the planning around their discharge home from hospital.Information is not being passed to GPs in a timely way to support ongoing care.

Procedural changes are taking place both in the ward affected and across the hospital to make discharge a safer and more supportive process for patients.

New system being considered that will allow the hospital to send discharge summaries to GP surgeries without depending on paper reports. They will be available to GPs the same day as discharge home.

A patient was in pain and suffered unnecessarily following an operation. Regular chronic pain medication was not prescribed.

Improvements have been made to the patient observation charts so that persistent pain can be seen as a trend. Pain assessment and management is now part of the Patient Assurance Framework to ensure that patients receive appropriate analgesia.

The process for communicating with patients and ensuring their needs are met at busy times in the Emergency Department needed to be reviewed.

The Emergency Department team has instigated regular checks of all patients when the department is full. This will ensure all patients are checked regularly, their observations taken, drinks offered where appropriate and ensure patients are comfortable and pain free.

Not all medication prescribed by the hospital clinicians can be administered by the community nurse in the dose or frequency required.

This was reviewed with community partners to align both our approaches.

10. Satisfaction Surveys

Where appropriate, complainants are sent a satisfaction survey to ask them about their experiences of raising a complaint in our hospital. 47 people (18%) returned a completed survey. The responses suggest that the Trust is good at providing information on how to make a complaint and writing responses that are clear and easy to understand. The key findings of survey were:

69% said it was it easy to find out about our complaint process. 53% said that all or most of the points raised in the complaint had been investigated. 82% said the response was very or mostly clear and easy to understand. 14% felt that the Trust will make changes as a result of the complaint

Overall the results were disappointing in respect of confidence that the Trust will make changes as a result of a complaint being raised and also that people do not feel that all their points of concern have been satisfactorily answered. The results of the survey support the decision by the Trust to review and revise the management of complaints in 2013 and the plan to publicise changes made on the Trust website.

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11. Complaints Training

Over the past 12 months, sessions have been delivered each month to staff as part of the statutory mandatory induction training; “Treating patients with dignity and respect avoid complaints”.

In addition training has supported all those involved in writing complaint responses called Apologies, explanations and complaints.

12. Policy

The Trust’s Complaints Policy was reviewed in January 2013 to ensure that the management of complaints continues to be in line with the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009.

13. Staffing

The Patient Advice and Liaison Service (PALS) and Complaints team have been working together for the past 12 months to handle concerns raised through the team. The aim of the team is to deal with concerns as expediently as possible and to the satisfaction of the complainant. By involving staff as soon as a concern is raised it is hoped to have a positive impact on reducing the number of complaints that need to be dealt with as formal complaints. There is evidence that this way of working is having a positive impact on the number of formal complaints.

14. The Patients’ Council

In the establishment of the Patient’s Council the Trust sought to recruit people who had complained about our services. The Patients Council, an independent Patient Group which has a seat at the Trust Board, has been formed to provide a critical challenge to the Trust to improve services for patients.

A Patient Experience strategy ‘Listening Hearing Learning’ has been developed and has been led by the Patients Council. The Strategy provides a direction for the Trust to engage increasingly with patients, to learn from their experiences and to improve services where possible. This strategy is based on the following values:

Continuous Improvement

Always working together

Respect for every individual

Excellence in everything we do

In delivering the strategy, the Trust will embed the 6 elements of the national nursing strategy, ‘Compassion in Care’. Six core objectives have been identified and milestones have been defined to be achieved over the coming months.

15. Summary of Key Achievements

Integrating the PALS and Complaints team to offer people choice in how concerns and complaints and for the last seven months of the year there was a decreasing trend in the number of complaints received.

The Trust performance for resolving complaints within the timescale agreed with complainants improved this year

Formation of the Patients Council, to become a critical challenge to the Trust to improve services for patients.

Complainants feel that the Trust is good at providing information on how to make a complaint and writing responses that are clear and easy to understand.

16. Future Plans

The Trust will continue to be proactive in its management of complaints. Focus on improving the patient experience will continue to be a priority for the Trust. This will be achieved by the triangulation of all patient feedback, including complaints giving assurance that the Trust has a single, joined-up view of patient experience from various sources.

The Trust will:

Work with the Patients Council on the milestones defined in the Listening Hearing and Learning Strategy.

Review and restructure the PALS and Complaints Team.

Review and revise its complaints management process and put in place training for key staff.

Continuously invite those who have concerns and complaints to meet with relevant staff to ensure their concerns are listened to, heard and acted upon.

The future plans demonstrate the Trust is committed to improve its performance in the areas highlighted by the Report of the Mid Staffordshire NHS Foundation Trust Public Enquiry Chaired by Robert Francis QC published in February 2013:

1. Action from complaints is effective in improving the patient experience.2. The experiences of patients rather than data are used as a response to concerns.3. Listening more effectively to patients. 4. More transparency in feedback to patients.5. Fostering a culture of openness and insight.

Our aim is to ensure that patient experience is improved and that we continue to reduce the number of formal complaints received by the Trust.

This report was written by Suzanne Blackmore Complaints and PPI Manager

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