POOLE HOSPITAL NHS FOUNDATION TRUST

COMPLAINTS ANNUAL REPORT

1st April 2009 to 31st March 2010

Briefing Paper for the Board of Directors

To be held on Wednesday, 28th July 2010

INTRODUCTION

The Statutory Instrument 2009 No 309 “NHS England, Social Care, England – the Local Authority Social Services and NHS Complaints (England) Regulations 2009” requires that Trust Boards must receive quarterly reports on complaints in order to monitor arrangements under the Regulations and use the information collected to identify trends and consider any lessons that feed into service improvement. The key areas to be covered in the annual report include the number of complaints received in total, the outcome, an analysis of the nature of the complaints, how many complaints have been referred to the Parliamentary and Health Service Ombudsman and the action taken to improve matters as a consequence of complaints being made. Reports must avoid any possible breach of patient confidentiality.

THE MANAGEMENT OF COMPLAINTS

The Trust’s Complaints Policy was amended and approved by the Trust Board in May 2009 following the publication of the revised complaints arrangements as set out in the 2009 Regulations. Guidance for the Investigation of Complaints, Claims and Incidents is available to staff and a guide “How to handle a complaint/concern” assists staff in dealing with patients’ complaints and concerns at ward and departmental level. Training is provided to all newly appointed registered nurses and Foundation Year 2 medical staff on the complaints policy and how to deal with difficult situations. The Trust employs a senior manager charged with managing the complaints procedure. The Medical Director is the Executive Director with responsibility for leading and overseeing the Complaints Policy, ensuring that processes are robust, lessons are learned and the impact for patients and the Trust mitigated. The Local Resolution stage of all investigations is scrutinised by the Chief Executive and letters of response are signed by the Chief Executive, in line with the requirements of the Statutory Regulations and the Trust’s Complaints Policy. The Trust’s Chairman receives copies of all complaints and responses. A leaflet entitled “How to make complaints, comments and suggestions – a guide for patients”, is available on all wards and departments and the Trust’s web-site provides information on how to access the complaints procedure.

NUMBER OF COMPLAINTS RECEIVED

The number of formal complaints received by the Trust for the year ending 31st March 2010 was 360. For the same period last year the total number received was 355. This equates to one complaint in every 909 admissions, Emergency Department attendances and Outpatient appointments. For the previous year, 1:914 patients/carers complained about an aspect of their hospital experience.

The table and graph illustrate the trend over the past eight years, by financial year.

Complaints received / Total
02/03 / 350
03/04 / 467
04/05 / 408
05/06 / 402
06/07 / 363
07/08 / 356
08/09 / 355
09/10 / 360
Totals: / 3061

When reviewing the trend in terms of the number of complaints received by the Trust over the last eight years, the average number received annually is 382.

The NHSLA standards highlight the importance of ensuring that patients, relatives and carers have clear access to register formal complaints and the Trust accepts these in a variety of different formats, although letters remain the most common form of contact. The table below illustrates the methods by which patients and/or their relatives complain: there has been an increase in email contact from the previous year from 15% to 19% and an increase in complaints received by telephone from 11% to 13%.

NATURE OF COMPLAINTS RECEIVED

As in previous years, complaints relating to professional and clinical care, staff attitude and communication problems are the most common causes of complaint. 44% related to clinical care. Looking at the trend over the previous 8 years for those complaints involving clinical care, the average has been 28.1%. As in the previous year when 40% of complaints centred clinical care, this year again represents an increase above the average. In terms of outcome, 44% were dismissed, 36% were upheld partially, 18% upheld in their entirety, 1% received reimbursement and 1% were withdrawn by the patient/relative. The common themes arising from complaints of this nature are described in the quarterly complaints reports to the Board of Directors.

The following table illustrates the nature of complaints received across the Trust. The incidence of the top 3 categories is consistent with the previous year.

Category of Complaint / Total
All aspects of clinical treatment / 159
Attitude of staff / 69
Communication/information to patients (written and oral) / 34
Patients' property and expenses / 28
Admissions, discharge and transfer arrangements / 23
Appointments, delay/cancellation (in-patient) / 16
Appointments, delay/cancellation (out-patient) / 8
Patients' privacy and dignity / 6
Hotel services (including food) / 6
Others / 3
Aids and appliances, equipment, premises (including access) / 2
Patients' status, discrimination (eg racial, gender, age) / 2
Transport (ambulances and other) / 2
Consent to treatment / 1
Totals: / 359

This table illustrates where by Care Group, complaints about clinical care have been received. Comparison with the previous year indicates a similar profile.

Clinical Care Group / Total
Medical Clinical Care Group / 74
Surgical Clinical Care Group / 53
Women and Children's Clinical Care Group / 19
Maternity, Child Health, Pharmacy, OPD (From 1st Jan 2010) / 9
Diagnostics and Clinical Support Services Clinical Care Group / 3
Nursing & Patient Services Directorate / 1
Totals: / 159

STAFF ATTITUDE

Turning to complaints about the attitude of staff towards patients and their relatives, 19% of all complaints received raise concerns about this issue. Complaints of this nature are raised in the quarterly reports to the Board of Directors and action points are directed to all the Clinical Care Groups and relevant Directorates. Customer care training has been implemented in the Breast Screening Unit in response to complaints received, training of this nature having already been undertaken in the previous year in the Emergency Department, Outpatient Department and Maternity Unit. ED and the Maternity Unit received fewer complaints about staff attitude compared with 2008/2009. The Complaints, Claims, Incidents and PALS Review Group monitors complaints of this nature, attitude having been highlighted on Care Group Action Plans and the Legal Services Department’s publication “Snapshots”. In terms of outcome, 41% were dismissed, 39% were upheld partially, 16% were upheld completely, 1% was withdrawn and 2% were referred for disciplinary purposes.

The following tables illustrate where, by care group/directorate and staff type, complaints of this nature have arisen.

Clinical Care Group/Directorate / Total
Medical Clinical Care Group / 29
Surgical Clinical Care Group / 18
Women and Children's Clinical Care Group / 10
Diagnostics and Clinical Support Services Clinical Care Group / 7
Maternity, Child Health, Pharmacy, OPD (From 1st Jan 2010) / 4
Finance and Information Corporate Directorate / 1
Totals: / 69
Staff Type / Total
Consultant / 13
Staff Nurse / 12
Registrar / 8
Administrative/Trust Staff / 7
Healthcare Assistant / 5
Physiotherapist / 4
Senior House Officer / 4
Midwife / 2
Radiographer / 3
Nursing Sister / 2
Bank Nurse / 1
Clinical Assistant / 1
House Officer / 1
Nurse Practitioner / 1
Nurse Specialist / 1
Occupational Therapist / 2
Other / 1
Staff Grade / 1
Totals: / 69

ACTIONS ARISING FROM COMPLAINTS AND LESSONS LEARNED

Summaries of a selection of complaints where action has been taken or lessons learned following investigation are reported on a quarterly basis to the Trust Board, Complaints, Claims and Incident Review Group and the Risk Management and Safety Committee. Associate Medical Directors and Associate Directors of Operations receive monthly and quarterly reports for their respective clinical care groups, detailing the nature of the complaint, response times, outcome and actions/recommendations arising from the investigation undertaken, in order that these can be scrutinised at the Quarterly Performance Reviews. Clinical Care Groups are expected to provide updates on actions taken. The use of the checklist for all formal complaints, which is completed by the lead investigator(s) identifies the root cause(s) of the complaint and also confirms what action has been taken and to whom the information is disseminated and discussed. Where appropriate, lessons learned in one care group are notified to all care groups.

The following table illustrates outcomes at the conclusion of complaints investigations.

Action taken following conclusion of complaint investigation / Total
No changes recommended/necessary / 190
Advice/warnings given to staff / 144
Procedural/guideline alteration/production / 9
Training/educational requirement identified / 8
Organisational change or review / 6
Human Resource Issues / 2
Remedial work,alteration to building/grounds / 1
Totals: / 360

Evidence of learning from complaints include:

·  Paediatric community team reviewed their assessment pathway to ensure that all community staff are clear about the correct process to follow.

·  All reception staff have undergone a one day customer service course, together with a qualification in customer service. This is now a pre-requisite for a job as an Emergency Department receptionist.

·  The low voltage, hot wire cautery machine was removed from theatres.

·  Consultant reviewed the competencies for the nursing staff conducting PUVA clinics and observed some clinics as an additional safeguard.

·  A Pancreatic biopsy information sheet has been developed and a leaflet “Having a herniogram – a guide for patients” has also been written.

·  The Maternity Unit made confidentiality the “theme of the week”.

·  The Medical Director wrote to all surgeons stating that day patients should be prioritised and if on mixed lists, should be operated on at the start of the list. For operations planned after mid-day patients should be admitted as though for an afternoon list and operated on at the beginning of the afternoon. List orders should not be changed except in exceptional and clinical circumstances.

·  Attitude of staff on mobile Breast Screening Unit and lack of dignity – customer care workshops prioritised and further advice given to women attending.

·  The need for staff to be more vigilant around small doses and volumes reinforced to Pharmacy staff.

·  Child with learning disabilities waited 30 hours to receive definitive treatment for injury – Lead Clinician wrote to all middle grades and registrars at Poole and Bournemouth reminding them that in cases of this nature, the case must be discussed with the consultant at an early stage.

·  Work on extravasation policy in paediatrics with Tissue Viability Nurse advice.

·  The Portering Manager reminded all porters of the importance of ensuring patients’ legs are in a safe position before lifting/lowering footplates on wheelchairs.

·  Senior Co-ordinators in ED reminding bank and agency staff of the 20 minute policy for children in the department in terms of initial assessment.

·  Infection control and prevention measures reinforced to ward staff and infection control link nurse to ensure appropriate practice.

·  Admissions offices to be contacted if difficult decisions to be made regarding potential cancellations to avoid inappropriate cancellations.

REQUESTS TO THE HEALTH SERVICE OMBUDSMAN

The Statutory Instrument 2009 No 309 “NHS England, Social Care, England – the Local Authority Social Services and NHS Complaints (England) Regulations 2009”, requires that the number of complaints referred to the Health Service Ombudsman is specified. In 2009/2010, 6 complainants referred their complaints, which equates to 1:60 complaints received. Until April 2009, requests were made to the Health Care Commission for independent review, the Ombudsman being the third stage. The amendments to the regulations changed this process, streamlining it to a two stage process of Local Resolution and then the Ombudsman. Six requests were made during the financial year and have been reported in more detail in the quarterly complaints reports to the Board. In four cases the Ombudsman decided not to investigate the complaints. The outcomes in respect of two cases are awaited.

RESPONSE TIMES

The guidance on response times at the Local Resolution stage allows three working days to acknowledge complaints. Letters of acknowledgement were sent to all complainants, 98% of which were within 3 days, compared with 96% for the previous year. The NHS Complaints Procedure no longer stipulates a time-scale within which the organisation must provide a substantive response. However, the Trust continues to aim for responses within 25 days. For this financial year, 85% of all complaints received were replied to within that time-scale, the same as the previous two years.

OUTCOMES

In terms of outcome, the vast majority of complainants want an acknowledgement of their concerns, to know why it happened, to receive a meaningful apology where shortcomings are identified, to be made aware of changes in practice arising from the investigation and for someone to be held accountable for what went wrong. Very few complainants start out wanting financial recompense. The Trust follows a policy of “Being Open” and apologises in those instances where complaints are upheld or partially upheld. The table below illustrates the outcome of investigations:

Outcome / Total
Complaint dismissed / 124
Complaint upheld partially / 119
Complaint upheld / 86
Ex-gratia/reimbursement payments made / 16
Complaint withdrawn / 14
Referral to disciplinary procedure / 1
Totals: / 360

16 cases involved reimbursement for the loss of property or out of pocket expenses. To date 13 patients have received payments, the total paid being £1,270. The total for the previous financial year was £6,931.

3 patients who sought explanations regarding the outcome of treatment subsequently instructed solicitors to investigate the potential for a successful claim.

The Board is asked to APPROVE this report.

Robert Talbot

Legal Services Manager Medical Director

July 2010