Building healthier communities

Patient Experience Quarterly Report 2019-2020

Quarter 3: 1st October 2019 to 31st December 2019

Created by the Leeds CCG Clinical Governance and Patient Experience Team

January 2020

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Introduction and purpose of the report

Leeds CCG is committed to delivering healthcare using an integrated approach with our local partners to improve not only the safety and effectiveness of care but the experience of care for patients and service users.

The patient experience framework describes how we commission quality care by listening, capturing and responding to feedback on experiences, views and opinions on a range of health and care services.

This report provides:

• An overview of patient experience intelligence by sector

• An overview of patient experience within Leeds health and care system

• An update from Leeds CCG Patient Insight & Experience Collaborative

• Ongoing developments

• To enable the CCG to understand ‘what people are telling us?’ a range of data from a number of patient experience sources needs to be collected, reviewed and analysed. This includes a number of text based feedback services and reports. Sources include Care Opinion posts (an online anonymous feedback forum), NHS Choices posts, Provider patient experience reports, Healthwatch reports and Social Media posts.

• The CCG also receives feedback and intelligence directly in relation to patient experience and complaints feedback

• This report includes all intelligence received between 1st October to 31st December 2019, Quarter 3.

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Leeds Health and Care System: Care Opinion and CCG Feedback

The Care Opinion site enables the CCG to monitor the feedback being posted for all services within Leeds. It also enables the CCG to monitor the service response rates and how changes have been implemented as a result of the feedback. In Q3 181 stories were published on Care Opinion (or NHS Choices). This shows that there is a high level of patient feedback being provided. No stories have initiated changes within a service or a provider in this quarter. This is something that our providers will be focusing on during 2020/21 and which the CCG will continue to monitor. In Q3 the CCG patient experience team received 78 contacts relating to services and providers across Leeds.

181

116

25 40

Stories have been added

stories have not beenread

stories have been readonly

stories have been readand a response provided

Q3 181 Care Opinion overview – Status report

3

38

27

3

10 Complaints

Concerns/Comments

Compliments

PALS Queries/Pt ExpQueries

Q3 78 CCG Complaints/Patient Experience Activity

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Care Opinion provides a forum for patients, families and carers to provide feedback (negative and positive) anonymously. The website asks users to post or tag words to describe ‘what was good?’ and ‘what could be improved?’. The bubbles below shows a summary, for all providers in Leeds, of the feedback provided during Q3.

During Q3 ‘PALS, advice and listened to’ were all areas reported as requiring improvement however, these areas were all from one post relating to Leeds & York Partnership Foundation Trust services. Overall, Q3 posts show that patients were happy with the care they received.

Leeds Health and Care System: Care Opinion & CCG

The Big Leeds Chat The Big Leeds Chat is a new way of listening to people in Leeds. It brings together the most senior decision makers in health and care, working together as one health and care team to talk to the people of Leeds about what matters to them. This year the event went to Central Leeds, Wetherby, Morley, Otley, Richmond Hill and Bramley. The data is being analysed and will be reported early 2020.

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Planned Care and Long Term Conditions – CCG Complaints and Care Opinion data

Care Opinion published 39 posts during Q3 relating to LTHT, 51% of those were positive comments. There were no changes planned by the provider as a result of any of the Q3 posts. The CCG received 15 complaints and 1 compliment during Q3 relating to LTHT. These included care and treatment, waiting times and staff attitudes.

0

change

20 responses

13 read

6 unread

1 1

13

11

7 6

0

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4

6

8

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14

ChapelAllerton

Leeds DentalInstitute

LGI SJUH W'DaleHospital

Unnamedlocations

Total number of comments received via Care Opinion for Planned Care services

The ability for patients to provide real-time feedback via the Internet, which has been progressed across LTHT utilising online links via hand-held tablets, are now available for use in all adult inpatient wards, including Critical Care.

St James’s University Hospital Had to attend for a 4 stage MRI scan on 20th December. The staff

were helpful, pleasant and kept me informed and were very reassuring as I am claustrophobic. My appointment was on time and efficiently managed. A credit to the hospital and the N.H.S.

1

9

2 1

3

0

2

4

6

8

10

Leeds DentalInstitute

LGI SJUH Compliment -LGI Unnamedlocations

Total number of contacts received via CCG for Planned Care services

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Unplanned Care - Care Opinion & Complaints Information

1

2 1 1

2 1 1 1 1 1

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1

1 Oct-19

Nov-19

Dec-19

Q3 shows four A&E posts, one positive regarding good care & communication from staff and three negatives relating to wait times, confidentiality when staff are speaking to patients or when staff are discussing patients with colleagues and how to handle patients who are brought in by ambulance with no means of getting back home. One post related to St George’s Minor Injury Unit (MIU) closing early and two compliments regarding the Out of Hours service staff providing wonderful care and going the extra mile at Wharfedale General Hospital.

There was one CCG complaint recorded in Q3 relating to the attitude of staff. Once consent was obtained the concerns were forwarded to the relevant organisation for investigation and response.

Details of issue Outcome Lessons learned

Nurse wanting to complain about the service she has received for the patient who is a fast track patient been ringing since 24th August for some medication still ringing at 12:30 on 25th August to chase this up very concerned it has taken this long and has rung back multiple times wants to check the process has been followed for each call

NHS 111 - All calls received have been reviewed and audited. The correct process was followed on each call. The delay in receiving a call back was from the GP out of hours service. LCD - There appears to have been confusion around which numbers to use for the day and night team however can confirm that our voice recorder shows that all numbers were attempted at different stages during the course of the 24th and 25th August. The appointment booking was cancelled on our system and a prescription was not left.

NHS 111 - Just audit feed back – good call, no issues, datix nothing to do with call handler part of call. LCD - Our Duty Management Team have been involved in the investigation and have arranged for feedback to be provided to all staff members involved for learning.

Caller to pass on his gratitude to staff for their excellent service and help they provided when he rang for his colleague who was experiencing chest pain and breathing difficulties.

Compliment letter arranged for staff. Compliment letter arranged for staff.

Came in to a&e pretty stressed but the doctor who dealt with me was really great and really calming and made an effort to

see me as quickly as possible and kept me updated while waiting

on results

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Unplanned Care - Other Information

Healthwatch research shows that the public value a wide range of factors when it comes to good care in A&E and they are working with the NHS to ensure new measures take people’s full experiences into consideration.

Why are performance targets being reviewed? The four-hour A&E waiting time target was brought in 15 years ago and sets out a national standard that at least 95% of patients attending A&E should be admitted, transferred or discharged within four hours. The NHS is reviewing this measure as well as other national targets in elective care, cancer, and mental health, to reflect the changing environment so that people receive the best possible care. See the link for full report https://bit.ly/2tAoLLG

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Mental Health and Learning Disabilities Care Opinion & CCG Complaints

Leeds Mental Wellbeing Service (LMWS) – Launched November 2019 This service replaced the service known as Improving Access to Psychological Therapies (IAPT) on 1 November 2019 and is a partnership between Leeds Community Healthcare NHS Trust, Leeds and York Partnership NHS Foundation Trust, Leeds GP Confederation, Northpoint Wellbeing, Community Links, Touchstone, Women's Counselling and Therapy Service, Homestart Leeds, Ieso Digital Health, SilverCloud Health and SignHealth. Anyone over 17 years of age, registered with a Leeds GP and experiencing one or more of the mental health difficulties mentioned on the website, can self-refer on the service website What kinds of a support does the service offer? Leeds Mental Wellbeing Service can offer workshops, group classes, a range of online support options and face-to-face sessions. The service follows the 'stepped care model', which offers the lowest level intervention or treatment first. December update A number of service developments are now under way and LMWS continue to develop the full service order, bring together IAPT, a citywide primary care liaison service (known as Primary Care Mental Health) and psychological therapies in the perinatal period into one contract.

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Children and Maternity: Care Opinion and CCG data

Care Opinion received one post regarding Maternity services during Q3 which praised all of the staff involved in the birth of her child. There were no complaints received by the CCG in this period.

Maternity & Neonatal Services in Leeds Consultation Jan – April 2020 Leeds Teaching Hospitals Trust is planning to build two new hospitals at Leeds General Infirmary (LGI). This change provides us with an opportunity to improve the way we deliver maternity and neonatal services in Leeds. We are planning to; -centralise maternity and neonatal services in LGI so that all services are in one place and we can keep families together when they need to use neonatal services -build a brand new midwifery-led unit at LGI -consult on the way we provide hospital antenatal services -keep community antenatal services the same For more information https://bit.ly/30hkpp6

Bereavement Services in Maternity Consultation Oct – Dec 2019 The Leeds Maternity Voices Partnership (MVP) is a group of parent and family representatives who work in partnership with midwives, doctors, and other health professionals to help improve future maternity care to women, partners, families, and babies: the MVP works closely with NHS Leeds CCG. Ongoing feedback will be gathered in order to improve bereavement services in maternity across Leeds. For more information https://bit.ly/2tgnPwc

Spotlight on children and young people’s hospital care The Care Quality Commission’s Children and Young People’s Survey 2018 was published in October 2019. More than 33,000 patients and their parents and carers took part in the age-banded research about hospital healthcare provided to under-16s as inpatients, day cases or emergency patients. Compared with the previous survey in 2016, researchers found that experiences of children, young people and their parents and carers were mostly positive and were largely unchanged in most areas this year. Most children and young people said that they were well looked after, and that staff were friendly. Most children said that they were able to ask staff questions — received answers to their questions — and that they were given enough privacy when receiving care and treatment. Most parents and carers reported positive experiences of communication around operations or procedures, said that staff agreed a plan for their child’s care with them, and had positive overall evaluations of their child’s care. The survey results suggest there is scope for improvement in a few areas, however, including: • Children and young people having enough things to do while in hospital • Involving children and young people in decision making • At discharge, information for children, young people, and their parents on care at

home and what happens next • Children and young people being treated primarily on age appropriate wards This year, the survey explored some new areas, including asking children and young people whether the hospital Wi-fi was good enough to do the things they wanted to do. Most said that it was, either always or sometimes, and 18% said that it was not. For more information see link https://bit.ly/30m1ycE

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Children and Maternity – CCG Patient Experience Report information

Declare Your Care is a year-long CQC campaign focusing on four key population groups which are known to have a lower awareness of CQC. Key findings for young people, their parents and carers Our research reveals that young people (age 16 to 24) do not raise concerns about their care. They fear they will be seen as a troublemaker, or they don’t think it’ll make a difference. More young people have also experienced poor care when using mental health services. The research looked at people in England who have had experience of health or social care in the last 5 years, either as a patient or carer. Young people are more likely not to raise a concern due to fears of being seen as a troublemaker (36% of 16-24s) 44% of young people (16-24) or their carers did not raise concerns or complain as they did not think it would make any difference. (This compares to 35% of adults and 21% of children under 16). 27% of young people aged 16-24 have experienced poor care when using mental health services in the last 5 years. This compared with only 7% of adults aged 55 and over. Please use the link for more information https://bit.ly/3a9GoCU

Building the Leeds Way Healthwatch Patient Reference Group supports Leeds Teaching Hospitals Trust (LTHT) to improve its services. This is mainly about ‘big’ changes where something will affect the whole Trust or where something will have a big impact on patients and the public. In January 2020, Mike Bacon from the LTHT Project team will visit the group to give an update and take questions on progress so far. The project involves building two state-of-the-art new hospital buildings at the LGI including the new home of the Children’s Hospital.

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Continuing Care and Neighbourhood Care: Care Opinion, CCG Complaints Data

Neighbourhood Care Overview: There was one post on Care Opinion in Q3 relating to the excellent physiotherapy service provided from the Leeds Community Healthcare service held at Beeston Hill clinic. The CCG has also received complaints/concerns relating to neighbourhood care. These concerns related to continuing healthcare and families raising concerns regarding continuing healthcare assessments .

Declare Your Care There are around 15 million people in England who have a long-term condition – and this is rising. Most people are receiving good care yet more could be done to support effective pathways for people with long-term conditions. This helps prevent health problems from escalating and avoids hospital admissions. New research shows that people with a long-term condition are among the highest users of services. Yet they do not always feel they have a voice. Key findings for people with a long-term condition People affected by long-term health conditions: • 88% who felt they had poor care did not complain as they were concerned they would be seen as a trouble-maker • 33% said that having more information about the standards of care to expect would encourage them to express a concern • 81% of patients with Chronic Obstructive Pulmonary Disease (COPD) regretted not making a complaint about poor care • Of the people who did not complain about poor health care they advised it was because they:

• did not think it would make any difference • did not know how • feared they would not be taken seriously

When people did raise a concern or complaint, most found: • the issue was resolved quickly • it helped the service improve • they were happy with the outcome.

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Continuing Care and Neighbourhood Care: Other information

In November 2019, Healthwatch Leeds held an Enter & View visit at The Gables Nursing Home. The visit was undertaken following feedback from members of the public who had highlighted areas of concerns about the environment of the home. See link for full report https://bit.ly/2QRJfHD Key Findings: • Feedback received (13 people both residents and relatives) spoke very

highly of the care • The majority of people felt involved in their or their relatives care • Although there was evidence that residents’ communication needs

were documented within their care plans there didn’t appear to be a mechanism to make the files of those residents ‘highly visible’ as required by the Accessible Information Standard (AIS)

• Although refurbishment work was underway there didn’t appear to be a long term plan in place

Key recommendations • Better long term planning of refurbishments to the care home • Improving how the care home meets the requirements of the AIS

Community Dental Service We asked patients, carers, staff and other key stakeholders across Leeds for their views on our plans to offer an improved specialist Community Dental Service in Leeds. The referral-only service provides treatment for people whose own dentist can’t meet their particular needs.

Leeds Palliative Care Network The Leeds Palliative Care Network’s new website is now live. It is a one stop online hub for information on palliative and end of life care services across the City. This unique, easy to navigate website provides advice and information on the services available throughout Leeds for patients approaching the end of their life and their families, friends and carers. It also features a dedicated area for health and social care professionals with a host of online resources, easily accessible round the clock. Leeds Palliative Care Network is a group of health and social care organisations who are working together to improve services for people approaching the end of their life. Its purpose is to help organisations work together to plan and deliver care, in the best possible way for palliative and end of life care patients, their families and carers.

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Primary Care within Leeds: Care Opinion

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Q3 Total number of comments received via Care Opinion by GP Practice

137

57 15

65

Q3 Care Opinion stories

Stories posted

Stories with response

Story read but no response

Stories unread

The CCG Patient Experience team have developed a GP leaflet to support and signpost patients to appropriate patient experience teams regarding complaints and feedback. An eye catching poster has been printed by the team for each location and these will be given out at Practice Manager and TARGET meetings. The Patient Experience team are also looking at costs for producing a wallet sized leaflet for patients to keep.

A number of practices highlighted in the chart below are recording significantly higher numbers. The Dekeyser Group Practice, showing the highest figure overall, have recently had their CQC inspection report published. The Practice have been rated ‘good’ overall however, they have been rated ‘requires improvement’ in the Responsive domain. It should be noted however, that the CQC found significant improvements to their telephone system since June 2019, the CCG will work to support the GP practice as they work to further improve telephone and appointment access. The next two highest practices Thornton & Family Practices are showing a higher level of response than usual. This is due to an increase in positive feedback, suggesting that they are working with their patients to improve services.

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Leeds Clinical Commissioning Group: Patient Experience

The CCG received seven comments, concerns and complaints during Q3 which related directly to commissioning activity. These issues referred to CHC assessments, IFR appeals, prescribing issues and chronic pain pathway issues.

Patient Experience Collaborative (PEC) Following the re-Launch of the Patient Experience Group there have been a number of changes. Following discussion the group name has been changed to reflect the way the Group will work. Each team across the CCG will be encouraged to have a team member attend the PEC quarterly meetings. All members will bring any patient feedback or information available from their team for review. The Clinical Governance Team will provide the current CCG quarterly patient experience report for analysis and review. The PEC will identify priorities from all information available and develop actions for improvement and embedding Patient Experience into commissioning decisions. The PEC will report to the Leeds CCG Quality & Performance Committee and will include a copy of the latest PE report and accompanying cover sheet which will outline the activity and actions of the PEC. All concerns or significant issues will be escalated via the Executive Director of Nursing and Quality to the Quality & Performance Committee.

How does it feel for me? One of the key recommendations from the CQC Local System Review of Autumn 2018 was the need to capture people’s experiences of health and care in the city, in particular when moving across health and care settings. A citywide quality group was established meeting monthly to take forward this work, titled the “How does it feel for me?” group. The group is made up of members from all sectors of the health and care system; with the exception of the care home sector to date (we are looking to fill this gap). Members of the group are made up of a mix of patient/person experience/engagement/quality leads and more recently complaints/compliments colleagues. Four pieces of work are now established as part of this group. The first one is led by Healthwatch Leeds and Leeds CCG. It is a six-month project (initially) which seeks to follow the experiences of four older people living in Leeds and capturing in-depth their experiences of moving around the health and care system. The approach has been based on videos of people and their carers sharing their experiences every month as close to ‘real time’ as possible. The videos and written updates are designed to give first-hand insight into person/carer/staff experience of current system. The outputs from this work are now being made available to all Partnership Executive Group (PEG) member organisations via an agreed process. They are also being used and shared wider across other health and care strategic environments such as West Yorkshire and Harrogate (WYH) System Oversight & Assurance Group (SOAG) meetings and the WYH Surveillance meetings to support their decision making. The second is a case note audit, led by Leeds City Council Adult Social Care with a multi-agency team approach. The audit builds on the value provided by the CQC Review mandated multi-agency case note audit. The process has been in place from September on a rolling basis. The process nominates individual cases where notes will be retrieved from relevant partners involved in that case. The case notes will then be considered collectively by a multi-agency team. The structured review considers the timeline of care for each person and how well transitions, decision-making and integrated responses create a good experience of care. The third seeks to gather the knowledge and insight from the citywide health and care Complaints group, chaired by Healthwatch Leeds with a focus on learning from complaints that cut across organisational boundaries. The fourth element aims to learn from the above projects but also think systematically about how do we capture, hear and act on people’s experiences of health and care services, with a particular focus on when they move across health and care settings and the voice of people with the greatest health inequalities. To date the group has held two workshops to identify existing mechanisms where people are already telling their story/sharing their experiences. These range from formal mechanisms which are nationally mandated or supported (e.g. Friends and Family Test / GP Survey / Adult Social Care Outcomes Framework) which provide some data on people’s feedback on individual services or single agency experiences to more person-led ways such as in discussion with their GPs, involvement with third sector organisations or online discussion forums.

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Ongoing Work and Next Steps of Leeds CCG Patient Experience Team

The Leeds CCG Patient Experience team continues to participate with a number of groups to support the patient experience function, this includes on a West Yorkshire and Harrogate Health and Care Partnership footprint.

Leeds Healthwatch Complaints forum: This group consists of all Leeds providers and commissioners (CCG, social care and NHS England) and is chaired by the Chief Executive of Healthwatch Leeds. The group ensures that we are applying consistent processes to support the Leeds ‘no wrong door’ policy when patients are providing feedback.

Heads of Patient Experience (HOPE) Network: The network is open to people working in NHS trusts or clinical commissioning groups (CCGs) whose role includes significant responsibilities for patient experience. The network:

• offers peer learning and support to members in their work, by enabling them to meet with others working in similar roles with similar challenges

• provides an opportunity to learn from innovations and best practice • provides members with an opportunity to collectively develop solutions to the problems and challenges they face in their

work. • provides opportunities to meet national and international experts in the field of patient experience research and

improvement. Information regarding the HOPE network can be found here.

West Yorkshire Patient Experience Network: This forum is led by NHSE and is made of 2 parts; local on a West Yorkshire footprint but also forms part of the Yorkshire and Humber forum. This group aims to share good practice for patient experience and engagement.

Next Steps: The report will continue to be developed throughout the year. A number of areas have been identified which require changes to our internal systems and processes to further align our reporting of patient experience:

• Review internal CCG systems and processes to align all patient feedback, including complaints, to the themes within the Patient Experience Framework • Evaluate the changes to the Patient Experience Collaborative to ensure a more proactive response to patient experience is being embedded into

commissioning decisions • Continued development of the ‘How does it feel for me’ project • Continue to develop, collate and report patient experience data aligned to pathways rather than individual organisations • Continued development of GP leaflet to support and signpost patients to appropriate patient experience teams regarding complaints and feedback

National Complaints Managers Forum: Support network for complaint managers with two national events each year. Information about the forum can be found online.