nhs fife annual complaint report 2018 -...

Title: NHS Annual Complaints Report 2018 - 2019 Version 1.0 Date: August 2019 Lead: Donna Hughes of 18 Review Date:

NHS FIFE ANNUAL COMPLAINT REPORT 2018 - 2019 NHS Fife values and understands that using patients/service users lived experience contributes significantly to how staff learn and come to understand the needs of people who require treatment and care in its hospitals and community care settings.

Over the last 12 months NHS Fife have demonstrated an ongoing commitment to listening and learning from the experience of patients/carers/service users. We have continued to seek feedback using a range of methods, recognising that no one size fits all. We have used feedback to improve practice and to influence service developments. We have used What Matters To You as our mantra in an effort to embed the principles of person centred care. Care Opinion has gone from strength to strength in 2018/19 and has proven to be a valuable tool for not only seeking real time, anonymous feedback; but in providing staff with what is often positive feedback. We can demonstrate simple changes in practice/procedures as a result of this feedback. Our Participation and Engagement Strategy clearly defines our values and commitment to Participation and Engagement and identifies the experience and involvement of people as key to embedding the principles of Participation and Engagement in every day practice. We continued to face challenges in responding to complaints in a timely manner due to a number of factors; however we have undertaken work to review and improve process to reduce delays.

In presenting the 2018/19 Annual Report I would like to extend my grateful thanks to every person who has taken the time to provide us with feedback and to every staff member who has responded to it. I would also like to extend my thanks to those supporting this work, including; Patients/Carers/Volunteers/Public Partners/ Staff/Patient Relations/Care Opinion/Third Sector Partners, including Advocacy providers/Scottish Health Council/Scottish Government/ Patient Advice and Support Service and the wider community. Helen Buchanan Director of Nursing


INDICATOR 1: LEARNING FROM COMPLAINTS

INDICATOR2: COMPLAINT PROCESS EXPERIENCE

SECTION 3: COMPLAINTS PERFORMANCE

SECTION 4: ACCOUNTABILITY AND GOVERNANCE


Indicator 1: Learning From Complaints NHS Fife values complaints alongside all other forms of feedback. We actively welcome and encourage patients/carers/service users and members of the public to let us know what we do well and what we can do better, in order that we can share good practice and make improvements to maintain the quality and safety of the care we deliver. A range of promotional materials are on display in ward/department/units to promote the Board’s desire to receive feedback. We have used every opportunity as part of our wider Participation and Engagement activities to encourage people to tell us what they think about our services. When attending community groups about other aspects of business we have taken the opportunity to deliver the message that NHS Fife welcomes all forms of feedback and are committed to improving and learning as a result. NHS Fife in 2018/19 received 847 Stage 1 complaints and 411 Stage 2 complaints. We have detailed a few examples of the work we have undertaken over the last year. In August 2018 along with other Fife public authorities NHS Fife co-ordinated work to produce Fife’s multi-agency British Sign Language (BSL) Action Plan. This involved consulting directly with Fife’s Deaf community in what improvements they would like to see in place to help make healthcare more accessible. One of the issues raised at this consultation was that deaf service users found NHS Fife’s complaints procedure difficult to access as it relied on being able to phone or write in to make a complaint. The deaf community felt this should be much more accessible in their own language. The Equality and Human Rights Team have worked with Fife’s Deaf Community and other types of sensory impairment support groups to provide additional supports to discuss any concerns or raise complaints regarding health care services. This work has led to some significant improvements being put in place, one of which is the setting up the face- to- face BSL Health drop-ins, which are now held once a month or sooner should an urgent matter be identified. Overall this given confidence to the Deaf Community that complaint handling can be facilitated in BSL, which is often the preferred language of communication for deaf people. The number of compliments from the Fife deaf community has risen significantly for NHS Fife as a result of the improvement. Acute Services Division (ASD)

Within ASD there has been changes made to the Patient Boarding Policy. The complaint investigation recognised a need for senior clinical leadership out of hours. Testing of this model is currently underway with plans to recruit to a permanent post.


ASD have also introduced local fasting guidelines which followed a complaint made by a patient who had fasted for a prolonged period of time and communication regarding fasting had been poor.

Health and Social Care Partnership (HSCP)

Within the Community Paediatrics Service changes have been made to the process for cancelling appointments due to staff sickness.

The Board currently report on key complaint themes within each of the Divisions and there is work ongoing across the Board to support improvement. However, there is recognition that sharing the learning and measuring its impact needs to be improved. Discussions are underway to address this

The tables below demonstrate the current complaint themes for Stage 1 and Stage 2 complaints.


181

108

75 61

36 29 27

0 20 40 60 80

100 120 140 160 180 200

Unacceptable waiting time

for the appointment

Staff attitude and behaviour

Disagreement with

treatment / care plan

Co-ordination of clinical treatment

Lack of support

Cancellation of

appointment

Insensitive to patient needs

Num

ber o

f Iss

ues

Issues (Themes)

Stage 1 - Complaints by Issues


NHS Fife continued to receive positive feedback. A total of 871 compliments were registered compared to 830 the previous year.

159 149

73 65 63

44 38

33

0

20

40

60

80

100

120

140

160

180

Disagreement with treatment / care

plan


Staff attitude and behaviour

Communication Face to face


Unacceptable time to wait for the appointment

Problems with medication

Insensitive to patient needs

Num

ber o

f Iss

ues

Issues (Themes)

Stage 2 - Complaints by Issues


NHS Fife is committed to learning from areas of good practice. Our Person Centred Steering Group is facilitating testing and implementation of Health Improvement Scotland’s ‘Care Experience Improvement Model’. The model is designed to gather qualitative feedback from patients/carers/families with information used to drive improvement. The model was recently tested within Mental Health Older Peoples Services. Staffs’ initial predication was families would complain about the environment however, the results were extremely positive. The team have analysed the feedback and shared this with other teams. Our mechanism for sharing learning from complaints which have progressed to the Ombudsman has remained unchanged during 2017/18. Information is widely shared when decisions are reached by the SPSO. A later section of this report will feature one SPSO case where the recommendations are driving a service wide review in relation to consent processes.

Care Opinion Care Opinion continues to be promoted extensively across the organisation. The following demonstrates that we have achieved what we set out to do and more:

• 18% increase in stories posted (411 stories compared to 346 stories posted in previous year)

• 90% of stories responded to (71% within 5 days compared to 95% in previous year)

• 90% of stories posted were non critical (76% in previous year) • 4 stories led to a change being made • 59% increase in the number of responders.

Much of the success of Care Opinion in the year 2018/19 is down to the leadership and commitment of the board’s Care Opinion’s Operational and Administrative Leads who have actively promoted Care Opinion through a variety of workshops and discussion sessions. Various services have also promoted the use of the child friendly version ‘Survey Monkey’. It is hoped that this will provide valuable feedback on the services as it continues to develop. We continue to encourage staff (Senior Charge Nurse and Charge Nurse) at local level to response and have developed a learning pack in order to provide support. We have worked in partnership with Care Opinion to improve the way in which we capture and share information as a means of continually improving our outreach.


The graph below shows the distribution of stories received with steady progress being made.


The graphic “Tag Bubbles” below highlights/themes information extracted from individual stories posted on Care Opinion. The green colour indicates positive opinions where individuals have stated what was good about their experience. The pink colour identifies what could be improved. Specific examples are: Staff: 124 positive opinions / 1 negative opinion Care: 97 positive opinions / 2 negative opinions Communication: 12 positive opinions / 14 negative opinions

NHS Fife reviews Care Opinion data to make comparisons between the feedback and the complaints themes. It is encouraging to note that although staff attitude and behaviour is among the top recurring themes, feedback via Care Opinion is extremely positive. However, communication remains problematic and this needs to be a focus for improvement over the next year.

Title: Annual Report 2018/19 Feedback, Compliments, Comments, Concerns Version 1.0 Date: August 2019 Lead: Donna Hughes of 18 Review Date:

Your Care Experience

Your Care Experience is a questionnaire developed to seek real time feedback from patients and service users. The questionnaire and IT platform used to collect the data has been reviewed. The questionnaire aims to gather qualitative and quantitative data and be relevant to all clinical services rather than solely in - patient services. The revised tool is undergoing testing in a number of in-patient and out-patient settings. Indicator 2 - Complaint Process Experience

NHS Fife is committed to ensuring all complainants have a positive experience when making a complaint. When dealing with complaints we believe it is important to find out what matters to the person raising the complaint and to determine from the outset what it is they would like to achieve as a result of the complaints process. To do this we speak to people to ensure that no assumptions are made and to make sure that people understand and feel able/have access to support to be involved in the complaints process. The Patient Relations Team in NHS Fife supports this by establishing contact on receipt of a complaint. To establish satisfaction with the complaints process, a questionnaire was developed to seek feedback from complainants. To ensure we remained inclusive, a range of methods (electronic, hard copy, telephone) was used. Initially the questionnaire was limited to Stage 2 complaints, although later extended to Stage 1 complaints in June 2017. Generally the return was poor for Stage 2 complaints (4 in a quarter) and commonly it was complainants who remained dissatisfied who responded. For Stage 1 complaints in the first month this was used the general feedback was positive and indicated satisfaction with the process. However, from this time onwards the general return rate for feedback forms was poor and therefore a decision was made at the end of 2018 to stop sending the feedback forms and review a new process which would also consider GDPR regulations. This was to ensure that complainants had ‘opted in’ to provide feedback. In 2019 Patient Relations have been reviewing how best to collate feedback from complainants; ensuring compliance with GDPR regulations. It was decided that the Patient Relations Officers would ask complainants if they would be happy to be contacted on completion of their complaint to provide feedback. If so, the Patient Relations Coordinator would call to obtain their feedback. There has been a challenge in the collation of complainant feedback using this process as often Patient Relations Officers would not remember to ask complainants to opt in or the complainant did not wish to provide feedback. It has therefore not progressed as we would have hoped. It is clear that the collation of feedback is important and enables the Board to re iterate the value in responding timeously to complaints and making every effort to resolve issues at a local level using front line staff. It also allows the Patient Relations Team to reflect on their process and make improvement.


However, as there has been very limited value in the feedback process thus far, Patient Relations are looking at alternative options for collating feedback to get the most valuable information. This includes looking at the options of using an online survey and discussion with other NHS Boards on how they collate and use feedback from complaints. While previous return on feedback forms has been poor, the Patient Relations Team remains proactive in highlighting trends or areas of concerns directly with the relevant services for immediate review and learning. Indicator 3 – Staff Awareness and Training To support the ongoing development of a person centred culture the Board supported more staff to undertake training in relation to adopting a personal outcomes approach. Good conversations training is available for all staff across the organisations to support staff in their conversations with patients/carers and families at local level. The Patient Relations Team continues to support junior doctors and student nurses training though the process of the Power of Apology Awareness Session. This has been well evaluated. The Patient Relations Team continually develops their own skills in relation to listening and communicating to ensure and efficient and effective service is delivered. The Patient Relation Officers also participate in supervision and reflective based learning. The Patient Relations and Clinical Governance Teams have aligned common elements of work and are now delivering joint induction training for staff which covers safe, effective and person centred care. This is currently under review. We continue to encourage staff to complete the elearning feedback and complaints training developed nationally. The following table shows comparative data over the last two years. NHS Fife Module

1 Valuing Feedback

Module 2 Encouraging Feedback and Using It

Module 3 NHS Complaints and Feedback Process

Module 4 The Value of Apology

Module 5 Managing Difficult Behaviour

2018/19 2017/18

79 35

76 35

77 35

74 35

77 35

Medical Staff Core Training


Course – FY2 Term 3 Programme Attendance

Power of Apology 13

Student Nurse Training – Patient Relations Attendance

3rd year nursing students undertook a placement within Patient Relations as a pilot to increase knowledge and awareness of complaint handling. This was supported by Practice Education Facilitators. The focus was to address the importance of complaints in the workplace and how staff attitude, behaviour and culture can influence complaints. This was piloted in January 2019 and the training was delivered by Patient Relations Manager, Coordinator and Patient Relations Officers.

6

Corporate Induction Attendance

Delivery of induction training in relation to Patient Relations and Clinical Governance roles. Corporate Induction is delivered by a number of staff in the Patient Relations and Clinical Governance Teams.

26

SAER / Duty of Candour NHS Fife is committed to delivering training on Adverse Event and the following table demonstrates number of staff trained in 2018/19. Course Attendance Adverse Event Review Training (including Root Cause Analysis and Human Factors)

131

Duty of Candour Learn Pro 1556 Datix Incident reporting and Incident reviewing Learn Pro 323

Indicator 4 - Total Number of Complaints Received

4a. Number of complaints received by the NHS Territorial Board or NHS Special Board Complaints and Feedback Team

1293

4b. Number of complaints received by NHS Primary Care Service Contractors (Territorial Boards only)

546


4c. Total number of complaints received in the NHS Board area

1839

NHS Board - sub-groups of complaints received

NHS Board Managed Primary Care services;

4d. General Practitioner 15

4e. Dental 6

4f. Ophthalmic 21

4g. Pharmacy 3

Independent Contractors - Primary Care services;

4h. General Practitioner 322

4i. Dental 8

4j. Ophthalmic 10

4k. Pharmacy 206

4l. Total of Primary Care Services complaints

591

4m. Total of prisoner complaints received (Boards with prisons in their area only)

Note: Do not count complaints which are unable to be concluded due to liberation of prisoner / loss of contact.

N/A

Indicator 5 – Total Number of Complaints Closed by NHS Board. (not including contractor data, withdrawn cases or cases where consent not received).


Number of complaints closed by the NHS Board

Number

As a % of all NHS Board complaints closed (not contractors)

5a. Stage One 863 67

5b. Stage two – non escalated 328 25

5c. Stage two - escalated 102 8

5d. Total complaints closed by NHS Board

1293 (Should = 100%)

Indicator 6 - Complaints Upheld, Partially Upheld, Not Upheld

Stage one complaints

Number As a % of all complaints closed by NHS Board at stage one

6a. Number of complaints upheld at stage one 299 35%

6b. Number of complaints not upheld at stage one 394 46%

6c. Number of complaints partially upheld at stage one 163 19%

6d. Total stage one complaints outcomes

(Should = 100%)

Stage two complaints

Number As a % of all complaints


Non-escalated complaints

closed by NHS Boards at stage two

6e. Number of non-escalated complaints upheld at stage two 63 23%

6f. Number of non-escalated complaints not upheld at stage two 126 30%

6g. Number of non-escalated complaints partially upheld at stage two 139 47%

6h. Total stage two, non-escalated complaints outcomes

328

(Should = 100%)

Stage two escalated complaints

Escalated complaints

Number As a % of all escalated complaints closed by NHS Boards at stage two

6i. Number of escalated complaints upheld at stage two 24 24%

6j. Number of escalated complaints not upheld at stage two 42 41%

6k. Number of escalated complaints partially upheld at stage two 36 35%

6l. Total stage two escalated complaints outcomes

(Should = 100%)

Indicator 7 – Average Response Time


Indicator Seven – Average Times

7a - The average time in working days to respond to complaints at Stage One

6.44

7b - The average time in working days to respond to complaints at Stage Two (Not escalated)

34.98

7c - The average time in working days to respond to complaints after escalation 26.85

Indicator 8 – Complaints Closed in Full within timescale

Number As a % of complaints closed by NHS Boards at each stage

8a. Number of complaints closed at stage one within 5 working days. 610 71%

8b. Number of non-escalated complaints closed at stage two within 20 working days 150 46%

8c. Number of escalated complaints closed at stage two within 20 working days 61 60%

8d. Total number of complaints closed within timescales

821

Indicator 9 – Number of Cases Where An Extension Was Authorised

Number As a % of complaints closed by NHS


Boards at each stage

9a. Number of complaints closed at stage one where extension was authorised 96 11%

9b. Number of complaints closed at stage two where extension was authorised (this includes both escalated and non-escalated complaints)

20 6%

9c. Total number of extensions authorised

6 6%

Completed by:

Name: Donna Hughes Position: Patient Relations Manager

Tel: 01592 648069 E-mail: [email protected]

Date: 29/08/2019

mailto:[email protected]

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