Paper to the Trust Board

1. INTRODUCTION

This is the monthly Patient Voice report produced for the Board of Directors. The main purposes of this report are to:

• Inform the Board of Directors of our headline indicators around Patient Experience.
• To focus on the feedback received from service users and carers about a specific service each month and the plans we have to address the main issues people raised.
• To update the Board of Directors on the action taken to address the main issues raised about the service the Patient Voice Report focused on three months previously.

The report is part of our approach to Service User and Carer Experience which is based on our involvement approach and strategy. One of our three involvement aims is to change services by listening and responding to service user and carer views and aspirations.

Our approach is also based on the Trust’s values and aligned to Department of Health priorities. As an NHS funded service we are required to carry out the Friends and Family Test. We must also meetthe CQC Standardthat requires us to seek and act on feedback so we can continually evaluate services and drive improvement.

As part of the Trust’s development of its approach and the Francis Report we are continually looking at how we can improve both how we listen and respond to the patient voice. Our feedback website enables the public to leave and view feedback and also able see the changes we have made in response to feedback. The website also enables staff to view feedback about their team.

As part of our approach the Boardof Directors receives a quarterly Involvement and Experience Report which looks at quality ratings, key themes and actions taken for each Directorate. This Patient Voice Report is a monthly report and focuses on key patient stories and comments raised by service users, patients and carers.

1.1 REPORT SUMMARY

The key highlights of this month’s report are:

• The Trust’s Service Quality Rating for September – November 2015is94%. Our Friends and Family Test Score is 95% (this is the percentage of people who would be extremely likely or likely to recommend our services if their friends or family need similar care or treatment).

This month’s Patient Voice Report focuses on the Health Partnerships with an in-depth look at Community Nursing within Mansfield & Ashfield and an update on Children & Young People (CYP).

It looks at some of the main issues, comments and stories relating to Mansfield and Ashfield Community Nursingas well as work that is being undertaken to improve the service user and carer experience. The main issues identified to tackle from feedback about Community Nursing serviceswere:

• Complainants were often unhappy with final response letter as did not always interpret the letter as it was intended
• Family had felt they were not involved in patients care and that communication had been poor
• Safeguarding had been discussed with a family member but this had not been documented.

It also updates on the issues discussed attheSeptemberBoard Meeting aboutChildren & Young People (CYP).

• Consent form for immunisation in schools – parents were expected to opt out rather than consent

• NCMP(National Child Measurement Programme) - A number of parents complained about the language used to advise that their child was overweight according to the Body Mass Index
• Children in schools would like some form of distraction whilst being vaccinated

2.TRUST WIDE HEADLINES

2.1TRUST SURVEY FEEDBACK

This report summarises data from September – November 2015 with a comparison with the previous 3 months, from June to August 2015. We received6524 responses during the above date range, 960 of which were from carers. Below are the headlines for the Trust taken from our feedback website:-

2.2 SERVICE QUALITY RATING

At the 95% confidence level, using a normal approximation from a bootstrapped distribution:

• The Trust overall score is accurate to within ± 0.33 points.
• The Local score is accurate to within ± 0.95 points.
• The Forensic score is accurate to within ± 2.32 points.
• The Health Partnerships score is accurate to within ± 0.29 points.

This means that we can be confident that the ratings for the Trust, Local and Health Partnerships are reasonably accurate. For Forensic Services, there is more uncertainty in the scores. This is because we have had a lower number of responses from this Division and we survey different directorates each quarter. In the quarter (July to September 2015) we surveyed Offender Health, Rampton Hospital and Low Secure and Community Forensic Services.

2.3 FRIENDS AND FAMILY TEST SCORE

At the 95% confidence level, using a normal approximation from a bootstrapped distribution:

• The Trust overall score is accurate to within ± 0.63 points.
• The Local score is accurate to within ± 2.19 points.
• The Forensic score is accurate to within ± 5.69 points.
• The Health Partnerships score is accurate to within ± 0.33 points.

This means that we can be confident that the ratings for the Trust and Health

Partnerships and Local Services are reasonably accurate. For Forensic Services

there is uncertainty in the scores.

The Friends and Family Test Score for Forensic Services remain lower across the year. This may be due to the question being not as applicable in Forensic Services and people in these services being less likely to put that they are ‘extremely likely’ to recommend these services. The score also varies each quarter due to the reasons given for the Service Quality Rating above.

2.4 PATIENT OPINION

Below are some of the key headlines from Patient Opinion over the last three months.

2.5 CHANGES MADE AS A RESULT OF PATIENT OPINION IN THE LAST MONTH

Below are a number of changes that have been posted on Patient Opinion in the last month

• Patients on Seacole Ward at The Wells Road Centre commented on too many members of male staff on the night shift. ‘We would feel more comfortable if there could be a greater ratio of female staff’.

Change Made: The electronic ‘Health roster’ has been changed for only one male to be allocated on nights at a time.

• Ladybrook Children's Centre, received excellent feedback about their half term activities.

Change made: Due to the positive feedback on Patient Opinion they have decide to continue the group again in half term.

3. HEALTH PARTNERSHIPS

This month the focus is on the Health Partnerships. We are taking an in-depth look at the views and experiences of patients and carers accessing Community Nursing Service in MansfieldAshfield updating on the issues discussed at the September Board of Director’s regardingChildren & Young People (CYP).

The graphs below compare the localities in the Division. The main issues raised for Community Nursing services from December 2014 to November 2015 and the previous year are also presented.

3.1 SERVICE QUALITY RATING

HEALTH PARTNERSHIPS

At the 95% confidence level, using a normal approximation from a bootstrapped distribution:

• The most recent Bassetlaw overall score is accurate to within ±1.86
• The most recent Mansfield and Ashfield overall score is accurate to within ± 1.05
• The most recent Newark and Sherwood overall score is accurate to within ± 0.85
• The most recent Nottingham North and East overall score is accurate to within ± 1.71
• The most recent Nottingham West overall score is accurate to within ± 0.98
• The most recent Rushcliffe overall score is accurate to within ± 0.92
• The most recent Specialist services overall score is accurate to within ± 0.53
• The most recent Sure Start overall score is accurate to within ± 0.44
• The most recent Children and young people overall score is accurate to within ± 0.67

This means that we can be confident that the ratings for all the directorates in Health Partnerships are reasonably accurate.

3.2 FRIENDS AND FAMILY TEST

HEALTH PARTNERSHIPS

At the 95% confidence level, using a normal approximation from a bootstrapped distribution:

• The most recent Bassetlaw overall score is accurate to within ± 4.14
• The most recent Mansfield and Ashfield overall score is accurate to within ± 0.79
• The most recent Newark and Sherwood overall score is accurate to within ± 1.4
• The most recent Nottingham North and East overall score is accurate to within ±1.98
• The most recent Nottingham West overall score is accurate to within ± 0.84
• The most recent Rushcliffe overall score is accurate to within ± 1.64
• The most recent Specialist services overall score is accurate to within ± 1.11
• The most recent Sure Start overall score is accurate to within ± 0.91
• The most recent Children and young people overall score is accurate to within ± 1.62

This means that we can be confident that the ratings for all the directorates in Health Partnerships, except for Bassetlaw which had a lower number of responses, are reasonably accurate.

3.3 UPDATE FROM CHILDRENS AND YOUNG PEOPLE SERVICE

September Patient Voice Report was focused on Children & Young People (CYP)and the key issues which were raised from the survey feedback. Below are some developments since that meeting:

4. Community Nursing Service – (Mansfield & Ashfield)

The role of the Community Nursing Service within Mansfield and Ashfield is to offer a comprehensive service to the population providing appropriate care following assessmentwhich will enable patients to be cared for in their own environment.

The Community Adult Nursing service manages care through community nursing integrated care teams. These comprising of registered nurses, community support workers, assistant practitioners, a community matron, a long term condition nurse, and a respiratory nurse and care home nurses to housebound patients.

The service promotes the physical and psychological wellbeing of patients and their carers, taking into account their social needs. The community nursing service is provided five days a week (Monday to Friday) 8a.m. until 6.30p.m.and 8.30a.m.until 5p.m. at weekends.

The core role of district nurses will include wound management, management of long term conditions, end of life care, administration of medicines, care co-ordination, case management, continence and leg ulcer management.

4.1 HEADLINES

4.2 MAIN ISSUES RAISED

The community nursing teams predominantly use the Service User and Carer Experience survey, and Patient Opinion to capture feedback. Any other methods used are temporary and relate to a particular theme.

4.2.1 FEEDBACK SURVEY

Below we outline the main issues raised from over the last three months and the Trust survey comments and Patient Opinion stories.

The main themes from the "Improve one thing" comments from the survey are below. We received 54responses to this question in the last three months and 324 in the 12 months previous to that (September 2014 to August 2015).

4.2.2 OTHER FEEDBACK (including from Complaints, the Patient Advice and Liaison Service, Patient and Carer Forums and other sources)

For September–November 2015 Community Nursing (Mansfield and Ashfield) received three complaints:

Complaint themes:

• Delays in provision of equipment

• Family involvement in patient’s care
• Breach of confidentiality

For September - November 2015 Community Nursing Mansfield and Ashfield received 0 informal complaints.

4.2.3 KEY ISSUES TO ADDRESS

From the variety of sources of feedback the issues that have been identified for improvement are outlined below together with any action taken or planned to respond.

4.2.4 COMMENTS/STORIES ABOUT THE MAIN ISSUES RAISED.

Below are some of the comments/stories (taken from complaints) that illustrate what has been said about the main issues raised:

• “It seems to me you are blaming my sister in law for what happened”
• “I voiced my concerns regularly , why were they not listened to”
• “I was advised by the Nurse that she would need to do a safeguarding referral , I feel as if it should be the nurses that have a safeguard against them”

4.3 MAIN COMPLIMENTS RECEIVED

The main themes from the ‘BEST THING’ comments from the survey are shown below. We received 82 responses to this question in the last three months and 444 in the 12 months previous to that.

4.3.1 COMMENTS/STORIES ABOUT THE BEST THINGS ABOUT THE SERVICE

Below are some of the comments from the feedback survey that illustrate what has been said about the best things about the service:

• “Our sincere thanks for all the help, kindness and support you gave to my dear wife and mother during her illness and passing. This was greatly appreciated by us all. We are so very grateful for the outstanding dignity, sympathy and wonderful care shown throughout. Once again very many thanks from us all. From Harold Cowpe and Family”

• “Just wanted to drop you a very small note to say a big thank you for everything you did for dad. You were absolutely amazing the whole time, giving 110% in care and attention. You were so loving with dad too and supportive to the whole family. You certainly made such an amazingly difficult time so much easier for all of us”

• “The dignified manner in which the nurses presented their selves and treated individuals in the home. They took on board that a few suffer with dementia and adapted their approach accordingly.”

Postings on Patient Opinion in the last three months:

• “I cannot ever thank you enough for the kindness you gave to my family member and myself. I cannot remember you all (not taking any credit from you) but Anna and Debbie you were and are wonderful girls. I don't know how I would have got through the week on my own as you know all my family were away on holiday so I didn't tell them how poorly he was. Without your support I could not have done it.my super heroes! !Thank you so much”

• “Just to say thank you very much to all of you for your help and care to my husband. I could not have managed without you. With your wonderful help I was able to keep him at home as he wanted to be. I had 53 happy years with him, so will miss him always - but I did promise him I would carry on and go out and meet people. Thank you again”

4.4 INVOLVEMENT & EXPERIENCE ACTIVITIES INCOMMUNITY NURSING, MANSFIELD AND ASHFIELD

Below is some of the activity that is being carried out in Community Nursing to involve people and listen to their feedback: