Number of Complaints and PALS enquiries received 90%

Northern Devon Healthcare NHS Trust Trust Board – 4 December 2018

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CUSTOMER RELATIONS PERFORMANCE REPORT As part of new key performance indicators being reported to the Trust Board and Executive team, the customer relations performance report has been revised. Complaints activity and report sections will now reflect the established KPI’s and all report sections will be traffic lighted to provide an overview of the status of the specific activity in line with the following thresholds:

Red 89.9% or less

Amber 90% - 94.9%

Green 95% or more

1. Complaints Activity

During the period 1 July – September 2018, 74 issues were received, which is an increase on the activity for Q1, 2018/19 (58). This section has been RAG rated as green to reflect the predicted cumulative annual activity to be lower than the previous financial year (255) based on this reported level. The graph below shows a breakdown of complaints and PALS activity by month for the financial year 2016/17 and 2017/18. The increase in PALS activity for the month of May 2017 was due to the launch of TrackCare.

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Number of Complaints and PALS enquiries received1 April 2016 - 30 September 2018

PALS

Complaints

Of the 74 issues received in this quarter, 9 were re-opened complaints, equating to 12% of activity, which is an increase on the Q1 2018/19 which was 5%. The number of reopened complaints within the current financial year equates to 9% and this trend will continue to be monitored. To assist with this monitoring, re-opened activity has been separately drawn out of the overall activity figures in the graph below.


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Complaints Activity by reporting period1 April 2015 - 30 September 2018

The table below provides a breakdown of complaints activity for the reporting period and cumulatively within the financial year by Division.

April - June

2018

July - Sept

2018

Oct - Dec

2018

Jan - April

2019 Total

Overall Complaints activity 58 74 0 0 132

Planned Care and Surgery - Surgery, Anaesthetics & Support Services 17 25 42

Unscheduled Care - Emergency Care 8 7 15

Unscheduled Care - Medicine 12 17 29

Unscheduled Care - Medicine - Acute Therapy 1 0 1

Unscheduled Care - Cancer Services 1 1 2

Unscheduled Care - Women's & Children's Mental Health Interface 11 6 17

Unscheduled Care - Health & Social Care 0 2 2

Unscheduled Care - Community Hospitals 1 0 1

Strategy and Development (including Specialist Services) 1 1 2

Director of Nursing, Quality & Workforce 0 1 1

Director of Operations 0 0 0

Director of Finance 0 0 0

Director of Facilities 1 0 1

Medical Director 0 0 0

IM&T 0 2 2

Multiple Directorates 5 12 17

The 5 complaints which were recorded as Multiple Directorates involve the following directorates:

Planned Care and Surgery (11)

Unscheduled Care – Medicine – Emergency Services (4)

Unscheduled Care – Medicine – General Medicine (3)

Unscheduled Care – Medicine – Acute therapy (3)

Unscheduled Care – Medicine – Women and Children’s (1)

Unscheduled Care – Medicine – Health and Social Care (1)

Director of Nursing Division (1)


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1.1. Risk Rating of complaints All complaints are risk rated according to their complexity and severity. The table below displays the reporting period’s data alongside the calendar year’s data. Those which are deemed as High usually relate to an incident being investigated in parallel as a SIRI.

2016/2017 2017/2018 April -

June 2018 Jul- Sept

2018 Oct - Dec

2018 Jan - Mar

2019 Total

Low 226 222 49 59 108

Minor 24 16 8 11 19

Medium 11 10 0 2 2

High 3 7 1 2 3

Total 264 255 58 74 0 0 132

1.2. Local Resolution Meetings During the period July - September 2018, 11 local resolution (face to face) meetings took place. An increase in the number of meetings has been seen this reporting period.

Apr– June 2018

July–Sept 2018

Oct – Dec 2018

Jan – March 2019

Accumulative total 2018/19

Accumulative total 2017/18

No of Meetings undertaken

10 11 21 38

2. Complaints Key Performance Indicators

There are set key performance indicators the Customer Relations team report on to meet both statutory and Trust requirements in the management of complaints. These KPI’s are monitored monthly by the Trust’s Executive team and our Commissioners, NEW Devon Clinical Commissioning Group. A breakdown of these KPI’s by Division can be seen at Appendix A on page 9 & 10. Acknowledgement All complaints are required to be acknowledged within 3 working days, in line with Trust policy and statutory legislation. The formal performance target is 80% set by our Commissioners and internally the team strives to acknowledge 95% of complaints within 3 working days. For the period 100% of complaints were acknowledged within 3 working days. Complaints performance During the period 97% of complaints were responded to within the timeframe agreed at the outset of the complaint, or within an agreed extended timescale. This performance has met the Clinical Commissioning Group’s expectations for this key performance indicator (95%). 2.1 Complaints investigation timeliness During the period 68% of complaint investigations were returned to the Customer Relations department within the allocated timeframe, which is a decrease on Q1 (71%) and Q4 (80%). This performance indicator still remains below the Trust’s and Clinical Commissioning Groups accepted threshold since these were introduced and work therefore needs to be revisited to improve this situation and prevent further deterioration of the decreasing percentage.


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2.2 Complaints investigation quality One indicator of investigation quality is the number of complainants that approach the Trust for a second time following a response to their original complaint. Sometimes complainants can engage a second time as they continue to have questions surrounding the care and treatment received, or the explanations have created additional questions; however on most occasions complainants are usually unhappy with the information they have been provided with.

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Planned Careand Surgery -

Surgery,Anaesthetics

& SupportServices

UnscheduledCare -

EmergencyCare

UnscheduledCare -

Medicine -Acute Therapy

UnscheduledCare -

Medicine

UnscheduledCare - Womenand Children's

Strategy andDevelopment

(includingSpecialistServices)

MultipleDirectorates

Director ofNursing,

Workforceand Quality

Breakdown of re-opened complaints by Divison1 April - 30 September 2018

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Breakdown of re-opened complaints by Speciality1 April - 30 September 2018


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2.3 Ombudsman referrals Within the reporting period, four new Ombudsman referrals were received involving multiple divisions and specialities. One related to concerns surrounding the clinical care and attitude of staff on Capener ward and the other case surrounded a patient’s care and treatment and wait in the emergency department and on KGV. Two Ombudsman cases were closed within the period and were Not Upheld. One was a multiple Divisional complaint and the other involved the ophthalmology team within the Planned Care Division.

3. Organisational Learning

1.3. Outcomes and Remedial Actions from closed complaints

During the financial year to date, 110 complaints have been closed following investigation. Examples of remedial actions undertaken in this reporting period can be seen below.

Learning and improved communication identified as a result of complaints this financial year:

Unscheduled care – Medicine - Care Manager of residential home raised concerns on behalf of their client following her 4 week in-patient stay on Capener ward. The Care Manager was unhappy with the nursing care provided together with the delayed diagnosis and discharge, particularly as she suffered with dementia. The ward manager agreed to discuss the need for a policy with regards to washing patients’ hair and to providing general patient care at a future Matrons’ meeting.

Women’s & Children’s - Patient raises concerns that the Midwifery Department failed to provide her with the correct form to entitle her to free prescriptions resulting in a fine from the NHS Authority of £71. Full reimbursement was made together with apology and learning. Changes to process now ensure all patients receive posted individual forms to reduce the risk of delaying or mislaying the forms. Training and the importance of maintaining new process with all midwives has been reiterated at the regular monthly team meeting.

Planned Care & Surgery - Patient concerned about patient privacy and dignity in the Surgical Assessment Unit within King George V ward as it is a mixed ward Patient also distressed by receiving a copy of the Discharge Letter which indicated she may be a cancer patient and she had to wait a further 8 days to see her consultant to receive her diagnosis and treatment plan. Apologies were given and department is undertaking a review of how they provide the service going forward, in order to ensure a similar situation does not reoccur.

Planned Care & Surgery - Patient's son raised concerns regarding the cancellation of his mother's hernia repair surgery as his mother was not assessed by an anaesthetist during her pre op assessment, which resulted in the cancelled surgery. Apologies given and travelling costs reimbursed. Changes to process for clinical anaesthetist pre-op review made.

Women’s & Children’s - Patient raised concerns about her midwifery care on Basset Ward at NDDH as she felt she was in labour and not listened to and staff refused to examine her resulting in her delivering her baby son in the corridor of Basset ward, without her husband being present due to him being sent home. Resolution meeting was held. Apologies given together with reflection and learning undertaken to remind to all midwives to escalate patient concerns, and discuss with labour ward co-ordinator at earliest opportunity.


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MULTI - Patient's daughter raised concerns regarding her father’s care and poor communication from staff as he suffered a fall on Lundy ward and fractured his neck of femur. Patient's health declined since admission to NDDH for bladder cancer surgery and sadly died. Family were not made aware that he had been diagnosed with vascular dementia. Family received apology and copies of SEA report. Learning identified to ensure confused patients are nursed in bay, not single rooms. Ensure enhanced observation paperwork completed and relevant parties are aware with request for 1-1 nursing care to be provided. Case discussed at matrons meeting

4. Quality of responses

5.1. Care Quality Commission Complaints

During the period no complaints were received by the Care Quality Commission (CQC).

5. Issues raised from complaints

Breakdown of complaints by the top 5 subject matters The following two pie charts identify the top 5 subject and sub-subject matters for the complaints received cumulatively within the financial year.

Length of wait for Outpatient appointment

5%

Communication to patients, parents or

carers 18%

Poor medical care

6%

Poor/unexpected outcome

8%

Delay in clinical review8%

Top 5 sub-subjects for complaints received between 1 April - 30 September 2018

Communication21%

Clinical Care and Treatment

50%

Attitude of staff11%

Access to Clinical Services 12%

Discharge arrangements6%

Top 5 subjects for complaints received between 1 April - 30 September 2018


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6. PALS activity

There were 835 PALS enquiries received within the reporting period, which is an increase from the 782 contacts received from 1 April – 30 June 2018 (Q1, 2018/19). A breakdown of enquiries can be seen below. 6.1. Summary of Main Themes of PALS The table below shows the number of PALS by subject matter and Directorate for the reporting period. PALS activity continues to be represented by acute services and there are low levels of activity within community services. It is recognised PALS issues within community services are often managed and resolved directly by staff and work is being undertaken with the teams to capture this information onto Datix. PALS enquiries by Division PALS enquiries by Subject matter

Apr-June

2018

July - Sept

2018

Oct - Dec

2018

Jan - Mar

2019 YtD

Planned Care and Surgery - Surgery, Anaesthetics & Support Services 368 414 782

Unscheduled Care - Emergency Care 25 21 46

Unscheduled Care - Medicine 235 229 464

Unscheduled Care - Medicine - Acute Therapy 47 55 102

Unscheduled Care - Cancer Services 10 9 19

Unscheduled Care - Women's & Children's Mental Health Interface 17 34 51

Unscheduled Care - Health & Social Care 8 9 17

Unscheduled Care - Community Hospitals 0 1 1

Strategy and Development (including Specialist Services) 7 13 20

Director of Nursing, Quality & Workforce 29 29 58

Director of Operations 0 0 0

Director of Finance 0 0 0

Director of Facilities 33 9 42

Medical Director 0 0 0

Trust wide 3 12 15

Totals: 782 835 0 0 1617

Apr-June

2018

July - Sept

2018

Oct - Dec

2018

Jan - Mar

2019

Accumulative

total 2018-17

Accumulative

total 2017-18

Access to Services - Clinical 286 320 606 1521

Access to Services - Physical 18 3 21 89

Admission arrangements 0 0 0 6

Attitude of staff 25 25 50 99

Benefits 0 0 0 0

Bereavement 1 3 4 4

Clinical Care and Treatment 36 33 69 180

Communication 217 227 444 881

Compliments 7 7 14 56

Confidentiality issues 2 3 5 3

Discharge arrangements 5 15 20 44

Equality and Diversity 1 0 1 0

Quality of Facilities 9 7 16 41

Hotel Services 2 1 3 8

Information Provision 161 172 333 780

Medical Records 5 10 15 54

Patient's Property 2 3 5 20

Privacy and Dignity 0 0 0 2

Security 1 0 1 0

Transport 4 6 10 50

Totals 782 835 0 0 1617 3838


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Information Provision is a core function of PALS and represents the information that is provided via the Information Centre. The tables below show a further breakdown of the top four issues raised via PALS, as highlighted in grey in the above table, by more detailed sub-subjects within that category. The breakdown is using quarter two data.

Breakdown of PALS enquries for Clinical Care and Treatment

Poor unexpected outcome 11 Delay in clinical diagnosis 2

Poor medical care 4 Injury through treatment 2

Delay in obtaining medication 3 Delay in obtaining results 1

Drug/medication errors 3 Failure diagnosis/ misdiagnosis 1

Poor nursing midwifery care 3 Poor AHP Care - Surgical group 1

Delay in clinical care review 2 Totals: 33

Breakdown of PALS enquiries surrounding Communication

Communication to patients, parents or carers 220

Communication between staff regarding patients 5

Corporate communications 1

Other 1

Totals: 227

Breakdown of PALS enquiries for Information Provision

Information leaflets 167

Information on how to complain 3

Clinical information inadequate 2

Totals: 172

Breakdown of PALS enquiries for Access to Services - Clinical

Difficulty contacting department by phone 190

Length of wait for outpatient 60

Length of wait for surgery 19

Cancellation of OPD 15

Errors booking outpatients 13

Cancelled operation 7

Delay at time of treatment or care 4

Difficulty booking appointment 4

Cancelled Clinic 3

Repeated cancellation of appointments 2

Failure to book follow up 1

Lack of information on waiting times 1

Length of wait for inpatient 1

Totals: 320


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Appendix A - Complaint Key Performance Indicators (KPI’s)

Red 89.9% or less

Amber 90% - 94.9%

Green 95% or more

Acknowledgement Performance

April - June

2018

July- Sept

2018

Oct- Dec

2018

Jan- March

2019

Overall acknowledgement performance 100% 100%

Planned Care and Surgery - Surgery, Anaesthetics & Support Services 100% 100%

Unscheduled Care - Emergency Care 100% 100%

Unscheduled Care - Medicine 100% 100%

Unscheduled Care - Medicine - Acute Therapy 100% n/a

Unscheduled Care - Cancer Services 100% 100%

Unscheduled Care - Women's & Children's Mental Health Interface 100% 100%

Unscheduled Care - Health & Social Care n/a 100%

Unscheduled Care - Community Hospitals 100% n/a

Strategy and Development (including Specialist Services) 100% 100%

Director of Nursing, Quality & Workforce n/a 100%

Director of Operations n/a n/a

Director of Finance n/a n/a

Director of Facilities 100% n/a

Medical Director n/a n/a

IM&T n/a 100%

Multiple Directorates 100% 100%

Complaints Response Performance

April - June

2018

July- Sept

2018

Oct- Dec

2018

Jan- March

2019

Complaint response performance to the Complainant 94% 97%




Unscheduled Care - Medicine - Acute Therapy 100% 100%



Unscheduled Care - Health & Social Care 0% 100%

Unscheduled Care - Community Hospitals n/a 100%

Strategy and Development (including Specialist Services) 100% n/a

Director of Nursing, Quality & Workforce n/a n/a





IM&T n/a 100%



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Timeliness of complaint investigations

April - June

2018

July- Sept

2018

Oct- Dec

2018

Jan- March

2019

Complaint investigation response performance 71% 68%




Unscheduled Care - Medicine - Acute Therapy 100% 100%



Unscheduled Care - Health & Social Care 0% 100%

Unscheduled Care - Community Hospitals n/a 0%

Strategy and Development (including Specialist Services) 67% n/a

Director of Nursing, Quality & Workforce n/a n/a





IM&T n/a 50%



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Appendix B - Ombudsman Complaints Within the reporting period, four new Ombudsman referrals were received. The Trust currently has seven cases subject to an Ombudsman review involving the Planned Care Division (3), Unscheduled Care – General Medicine (2) and Multiple Divisions (2). Two Ombudsman investigations were concluded within the period and both were Not Upheld by the Ombudsman. One was a multiple Divisional complaint and the other involved the ophthalmology team within the Planned Care Division.

Division Details of complaint Status Date

received

17609 – Planned

Care

The patient is unhappy with the delay with their hip replacement surgery being

undertaken. The patient has been informed there is a 12 month wait for the surgery and feels they have no choice

but to pay privately for the surgery, costing £13,000.

Information has been sent to the Ombudsman for their

consideration.

11 September 2018

17370 Unscheduled

care – General Medicine

The patient is concerned about the care and treatment they received by the

Rheumatology department since she 2016 when they moved to the area. The

patient is concerned they were never examined properly and is concerned

they are now being treated incorrectly


consideration.

22 August 2018

17314 - Unscheduled

care – General Medicine

The daughter of a patient remains unhappy about their mother’s care and

treatment whilst an inpatient.


consideration.

20 August 2018

17239 – Multi Divisional

The patient is concerned about conflicting information given by two

consultants in relation to whether their pain relates to their hip or back. The

patient is also concerned that physiotherapy exacerbated their back

and spine problems post-surgery.


consideration. 7 August 2018

16831 – Multiple Divisions

The daughter of a patient is concerned about their father’s clinical care and the

attitude of staff on Capener ward


consideration.

Received:

28 June 2018

15528 - Planned Care and Surgery

The patient is unhappy she was not seen in the eye clinic for 4 hours when

referred there by A&E as an emergency and by the time patient was seen the

scan room was closed. The patient has a detached retina which they consider may be due to the delays in receiving

treatment and is required to have operations annually.


consideration

Received:

27 February 2018

13976 – Planned Care and Surgery

The complainant is concerned about their husband’s cataract procedure which resulted in complications and

numerous appointments at both NDHT

and RD&E.

After receiving copies of the Trust’s complaint responses and

the patients records the Ombudsman is investigating the

complaint

Received:

27 November 2017


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15376 - Planned Care and Surgery

The patient is unhappy following a trabulectomy where the bleb was

massaged too rigorously bringing down his eye pressures. Patient underwent a further procedure as the stitches came loose, which patient feels was due to

over massage.


consideration.

After investigation the Ombudsman did not uphold any care issues related to the

Trust

Received:

13 February 2018

Closed:

28 August 2018

16826 – Multiple Divisions

The patient is concerned about the care and treatment and wait whilst in the

emergency department and subsequently on KGV


consideration.


Trust

Received:

27 June 2018

Closed:

23 August 2018

14605 – Planned Care and Surgery

The complainant is unhappy about the lengthy delay they experienced after

being placed on the waiting list for knee replacement surgery

This was a joint investigation with the RD&E. After

investigation the Ombudsman partially upheld this complaint against the RD&E care with a

£200 redress payment

Received:

9 October 2017

Closed:

10 June 2018

15623 – Medicine Division

The complainant is concerned there are many discrepancies between what they and the family witnessed in relation to care and what is documented in the

medical notes.

After investigation the Ombudsman has not upheld

the complaint.

Received:

6 March 2018

Closed:

10 June 2018

12442 – Health and Social Care

The complainant is unhappy with the way their late mother was treated with

regards to her inpatient stay, a Continuing Healthcare (CHC)

assessment, and during her stay at a residential home

This is a shared complaint with the local authority (Devon

County Council) re: the care home provision


Trust but upheld the local authority issues

Received:

8 June 2017

Closed:

16 April 2018

Documents

Number of Complaints and PALS enquiries received 90%