customer relations performance report · trust board – 2 august 2016 incorporating community...

Northern Devon Healthcare NHS Trust Trust Board – 2 August 2016 Incorporating community services in Exeter, Mid and East Devon

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CUSTOMER RELATIONS PERFORMANCE REPORT

The Trust’s Customer Relations department manages the Patient Advice and Liaison Service (PALS) and the statutory complaints function, both of which support patients or service users in raising issues of concern or dissatisfaction. Responses to dissatisfaction can be provided more formally via a written response or more informally via a local response by a service manager or local resolution meeting in line with an individual’s wishes. The purpose of this report is to appraise the Board of complaints and PALS activity and details of any emerging trends. The established key performance indicators (KPI’s) used within the Trust have been applied within this report to benchmark 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 April – 30 June 2016, 79 issues were received, which is slight increase on the activity for Q4 (76). This section has been RAG rated as green to reflect the small increase in activity level, which is currently below the 10% increase threshold. Of the 79 issues received in this quarter, 7 were re-opened complaints, equating to 9% of activity. This is a slight decrease from the 10% seen in Q4, and this performance indicator has continued to decrease from the 25% seen in Q2 of 2015/16, indicating the quality of our complaint responses have significantly improved as a result of the increased support from our Customer Relations team to the operational directorates in respect to complaint investigations and responses. The graph below shows the number of complaints received in this reporting period broken down by financial quarters, and the table below shows the quarterly breakdown by directorate, which has been kept under the old directorate operational structure for 2015/16 reporting. To assist with the monitoring of investigation quality, 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 period 1 April 2015 - 30 June 2016


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9 complaints have been received cumulatively within the year for Multiple Directorates and these have involved the following directorates:

Planned Care and Surgery (9)

Unscheduled Care (7)

Health and Social Care (3)

Facilities (1)

1.1. Local Resolution Meetings During the period April - June 2016, 17 local resolution (face to face) meetings took place. An increase in the number of meetings has been seen this reporting period.

2013/ 2014

2014/ 2015

2015/ 2016

Apr-June 2016

July-Sept 2016

Oct – Dec 2016

Jan – March 2017

Accumulative total 2016/17

No of Meetings undertaken

83 84 82 17

17

It is recognise the amount of time and commitment our clinical and operational staff invest into meetings can be significant, which is greatly appreciated as there are clear benefits of holding such meetings to discuss issues in an open and transparent way. The benefits can be seen individually by a patient/service user or staff member, operationally by the service managers and/or clinical leads who attend the meetings and organisationally by the low number of re-opened complaints and Parliamentary and Health Service Ombudsman referrals.

April - June

2016

July - Sept

2016

Oct - Dec

2016

Jan - April

2017 Total

Overall Complaints activity 79 0 0 0 79

Planned Care and Surgery 21 0 0 0 21

Unscheduled Care 24 0 0 0 24

Community Hospital 3 0 0 0 3

Health & Social Care 12 0 0 0 12

Specialist Services 5 0 0 0 5

Director of Facilities 2 0 0 0 2

Medical Director 0 0 0 0 0

Director of Nursing 1 0 0 0 1

Director of Finance 0 0 0 0 0

Director of HR 1 0 0 0 1

Director of Strategy and Transformation 1 0 0 0 1

Multiple Directorates 9 0 0 0 9


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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 directorate can be seen at Appendix A on page 10. 2.1 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 88% of complaints were acknowledged within 3 working days. Analysis of this performance indicator shows a number of complaints that breached the 3 day acknowledgement were received in community settings and the length of time it took for them to be received by the Customer Relations Team and formally acknowledged was outside the timeframe. A reminder has been given to community teams of the requirement to acknowledge all complaints within three working days and the importance of forwarding any correspondence onto the customer relations team in a timely way, or seek advice if the timescale is imminent. 2.2 Complaints performance During the period 94% of complaints were responded to within the timeframe agreed at the outset of the complaint, or within an agreed extended timescale. This performance met the Trust’s expectations for this key performance indicator. 2.3 Complaints investigation timeliness During the period 78% of complaint investigations were returned to the Customer Relations department within the allocated timeframe. Whilst this has improved slightly on the previous quarters data, it still remains below the Trust’s accepted threshold and work therefore continues to be undertaken to improve this situation. This is believed to be as a result of increased involvement of the Customer Relations team in the management of individual complaints and more collaboration between the team and the operational/clinical teams. 2.4 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. The Trust saw a gradual increase in the number of re-opened complaints in the first two quarters of 2015/16 and in the most current quarter this has reduced significantly, and has been attributed to the continuation of local resolution meetings as a way to resolve issues face to face and the increased collaboration of between operational teams and the customer relations team.


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The following two graphs show the number of re-opened cases this financial year by Directorate and service area.

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Breakdown of re-opened complaints by Directorate 1 April 2016 -30 June 2016

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ContinuingHealthcare

HR Policies andprocedures

Physiotherapy Radiology Security Urology

Breakdown of re-opened complaints by Directorate 1 April 2016 -30 June 2016


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2.5 Ombudsman referrals Within the reporting period, one new Ombudsman referral was received, which related to care provided by the medical team within the Unscheduled Care directorate. One Ombudsman case was closed within the period, and related to care provided by the medical team within the Unscheduled Care directorate. The Ombudsman upheld this complaint and requested the Trust pay £5000 to the family in recognition of the injustice they experienced from the service failings identified within their report. A detailed action plan was created outlining service improvements in relation to increased clinic capacity and improved access to electronic records.

3. Organisational Learning

1.2. Outcomes and Remedial Actions from closed complaints

During the financial year to date, 81 complaints have been closed following investigation. Examples of remedial actions undertaken can be seen below.

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

The Divisional Nurse for Planned Care & Surgery will share a patient’s experience anonymously with all Ward Managers on the surgical wards and Surgical Sisters at the team meeting. They will highlight the importance of contacting the liaison nurse when a patient has a purple sticker to flag the patient is under the care of the Oncology service and awareness of purple sticker will be undertaken within appropriate forums in the Unscheduled Care directorate.

The Divisional Nurse for Planned Care & Surgery will speak with Ward Mangers to discuss medication concerns that arose from a complaint

A Consultant in Emergency Care has presented a power point presentation at the

emergency department (ED) clinical governance meeting to include slides addressing the differences between the information from the ED notes and the time line provided by a patient, highlighting the significances for discussion, reflection and learning.

Staff have been reminded to always be courteous and respectful to patients and/or relatives that attend the emergency department

Clarification was sought from an agency who provide temporary staff to work within the Rapid Response Service and Hospital at Home (H@H) service surrounding the level of training they receive. Assurance was sought from the agency that before allowing the staff member to conduct any Rapid Response or H@H shifts they have to prove to the Manager that they are able to work under their own initiative, able to provide a high level of care with minimal information, able to identify risks and know how to report these risks, able to work under pressure and cope with short notice changes whilst still remaining calm and professional, alongside established competences with medication

A ward manager discussed with their staff what patients should be offered in terms of food and fluids, who are recognised to be coming to the end of their life following a relatives experience


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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 within the period. It should be noted that these two graphs do not correlate.

Communication20%

Clinical Care and Treatment

37%

Attitude of staff12%

Access to Clinical Services 16%

Discharge arrangements

4%

Top 5 subjects for complaints received between 1 April 2016 - 30 June 2016

Poor nursing/midwifery care

6%

Concerns surrounding

diagnosis6%

Dissmissive behaviour

6%

Delay in daignosis5%

Delay at the time of treatment/care

5%

Top 5 sub-subjects for complaints received between 1 April 2016 - 30 June 2016


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6. Trend Monitoring

Difficulty in contacting the Clinical Management Centre (CMC) A trend was noticed during the reporting period January – March 2014 (Q4 2103/14) for the number of contacts made with the PALS team surrounding difficulties patients have experienced in contacting the CMC. The Planned Care and Surgery directorate are monitoring capacity within the CMC team and additional resources were implemented to assist with this operational situation. This trend is continuing to be monitored through the graph below.

Continuing Healthcare (CHC) Funding A trend has been emerging through PALS and complaints surrounding Continuing Healthcare (CHC) assessments. The graph below shows a breakdown of activity by quarter and this is continuing to be monitored by the Operations directorate and CHC team. Issues of concern can relate to the outcome of an assessed need, considerations from relatives about a lack of involvement in the process, and the timeliness in which the assessment is completed. In relation to the latter, the Trust has undertaken significant work to address both capacity issues and quality issues through a quality improvement initiative. This has included a training programme, structural re-organisation of the central CHC team and an improved internal quality assurance review process to verify assessments prior to a final review and ratification by the Clinical Commissioning Group.

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139 135

69

48

53

114

88

115

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68

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Apr -June2013

July -Sept2013

Oct -Nov2013

Jan -March2014

Apr -June2014

July -Sept2014

Oct - Dec2014

Jan -March2015

April -June2015

July -Sept2015

Oct - Dec2015

Jan -March2016

Apr-June2016

Activity levels surrounding difficulties experienced in contacting CMC by quarter for 2013/14, 2014/15, 2015/16, and Q1 2016/17

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Jan - March2015

April - June2015

July - Sept2015

Oct - Dec2015

Jan - March2016

Apr-June2016

Activity levels surrounding Continuing Healthcare (CHC) by quarter for 2014/15, 2015/16, and Q1 2016/17


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7. PALS activity

There were 769 PALS enquiries received within the reporting period, which is a static position from the 764 contacts received from 1 January 2016 – 31 March 2016. A breakdown in 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 by Directorate PALS by Subject matter

Apr-June

2016

July - Sept

2016

Oct - Dec

2016

Jan - Mar

2017 YtD

Planned Care and Surgery 329 0 0 0 329

Unscheduled Care 328 0 0 0 328

Community Hospital 1 0 0 0 1

Health & Social Care 19 0 0 0 19

Specialist Services 11 0 0 0 11

Director of Facilities 42 0 0 0 42

Medical Director 0 0 0 0 0

Director of Nursing 29 0 0 0 29

Director of Finance 2 0 0 0 2

Director of HR 2 0 0 0 2

Strategy and Transformation 4 0 0 0 4

Trust wide 2 0 0 0 2

Totals: 769 0 0 0 769

Apr-June

2016

July - Sept

2016

Oct - Dec

2016

Jan - Mar

2017

Accumulative

total 2015-16

Access to Services - Clinical 251 0 0 0 251

Access to Services - Physical 14 0 0 0 14

Admission arrangements 3 0 0 0 3

Attitude of staff 30 0 0 0 30

Benefits 0 0 0 0 0

Bereavement 1 0 0 0 1

Clinical Care and Treatment 49 0 0 0 49

Communication 133 0 0 0 133

Compliments 2 0 0 0 2

Confidentiality issues 4 0 0 0 4

Discharge arrangements 16 0 0 0 16

Equality and Diversity 0 0 0 0 0

Quality of Facilities 3 0 0 0 3

Hotel Services 2 0 0 0 2

Information Provision 224 0 0 0 224

Medical Records 22 0 0 0 22

Patient's Property 10 0 0 0 10

Privacy and Dignity 1 0 0 0 1

Security 1 0 0 0 1

Transport 3 0 0 0 3

Totals 769 0 0 0 769


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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 enquiries for Clinical Care and Treatment

Poor medical care 14 Drug/medication errors - Surgical group 1

Poor unexpected outcome 10 Injury through treatment - Surgical group 1

Delay in obtaining results 6 Lack of empathy/ caring 1

Delay in obtaining medication 3 Poor Allied Health Professional (AHP) Care 1

Failure to refer on to another service 3 Slips, Trips & Falls 1

Poor nursing/ midwifery care 3 Surgical error 1

Failure diagnosis/ misdiagnosis 2 Cancelled operation 1

Delay in clinical diagnosis 1 Totals: 49

Breakdown of enquiries for Information Provision

Information leaflets 184

PAS (Patient Adminstration System) enquiry 16

Ward enquiry 11

Information on how to complain 9

Other 4

Totals: 224

Breakdown of enquiries for Communication

Communication to patients, parents or carers 127

Communication between staff regarding patients 3

Interpreting services 2

Other 1

Totals: 133

Breakdown of enquiries for Access to Clinical Services

Difficulty contacting department by phone 122

Length of wait for outpatient 45

Service transferred 17

Length of wait for surgery 14

Cancelled Clinic 9

Cancelled operation 8

Errors booking outpatients 8

Difficulty booking appointment 7

Cancellation of OPD 7

Waiting time A&E 4

Delay at time of treatment or care 3

Failure to book follow up 2

Cancellation on inpatient appointment 1

Lack of information on waiting times 1

Repeated cancellation of appointments 1

Short notice changes 1

Other 1

Totals: 251


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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 Within the statutory complaints regulations there is a requirement to acknowledge all complaints with three working days. The table below details the Trust’s performance and action has been taken to address the areas where performance was below the threshold, as identified in section 2.1 on page three.

Complaints Response Performance The table below shows the Trust’s performance in responding to complaints either within the agreed timescale or an agreed extension.

April -

June 2016

July- Sept

2016

Oct- Dec

2016

Jan- March

2017

Overall acknowledgement performance 88% 0% 0% 0%

Planned Care and Surgery 82% 0% 0% 0%

Unscheduled Care 81% 0% 0% 0%

Community Hospital 33% 0% 0% 0%

Health & Social Care 100% 0% 0% 0%

Specialist Services 100% 0% 0% 0%

Director of Facilities 100% 0% 0% 0%

Medical Director n/a 0% 0% 0%

Director of Nursing n/a 0% 0% 0%

Director of Finance n/a 0% 0% 0%

Director of HR 100% 0% 0% 0%

Director of Strategy and Transformation 100% 0% 0% 0%

Multiple Directorates 100% 0% 0% 0%

April -

June 2016

July- Sept

2016

Oct- Dec

2016

Jan- March

2017

Complaint response performance 94% 0% 0% 0%






Director of Facilities n/a 0% 0% 0%


Director of Nursing n/a 0% 0% 0%


Director of HR n/a 0% 0% 0%

Director of Strategy and Transformation n/a 0% 0% 0%



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Timeliness of complaint investigations The table below details the Trust’s performance in relation to investigations being returned within the requested timeframe. Work continues with the directorate teams to bring compliance of this key performance indicator up to the required threshold and a marked improvement of 15 % has been seen since the last reporting period (63%).

April -

June 2016

July- Sept

2016

Oct- Dec

2016

Jan- March

2017

Complaint investigation response performance 78% 0% 0% 0%






Director of Facilities 100% 0% 0% 0%


Director of Nursing 100% 0% 0% 0%


Director of HR n/a 0% 0% 0%

Director of Strategy and Transformation 100% 0% 0% 0%



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Appendix B - Ombudsman Complaints During the Quarter 4, one new request was received from the Ombudsman and one case was closed. Details of all the current open Ombudsman cases this financial year are below.

Directorate Details of complaint Status Date

received

8462 – Unscheduled

Care

The complainant is concerned about the care and treatment

their late mother received when she was admitted to

hospital where she died and communication with staff

This complaint is currently being reviewed by the Ombudsman and we are awaiting

further instruction. 20 April 2016

5004 – Unscheduled

Care

The complainant is concerned about the care and treatment

their late son received from the Neurology service following a

24 hour ECG.

The complaint was Upheld and the Ombudsman considered there were service failings. They requested a

payment of £5000 was made to the family for the injustice they experienced and an action plan was issued to the family, the

Ombudsman, CQC and the Trust Development Agency (TDA – now NHS

Improving).

Closed: 10 June 2016

Received: 29 June 2015

Details of current OPEN Ombudsman cases

Directorate Details of complaint Status Date

received 8462 –

Unscheduled Care

See above See above 20 April 2016

7759 – CSDU –

Health and Social Care

The complainant is concerned about end of life care and

treatment provided to a loved one

This complaint is currently being reviewed by the Ombudsman and we are awaiting

further instruction. 8 March 2016

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