Item 7

Compliments and Complaints Report

Quarter Two July - September 2015/16

Presented by: Tracy Luckett

Director of Nursing and Allied Health Professions

Produced by:

Tim Withers, Patient Experience Manager

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 July 2015 and 30 September 2015 (Q2 2015/16) and supports the information in the monthly performance report regarding complaints. This report will also be presented to the Clinical Quality Review Group (CQRG) where the trust discusses the quality of Moorfields’ services with our lead commissioners and at the patient experience committee to identify themes that can inform service change. Part of the purpose of this quarterly report is to address one of the recommendations set out in the parliamentary report ‘A review of the NHS hospitals complaints system: putting patients back in the picture (2013)’ that suggests regular reporting of complaints issues to the trust board. The overall experience of Moorfields’ patients remains positive, and work continues to improve those areas of our service where we recognise there is room for improvement. The themes of the feedback received by the trust during the second quarter, though they came from a variety of sources, were consistent throughout, highlighting especially the competence and personal approach of the staff, the level of support given and the efficiency of the service. The genuine expressions of gratitude suggest that Moorfields delivers an effective, individual and compassionate service on a daily basis across the trust, and perhaps mitigates against those problems that we have yet to fully understand and address; “Even though waiting time was long, it is sort of expected in such a huge city, my experience was more than amazing, the nurses were well organised and trained and the doctor was spot on, really all knowledgeable and helpful and obviously knew what he was doing”. However, when we do fail to deliver the service expected, and it does tend to be the exception rather than the rule, the frustration and scepticism is palpable, especially around issues such as waiting times in clinic, administration and to a lesser extent staff attitude. Clinical issues remain the main cause of formal complaints, with appointment issues and communication being the other areas of concern.

The number of PALS enquiries increased over the quarter for all categories of enquiries or concerns, most notably in regard to communication issues (see below).

2.0 Compliments As noted above, the trust receives many compliments each day, be they as part of patient feedback surveys, social media or thank you letters received directly. Friendliness, quality of care, professionalism and clinical outcome, the strengths Moorfields’ staff would like to see recognised, remain the main themes. 2.1 Friends and Family Test (FFT) comments The FFT allows patients to express their opinions about the care they receive, and many choose to do so, giving them an opportunity and a voice that has previously not been there. It also gave patients the opportunity to thank the staff in writing where as previously they might have just given a verbal appreciation, or occasionally sent a card or letter. During quarter two, 22,984 patients (13% of patients seen) completed the FFT, of whom 97% responded extremely likely or likely as to whether they would recommend the trust against 1% who said they would not. Of the 97% who said they would recommend the trust, 76% left a positive comment, 300 of whom mentioned individuals in the comments. These are passed on to the staff

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concerned by their management team and there is currently work underway to give staff who are mentioned, wider recognition. Typical examples of the positive comments made are: “The young man at reception is very nice and works well, the nurses are polite and good, the doctors were very professional, all good, many thanks A&E “You have much improved the system for triaging and the various things like eye drops that have to happen before you go to the doctor, all the staff were polite, friendly and took the time to answer my questions A&E “Good patient caring skills, staff were friendly and helpful, got a call the day before to confirm the appointment, generally good friendly manner of staff” ST Ann’s Day Care “All the nurses and staff are absolutely lovely and despite appointment running late due to broken air conditioning in theatre, the nurses ensured they kept us informed and provided tea and biscuits PBDC “From reception to all members of staff, you all behave professionally well, time conscious and efficient, team very accommodating and respectful please keep this up” Ophthalmology Clinic

“Moorfield staff is very welcoming, polite and pleasant to talk and give information on doctors, nurses are very caring, and satisfy all your queries/questions” “I was seen very quickly, all the staff is so polite and smiling and knowledgeable. I have been followed up regularly after my operation and advised well; doctors were prepared to answer to my questions” Northwick Park

“Just a bit less waiting time please, although this time was quicker I am glad to see that the nurses now

come out into the waiting area instead of shouting your name from a distance” VR Clinic Of the 1% who said they would not recommend Moorfields, 66% cited delays as the reason: “Booking your clinics properly and planning the slots to match what patients are going to need (fields, pressures, dilution, etc.) Booking 22 people for 1.30 to be seen by 6 doctors and 1 nurse is obviously wrong” Cataract clinic

“You were overwhelmed by demand. Staff told me that "it's always like this!! Not enough staff. Not enough seating. Poor facilities for patients waiting long times Staff could not speak English clearly and spent much time wandering around the department trying to locate patients in a very inefficient manner More like a third world facility. The doctor that I saw was competent and is to be commended

for working in such an environment” A&E

2.2 Compliments received by or forwarded to PALS The PALS department received or were forwarded 47 compliments during quarter two, the majority by letter, email, or taken from the trust website and also by patients coming into the PALS office. The compliments are received from across the trust with the majority during quarter two being for City Road outpatients, Bedford, A&E, St Anne’s and the day care units at City Road. 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 the teams or individuals being thanked. Many reflect the themes noted in other patient feedback:

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“Thank you so much for my days with the Moorfields team. What could have been a worrying, stressful time, was in fact a happy and interesting experience. The quiet efficiency in all departments was very noticeable, especially as we waited in (the day care) room. No words were needed as staff went about their duties, just words of concern for patients. The friendly atmosphere throughout, of nurses, staff and surgeon made one know that we were in kind capable hands and that meant a lot to me. May I just mention something that I’ll not forget? During the operation I had gripped the metal frame for balance; very gently my hand was transferred to a warm friendly hand. Thank you nurse. Thank you so very, very much.” Bedford

“I have nothing but praise for everything/everybody connected with my visit, from pleasant travel in the hospital bus to the ‘cool, calm and collected’ attitude of all staff. It proved to be an enjoyable outing and I look forward to returning when the time is right for removal of my cataracts.” City road

Compliment received for the Oncology Clinic. The receptionist in the clinic was lovely and the patient was seen quickly. The staff made the experience delightful and the service is very much improved.

Patient came into PALS office following a visit to the A&E department because he wanted to let us know how wonderful all the staff had been to him. He said the staff were helpful and efficient and the service was excellent.

Patient's husband came into PALS Office to say how wonderful the clerk on clinic 4 was and how she went out of her way to help him.

“I just wanted to say what a fantastic and speedy response I got from (the nurses) at Croydon University hospital to a query I raised from my concerned mother about a change in packaging to her eye drops. Their speedy response helped alleviate the fears of a frail and frightened old lady and I cannot compliment them enough on the way they handled my query.” A&E

2.3 Compliments from Patient feedback websites Compliments, as with complaints, are no longer private between the patient and the trust, but can be seen in the public domain on patient feedback sites such as NHS Choices and Patient Opinion. Of the comments left on these sites during quarter two, around half of the comments were in praise of the good care received at Moorfields. Where the comments are negative, we are unable to contact the poster due to the anonymity of the sites, but we respond to all comments and invite them to contact PALS so that we can investigate their issue further. “I would like to thank my surgeon and the team for looking after me so well, but particularly the doctor who has seen me any time I have needed to.... The doctor is professional yet kind, caring and always takes time to explain things to me (even if I did muddle my meds up a bit ) ... We are all very quick to complain about our doctors and the NHS but I cannot fault these doctors ...thank you ... You do a great job” “Diagnosis: Central retinal occlusion. Extremely upset and concerned. All staff from reception to triage and then eye doctor were all kind, caring and treated me with dignity and empathy. I want to thank them all.

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I visited Moorfield Eye Hospital after my GP received MRI Scan reports from my local hospital following blurred vision in my right eye…I was incredibly impressed with Moorfields throughout my time there, all the staff were attentive at all times and introduce themselves to me at every stage. Unlike the Eye Clinic at my local hospital, all the staff willingly explained what they were doing and the tests that would be carried out. Following the tests, I spoke with one of the doctors who told me that my issues were Neuro-based but was able to give a possible diagnosis”

“Excellent Level of Treatment. 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)” Conversely, patients who are critical of the service they have received are equally enthusiastic about stressing what they perceive as failings on behalf of the trust. Most of those who post on these sites, do so anonymously, but are encouraged to contact the PALS department so more specific details can be obtained and the issue they raise be further investigated. The postings are sent to departments as they come in and are circulated to all directorate management teams on a weekly basis.

“Really appreciate being treated at Moorfields, especially under the NHS and don’t mind waiting. However having arrived for a 10.15am appt apart from a brief eye test, my husband was still waiting to see the doctor at 12.30 when I had to leave them to get back to West London for another appt. The waiting is not the issue but if it can be foreseen by the staff, we may have been able to have stretched our legs for a short while or have a much needed cup of coffee while we waited. Had I known that this appointment would possibly take that long I would have rescheduled my appointment in order to stay with my husband who sometimes needs my assistance. My comments are in no way a criticism of the

ophthalmology department.” “As an NHS Employee I don’t like to give negative feedback on one of our services but had a very poor experience when visiting A&E three weeks ago. I attended my local hospital suffering from problems focusing and dizziness, where I was given a referral letter to take to Moorfields. In the first hour I was called by about 3 different people to repeat my name and address and attempt to pass on the letter but this was declined each time. I wondered why there was not one person who could take the address and symptom details rather than being moved from seating area to seating area… I eventually was seen by a doctor who clearly was having a bad day. The doctor was short and blunt in conversation and seemed to decide within seconds that I was a time waster, telling me that my problems were related to my age (I'm in my 40's). I had to talk over the doctor to explain the problems were a very recent development and that I had a letter from the other hospital. What surprised me more was the doctor's attitude to colleagues who the doctor asked to assist them in carrying out a few brief tests. I felt genuinely embarrassed for two staff who were ordered about in a patronising manner and reprimanded in front of a patient. I was told I had a dry eye problem and should use eye drops, any product would do and was given a letter for my GP. Thankfully I kept a prearranged appointment with my optician the next morning, who read the letter from Moorfields and was able to explain further that the dry eye condition I had was an extreme case and that they would have recommended a number of ointments and eye products which I was given details of. I've also been advised by the optician that I may need to go back to Moorfields if this doesn’t clear up the problem, but would now be very reluctant to do so. We all have stressful days in our work but being dismissive of people who have waited 4 hours to be seen is unprofessional”

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2.4 Social Media Patients also post compliments on Facebook and via twitter, these, by their nature, tend to be concise:

Had to go to @Moorfields eye hospital today, what a brilliant hospital with great staff! The #NHS at its very best!

Thank you to @Moorfields which has not only excellent doctors but also the most helpful #pharmacists!

@Moorfields Thankyou to Dr and Nurses that have given me back my eyesight at St Anne's hospital 2 ops in four weeks thanks Moorfields you are amazing. My son has been seen under your care since he was 6 months old…We have had first class care always and everyone we have ever had the pleasure of meeting - every doctor, consultant, nurse, and anaesthetist, has been wonderful. So kind, informative, and so very reassuring. Most of all (my son) has a fabulous rapport with his consultant and really, truly loves his trips to the hospital. Thank you from the bottom of our hearts.

2.5 Moorfields Dubai

Moorfields Dubai undertakes a monthly patient satisfaction survey which, though small, scores are consistently high in areas such as welcoming reception, cleanliness, information giving and explanations and overall satisfaction. The Q2 FFT score was 82%

Comments reflecting the appreciation of patients include:

“As I have made several visits to the hospital, I would like to draw your attention to the nurse named Rose. She has an exceptional kind and patient personality. She noticed how my eyes watered whilst taking the eye tests so instructed me to briefly blink momentarily I between the scans etc. She was the only one to have done this and made the experience less uncomfortable. She also explained about the procedures fully with excellent instructions. Rose gives a very personal service and is well informed with a very caring and nurturing manner. Many thanks for the best experience in Moorfields to date. Rose is an absolute asset to Moorfields Hospital. Thank you.”

“Dr Paola, I cannot adequately express my sincere appreciation for all of the work and time that you devoted on my behalf - you are absolutely marvelous and caring. I am looking forward to meeting you again in October where I will crush that eye exam. Inshallah.”

3.0 Complaints Q2 2015/16: An average of 18 complaints a month was received by the trust during Q2, up on the previous quarter with the total number of complaints received being 54, compared to 45 previously with a similar rise in actual complainants. Though an increase on recent previous quarters, the numbers of complaints received are in line with historical trends. The number of clinical complaints was 25, around the same as previous quarters and suggests that issues where patients are at risk are being identified and treated as formal complaints. Issues around appointments and communication have noticeably increased. This is possibly due to the recording of complaints, rather than complainants, as hither to (where previously a

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patient’s primary complaint was about a clinical issue, it may have also contained an element relating to an appointment). All complaints and PALS enquiries are reviewed on a weekly basis with the risk and safety management, and where appropriate the safeguarding teams, and circulated to the directorate management teams to ensure that concerns are handled appropriately. The management teams can then identify themes in their areas and introduce service changes to prevent re-occurrence. 3.1 Complaints received Q2 2015/16

(Fig. 1) Complaints received by quarter 2014/15 and 2015/16

Q3 2014/15 Q4 2014/15 Q1 2015/16 Q2 2015/16

48 33 45

(40 complainants) 54

(47 complainants)

Percentage of patients seen who went on to complain

0.03% (159,583, patients

seen)

0.02% (163,959 patients

seen)

0.02% (167,127 patients

seen)

0.03% (167,410 patients

seen)

Complainants per 10,000 patient contacts

3.3 2.0 2.6 3.2

(Fig. 2) Number of complaints received 2014/15 -2015/16: actual (blue) 12mth rolling trend (red)

3.2 Complaints by type

(Fig. 3) Complaints received by type Q2 2014/15 to Q1 2015/16

19

14 15

11

7

15

12

15 18

12

22 20

0

10

20

30

Oct. Nov. Dec. Jan. 15 Feb. Mar . Apr May. Jun Jul. Aug. Sep.

26

23

22

25

3

1

8

7

4

2

3

10

4

1

4

8

4

7

4 1

3

3

4

3

0 10 20 30 40 50 60

Qtr. 3 2014/15

Qtr. 4 2014/15

Qtr. 1 2015/16

Qtr. 2 2015/16

Clinical Appointments Communication

Waiting times Customer care /attitude transport

Other

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Clinical complaints - Clinical issues continue to be the most common cause of formal complaints received, with the number received staying around the same for the past several years. They are by nature, individual and reviewing by the directorate, site, service or individuals involved does not suggest identifiable themes or areas where generic service change might prevent further episodes. Seventeen of the complaints included what the patient felt were problems or errors regarding the outcome of their treatment such as adverse drug reactions, unsatisfactory surgical outcomes and failure to respond to, a lack of consistency in, or questioning the appropriateness of their treatment. A further three concerned a failure to diagnose, the wrong treatment given and a patient who had sustained an abrasion during examination. The remaining five issues raised were around the consenting process, discharge procedures, delays in treatment, procedures in theatre and funding for treatment. All investigation and responses to patients who make clinical complaints are reviewed by the Medical Director.

Other complaint - The number of complaints regarding appointments was similar to Q1, notably higher than in the past. These were to do with appointments being cancelled (in one case repeatedly), not booked or confusion around the process. Of the seven complaints regarding poor communication, two were from patients wishing to be communicated with by email and this not happening, two were about not being able to get through on the telephone, one about not being listened to in clinic, and a further two about information in not being made clear and the poor English of a member of staff. Of the other complaints, two concerned IG issues around misdirected GP letters, four complained of waiting times in clinic, there was one complaint regarding transport, four around what was perceived as unprofessional or offhand behaviour on the part of doctors or receptionists, and of the others, there were two each regarding finance payments and disorganization of departments. Complaints breakdown by type (Directorate) and type (Ophthalmic Service) can be found in appendix 1. Though no trends or themes were identified it was notable that St George’s received an increase in complaints for August (as did A&E in September), though with no unifying theme for either. A&E was particularly busy during September; however the types of complaint were more about clinical issues than waiting times. There has also been a fall in complaints over the past four quarters for Surgical Services and the cataract service. 3.3 High Risk complaints There was one complaint that was risk rated as ‘High’ (based on the risk matrix that measures the consequence of an event by its likelihood) and this was in regard to a patient who, despite his concerns, was discharged home and was subsequently re-admitted, later that evening, to another hospital with complications that would have been identified and treated had they not been discharged. The case was discussed at the Serious Incident (SI) panel, but was not deemed to be one as the complications could not have been anticipated.

There were two other cases, that emanated from a complaint, referred to the SI panel during quarter two. One concerned a patient whose diagnosis might have been missed due to a failure to ensure the appropriate examination was undertaken. The other was a patient who received the incorrect laser treatment, though no harm was done. Neither was considered to be an SI.

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3.4 Re-opened cases

During quarter two there were two complainants for whom their case was re-opened. These were for further questions, and one that challenged the trusts explanation of mistakes made in a funding application for treatment.

3.5 Response time

Where the final response breached the 25 day limit, this was due to three very complicated and detailed issues several aspects that needed addressing. 98% of complainants were acknowledged within the three day target.

(Fig 4) 25 day response rate Q3 2014/15 to Q2 2015/16

3.6 Litigation

Four claims from were received patients during Q2. Three were clinical; a wrong diagnosis, a failure to arrange follow up and a surgical outcome. There was one non-clinical claim concerning a (non-ophthalmic) injury resulting from an accident with non electronic equipment. There were five claims settled during Q2. Two regarding a delay in diagnosis, one due to clinical injury, one due to failure to treat and one non-clinical due to an accident due to the environment. One case was repudiated by the NHSLA. 3.7 Ombudsman referrals There were no referrals to the Parliamentary and Health Service Ombudsman during quarter two. They did inform us that they would not be further investigating one case regarding a cancelled surgery that was referred to them in June 2015. 4.0 Response to complaints Not all of the issues raised in complaints during the second quarter allow for specific service change. Many of the clinical concerns stem from lack of clarity, from the patient’s perspective, around their care pathway, the reasons for treatment decisions and expected clinical outcomes. As a result, when they are responded to, this commonly takes the form of a narrative and justification of the care they have received. All clinical complaints are reviewed by the Medical Director and where fault on the part of the trust is suspected, the case is referred to the SI panel.

Other ‘non-specific’ responses to complaints include offering complainants meetings with the clinical or managerial staff involved to clarify any misunderstandings, speaking to staff about

Complaints answered within 25 days Q2

Q3 14/15 73%

Q4 14/15 73%

Q1 15/16 89%

Q2 15/16 87%

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how to better handle patients concerns and ensuring they undergo customer service training as part of the Moorfields Way, arranging more appropriate appointments, asking the Eye Clinic Liaison Officer (ECLO) to contact the patient to offer extra support and the sending of clinical information as requested by the complainant.

Some of the trust wide work currently being undertaken, such as the Moorfields Way, Telecommunications project and outpatient improvement programs, will hopefully address several of the underlying issues that currently cause patients to complain and certainly to contact the PALS team. For example, waiting times in clinics (and this is an issue constantly raised in FFT comments) is being addressed by the introduction of clinic ‘floorwalkers’ to liaise between the patient and clinic, prompt cards informing them that they can leave the clinic without missing their turn and patient pagers, so that should a patient wish to leave the waiting area for any length of time (for a coffee for example), they will be called when it is their turn.

Other specific service changes are:

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

Following requests that information be routinely sent by email, a group has been set under the chair of the Directror of Nursing and Allied Health Professions to look at accessible in formation across the trust, so that patients can be identified and receive communications in the manner they choose. The two complaints in question are now receiving information in this matter.

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.

After a patient was given conflicting information as a walk-in at St George’s and did not receive an appointment until after the date, a standard operating procedure will be reintroduced to the walk-in service to reinforce timely registration of patients and a review of the administrative processing of short-term follow up appointments is being undertaken to ensure that the clinical protocols are being adhered to. The local manager is monitoring the length of time that it takes to answer telephone calls.

Following a patient receiving an abrasion, a doctor's laser treatment method has been observed to ensure that they are not inadvertently increasing the risk of corneal abrasions.

Following a complaint that a patient was interrupted six times during a consultation, local changes are being explored which to ensure that interruptions during consultations are kept to a minimum.

Following an incorrect laser treatment being performed, a root cause analysis is taking place and changes to practice will be put in place to ensure there is not repetition. The lessons learned will also be discussed at the forthcoming clinical governance meeting.

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 is being undertaken to ensure that they give clear and accurate information.

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A member of the medical staff has been asked to reflect on their behaviour following a complaint from a patient who felt their manner offensive.

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 PALS and Complaint team activity

The PALS and complaints team continue to promote the importance of learning from complaints and PALS enquiries across the trust, through continued training sessions, site visits (where they ensure that leaflets and posters are on clear display) and the provision of complaints and PALS data for departments. Two issues identified in the CQC preparedness work and noted in the CQC reports from other trusts is the awareness of complaints handling at a local level, and being able to identify changes that have been made as a result of complaints. To help address this, the PALS team have been involved in producing a complaints infographic, producing more detailed posters outlining the complaints process to be put in staff rooms across the trust, encouraging staff to read the PALS patient booklet themselves and are currently developing materials to go on the trust web and intranet sites focusing on examples of ‘You said -We did’. 5.1 Complaints Handling: survey 2014 Since January 2015, most complainants have received, two months following the closure of their complaint; a survey asking them how they felt various aspects of their complaint was handled. Of the 98 questionnaires sent out, 28 (28.5%) were returned. Of the type of complaint referred to, 62% were clinical, 23% Staff Attitude and 23% something else (such as issues about appointments, communication and waits in clinics etc.) Q3. 68% of complainants raised their concerns with the staff dealing with them in the clinic, day care ward, A&E, or over the telephone etc, before making a formal complaint or discussing it with PALS. Q3a. When asked how helpful they found the staff in trying to resolve their concern or issue 63% said they found them unhelpful or very unhelpful.

Did not resolve my issue, instead explained the steps I had to take.

A&E staff kept repeatedly informing me that they would ring back. They failed to. Hence my formal complaint

I felt that they were trying to justify the doctors mistakes, all my concerns raised had an answer to which was not sorry, or helpful.

Didn't feel listened to by staff, she wanted to argue over detail and would not address my concerns

Q4. When they decided to complain, 71% of patients who needed to found information on how to do so.

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Q4a. Source of information

Q5. 70% of complainants said that they found the complaints team supportive or very supportive. Q6. 67% of patients said the complaints team gave them all the information they needed about how their complaint would be handled Q7. 27% said they were not informed of when they would receive a response to their complaint at the start of the process NB. This information is included in all complaint acknowledgment letters.

Q8. Only 44% felt they could have contacted the complaints team at any time to find out how your complaint was progressing? Of those who felt they could not contact the team, the comments as to why were:

At the risk of being thought cynical, I had already decided the CE formal reply would be less than fully constructive - hence and not bother to check

I was now in contact with the manager at Bedford

I could have contacted them but they wouldn't have helped

Very definite information given as to time scale, so did not seem any point

I did not wish to presume I had any special entitlement to special treatment or be a nuisance

No idea who to contact apart from PALS

Q9. Only 50% said they were satisfied that all their concerns had been addressed in the response they received, however, 58% felt that the response was honest in responding to the concerns raised.

Q10. Overall, 36% of complainants felt their complaint had been handled poorly. When asked how we could improve the following suggestions were given:

By being more flexible in your response to issues raised rather than fixing them rigidly in a system. By not being defensive when not being criticised, perhaps by looking at the power of the most senior medical staff

I think first of all you should spend more time with each patient, the consultant should ask whether there are any issues that concern the patient and more proper care should be given. I have glaucoma which was left untreated and when I went privately it was diagnosis and treatment sorted.

Be honest, admit your mistakes and rectified them, I will always suffer the consequences of this hospital, and you're not even sorry. You have masked your mistakes to perfection.

27% 7% 13% 40% 13%

0% 20% 40% 60% 80% 100%

1

Outside: GP/ Healthwatch, etc. MEH Staff MEH Website MEH PALS MEH PALS Leaflet

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If asking the customer what they are looking for by way of resolution to their complaint and include this is the complaint response. Include a second stage in the complaint process for those who are still unhappy rather than requiring complainants to go straight to the Ombudsman.

Be open and more honest, to take it seriously.

Learn how to say sorry. When an urgent second opinion is requested, make sure it happens; be less defensive, everyone makes mistakes.

Address the complaint on the letter not your perceived complaint, look reasonably at both sides of complaint, and don’t just defend your staff.

Actually address the complaint rather than simply recount my treatment to date, the consultant I complained about made no response and it was left to another doctor to deal with it, shameful.

Thank you for dealing with the matter so promptly and effectively, well done!

If the eye ointment had been given in the first place, which it was not, then there would have been no complaint. If the appointments had not been cancelled over and over again the complaint would not have been put it.

Staff seem to be overwhelmed by numbers of patients, I would have been prepared to wait for an appointment, so not so many patients always milling about and staff thus under less pressure and able to give more care and attention, this would lead to less complaints

Complaints leaflets readily available.

Recognise the root cause of the problems, which I think are mainly generated by poor administrative support, and reception compounded by under-training, staff indiscipline and a seriously eroded culture of care at that level.

5.2 Findings and response Though 28 responses is a statistically small number and results must be treated with caution, especially as the underlying issues can be emotive, generalisations can be drawn from these results and actions identified going forward. On the positive side, 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, the relatively poor score for the helpfulness of staff dealing with concerns ‘in-situ’ (Q3a) echoes the results of the CQC preparedness feedback and the highlighted lack of knowledge of staff in dealing with complaints. Hopefully some of the points outlined above in 5.0 and in the wider Moorfields Way programme will go some way to address this, especially in stressing the importance of local resolution and escalation to senior managers and clinicians at the time.

The issues raised in Q6, Q7 and Q8 regarding an understanding of how their complaint will be handled, regardless of the fact that, certainly in regards to time frames and to some extent the process, this information is given over the telephone and confirmed to complainants in writing in all cases, suggests that there is room for more clarity regarding this. The complaints team is finalising a leaflet, to go with the complaint acknowledgment letter, setting out clearly what happens when a complaint is received and what complainants can expect, stressing in particular the availability of the complaints manager

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should they wish to discuss their case at any point. The MEH Website content relating to complaints will also be reviewed.

Currently, Directorates are asked to complete their investigations within a two week period. Going forward, they will be asked for a status update at this point if it is not completed, rather than the three to four week point as at present. The Complaint Manager will also routinely contact the complainant at the two week point (presuming we have not responded by then) with this information and assurance.

We will also include in the acknowledgment letter that should a complainant feels that

their issue might be better resolved via a meeting, that this can be arranged. Currently, this only tends to happen if they are not satisfied at the end of the process.

Of more concern perhaps are the results from Q9 and Q10, regarding the satisfaction of complaints with the outcome. This has perhaps been masked by the relatively few (and reducing) number of re-opened cases and referrals to the Parliamentary and Health Service Ombudsman (PHSO). Also, many of those who were not satisfied concerned clinical complaints, and conceivably, if one genuinely believes that that they have been harmed in some way, they might treat any explanation with a degree of skepticism.

That notwithstanding, the directorate teams who manage complaints have been asked to ensure that investigation findings are scrutinised to a high degree before return to the complaints team to ensure that all aspects of a complaint have been addressed and outcomes clearly identified. The patient’s perception may also be more than is contained in a complaint letter or expressed in conversation at the start of the process. The final written responses that patients receive are individual to them, however there is always advice included that if they are not happy the can either contact the Complaint Manager or PHSO. Going forward this advice will be made more explicit, stating clearly, that if they feel any issues have not been addressed they are encouraged to contact the Complaint Manager again so that a resolution to their satisfaction might be achieved either through a further report or meeting. The changes discussed will be embedded over the coming quarter, when the survey will be run again.

6.0 PALS enquiries

The majority of PALS concerns are dealt with, as they happen either by the two PALS officers or in liaison with the directorate teams. All PALS enquiries are circulated on a weekly basis so that directorates can identify the themes and issues and address them at service performance meetings. 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.

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673 PALS enquiries in were received in quarter two. This compares with 564 for the previous quarter. There was a notable increase in the number of communication related enquiries for both information and concerns, though generally, all categories increased in number. Appointment issues were the second most common enquiry followed by clinical questions and concerns around staff attitude. (Fig 5) PALS activity Q3, Q4 2014/15 & Q1 & Q2 2015/16

8.1 PALS Information and enquiries

As noted above, activity was up on the previous quarter, notably due to an increase in what was catagorised as communication. The majority of these were enquiries about clinical administration (as opposed to Clinical Enquiries - i.e. seeking medical information or advice) and ranged from requests for information about how they can be seen at Moorfields, requests for summaries of treatment, to questions about social service entitlements due to ophthalmic conditions, the legality of driving with eye problems and how to become involved in clinical studies. Other communication issues were about hospital services, information about admissions, and discharge procedures and requests for reports or letters and patients wanting information about their appointments etc. The types of enquiries remain the same with appointment enquiries focusing on patients wishing to change, alter the location, cancel their appointments or wishing to bring an appointment forward.

(Fig 6) PALS Information and enquiries Q3, Q4 2014/15 and Q1 & Q2 2015/16 by number and percentage

45

147

276

48

127

264

63

199

302

47

258

368

Compliments Information or enquiries Concern or informalcomplaints

Quarter 3 2015/16 Quarter 4 2015/16

Quarter 1 2015/16 Quarter 1 2015/16

1

5

5

5

42

38

72

72

3

4

6

7

7

4

4

8

13

14

17

27

36

41

55

82

4

5

7

6

7

12

1

39

17

27

35

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

Q3 2014/15

Q4 2014/15

Q1 2015/16

Q2 2015/16

Administration Appointment issues Cancelled Appts

Cashiers Clinical Issues Communication

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There is no such thing as a PALS typical enquiry but some typical examples are:

PALS Enquiry Outcome

Now living abroad. Needs further treatment hence asking for copy of notes.

Enquirer informed that the query is now with the Health Records Dept. who will contact them.

Patient was concerned that she had been logged on our system incorrectly. Patient also requires a copy of appointment letter to be sent to her.

Patient's title has already been changed on PAS. Another appointment letter to be sent to patient with correct title.

The patient's father called. The patient has been referred to the MR Clinic and he has been told he will need to be seen urgently but he has heard nothing yet.

MR Service Manager has booked the patient an appointment The patient's father is very grateful that this has been arranged.

Email received from patient who would like to know what the process is to see a specialist.

Patient advised of how to obtain an NHS appt and private appt. Patient also advised of Helpline number for medical queries.

Asking for a soon appt. Her appointments have been messed up. She is a MEH patient at St Georges but would like to attend at City Road.

Patient happy to be rebooked for this Saturday at City road

Patient has been given an admission date of 01.10.15 which she cannot make due to another hospital commitment. Patient would like date rebooked. Patient also has some questions regarding her admission.

Operation date changed to a date patient is happy with and Pre-Assessment Sister has contacted the patient to address her queries.

8.2 PALS Concerns and informal complaints The main change of note between quarter one and quarter two was the increase in concerns relating to communication such as calls not being answered, chasing correspondence or medical results promised but not received, and the reduction in transport issues. The main concerns regarding appointments were the cancellation and changing of appointments.

(Fig 6) PALS Concerns and informal complaints Q3, Q4 2014/15 and Q1 & Q2 2015/16 by number and percentage

19

31

21

15

44

48

93

93

17

16

13

16

41

47

38

45

3

8

41

41

49

70

10

4

5

13

22

21

9

21

27

23

26

36

14

14

20

23

20

12

25

28

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

Q3 2014/15

Q4 2014/15

Q1 2015/16

Q2 2015/16

Administration Appointment issues Cancelled ApptsClinical Issues Cashiers CommunicationOptometry Transport Staff AttitudeWaits in clinics or day care Other

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Examples of the types of concern received are:

PALS Concern Outcome The patient is frustrated because he was asked to ring a member of staff to arrange an admission and has found out has gone on maternity leave

Apologised and arranged for the patient to be called from admissions and an admission date has been given

The mother of the patient was so frustrated by the fact that she could not rearrange her daughter's appointment that she came up to MEH

The department made an appointment for the patient that afternoon

The patient was concerned about her appointment as she felt overlooked by the doctor

Apologised and offered to go back to the clinic with the patient but she did not want to return and just asked me to let the consultant know what happened

Concerned about length of time to next appointment; poor communication; incomplete letter not mentioning about potential for an operation; private medical records not forming part of NHS records

Service Manager has arranged for patient to have an apt. in September with Consultant. Service manager will retrieve MF Private notes and have them put with NHS notes and ask the consultant to write an updated letter.

Contact lens paid for not received, six weeks have gone bye. Patient has chased it several times but still waiting.

Patient apologised to. Informed that the lens should be received by him by Wednesday next week. There were maufacturing issues.

The patient was frustrated as she was unable to get through to St Georges to find out about her appt.

Apologised for the difficulty that the patient experienced getting through and provided the information she needed

The Board is asked to note the content of this report.

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TPW/CC/Q2/11/15

Appendix 1

Complaints received by type / Directorate Q3, Q4 2014/15 and Q1, Q2 2015/16

Complaints received by type / Satellite Q2, Q4 2014/15 and Q1, Q2 2015/16

Complaints received by type / Service -Q3, Q4 2014/15 and Q1, Q2 2015/16

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Complaints received by type / Service -Q3, Q4 2014/15 and Q1, Q2 2015/16