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APPENDIX 2

Patient & Carer Experience Q3 Board Report

1. Introduction

This is the third quarterly report for patient experience which aims to triangulate patient feedback across the organisation, encompassing information from complaints, PALS and the Friends and Family test to give an indication of the quality of services from a patient/carer perspective and where improvements may be required. Since quarter two the Patient & Carer Experience Strategy has been drafted and circulated for comments, this will be consulted on and finalised ready for submission to the March Board.

Formal Complaints 2.1 Formal Complaints Received

During Quarter 3, 57 contacts were received by the Complaints Department. 48 became formal complaints. This is showing a steady increase over the last 3 quarters.

2.2 Total Complaints (responded to)

During quarter 3 52 complaints were responded to (this included response to complaints received in previous quarter). The graph below depicts the trend for the year to date.

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Of the complaints responded to in the quarter, 2 complainants to date have indicated they are dissatisfied with the original response from the Trust.

Some complainants are not satisfied with the outcome of our initial investigations and in this situation the complaint will be re-opened, a further meeting held and further investigation if required. In Quarter 1, 12.5% of complainants were not happy with the initial response, this fell to 10.7% in Quarter 2, and again decreased to 4.2% in Quarter 3 A main factor for the decrease of dissatisfied complainants is due to the increasing standard of the complaint letter responses. 2.3 Response Times The Trust aims to respond to all formal complaints within 25 working days; although the complaints regulations no longer stipulate a timescale. The Trust standard is to ensure all complaints are responded to within the agreed timescale.

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Of the 15 complaints that took over 25 days to respond to the complainant (29%), this was due to late or inadequate investigations being submitted to the Complaints department for the response to be drafted. Training dates have been set for Q4 to further develop staff skills in responding to complaints

This report will be updated to show the response times across the quarter, eventually giving a picture of response times over the past 12 months. The number of complaints responded to under in 25 working days has increased in Quarter 3

2.4 Top Categories for Formal Complaints received (2015/16 accumulative by

quarter)

Of the 48 formal complaints responded to in Q1, 107 separate issues were covered. In Q2, 28 formal complaints were responded to covering 79 separate issues, and Q3 had 83 separate issues for the 52 formal complaints received. This figure is due to single complaints containing multiple issues. Of the categories recorded, the top categories consist of issues raised 3 times or more. These categories are detailed below.

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2.5 Comparison with Previous Years (year to date)

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Please note categories have changed for 2015/16 so no data is recorded for conflicting information in previous years as this was recorded under communication. It should be noted that communication is to be included in staff complaints training in Quarter 4

2.6 High level Themes

Of the main high level subject codes, for Q3, the top 5 areas are as follows;.

A new area of ‘Trust Admin/policy/procedures’ moved into the top categories in Quarter 3. This includes complaints received under subjects including

Access to health records

Policy decision

Visiting time arrangements

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The graph below shows these top primary subject codes compared over by quarter over the current year

All the primary subject codes relate to a number of sub-subject codes covering a wide variety of issues in the main area. The codes relate to the issues raised rather than complaints upheld. The column for all other categories includes areas

Admissions and discharge (4)

Access to treatment and drugs (4)

Clinical treatment (1)

Facilities (2)

Other – failure to refusal to visit patient at home (2)

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2.7 Complaint Outcomes

The graph above shows the formal complaints closed each quarter. Upheld complaints are those that when investigated, it has found through investigation that the majority or all of issues raised were well founded; partly upheld complaints are where some of the issues raised were well founded and not upheld complaints are where the issues raised could not be substantiated through investigation. From those complaint areas upheld, these are followed up by an action plan developed by the investigating manager. The complaints department is currently collating a table of all current and outstanding action plans by Care Group which will, working alongside the Care Group, incorporated into the Organisational Learning plan to be monitored and tracked through the Patient & Carer Experience Group and presented to QPaS quarterly. 2.8 Monitoring of Complaints Actions Of the 52 formal complaints responded to in Q3, we have received action plans for 43 of these, 12 had no actions identified and there are 9 action plans outstanding, a new process is being developed with the care groups for the development, sign off and management of action pans. This will be in place for the 1 March 2016 following the training. Below are some examples of the learning identified from complaints; other actions identified were patient specific and therefore not included

Secure Services

A review of the way in which external appointments for medical treatments are organised by Swale Ward has been undertaken. A new procedure is now in place whereby all appointments away from the hospital are scrutinised within the team meeting during the week before. All arrangements for staff escort and vehicle bookings are checked.

Psypher

Improve communications with family members and carers. Following referral to Psypher Care Co-ordinator and one of Psypher’s family intervention team to meet

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with client's family and carers to provide education re patient’s condition and what the team can offer them and the patient.

To ensure that the patient and their family are provided with written information regarding their condition and what treatments are available, including information about medication.

To ensure that patients and their family are given copies of care plans and safety plans. In cases where the patient has given consent for information to be shared with their family but the patient is disputing the care plan or safety plan, it should still be shared with family.

In all cases when a patient is being transferred to another staff member using CPA, the patient and family need to be informed as soon as possible and in a sensitive manner. A face to face transfer meeting should take place with patient, family and all workers involved.

When there are any safeguarding concerns and Social Services are also involved with Psypher patient, any issues should be communicated to the Social Services staff member. If there are issues about not being able to contact Social Services by telephone, the issues need to be communicated in writing to the Social Worker or Team Manager

CAMHS

Review and consider re-writing the part of the CBT clinic invitation letter regarding the choice to ‘opt out’ in order to make this option and its consequences clearer to patients.

To review and update the local Hull CAMHS Discharge Guidance and to include the responsibility practitioners have to offer to facilitate/support with accessing other services (or refer on) and not to rely on "self refer". Also to review guidance where a patient is not agreeing to the discharge.

Community Hospital

To review ambulance booking system on the ward and ensure we move to electronic system.

To review discharge processes and ensure that patients are not discharged from an appointment.

To develop a communication pro-forma to aid communication, when patients go to outpatients including any risks, mobility issues and medication issues.

Out of Hours GP Service

To ensure that any changes in clinical cover are communicated to members of staff and that patients are informed and alternative PCCs can be offered.

Podiatry

Training that patients must be kept onto Podiatry service with increased risk of Diabetes - foot problems such as verruca/callus on a pressure area will need treatment regularly

Physiotherapy

There is no Waiting List Standard Operating Procedure (SOP) in place for Community Physiotherapy Services. The Triage Guidelines for Community Physiotherapy Services require review to ensure the response is appropriate for all patient groups.

These are incorporated into the Organisational Learning Report (OLR) monitored monthly through ORMG and quarterly through the QPaS meeting. The key areas of ‘Communications’ and ‘Values and behaviours of staff’ have been identified as key areas for improvement in the draft ‘Patient and Carer Experience Strategy’ and improvements will be monitored by the Patient and Carer Experience group.

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3 Complaints by Care Group

3.1 Complaints received by Care Group

The above graph shows the complaints received by each care Group. This totals 47. There was also one complaint logged this quarter under Safeguarding which comes under Nursing and Service Delivery and therefore does not show in the above graph for Care Groups.

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3.2 Complaints responded to by Care Group

Again the graph above shows the division of the complaints responded to by Care Group. Out of the 52 formal complaints we have responded to in Quarter 3, 51 are included above and the last complaint is from the Nursing and Service Delivery as described in 3.1

The number of complaints received for each of the Care Groups over the past 3 quarters is as follows:- Increase in complaints received in Quarter 3

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Community & Older Peoples Care Group received 15% in Q1 which increased to 26% in Q2. Q3 is showing an increase again with 41% of the complaints received.

Decrease in complaints received in Quarter 3

Mental Health Care Group received 60% in Q1 which has decreased to 43% in Q2 and has again decreased slightly in Q3 to 41%

Although Childrens & LD Care Group complaints received increased from 11% in Q1 to 23% in Q2 it has again fallen back to 12% received in Q3

Specialist Services increased their complaints received in Q2 down to 8% from 14% in Q1 and this has reduced back down to 8% in Q3.

Due to the increase in the C&OPMH for the 3rd quarter running we have looked further to see which area of these care groups the increases are logged in: (see graph below)

In the C&OP Care Group 15 complaints were raised for the Community Services

This shows that the main increase for the C&OP care group is the Community Services area For the C&LD Care Group is from the CAHMS services

OOH GP/Nursing –

- Patient unhappy that Doctor did not provide a home visit and had been told to ring for an ambulance

- Patient unhappy at the time it took for a doctor to ring back - Patient unhappy that she had been given appointment time and Doctor not there

when she attended

Community

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- Patient unhappy with clinical treatment she had received

- Patient unhappy with personal comments made by member of staff

- Patient unhappy with delays encountered in receiving treatment

- Patient unhappy about attitude of member of staff

- complainant unhappy that reply to patients GP was sent to his patient

- patient unhappy with length of wait time between appointments

- complainant unhappy that note on referral form to contact daughter not taken

note of and patient visited whilst alone

- complainant unhappy that she had left message for staff to call and not

received call back

Community Hospitals

- Patient unhappy with mix up with patient transport

- Complainant unhappy about amount of time she had to wait for an

appointment

Older People

- complainant unhappy that his mother’s CPN was trying to make her go out

- complainant unhappy that tree branches and leaves had been falling into his

back garden from one of the units and making a mess

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3.3 Complaint response times by Care Group

The graph above shows response times by quarter for 2015/16. Year to date, the Trust has responded to 128 formal complaints; of these 86 (68%) were sent within the 25 working day timescale and the remaining 42 (32%) were late. The importance of responding within the 25 day timescale will be included in quarter 4 training.

3.4 Complaint outcomes by Care Group

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The complaint which does not show in the above graph, which was registered

through the Nursing and Service Delivery, was not upheld

4 Ombudsman

In Quarter 3, the Trust did not receive any requests for information; but two cases were closed as follows:-

1242 – Single Point of Access, East Riding/IAPT – The Ombudsman asked the Trust to

respond formally to the additional issues as a formal complaint; this has been completed.

1201 – Adult Mental Health, Inpatient/Community – Issues regarding assessment and treatment whilst as an inpatient and attitude of staff. This was considered by the Ombudsman and closed with no further actions for the Trust.

2.4 Complaints Key Messages

As part of the structure review the complaints team will be integrated with the patient & carer experience team to ensure that listening and responding to patient and carers concerns is at the core of our patient and carer experience strategy. For the first two quarters, the Trust has responded to 76 formal complaints, of these 28 responses (37%) were sent late. This has decreased in Quarter 3 to 29%. Late responses are predominately due to investigation paperwork being submitted late to the Complaints department and/or the investigations being inadequate. As described above the team are providing training across care groups to promote the importance of effective complaints management. During quarter 3 the Trust attended the new patchwide patient and carer experience forum and has met with Healthwatch and voluntary services across Hull & East Riding.

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The report now contains detailed information on complaints by care group, the team are now working with care groups to analyse the data to provide themed reports to the care groups from the 1 March 2017. This is a key priority for the patient and carer experience strategy to ensure learning.

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5 PALS (Patient Advice and Liaison Service)

During the period October – December (Quarter 3) the Trust has responded to 236 contacts

with the PALS service. Out of these contacts, 38 were referred to other Trusts (25%) as not

related to Humber. 56 were compliments (see below) of the remaining 142 the majority of

enquiries were regarding:

Unhappy with clinical treatment

discharge queries

unhappy about advice given about products ie continence pads

no physiotherapy available

not able to have leave from the unit

the correct dressings not available

the waiting times for services

manner and attitude of staff

cancellation of appointments

medical record queries

not been able to get through to the teams to make appointments

All contacts were dealt with effectively and as per Trust policy, in that the query is received

and passed to relevant team, the team leader or manager then contact the patient or carer to

attempt to resolve the issue. In the majority of cases the patient or carer is happy with the

outcome, if not then they are advised to contact the complaints team to make a formal

complaint.

PALS have been recorded under the following categories:-

Advice and information – Clinical

Advice and information – General

Appointments delay/cancel – outpatients

Assessment process

Attitude of Staff

Clinical Treatment

Comments or suggestions

Commissioning issue

Communication/information to patients

Communication/information to relatives/carers

Compliment

Information Governance

Information received advice

Information received from staff

Medical Records

Medication concerns

Patients privacy, dignity, respect and safety

Patient’s property and expenses

Policy and Commercial decisions of the Trust

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5.1 Total number of PALS Responses

The numbers of responses have risen significantly during the quarter.

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5.2 Total PALS recorded 2015/16 in categories

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4.3 Top themes for PALS 2015/16 comparison

2015/16 will increase over the year with the addition of each quarter’s data to give the full picture in

quarter 4 each year.

The top themes for 2015/16 above relate to 75% of all the calls taken regarding our Trust.

Compliments

It should be noted that the majority of the rise in PALS responses is attributable to compliments received, from 16 compliments received in Q1, 48 received in Q2 and 56 in Q3. Some examples are given below:-

Physiotherapy - "Just to say thank you very much for all the time, care and skills you have given to me. Together we have had a lot of success, more than expected"

Stroke Team - "A big thank you to the fantastic ladies of the stroke team. Kind regards"

Out of Hours GP Service - Compliment stated the OOH GP was very helpful and called back straight away and gave a time to visit the PCC. The OOH GP had been wonderful with the child and dealt with him quickly and were given great advice and a prescription.

Neighbourhood Care Service - "To all the many district nurses who have helped my father with his frequent catheter blockages. Thank you for your patience, efficiency and kindness"

Speech and Language Therapy - "Thank you for all you have done so far. (Patient's name) enjoys your sessions and in her own words tells us what she has done"

Admiral Nurses - "I can't believe over a month has gone by since I lost (patient's name). Thank you so much for the support you gave us and helped me to understand what was going on with him”.

Wheelchair Assessment Service – Patient telephoned to say thank you for her care when she had been seen in the clinic she said it was much appreciated.

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Dietetics - Caller wanted to compliment the member of staff he had seen, he said he had been easy to talk to and offered excellent advice.

Paediatric OT - Parent of the patient stated how efficient the service had been.

Learning Disability Service - "Thank you for always being there for (patient's name) and me over many years. We could never have coped without your constant help."

Older People’s Mental Health, Inpatient - "To everyone, thank you so much for your care and compassion was above and beyond. You cared for (patient's name) with tenderness and kindness and also cared for me. Many thanks"

Adult Mental Health, Inpatient - "I would just like to say that you are all wonderful people and thank you for trying to help me. I know you did your best. I really appreciate everything you have done for me and I will never forget you. You saved my life literally. I wouldn't be here if it wasn't for you so thank you from the bottom of my heart. You are all great at your job. I now know that you all do care about me and I will miss you and I will try not to come back this time. I love you all and thank you."

Rehabilitation Service - "I have made new friends here and I am leaving feeling more like myself. Hopefully I will get a job in the new year as a postal worker. I will miss everybody when I go, I have enjoyed my time here and all the help I got from staff. Good luck to everyone in the future. Thank you"

Secondary Mental Health Service – Patient emailed to thank the staff involved for a very positive experience.

Hull Memory Clinic - "Very welcoming-thank you for being so nice! Lovely place-quite unexpected. I am sure mum would be happy to re-visit."

Positive Assets - Letter received from a lady who had wanted to thank the team and in particular a member of staff for all their help and support over the last 4 years.

4.4 PALS Key Messages

This is the third report of this style, the data is starting to show the information over the current year. This will continue to be tracked each quarter to give a picture of the number of responses from the PALS department over the 12 month period. This will be compared year on year in future reports. The development of the PALS services is key to the patient voice volunteer programme described in section 2.9. Again in Quarter 3 over a quarter of all calls received (25%) are regarding other Trusts and need to be signposted on. Our next highest category this quarter is advice and information (general) which has tripled since quarter 2, closely followed by compliments received, staying in the top 3 categories.

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5 Friends and Family Test

This is not included in the current report as analysis for the Quarter 3 Family and Friends Test data

will not be complete until the end of January and therefore two quarters will be reported in quarter

4.

6 Patient Experience Summary The Trust has a robust system in place for handling complaints that meets the Health & Social Care Act requirements and whilst this is positive, the Trust is undertaking a review of the approach to complaints management to ensure that it is aligned with post Francis thinking and is encompassed within a strategy which lays out an approach to patient experience where feedback is used to continuously improve care. The improvements in data collection and analysis will support a wider understanding of complaints, supported by training for staff. The full Q3 report as presented to QPaS is available for Board members from s.hutchcroft @nhs.net