Avon and Wiltshire Mental Health Partnership NHS Trust

Avon and Wiltshire Mental Health Partnership NHS Trust

Complaints, PALS and Praise

Annual Report 2013/14

1.Introduction

This report provides information on complaints, PALS activity and praise within the Trust between 1 April 2013 and 31 March, 2014. Overview of praise, complaints and PALS related work was undertaken by the Critical Incident Overview Group and through Locality Governance Groups.

2Regulation 17 and legislation

The Trust declared itself compliant for Health and Social Care Act 2008, regulation 17 a, b and c for the year.

3.ComplaintsManagement

The overarching policy for the management of complaints and concerns has been reviewed this year and is called the Complaints and Concerns Policy. This Trust is consulting with its service users and carers and stakeholders about this policy and once this feedback is considered it will proceed through the committee process.

The report ‘A Review of the NHS Hospital’s Complaints System – Putting Patients Back in the Picture’ (Oct 2013) described what service users, their relatives, friends and carers want to see improved. An action plan was developed by the Trust following this publication that will be delivered by the Nursing and Quality Directorate, the Quality Academy and the Medical Directorate.

It is proposed that the Trust Board adopts the principles of good complaint handling from the Clywd/ Hart report as their own and these are the overarching principles of the Complaints and Concerns Policy. They are:

Information and Accessibility – Service users want clear and simple information about how to complain and the process should be easy to navigate.

Freedom from fear – Service users do not want to feel that if they complain their care will be worse in the future.

Sensitivity – Service users want their complaint dealt with sensitively.

Responsiveness – Service users want a response that is properly tailored to the issues they are complaining about.

Prompt and clear process – Service users want their complaint handled as quickly as possible.

Seamless service – Service users do not want to have to complain to multiple organisations in order to get answers.

Support – Service users want someone on their side to help them through the process of complaining

Effectiveness – Service users want their complaints to make a difference to help prevent others suffering in the future.

Independence – Service users want to know the complaints process is independent, particularly when they are complaining about a serious failing in care.

The Francis Report (2013) has also led to the introduction of a ‘duty of candour’ within the NHS. This policy embraces all of these requirements.

The revised complaints and concerns policy also seeks to align investigations of ‘red graded’ complaints with root cause analysis investigations. This will mean that one robust investigation is completed, with the involvement of family, service user or carer. The complainant in these cases can be supported by the PALS and Complaints Manager throughout the process if they wish. In 2013/14, where we have offered this support and it has been accepted it has worked well for the complainant. It has been of particular benefit to complainants who are bereaved or where serious incidents have occurred.

It is of particular note that the Trust uses the persistent and unreasonable complaints protocol on very rare occasions. This is where the Trust would need a specific plan to deal with a person who continually made the same complaint, would not accept the responses given, or was vexatious in their behaviour. AWP strive to resolve the concerns of service users and carers and will work flexibly and with compassion to reach a resolution. While we accept that we will not always be able to satisfy all of the people who complain, as a Trust we are committed to trying our very best to do so.

4.Service User and Carer Stories

AWP Trust Board has continued with its commitment to hear complaints at public board meetings. They have heard presentations from senior managers from a range of services, supported by the PALS and Complaints Manager. The Board has also heard directly from users of services and their carers about their experiences.

Presentations have described complaints and experiences about:

• Carer engagement with teams and the ‘Triangle of Care’
• A carer’s experience of Eating Disorder Services
• Provision of beds for detoxification
• Access to S136 beds
• Prescribing systems in memory services
• Dual diagnosis in inpatient settings and community services
• A carer’s experience of crisis intervention and listening to carers

5.Complaint Activity

There were a total of 272 formal complaints werereported in the Trust during 2013/14, which represents a small decrease from the volume of complaints reported last year.

Trend Complaint Data

* Specialist and Secure Delivery Unit dealt with 10 complaints relating to the closure of the Psychopharmacology Unit at Bristol University. The complainants were AWP service users therefore the complaints were managed by AWP initially.

**includes enquiries made by MPs.

93% of complaints were responded to within the Trusts internal timescale of 25 working days, or within a timescale agreed with the complainant on an individual basis. A full breakdown of response times by locality can be found at Appendix 3.

5.1 Delivery Unit Complaint Data (Formal and Informal Complaints)

(Denotes last year’s figures – not possible for Secure & Specialised/SDAS due to organisational changes)

* 9 complaints for Corporate/ Support Services

5.2Outcome Data Formal Complaints

Following the investigation of a complaint the complaints team assess whether a complaint is upheld in all parts, upheld partially, i.e. some of the elements are substantiated, or the complaint is unfounded. The Complaints Team have been concerned as to whether the threshold they subjectively apply as to whether a complaint has been upheld or not are too high. In response, the Complaints Manager audited a sample of cases to review these judgements.

As a result of that auditing activity, the Complaints Manager carried out a review of all cases, arising in a change in approximately 30% of recorded outcomes. The majority of the changes were in the favour of the complainant. Therefore changes will be proposed that when complaints are completed, before response sign off, they are reviewed by the locality triumvirates (or nominated member of senior staff). It is recommended that the complaint is assessed at this point and whether it is upheld, partially upheld or not upheld and the reason for this is recorded. This will then accompany the approved draft to the complaints department. The complaints manager will then also make an assessment. If the two assessments differ, this is to be discussed, and a consensus view recorded on the case file, again, with the reasons for the decision

Following review of completed cases the following outcomes were recorded:

* (41 complaints are on-going at time of reporting)

5.3 Grade of complaints

The Trust is keen to integrate all its patient safety activity and uses the same methodology to grade its complaints as it does to grade its incidents. Overwhelmingly the Trust’s complaints are graded as yellow, i.e. predominately minor to moderate matters, as shown on the table below

There were 11 complaints that were graded as a high risk (red);these complaints are generally investigated by commissioning root cause analysis.

6. Referral to the Parliamentary Health Service Ombudsman (PHSO)

The Trust makes every effort to resolve complaints within Local Resolution. Complainants are given the opportunity of contacting the Trust again following receipt of the final response to clarify any issues in connection with their complaint, and a further meeting or investigation will be offered if appropriate.

Following the Francis recommendations Trusts were warned that it was likely that the numbers of investigations undertaken by the Ombudsman would rise nationally. The figures for 2013/14 are not reflecting this as we have seen a marked decline in the numbers of people approaching the Ombudsman. It is hoped that this is a reflection of the flexibility of the complaints process and the willingness of the Trust to resolve complaints and to revisit issues if people are not satisfied with the investigations.

Trend Ombudsman Data

6.1Activity this year

• 3 complaints have been upheld (all 3 were complaints initiated in previous years)
• 7 complaints were referred to the Ombudsman. A marked decline from the previous two years
• 3 investigations have been declined
• 4 complaints have been accepted for investigation. 1 complaint was investigated and not upheld
• 1 complaint, previously declined by the Ombudsman in preceding year, was been accepted for investigation, and was not upheld

Complaints upheld by PHSO

Complaints upheld by the Parliamentary Health Service Ombudsman are reported to the Critical Incident Overview Group for scrutiny of the decision and Trust action plans arising from these reports. The membership of this group ensures that there is a Trust wide debate of the issues enabling shared learning across Delivery Units.

Upheld Complaint 1

The Ombudsman found that the Trust failed to diagnose a service user’s serious underlying mental health problem and instead continued in the assertion that the problems the service user was having were caused by cannabis use. The Trust did not listen to the carer when she raised concerns about the service user’s behaviour and the Trust failed to investigate the concerns raised thoroughly continually stating that the care provided was appropriate. The Ombudsman has asked the Trust to write to the complainant and acknowledge the service failure identified in the report and to make a payment of £1000. An action plan has been developed that describes what the Trust has done or plans to do to ensure that lessons are learned, this has beenpresented to the complainant and to the Critical Incident Overview Group and to the Trust Board. The plan has been shared with commissioners, CQC and the NHS Trust Development Authority.

• Locality to ensure that all staff are fully updated regarding Dual Disorder including the framework around CPA in Dual Disorder. To address any deficit in skills and knowledge through Dual Disorder training.
• For all staff to work in partnership with carers, taking into account any carer information and perspective particularly relating to risk assessment. Triangle of Care Audit (assessment of partnership working between staff, Service User and Carers) has been instigated in all clinical teams. Carer Champions have been identified in all teams and Carer Champions meetings are held to progress the Carer’s agenda and work plan.
• Clinical Toolkit around formulation has been developed regarding formulation for all clinical teams and is available on the Trust intranet. This is being supported by bespoke training to individual teams

Upheld Complaint 2

A complainant stated that he is suffering from muscle pain and spasms because medication treating his mood disorder was suddenly stopped. The Ombudsman found that the doctor did not seek to involve the service user in discussions about stopping medication, did not take into account all other relevant factors and that the abrupt stopping of the medication was not in line with current guidance. The Ombudsman recommended that the complainant was paid £5000 in recognition of the injustice that he suffered and that a written apology was sent accepting the findings of the case. The action plan developed included:

• A remediation plan for the prescribing doctor to be monitored by the medical lead and clinical director.
• The Clinical Director and Deputy Medical Director are developing a formal alert to capture the learning from this complaint and best practice regarding withdrawal of psychotropic medication. AWP library services have completed a substantial literature search on tardive dyskinesia for use in compiling this.
• Formal protocols are being developed in collaboration with the locality and the medicines management group. These will then be disseminated to the wider trust group.
• The ward will pilot medication decision support tools. This will be collaborative work with the locality and pharmacy and will be disseminated across the Trust once initial evaluation is completed.

Upheld Complaint 3

A carer complained that the service user should not have been allowed to discharge herself from hospital, and that the intensive team should have contacted her after discharge. The carer also complained that medication was suddenly stopped while the service user was an inpatient and it should not have been. The Ombudsman found that the decision to stop the medication was sound. However, they found that the risk assessment carried out when the service user wished to go home was not structured or thorough enough, and that there was a lack of care planning during the admission. They also found that the intensive team did not contact the carer as they should have done when their efforts to contact the service user failed. The action plan developed included:

• That clients who have had a number of admissions in quick succession are reviewed by way of a team professionals meeting to look at what seems to be happening and what is not working in relation to the current care approach, what has changed and whether the risks are sufficiently known about and a plan in place to manage them. What could be done differently, what has not been considered, what else could be offered, what is not possible,
• New supervision processes are being put in place at present for all teams that will replace the previous system with a more formal case management process that will track level of risk, safeguarding issues and that all relevant processes have been followed.
• All staff offer carers assessments and appropriate carer’s care planning. Up to date information on carer’s issues, training and supervision, should be fed through the monthly team Governance meeting and minuted. All Wiltshire in-patient and community teams have completed the triangle of care self-assessment regarding carers (this is a national standard). The self-assessment, action plans and on-going performance against them is reported through the locality governance meeting.
• Short term working group to be created with service user and carer representation in addition to central patient safety staff to review the current discharge processes and forms against national guidance and make recommendations for the implementation of a provisional discharge plan

7. Complaints Reporting on Five themes of Patient Experience

During this year the Complaints data has been entered into the Ulysses Safeguard database, which is also used to record data on PALS and Incidents. The database enables the Trust to report user and carer feedback by the Department of Health five themes of patient experience. A case can be recorded against multiple categories which are:

• Access and Waiting
• Safe, Co-ordinated High Quality Care
• Building Better Relationships
• Information, Communication and Choice
• Safe, Clean and Comfortable place to be

7.1Summary of complaint themes over 3 years

Headlines:

• Complaints about attitude and behaviour of staff have doubled this year after falling for 2 years in a row.
• After falling for 3 years in a row, complaints about medication have risen considerably.
• Complaints about discharge arrangements fell from 30 to 22 in 2012/13, however this has risen again this year to 37.
• Complaints about environment remain low again this year, with safety being the most often cause of complaint this year.

Appendix 1 shows trend complaint theme data.

7.2 Medication Deep Dive

• 48 formal complaints and 9 informal complaints informal complaints were received
• 27 of these complaints were made by carers or relatives and 30 were made by service users themselves

• 23 complaints made related to inpatient services and 33 related to medication in the community
• The most complained about area of prescribing was side effects, this was followed by complaints that not enough information about medication prescribed had been given.

7.2.1 Actions taken:

• The Trust has now implemented a new way of recording medication within the electronic records and the practice is now in place that all medication changes will be recorded in this way.
• Since last year the Trust has introduced a more robust approach to medicines reconciliation.The aim of medicines reconciliation is to ensure that medicines prescribed on admission correspond to those that the service user was taking before admission. This should be carried out within 72 hours of admission and one of the sources of information should be the service user’s GP. Any allergies should also be recorded at this time.
• A review of procedures for reducing methadone prescriptions when discharging service users was carried out. Also, a speedy system of appeal was introduced for service users to use if they disagreed with a decision to discharge them from drug and alcohol services.
• BSDAS to produce a leaflet that describes clearly the process that will be followed once a service user identifies that she is pregnant, identifying services they can expect to be involved with in their care, expectations placed upon them throughout their treatment; and dispensing arrangements
• In Bristol Recovery Services, when a service user makes a request for a medical review to re-consider prescribed medication they should expect to be contacted within seven days of making their request.

7.3Safety Deep Dive