Report to Trust Board–21 July 2016

Report Title 2015/16 Annual Compliments and Complaints Report

Report from Tracy Luckett, Director of Nursing and Allied Health Professions

Prepared by Tim Withers, Patient Experience Manager

State impact on CQC domain (if applicable)

Demonstrates learning from complaints and concerns as part of the Responsive domain

State impact on corporate priorities

Informs action taken to deliver excellent patient safety, outcomes and experience

List of attached appendices (if applicable)

Appx 1. Complaints by Site/Directorate/Service/Type

Reference documents that are not attached (e.g. previous reports or appendices)

2012/13 Annual Compliments and Complaints report. 2013/14 Annual Compliments and Complaints report. 2014/15 Annual Compliments and Complaints report.

Version 3, 14 March 2016

Brief Summary of Report

Summary of compliments and concerns received 2015/16

Action Required/Recommendation

For Information and noting

Item 7

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Compliments and Complaints Annual Report 2015/16

Trust Board

Presented by: Tracy Luckett

Director of Nursing and Allied Health Professions

Produced by:

Tim Withers: Patient Experience Manager

21 July 2016

Action for Board:

For information √

For consideration

For decision

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1.0 Introduction

This report provides an overview for the board of compliments and complaints received by the trust between 1 April 2015 and 31 March 2016 and will summarise the activities of the PALS and complaints team over the year. Irrespective of how patient feedback is collected, the majority of patients are satisfied with the service they receive from Moorfields with the majority being fulsome in their praise. It appears that Moorfields main strengths continue to be the clinical outcomes experienced by patients and the way that staff interact with them. The feedback suggests that the approach of staff to patients and their carers is friendly, reassuring, considerate and, most importantly perhaps, individualised. The sense that they feel they are in a safe environment and being dealt with by professionals is also tangible. It is important however that Moorfields staff avoid complacency, as there are issues that continue to remain a source of frustration for patients and carers, notably around the administration of appointments, communication, waiting times and environment, and to a lesser extent staff attitude and hospital services. Clinical concerns, though relatively small in number, and very specific in nature, are the leading cause of complaints and carry potentially greater inherent risk to both patients and the trust. 2.0 PALS and Complaints Team Activity

The PALS and Complaints team consists of the Complaints Manager two Patient Experience and Support Officers (PALS), and the service is supported by Patient Experience Manager. Though based at City Road, they provide a service to all sites across the trust and are available to patients by email, telephone, face to face or through close liaison with our host trust’s PALS teams. Though previously a nine to five service, in view of shifting clinic patterns and finish times the service is now covered until 19.00hrs in the evening most evenings of the week. As Saturday activity grows the team will also explore ways of covering these sessions if demand warrants it.

Management of complaints at Moorfields operates within a legislative framework set down by the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009, and we work towards the recommendations laid out in the parliamentary report, ‘A Review of the NHS Hospital Complaints System: Putting Patients Back in the Picture’ (2013), a corollary of the Francis report, and the Care Quality Commission report: Complaints Matter (2014), as well as advice published by the Parliamentary and Health Service Ombudsman (PHSO). 2.1. Communicating with patients: The two main objectives of the Moorfields PALS and Complaints team are to resolve issues and concerns raised by patients effectively, efficiently, and to the patient’s satisfaction and to do so in a supportive and accessible way. We try to contact all potential complainants over the phone to offer a sympathetic hearing, and establish a relationship as advocate throughout the complaint process.

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The team also actively advises complainants of the availability of, and how to contact, the NHS Independent Advocacy Service, information which is also in the PALS leaflet, on the Moorfields website and is included in complaint acknowledgment letters

2.2 Raising the profile

Patient information: The PALS and complaints team continue to promote its role and function both to patients, carers and, especially important prior to the CQC visit, to staff. Posters, PALS information booklets, and information on patient information screens are promoted across the trust. The website complaints page has been re-designed to carry more information about the complaints process, an online complaints letter template and guidance have also been included, as have examples of changes that have been made as a result of complaints (to overcome some patients reluctance to complain, thinking nothing will be done). Site visits: A programme of visits by the team to Moorfields Satellite sites and their host trust’s PALS offices was carried out during the year. This allows the team to make themselves known to local staff and to meet patients and promote the service by checking that the PALS and complaints information is available. It is notable that the number of PALS enquiries from satellite sites has increased exponentially from 98 in 2013, to 212 in 2014, to 401 in 2015. 2.3 Complaints Policy: The Moorfields Complaints policy (2015) is due for review in 2017.

2.4 Complaints and concerns handling training: Concerns and complaints training sessions began in September 2014 covering the national and local contexts of complaints handling, the process at Moorfields, and stresses the importance of trying to resolve issues for patients at the time. Since the programme began, 176 staff of all disciplines have been trained at specific sessions, conferences and clinical governance sessions. Work is underway to create an e-learning package for Insight, the trust training and education portal. 2.5 Representation: The PALS and Complaints team has representation on several trust wide committees and there is now representation from the team on the Patient Experience, Privacy and Dignity, Serious Incident, Catering, Arts, Transport, Quality and Safety, Equality and Diversity and Editorial committees as well as service meetings when invited.

2.6 Reporting: Compliments and complaints, in terms of both narrative, activity and

performance indicators, are reported to the board on a quarterly basis. Reports are also shared and discussed with our commissioners through the Clinical Quality Review Group (CQRG), and are discussed at the Patient Experience Committee. Data analysis of complaints is also included in the six monthly Quality and Safety and Aggregate reports. A weekly open complaints summary which includes a summary and outcome of all PALS enquiries and concerns received for the week and Social Media feedback is sent to the Directorate Management teams.

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A quarterly summary of complaints (the KO41a) is also submitted to Health and Social Care Information Centre (HSSIC) and a further summary is submitted with examples of actions taken, to the North and East London Commissioning Support Unit.

2.7 Patient Questionnaire. Though the first half of 2015/16 a complaints handling questionnaire was sent to complainants who had complaints closed during that period. 28 responded, which, though statistically small number, and as the underlying issues can be emotive, generalisations were drawn from these results and actions identified going forward. The full report was included in the Q3 Compliments and Complaints Report. Patients commented on the availability of information explaining how to complain, and the variety of sources used was encouraging, as was the degree of support and information given to complainants by the PALS and Complaints team. However, there were areas identified which indicated room for improvement, such as the helpfulness of staff at a local level when a patient wished to complain or had an issue they wished addressed. It is hoped that this issue has been addressed to a certain extent, as in the period prior to the CQC visit a greater onus was given to this subject as part of staff preparation, supported by the concerns handling and Moorfields Way supervisor training. There were also issues raised regarding complainants understanding of how their complaint was to be handled. As a result, a leaflet, setting out clearly the process of how it will be handled, who will investigate, how it will be investigated, how the responses are collated and what support is available, has been produced which also includes an encouragement to complainants to contact the complaint manager if they have any issues. This leaflet is sent with each acknowledgment letter. The MEH Website content has also been rewritten in this regard. Although there are relatively few reopened cases or PHSO referrals, the survey suggested complaint responses they received might not have been as comprehensive as they might have been and that the concerns they would like to see addressed may not have been articulated fully or understood in their letter or conversations with the complaints manager. As a result, the final written responses that patients receive, which, though individual to them, include a generic passage which has been re-written stressing our wish to help resolve their concerns together and encouraging them to contact the complaint manager if they feel not all of their concerns have been met. Members of the directorate management teams who manage complaints have been asked to ensure that investigation findings are scrutinised before return to the complaints team to ensure that all aspects of a complaint have been addressed and outcomes clearly identified, there has also been an increase in the number of complaints returned to investigators by the complaint manager seeking further clarification. The survey is currently being repeated, the results of which will be included in the quarterly reporting. 2.8 Other activity: Members of the PALS team also spent a day with the PHSO to gain a better perspective of their role. They also spent time following a service manager at City Road to better understand the some of the appointment issues raised. They also attended two national conferences relating to complaints management. The trust Visibility of

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Leaders programme, with an executive lead working with the team continued throughout the year and the Complaints Manager from a north London trust visited to see how complaints are managed at Moorfields. The Complaints team also prepared for the CQC inspection of which complaints handling was an integral part. 3.0 Compliments There were a great number of compliments received by the trust during the year and though they come from a variety of sources there is a degree of consistency that reflects what our patients think of the service they receive. The PALS and complaints department receive relatively few direct or forwarded compliments, however, one suspects that local sites receive many that are not submitted. To a degree, traditional thank you letters and cards have been replaced by comments on the Friends and Family cards as well as by use of social media such as NHS Choices or Patient Opinion. As noted above, it is the professionalism, friendly and caring attitude of the staff that patients appreciate most, as well as the clinical care and the efficiency of the service. 3.1 Friends and Family Test (FFT) comments The FFT not only provides an objective score but allows the patient an opportunity to express their views, views that they previously might not have shared. It also gives patients the opportunity to thank the staff in writing where as previously they might have just given a verbal appreciation, or possibly sent a card or letter. During 2015/16, a total of 99,104 (14.8%) patients completed the FFT of whom 96% said they would recommend the trust to their friends and family. An increasing number of those who compliment the trust cite individuals in their comments, during 2015/16, 1614 did so, a 40% increase on the previous year. Many examples of the type of compliment are included in the quarterly Compliments and Complaint quarterly reports, so below are a few that give a flavor of those received:

“Extremely calm, respectful, yet kindly treatment by everyone, from receptionists, nurses, imaging staff and doctors. I was very apprehensive and worried before my appointment but feel confident that I am in safe hands with highly skilled people. I had long periods waiting but was kept well informed so this time passed better. These people are great communicators and that's so important. A big thank you from me and my wife/carer, who felt included in all of the processes today.” Uveitis clinic “From the minute I stepped into A&E everyone I dealt with was professional, friendly, reassuring and human. I was seen so quickly I didn't have time to fill in the registration form fully. The nurses who made the initial checks were kind, humorous & explained everything then waited to make sure I understood & was happy to continue. The Consultant was reassuring, thorough and gentle. Everywhere was spotless and there is such an air of calm efficiency about the place that I was completely unconcerned. This is the model for any medical/health practice to follow & aim to meet their standards. I would recommend Moorfields to anyone in need of eye care. Fabulous. Thank you so, so much!” A&E “As a first rate teaching hospital I have great confidence in the treatment given. I have been attending for many years and have always had excellent attention.” Glaucoma

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3.2 Compliments received by or forwarded to PALS The PALS department received 202 compliments during the year, the majority by letter, email and occasionally face to face. There are currently too few compliments received by PALS to use as a quantitative measure, but areas are encouraged to forward them when received. When the PALS team receives such comments they pass them on to the teams or individuals being thanked. Many reflect the themes noted in other patient feedback.

3.3 Compliments from Patient feedback websites Compliments, as with complaints, are no longer private between the patient and the trust, but are shared in the public domain on feedback websites such as NHS Choices, Patient Opinion and IWantGreatCare, which has the advantage of promoting the strengths of the trust to a wider audience. Equally however, it can also highlight where we might need to improve and we must be cognisant of the fact that it might influence patients, GP’s and commissioners choices of where to access care. This year there were 57 comments left on NHS Choices (compared to 83 the previous year) of which 33 described and praised the good care received at Moorfields. Some examples are: “I would recommend and thank Moorfields for the excellent ongoing treatment I received. My case was handled by kind and sensitive staff and exceptionally knowledgeable and experienced medical professionals. It is encouraging to feel like you are being treated by the best of the best.” (Clinic 4 and A&E) “I get cross when I hear people moaning about the waiting times at appointments but believe me I have waited 54 years to get the clearest vision I have ever had! The skill and expertise of surgeons has been worth waiting for! I admit I was nervous before the first op as I didn't know what the outcome would be but I would recommend anyone with eye problems to get referred to Moorfields for the expertise of the surgeons and the kindness of the staff. Once again a massive thank you to the surgeon and the team!” “After an urgent referral from my optician I went to Moorfields where after a few hours of waiting in A&E I was placed with an absolutely fantastic consultant who went above and beyond to make me feel comfortable and was very reassuring. I was so worried beforehand but the consultant completely put me at ease. I was told what was going on, but was also told to come back the next day for a second opinion, demonstrating the level of patient care Moorfields provides. I returned in the morning and the second consultant confirmed to me what the previous one had said but it was brilliant to make double sure and completely put my mind at rest. You can be assured you will be looked after fully at Moorfields and I would highly recommend their A&E department for anybody experiencing eye problems, you will be in the best of care.”

3.4 Social Media Patients also post compliments on Facebook and via twitter, and though these tend to be short and to the point the majority are expressions of gratitude:

Had a cataract done yesterday & would like to thank everyone involved for the treatment I received. Mr Stevens & the wonderful staff at Mackellar ward. The staff at the theatre who calmed me & sent me to sleep and the lovely Suzie (whose smile I woke up to in recovery) not forgetting Rachel who wheeled me back to the ward (with a bit of banter about Scottish football). I know Cataract work is minor to your professional staff but to me it was major.

All the nurses on Sedgwick ward were amazing and very kind. I feel very lucky to have been put in their care.

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I would just like to thank all the staff at clinic 4 and refractive theatre. Outstanding care and compassion given and (you) should be very proud and special thanks to Karen, the clerk staff, she is outstanding under huge pressure

@Moorfields Thankyou (staff in) Optometry spent more than the needed time with me and had

lots of patience when I could not fit my lenses

Can I just say that the fabulous #nurses #doctors #consultants who have been so caring for my mum this week @Moorfields you are amazing! X

4.0 Complaints 2015/16:

An average of 16 complaints a month were received by the trust during 2015/16, an increase of 23 on the previous year, to 197. However, from April 2015, the way complaints have been reported to Health and Social Care Information Centre (HSSIC) has changed so that the trust is required to submit the number of complaints (i.e. if a patient raises more than one issue), rather than as previously, the number of complainants. In terms of complainants the increase on the previous year is less at only five greater. 4.1 Complaints received 2012/13 to 2015/16

(Fig. 1) Complaints received 2012/13 to 2015/16

2012/13 2013/14 2014/15 2015/16

291 249 174 197 (179 Complainants)

Percentage of patients seen who went on to complain

0.05%

564,315 patients

0.04%

574,380 patients

0.02%

642,213 patients

0.03% (0.02%)

669,265 patients

Complaints per 10,000 patient contacts

5.1 4.3 2.7 2.9 (2.6)

(Bracketed figures are per complainant for comparison with previous years)

(Fig. 2) Number of complaints received 2015/16: actual (blue) 6mth rolling trend (red)

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15

18

12

22 20 21

17

11 15

12

22

0

10

20

30

Apr May. Jun Jul. Aug. Sep. Oct. Nov. Dec. Jan Feb. Mar .

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4.2 Complaints by type

(Fig. 3) Complaints received by type 2012/13 to 2015/16

The number of clinical complaints was 93, almost the same as the previous year. There was an increase in the number of ‘administrative’ complaints around appointments and communication. This can be partially accounted for through the change from counting complainants to counting complaints as noted above as, for example, a clinical complaint might also include a degree of poor communication or an appointment problem. Other categories remained around the same, though there was a slight decrease in concerns about staff attitude.

4.2.1 Clinical complaints. As with previous years, clinical complaints continue to be the most common cause of complaints, however many of these are very specific in nature and though broader themes can be drawn, it is difficult to identify any specific service failures. Over the past four years the number of clinical complaints has stayed fairly consistent, with a slight increase over the previous year. When looked at by service (appendix 1), again there is no notable change. The majority of the 93 clinical complaints received during the year were where the patient had issues with the care they had received or questioned the treatment given. These cover a wide spectrum and are all very specific in nature. The majority were from patients who felt that the treatment or care they had undergone had not been effective, had resulted in unexpected outcomes, that the wrong treatment choices had been made or who felt that their treatment had led to unnecessary complications or outcomes. Others questioned their discharge from service, failures in diagnosis, prescription decisions, and access to treatments they felt they should have been given.

All clinical complaints are individual to the person concerned and though in several cases the trust was found to be at fault and this was acknowledged, many appear to rest on the level of understanding by the patient of their condition and treatment plan, especially when they are undergoing long-term treatment, and may not have the information about

100

83

94

93

51

38

12

23

20

34

14

29

30

21

8

10

42

45

31

27

8

9

21

8

3

4

19

10

12

10

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

2012/13

2013/14

2014/15

2015/16

Clinical Appointments Communication

Waiting times Customer care /attitude Administraion

Transport Enviroment other

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decisions or treatment choices other than a GP letter. The majority of written responses to such concerns tend to clarify their care pathway and explain why decisions were made, and recognise and apologise for process and clinical errors that did occur. Perhaps the relatively few referrals to the PHSO or re-opened complaints might suggest this is enough to give the majority reassurance. However, it does tend to suggest that at some point communication, understanding and clarification were not as they might have been, and though it is difficult in the clinical setting to identify to whom this might apply, it is beholden on each individual clinician to ensure that their patient understands, is involved with, and is happy with the care and treatment choices they receive. All clinical complaints are reviewed by the Medical Director and in reviewing the directorate, site, service (appendix 1), or individuals involved, there does not appear to be any themes or areas of poor practice identifiable.

4.2.2 Other complaints: The number of complaints regarding appointment issues has

increased (23), as has those for communication (29), but as noted above, this is partly due to the reporting change and they have stayed relatively consistent for each quarter of the year (i.e. they are not increasing over the year). They centre on errors in booking, cancelled or delayed appointments or their availability. There were also two complaints regarding missing medical records. In terms of communication complaints, these were as a results of problems with GP and appointment letters, failure to get through to or be contacted by Moorfields staff and not having a request for email honored. There were also concerns about communication during their consultation. Staff attitude, though fewer than previous years, remains relatively high (27) considering most are unnecessary. Mostly it is around offhand or rude behavior from all staff groups, though predominantly medical and reception staff though nurses, optometry staff and estates were also mentioned. Waiting times (for surgical and outpatient appointments as well as in clinic), transport (two of which were delays due to traffic) and ‘Other’, e.g. finance requests or challenges to treatment costs and two optometry dispensing errors. Again, aside from long recognised systemic difficulties such as clinic waiting times, appointment issues and communication, no themes stand out as being linked to site, service or directorate. 4.2.3 Paediatric complaints: Of the complaints received during 2015/16, nine were for paediatric patients from four sites (four were for the RDCEC), which compares to five the previous year, all from the RDCEC. Three of these were appointment issues, two raised clinical questions and two for staff attitude and there was one each for communication (getting through on the phone) and a financial issue.

4.3 High Risk complaints: Of the 5 complaints that were risk rated as ‘High’ (based on the risk matrix that measures the consequence of an event by its likelihood), 2 were clinical complaints relating to a potential missed diagnosis and one where a patient was discharged too soon, the latter not the former, was upheld. The other three related to a patient being discharged without examination, failure of communication with a GP and a delay in providing an oncology appointment within time. All were upheld.

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Seven complaints were referred to the Serious Incident (SI) panel during 2015/16, these related to:

A retained needle (though recognised at the time)

A possible reaction to medication

A possible missed diagnosis

Discharging a patient too soon

An incorrect laser treatment

A possible missed diagnosis

A reaction to combination of medication

Only the last of these was confirmed as an SI. All complaints and PALS enquires are copied in to the Risk and Safety team and safeguarding leads for review and to ensure that incidents are reported and where necessary escalated effectively, e.g. as an SI. Identifying the risk rating of complaints now sits with the management and clinic teams rather than the complaints team who perhaps lack the clinical or managerial expertise to judge appropriately.

4.4 Re-opened cases

During the year there were 13 (6%) (down from 20 (11%) in 2014/15) complainants for whom their case was re-opened. Four of these were where complainants disagreed with the findings, two requested further clarification, two who felt that not all their concerns were addressed, three who raised new concerns, and one who wished for a response from a particular member of staff. None were re-opened following the second response.

4.5 Response time

Where the final response breached the 25 day limit, there was an improvement on the previous year, achieving the 80% required. Where delays were incurred it was due to the complaints team feeling that not all questions were addressed and sending out for further investigation or waiting for medical staff input. Patients are contacted by phone and letter if there is a risk of a breach explaining why.

97% of complaints were acknowledged within the three day target.

(Fig 4) 25 day response rate 2012/13 to 2015/16

4.6 Litigation

There were eight claims from patients received during 2015/16 compared to seven the previous year. These were:

An environmental injury to a member of staff

The alleged incorrect dose of a drug being administered

Complaints answered within 25 days

2012/13 81%

2013/14 65%

2014/15 78%

2015/16 83%

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A possible missed diagnosis and delay in treatment

The alleged failure to undertake the appropriate tests following an operation resulting in further surgery

A patient’s cornea being compromised following the administration of an eye drop combination

The wrong diagnosis

A poor surgical outcome

A (non-ophthalmic) injury resulting from an accident with non-electronic equipment

4.7 Ombudsman referrals

During 2015/16 there were three referrals to the Parliamentary and Health Service Ombudsman (PHSO). This compared to four the previous year and two the year previous to that. One concerned the cancellation of surgery and the other related to post op complications and who felt the risks were not explained fully. None were investigated by the Ombudsman. One, concerning the wrong medication being prescribed is still with the PHSO.

4.8 Moorfields Private

At the beginning of 2015 a shared template was set up so that the NHS complaints team could have access to Moorfields Private Complaints in order to review the types of complaints they receive to see if there was any divergence between the kind of complaints received by Moorfields Private and the rest of the trust.

During 2015/16 there were seven complaints recorded, one complaint was about an injury due to a faulty door closure mechanism, three concerned the environment (the waiting area and private rooms), two concerned delays in going to surgery and one was in regard to the performance of a practice manager. Two were to do with their appointments and payment arrangements and two were regarding the outcome of surgery following which one of the patient was been offered a meeting. There were no untoward themes found in the type of Moorfields Private complaints, nor in comparison to NHS complaints.

4.0 Response to complaints

Not all of the issues raised by complaints during 2014/15 allow for specific service change, but often it is a clarification of treatment, care given and the reasons for it, that is required. This includes not only a detailed written response but also, where appropriate, meetings with patients to better explain any perceived misunderstandings. During 2015/16 ten meetings with patients were arranged, with another nine offered but declined.

Several of the issues raised by complaints (and PALS concerns) are born of systemic problems across the trust that require a trust wide response in tackling them. Waiting times and delays in clinics and day care, communication, staff behaviours are being responded to by programmes such as the Moorfields Way (new job interview guidance

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has been produced, appraisals are framed around the Moorfields Way requirements, staff training stressing those commitments has begun including sessions on dealing with concerns and complaints handling). The development of virtual clinics, the Telecommunications project to simplify communication for our patients, the creation of a Transformation Board to coordinate all improvement work and the Accessible Information Standard work will hopefully address several of the underlying issues that currently cause patients to complain.

Specific changes made as a direct response to specific complaints are however undertaken and reported in the quarterly compliment and complaints reports, but some examples are included below:

In response to a patient attending but not being seen at the walk in service at Moorfields St George’s and referred elsewhere (and of which there was no evidence), a log has been established to record the details of all patients who visit out of hours and the outcome of their visit.

Following a patient missing an appointment when the letter arrived too late (possibly following a change to the sending of letters by second class postage, an agreement has now been reached that letters to be sent out by first-class post will be batched and approved by the Facilities Manager in advance.

Additional training in communication skills is being arranged for a doctor whose behaviour was questioned, in order to avoid a similar situation in future.

Following the complaint of a patient who felt that his hearing needs were not addressed, fixed hearing loops are being introduced to the clinics in the clinics and a review to ensure that signs are in place informing patients that hearing loops are available and accessible for patients who require them.

As a result of a complaint by a patient regarding his treatment, a combined corneal /glaucoma clinic has been set up for patients receiving Boston Type 1 KPro (artificial cornea) treatment to co-ordinate the care of patients who undergo this extremely challenging treatment to try and ensure the best possible outcome for them.

In light of a patient who had difficulty contacting the St George’s clinic regarding an appointment, the email address of the service will now be included on all appointment letters.

A flexible repayment plan was agreed by Moorfields for a patient who was prevented from leaving the country due to unpaid healthcare costs.

Following a patient who had surgery cancelled due to the appropriate scan not being undertaken, MEH North has revised the procedure for referring patients to ultrasound at City Road to ensure that there is a more robust process in place.

As a result of a patient being booked for surgery at a satellite site (rather than City

Road) where the particular procedure could not be carried out, the case was discussed at the Clinical Governance meeting and all staff informed of the correct process.

As a result of a parent complaining about the number of times the consultation was interrupted by telephone calls, the reception staff now handle all in-coming calls.

In response to a patient who has a difficult journey and whose GP refused transport following the complainant’s transfer of care to Moorfields from another trust, the Facilities Manager contacted the patients GP and advocated on his behalf requesting that transport should be provided.

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A complaint resulting from corneal damage being related to possible drug interactions (highlighted also by other incidents) resulted in the drop combination use ceasing both within the trust and nationally.

In response to an internal referral not being handled appropriately and causing a delay in issuing an appointment, the process has been reviewed and in future whenever such an internal referral is made, it will be confirmed by email which will allow the booking staff to recognise and action an urgent appointment immediately.

Following complications for a patient following aquesys gel stent surgery, a review of the discharge procedure in such instances is being undertaken.

As a result of a funding issue that was not resolved, the contracts team is to provide a regular status report of all open individual funding request (IFR) applications.

Subsequent to a confusion over medical records being available in the oncology service a trial is taking place to have scanned Bart’s' records available at Moorfields for on-line viewing.

A complainant felt that the uveitis information on the trust website was possibly confusing, as a result, a review of guidelines on the website and information leaflet was being undertaken to ensure that they give clear and accurate information.

After a patient’s discharge was delayed due to problems with hospital transport being delayed in rush hour traffic, a policy is in place to ensure that after a one hour delay for hospital transport a local taxi will be booked on account. All staff in satellite sites have been reminded of this.

5.0 Non-Executive Director Oversight

Sumita Sinha is the non-executive director with oversight for PALS and complaints on the Moorfields Trust Board. Her summary is below: Two key achievements stand out from my annual review of ‘complaints and compliments’. One is the visibility of both the complaints team and the feedback process. That there is a big rise in feedback is probably due to the greater degree of receptivity for it from Moorfields’ team along with the patient’s ability to access the process easily, particularly owing to increase in use of social media. The rise of feedback, both positive and negative, also shows that the PALS and complaints team have made themselves more visible by using posters, booklets and digital information; and through site visits. It is good that the PALS and Complaints team has representation on more Trust wide committees. Training of staff is another key achievement. Hundreds of staff have been trained to deal with concerns and complaints since 2014 using the Moorfields Way and other mandatory training. An e-learning package, which is being installed, should allow even more staff to access this training. So it is not a surprise that the response time for handling complaints has improved from last year. A new direction has been to pass on complaints to the management and clinic teams so that they can judge the risks appropriately and direct the response. The complaints team has again pointed out that several issues such as waiting times, under capacity, communications, staff behaviours and poor environment are due to ‘systemic problems across the trust that require a trust wide response’. The report

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highlights on page 8 that the major source of complaints are clinical in nature but no specific themes stand out as ‘being linked to site, service or directorate.’ Apart from negligence and poor service, such complaints may also arise due to lack of communication from the clinical team as well as differing expectation from the patient. The wider implementation of Moorfields way and embedding its principles in the way that the staff communicate with patients will alleviate some of these problems.

6.0 PALS enquiries.

The majority of the issues raised as PALS concerns are resolved within a few hours or two to three days at most. However, where a patient requires a written response, a detailed investigation or there is a question over their clinical care or treatment, these are normally treated as a formal complaint and the patient advised accordingly, though the decision is theirs. PALS enquires are classified as one of three types: compliments, general enquiries for information or advice and concerns or informal complaints. The latter two are somewhat similar as most of the concerns and informal complaints are at root, requests for information or a resolution of an issue but the frustration caused to the patient by the problem is such that it presents as a concern or informal complaint. How these are recorded is left to the discretion of the PALS officer taking the call or enquiry. The details of all PALS enquiries received are circulated on a weekly basis to the directorate management teams for review and discussion at their performance meetings. Those enquires that suggest an incident report needs to be completed are highlighted and sent to the risk team for assessment who will then contact the appropriate team.

(Fig 5) PALS activity 2012/13 to 2015/16

2450 PALS enquiries in were received in 2015/16. An increase of 668 on the previous year and can be accounted for to some extent by the promotion of the service across the trust and on the trust website and possibly to increased patient activity (the percentage of patients contacting PALS in 2015/16 was 0.36%, as it was in 2012/13).

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1137

806

87

791

951

138

624

1020

202

982

1266

Compliments Information or enquiries Concern or informalcomplaints

2012/13 (2045) 2013/14 (1829) 2014/15 (1782) 2015/16 (2450)

16

There was a notable increase in the number of appointment and communication enquiries throughout the year, due possibly to the higher profile of the PALS as discussed above and higher overall activity, but equally it suggests that patients may not be clear whom to contact directly when they are trying to resolve issues around appointments, reports or letters or other issues regarding their care and treatment. Over the coming year, PALS concerns, and to some extent, enquiries, will act as a measure of the success of the Moorfields Way and other patient improvement activities across the trust.

6.1 PALS Information and enquiries (Fig 6) PALS Information and enquiries 2012/13 to 2015/16 by number and percentage

6.2 PALS Concerns and informal complaints

(Fig 6) PALS Concerns and informal complaints 2012/13 to 2015/16 by number and percentage

21

13

9

18

252

185

171

329

254

174

86

33

41

16

50

95

412

274

152

330

32

18

13

17

37

21

10

43

86

89

126

112

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

2012/13

2013/14

2014/15

2015/16

Administration Appointment enquiries Cashiers

Clinical enquiries Communication Optometry

Transport Waiting time Other

32

42

82

79

216

234

246

376

87

96

154

164

199

259

175

236

61

52

38

44

71

57

68

63

46

77

86

124

35

49

62

78

50

74

92

84

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

2012/13

2013/14

2014/15

2015/16

Administration Appointment issues Clinical Issues

Cashiers Communication Optometry

Transport Staff Attitude Waits in clinics or day care

Other

17

7.0 PALS and Complaints team 2016/17

During the coming year, the PALS and complaints team will continue to provide a comprehensive service to Moorfields patients and staff. Our priority will be to respond to any recommendations following the CQC inspection in May and to continue to listen to our patients in regards to what they want from our service. The complaint handling survey will continue and we plan to introduce a similar survey for the way our PALS issues are managed. PALS are currently working with Moorfields North Directorate to make the way PALS enquiries are managed more effective and efficient. This will be evaluated and if successful will be rolled out to other directorates and progress reported in the quarterly complaints reports. The commencement of a ‘Patient Story’ initiative at trust board meetings will be managed by the complaints team in identifying and supporting patients to talk about and discuss their experiences with board members. The team will explore the possibility of changing to an internet based version of Ulysses (similar to the incident reporting model) which should allow for more effective follow up and reporting of outcomes as well as enabling local staff to record issues they have managed themselves and enable the trust to have a more comprehensive picture of the concerns of patients (i.e. not only those that are reported to the PALS team).

TPW/ACR/ /15/05/15