SOUTH WARWICKSHIRE NHS FOUNDATION TRUST

Meeting Board of Directors

Date 28 January 2016

Subject Patient Experience Quarterly Report

Enclosure H

Nature of item For information For approval For decision

Decision required (if any)

The Board is asked to receive and note this report.

General Information

Report Author Patient Experience Team Lead Director Helen Lancaster, Director of Nursing

Received or approved by

Meeting Date

Resource Implications

Revenue Capital Workforce Use of Estate Funding Source

Applicable Quality Improvement Priorities

Care Quality Commission Rating Nurse Staffing Levels Paperless Working Electronic Requesting Food Delivery Dementia Complaints Feedback

Freedom of Information

Confidential (Y/N) (if yes, give reasons)

No

Final/draft format

Final

Ownership

Trust

Intended for release to the public

Yes

South Warwickshire NHS Foundation Trust

Report to Board of Directors – 28 January 2016

Patient Experience Quarterly Report

Executive Opinion This report provides an assuring picture on activity relating to patient experience across the Trust. With the expansion of the Patient Experience Key Performance Indicators (KPIs), we can see a reassuring picture of elements which can impact patients’ experience. Ward and service staff continue to review and learn from feedback and complaints, in particular the upheld complaints. Notably, patient recommendations in the Friends and Family Test (FFT) continue to be high. Executive Summary Complaints Activity

• comparable number of complaints recorded in comparison to previous month, with no untoward theme identified in subjects or grading of complaints;

• all complaints were acknowledged within the 3 days timescales and a previous administrative error was rectified, which led to a decline in performance last month;

• whilst performance has improved significantly, investigation leads can frequently fail to keep the Patient Experience Team informed of developments and progress, leading to duplicated efforts. This has been escalated to Associate Directors of Operations through Audit and Operational Governance Group (AOGG) meetings;

• no complaints were escalated to the parliamentary ombudsman, and • learning and themes have been disseminated to wards including a new quality

briefing paper which is issued to all staff. This paper includes a section on feedback from patient feedback and lessons learnt from complaints, which will enable better triangulation and also support wards to learn from patient feedback.

Patient Feedback

• A&E Response Rates – whilst patient recommendation continues to be notably high in all areas when compared to regional and national rates, there has been a decline over the last two months in response rates in A&E. The response rate has improved slightly in comparison to previous months, however still remains below past performance which has been in excess of 28%. The FFT survey remains a critical element of a patient’s journey and is the only tool used in A&E to measure patient satisfaction. Actions being taken to address this comprise of: - Targeted awareness campaign including ‘floor-walks’ to be carried out by the

Trust FFT lead and Deputy Director of Nursing to engage with staff and patients. - A&E reception staff hand out survey forms with any paperwork they provide

patients - Weekly collection and monitoring of surveys to resume as previously done when

patient participation declined. Helen Lancaster Director of Nursing

Patient Experience Quarterly Report Complaints and Patient Feedback

Data extracted 15 January 2016

Data source Datix Risk Management System

2

Patient Experience Performance summary – 2015/16 Quarter 3

3

Overview of Complaints Data

During December 2015 the Trust received 6 formal complaints, making the total number of 40 formal complaints received during Quarter 3 2015/16 To enable a better review of data and to identify trends, the charts below provide an overview of activity for recent months.

Complaints by Grade Oct 2015 – Dec 2015:

Amber, 20 Dark

Amber, 9

Green, 7

Red, 3

Complaints by Subject:

5 4

3

13

2 1 1

4 2

02468

101214

Complaints by Division by Quarter:

21

34

8 4

0 05

10152025303540

Elective Care EmergencyCare

Integratedand

CommunityCare

SupportServices

Corporate

15/16 Q1

15/16 Q2

15/16 Q3

Number of Formal Complaints Received:

0

5

10

15

20

25

30

Jan2015

Feb2015

Mar2015

Apr2015

May2015

Jun2015

Jul2015

Aug2015

Sep2015

Oct2015

Nov2015

Dec2015

4

Quarter 3 Overview: of Area Activity Report This area activity report shows the status for Q3 2015-16. As the monthly number of complaints are low, data has been aggregated for the Quarter to enable

better scrutiny of performance

Ward/Area Total Q3 2015-16 Red D Amber Amber Green

2014/15 Q2 Activity

No % indicates no complaint

received

2015/16 Q3 Activity %

Antenatal Assessment Unit 1 0 0 1 0 0.02% 0.01%

Accident & Emergency 6 0 1 4 1 0.6% 0.4%

Avon Ward 2 0 0 2 0 0.13% 0.11%

Castle Ward 1 0 0 1 0 0.03% 0.03%

Dermatology Day Unit 1 0 0 1 0 0.09% 0.08%

ENT 1 0 0 0 1 0.3%

Integrated Health Team 2 0 1 1 0 0.19% 0.19%

Mary Ward 1 0 0 1 0 0.09% 0.08%

Machen Eye Unit 8 0 3 1 3 0.09% 0.09%

MAU/Fairfax 3 1 0 1 1 0.81% 0.63%

Midwifery 1 0 0 1 0 0.19%

Oken Ward 1 0 1 0 0 0.03% 0.03%

Outpatients Department 1 0 0 0 1 0.13% 0.11%

Physiotherapy 1 0 0 1 0 0.15% 0.11%

Victoria Ward 1 0 0 1 0 0.19% 0.15%

5

New Complaints Received: December 2015

ID First received Description Division Ward/Site Subject (primary) Grade

3266 22/12/2015

Brother complained that his sister has received yellow & red cards from the hospital, he demands an explanation and alleges that his sister has been bullied and intimidated by the Trust, making fabricated allegations against her. Concerns include: Clinical care, communication, staff attitude, attitude of the Trust, red & yellow carding, failure to refer for counselling or psychology, failure to provide support, allegations made by the Trust, failure to provide video recordings of incidents which would vindicate patients behaviour, victimisation of patient, assault of patient, failure to treat with dignity & respect, failure to treat pain following accident, escorting patient from Trust premises & leaving her outside, fabricating information given to family members 25 miles away, unacceptable conduct by the Trust.

Trustwide Trustwide Clinical Care Amber

3265 22/12/2015

Patient unhappy with appointment in Machen Eye Unit, unhappy with the way tests carried out and feels kept waiting too long to see Consultant, also feels staff were unhelpful and would not find out how much longer he should wait. Patient left and went home without seeing the Consultant.

Elective Care Machen Eye Unit

Waiting Times - clinic Green

In the month of December 2015 the Trust received 6 new complaints. Below is a list containing details of the new complaints received. These complaints are currently under investigation.

6

3269 18/12/2015

Complaint about nursing care. Patient states that the healthcare assistance on night shift looked after her young grand children during her shift. This disturbed the patient and meant that she did not receive the nursing care she should have.

Emergency Care Avon Ward Nursing Care Amber

3268 16/12/2015

Damage to patient’s bladder caused during a gynaecological repair. Patient was not made aware of the problem that happened during surgery.

Emergency Care Oken Ward Clinical Care Dark

Amber

3261 04/12/2015

Family complaint regarding problems with District Nursing team in Rugby not knowing where key-safe is or injection equipment in secure box is to be able to treat diabetic father. Incorrect medication doses given resulting in patient losing driving licence

Integrated and Community Care

Patients Home Medication - administration Amber

3260 07/12/2015

Daughter attended A&E on 11/5/15 with a deep laceration to the left eyebrow Parents had given daughter pain killers at 0735 hrs - pain observations were recorded as zero indicating no pain - not given further pain relief. Sent to UHCW for suturing as would be in layers to give a good cosmetic finish.

Emergency Care

Accident & Emergency

Communication (verbal) Green

7

Complaints Closed: December 2015 A total of 11 complaints were closed during the month of December 2015. The listing below provides details of these closed complaints.

ID First received Closed Ward/Site Subject (primary) Sub-subject (primary) Grade

3226 14/10/2015 09/12/2015 Machen Eye Unit Appointments Delay Amber

3243 04/11/2015 11/12/2015 MAU/Fairfax Ward Nursing Care Basic nursing care Dark Amber

3208 08/10/2015 09/12/2015 Midwifery Communication (verbal) Insufficient Amber

3233 23/10/2015 29/12/2015 Outpatients Dept Appointments Delay Green

3257 27/11/2015 29/12/2015 Accident & Emergency Clinical Care Diagnosis Amber

3248 11/11/2015 14/12/2015 Victoria Ward Communication (verbal) Insufficient Amber

3216 14/09/2015 29/12/2015 Guy Ward Discharge Support services Dark Amber

3263 19/11/2015 11/12/2015 Accident & Emergency Communication (written) Healthcare documentation Green

3262 30/11/2015 10/12/2015 Machen Eye Unit Appointments Cancellation Dark Amber

3225 19/10/2015 04/12/2015 Willoughby Ward Clinical Care Dark Amber

3238 26/10/2015 16/12/2015 Castle Ward Clinical Care Clinical review Amber

8

Lessons Learnt: Quarter 3 2015/16

Datix ID: 3258 Helen Clarke Suite • Post Radiotherapy Breast Cancer patient information leaflet due to be reviewed in the next 4 weeks

(November 2015).

Datix ID: 3201 Continence Service • The Continence service has been asked to ensure confirmation letters are sent to confirm bookings and

to ensure staff have been advised of these times. • All Continence staff has been reminded of the importance of clearly introducing themselves and any

other staff/students present and obtain consent if necessary. • Documentation for an interpreter if required should be completed. Continence staff have been

reminded to comply with this requirement. • The comment "you have an answer for everything" was made and although not intended to be

derogatory in any way the Manager of the Continence service has advised her staff to not use this phrase again.

Datix ID: 3175 Pathology • Procedure within the pathology reporting has been reviewed and as a consequence - the procedure of

copy and pasting of core biopsy results into a final pathology report has been stopped. • The Oncotype test in now available to NHS patients • An audit of 20 patients having similar tests were checked

Datix ID: 3214 District Nursing • Verbal complaints taken by ISPA have strengthened the process for passing on. • Staff to have additional training when dealing with challenging families and identify crises points • Families should be made aware of acceptable behaviour for their staff to tolerate. • Staff to work more closely with partners and escalate concerns raised by families when requesting

support.

The following actions have been implemented in response to a complaint received by the Trust which the investigation showed the complaint to be upheld and lessons learnt identified in the form of an action plan. Below shows the lessons learnt from complaints closed during Quarter 3 2015/2015.

9

Datix ID: 3242 Accident & Emergency • Staff told to wear gloves when hands are stained and cannot be removed with washing. Also discussed

about including patients relative with dosage of medication. Datix ID: 3255 Ante Assessment Unit

• Patient/receptionist conversations to only take place at reception desk. • Reception personnel to address staff by their correct title and name. • Installation of signs advising patient to wait their turn before approaching reception desk • All staff to ensure up to date training with Governance e-training specifically covering data protection

and patient confidentiality. Datix ID: 3229 Machen Eye Unit

• Additional clinics arranged to accommodate the number of patients that need to be seen. • Recruiting medical staff to support injection and medical retinal service. • New booking system implemented. • Patients to receive next appointment within five working days of their last attendance.

Datix ID: 3221 Machen Eye Unit • The member of staff who was rude to patient has been disciplined in line with Trust policy.

Datix ID: 3206 Physiotherapy • Patient is now having physiotherapy with a previous therapist although he has to have his appointment

in school time. Datix ID: 3198 Machen Eye Unit

• Additional clinics arranged to accommodate the number of patients that need to be seen. • Recruiting medical staff to support injection and medical retinal service. • New booking system implemented. • Patients to receive next appointment within five working days of their last attendance.

Datix ID: 3131 Integrated Care • An action plan was instigated to improve the staffing issues in the Alcester Integrated Team, and

additional staff have been recruited. Datix ID: 3045 Avon Ward

• Discussed with staff to highlight better communication would have made a considerable difference to family, the assistance available to the patient and may have resulted in the family not making a complaint.

Datix ID: 3262 Machen Eye Unit • Machen Eye Unit are working with the Patient Access team to improve the answering of telephone

contact regarding appointments.

10

Patient Advice and Liaison Service (PALS)

Number of PALS Contacts

Oct-Dec 2015

Top Subjects of Contacts December 2015

05

1015202530354045

Oct 2015 Nov 2015 Dec 2015

24

5

5

5

7

5 2

Appointments

Clinical care

Communication

Discharge

Information

Patient property

Transport

The PALS is an independent and confidential advice and support service for patients and their relatives/friends. It offers the opportunity to raise concerns enabling appropriate intervention at an early stage. The service works closely with patients, relatives and staff to identify where the Trust can improve the patient experience.

11

Dementia Carers survey As part of the broader suite of CQUINs for dementia, providers must demonstrate that they have undertaken a monthly audit of carers of people with dementia to test whether they feel supported and report the results to the Board. Frequency of reporting to SWCCG is bi-annually. In collaboration with the Department of Health and the Butterfly Scheme© the Trust, as part of its monthly audit of the dementia care bundle, issue carer satisfaction surveys to relatives and carers of patients admitted into the acute hospital, with known or suspected dementia. There following exclusions are applied;

• Patients with no known relatives or visitors • When relatives have opted not to enrol the patient onto the butterfly

scheme. The survey asks a suite of questions about patient and care experience, incorporating the mandatory requirement to measure carer’s perceptive level of support whilst the patient was in hospital. Response rates remain low despite the distribution of up to 45 surveys per month however the surveys returned, provide rich qualitative data which informs changes in practice, process and training. Whilst there are no targets mandated for carer engagement and feeling supported, the Trust has exhausted a multitude of avenues to engage with carers. The survey has been provided to all carers however participation remains low. Where participation has taken place, the percentage of carers feeling supported remains above 70%.Findings and a summary of the year’s activity will be reported to Patient Experience group at the end of Q4 with progress and any risks.

Actions taken to increase carer participation: • Survey was reviewed in July 2015 and formatted to make it easier to read • Dementia friendly FFT (friends and Family test) survey being piloted in

January 2015. • Lead matron reviewing feasibility of holding one-to-one sessions with carers

to provide an opportunity to discuss any aspects in confidence and in a holistic manner

Month Surveys issued Surveys returned

% who felt supported

April 30 4 75% (3/4 patients)

May 31 3 100%

June 27 5 80% (4/5 patients)

July 31 2 100%

August 33 5 80% (4/5 patients)

September 29 3 100%

October 27 5 100%

November 24 3 100%

December 27 4 100%

12

Catering and Cleanliness Food/meal experience Cleaning standards

• The scores have stayed consistently high against the target of 85%.

• The new food delivery commenced on July 14th at Warwick Hospital and is now the same service at all Trust Hospital sites. This has been a huge project to change the way the food service is now delivered with the introduction of Ward Hosts/hostesses - there have been a few teething problems which the Hotel Services team are working with Amey to resolve.

• During the first few weeks of change over all services for all mealtimes were visited by both Trust and Amey Managers to answer questions and try to facilitate a smooth change over.

• We are receiving very positive feedback from our patients who are enjoying the food now served. We are now able to serve toast for breakfast which has definitely been an advantage.

• We have continued to jointly audit this food service with our Patient Forum, Matrons/Heads of Nursing, Dietetics and Amey team member. There have been 20 audits in this period. Spot checks continue to be carried out by the Hotel Services and Amey Management teams.

• Due to November 2015 scores being required earlier, the deadline for the audits was brought forward. As a result a smaller volume of technical audits were completed, resulting in a lower score.

• At the contract meeting with the Amey Contract Manager it has been made clear that all areas must be audited in December 2015 and moving forward.

• There were 2 areas that fell below the standards including Dugdale Ward on the Warwick site which scored 86% and Nicol Unit on the Stratford site which scored 90%; these areas were immediately rectified.

• There are now twice weekly walk rounds with the Director of Nursing, Heads of Nursing/Matrons, Infection Prevention, Hotel Services, Maintenance and Amey to ensure that standards improve and are maintained.

The cleaning scores for the quarter are based on Patients that felt the service was either good or excellent (250 surveys completed)

The patient meal satisfaction scores for the quarter are based on Patients that felt the service was either good or excellent (250 surveys)

13

Friends and Family Test (FFT)

Percentage of recommendations from Patients

(November 2015 - Latest data available from NHS england)

A&E Community Inpatients National average 88.1% 95.5% 95.9%

Regional average 86.9% 92.6% 95.6%

SWFT 94.5% 95.5% 96.5%

The Friends and Family Test (also known as the net promoter score) is a measure of patient experience of services, using a single question that asks how likely, on a scale ranging from: extremely unlikely to extremely likely, a person is to recommend the service to a friend or family member if they needed similar treatment.

Reviews during Quarter

6269 Response rates have been the focus for NHS England, and whilst the Trust has met this performance requirement and remained in a strong position, the Trust has focussed on patient recommendations.

A&E FFT Response rates – Whilst patient recommendation continues to be notably high in all areas when compared to regional and national rates, there has been a decline over the last two months in A&E response rates. There has been a notable improvement in comparison to previous the month (November 10.7%), however still remains below past performance. The FFT survey remains a critical element of a patient’s journey and is the only tool used in A&E to measure patient satisfaction.

Actions have been identified to enable the necessary improvements to be made and for performance to return to previous levels, with the continuation of weekly collection and monitoring of surveys and comments.

Inpatient FFT Response rate: It has been established that incorrect envelopes were used to post the inpatient ward survey cards, as result these surveys were not recognised by the scanning devices used by iWantGreatCare. These are currently being manually inputted by the Trust service provider, iWantGreatCare and we expect finalised data to be received within 10 days (at time of writing this report)

14

Friends and Family Test (FFT) Exemplary keywords from feedback

Emerging themes The free text comments are analysed by the Trust’s FFT Lead and the emerging trends since implementation have been summarised below. These are monitored through the Patient Experience Group for improvement and implementation of appropriate remedial actions. The themes are consistent and have been categorised below;

Top 5 Positive themes: • Patients receive clear explanations from staff • Cleanliness of wards/ bed areas • Effective and promptness of staff • Attentiveness to care • Excellent atmosphere, friendliness of staff.

Top 5 Negative themes: • A&E waiting time – no real-time waiting time updates available • Lighting disturbances at night • Noise levels, especially at night • Food quality inconsistencies • Ward signage to toilets

15

Friends and Family Test (FFT) “You said, we did”

The NHS Friends and Family Test is now an established part of SWFT Patient Experience feedback. All adult patients are given the opportunity to comment on the care they received using a survey card which they can either complete on site or if they or their friends and family choose to complete this on line they can do so from their own home.

We have an embedded process to review feedback and to take appropriate actions when we receive feedback from less satisfied patients.

On Avon ward they…. Introduced a staff information board - particularly for bank & agency nurses to be familiar with ward routine and expectations Introduced a ‘Local checklist’ – given to staff who don’t usually work on the ward including ‘introducing themselves to patients’ Hold staff Nurses to account for their bays Introduced a ‘Weekend checklist’ – staff can see where gaps in assessment are

On Dugdale-Arden they…. Obtained radios for each ward area through the generosity of League of Friends Now use discharge lounge for TV when closed Have a TV in the male bay Work with volunteers to provide company and to help with social interaction Improved the explanation of “rehabilitation”, when staff use the word in face-to-face discussions Increased the involvement in goal planning to improve understanding of goals and objectives of therapeutic activities

On Castle ward they…. Provide information leaflets to carers/family as part of the introduction to the ward Encourage staff to have lunch with patients if work commitments allow Work with volunteers to provide company and to help with social interaction

16

NHS Choices star ratings Ellen Badger Hospital

Royal Leamington Spa Rehabilitation Hospital

Stratford Hospital

Warwick Hospital

17

NHS Choices comments NHS choices is closely monitored by the Trust. Comments on NHS Choices continue to be positive with only a small volume of negative comments. In these

rare instances, we advise individuals to contact the Patient Experience Team to identify any issues and to be logged as formal complaints if required.