Item 7

Compliments and Complaints Report Quarter Three October - December 2015/16

Presented by: Tracy Luckett

Director of Nursing and Allied Health Professions

Produced by:

Tim Withers, Patient Experience Manager

Board of Directors Meeting

03 March 2016

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1.0 Introduction This report provides an overview for the board of compliments and complaints received by the trust between 1 October 2015 and 30 December 2015 (Q3 2015/16) and supports the information in the monthly performance report regarding complaints. This report will also be presented to the Clinical Quality Review Group (CQRG) where the trust discusses the quality of Moorfields’ services with our lead commissioners and at the patient experience committee to identify themes that can inform service change. Part of the purpose of this quarterly report is to address one of the recommendations set out in the parliamentary report ‘A review of the NHS hospitals complaints system: putting patients back in the picture (2013)’ that suggests regular reporting of complaints issues to the trust Board. The majority of Moorfields’ patients and their carers would appear to be satisfied with the care and service they receive from the staff, and when they are encouraged to comment through surveys or FFT feedback, they reflect an overwhelmingly positive feedback with 96% of clinic patients and 99% of Day Care patients saying that they would recommend the trust to their friends or family. There are however, recognised aspects of the service that the trust has still to address fully and that continue to frustrate patients in their day to day dealings with our services; waiting times, appointment administration, communication and staff attitude etc. and though there is work underway to address these issues, while they are outstanding they will continue to be a source of irritation to our patients. Two comments from the NHS Choices website reflect the contrasting experience of two of our patients:-

“I have recently been discharged from Moorfields having had treatment for (a retinal problem). I cannot praise the treatment I had higher than to say everyone I saw was very pleasant and friendly. I have been coming for the past three years and had laser treatment several times, and each appointment I have had I have not waited very long and was usually out after about 1 1/2 hours including when I had the laser treatment. The consultant was very nice and friendly and always had a chat about the treatment and my condition and how things were progressing etc. Although it was a busy clinic there was never much of a delay. I would like to thank all the staff and keep up the good work.”

“Went to Moorfield’s for a checkup in the morning and was only seen to by the nurse after 45 minutes of waiting past the appointment time. The nurse was mistaken about the queue to see the doctor after the nurse checkup as she said there were two patients ahead. I saw two patients go in to be seen by the doctors… and then asked the receptionist our position in the queue and they said there are 2 patients in the queue. The receptionist then asked me a rhetorical "It's not very ethical for me to hurry up the doctors is it?" even though my frustration was about managing expectations of patients, it shows that the receptionist misunderstood what I was getting at. At least they made the effort to spend the time to inquire for me. I then spoke to the (manager) in-charge of the clinic and they said that on all appointment letters it states that there is an aim that patients would be seen within

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2 hours. That is a terrible explanation; to queue up people for two hours to see the doctor while what seems to be a first-come-first-served rule. What's the point of an appointment system at all if you are not going to be seen anywhere close to the appointment time?”

In response to such comments, a number of groups are looking at ways to improve the expectations and experience of patients. In clinics, floorwalkers, whose role is to support patients whilst they wait, have commenced their role, laminated prompt cards encouraging them to ask about waiting and informing patients that they won’t lose their place if they go for a coffee etc. have been introduced, and the technical test of handing out patient pagers has been undertaken and is currently at the purchase stage. Deep dives into the dynamics of how clinics function and why delays arise is also currently under way in the Glaucoma and Uveitis clinics, learning which should be transferable to other sites and clinics. 2.0 Compliments The Trust receives many compliments each day, be they as part of patient feedback surveys, social media or thank you letters received directly. Recurring themes that reflect the personal interaction between staff, patients and their carers predominate as well as the clinical outcome of their care and the effective service they receive. 2.1 Friends and Family Test (FFT) comments The FFT allows patients to express their opinions about the care they receive, and many choose to do so, giving them an opportunity to comment on the care and service they receive highlighting the topic that is important to them. It also gives patients the opportunity to thank the staff in writing where as previously they might have just given a verbal appreciation, or occasionally sent a card or letter. During quarter three, just under 23,000 patients (13% of patients seen) completed the FFT, of whom 96% responded ‘extremely likely’ or ‘likely’ as to whether they would recommend the trust against 1% who said they would not. Of those 96% who said they would recommend the trust, around three quarters left a positive comment or suggestion, 314 of who mentioned specific individuals in the comments highlighting their caring, friendly approach or their professionalism and efficiency. These not only encourage the staff to see that their efforts are recognised and shared, but might also play a part in the revalidation of medical and nursing staff with their professional bodies.

“I have always been given top treatment and attention, staff always cheerful and competent, the treatment given has been most supportive, and has stablised and improved my eyesight and helped me continue working” General Ophthalmology Clinic “Many patients do not know the structure and names of the components in an eye. I strongly recommend, particularly when discussing an operation, that a large, clear diagram of the structure of an eye should be available - this would greatly assist the patient to understand the situation. It would have been a great help to me before my operation.” Mackellar Ward “Because Moorfields does research and is amongst the first with any new drugs/treatment, the chairs are very uncomfortable in the retinal unit waiting room

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(after a three hour journey by train) to spend three hours on a hard seat is too much.”

“Pleasantly surprised by how efficient the service was. I arrived half hour early and upon arrival I was seen almost immediately and the whole routine of procedures carried out was very smooth and efficient, very pleased with the whole service. Thank you and keep it up!” MR Clinic “Very kind and attentive staff, I'm writing this on behalf of my mum who was very nervous but lovely nurses put her at ease. And thanks for the many cups of tea! The team was also great at communicating with patients from a diverse background, very good at communicating with my mum, who speaks limited English, thanks so much.” Mile End “Really excellent experience attending Moorfields A&E last night at 1am. Was seen within one hour and service received was so professional. Especially grateful to the kind nurse who gave phone advice and then was very helpful on arrival and during triage.” A&E

Of the 1% who said they would not recommend Moorfields, delays remain the main reason:-

“I have been coming to this clinic for a couple of years now and feel there is a lack of communication between the clerk and patients I have been sat in clinic for 2 hours not been seen once, and haven't been spoken to by anybody.” MR Clinic “For staff to acknowledge that I and other patients have arrived, not to be constantly checking their phones, for staff to not deliberately look away whilst waiting at the desk, dreadful customer service.” St George’s “There are too many patients and not enough doctors and nurses everyone is extremely stressed and they need help to cope” MR To be kept informed of reason for long wait, please could you educate clinical staff particularly doctors to be 'bare below the elbow.' “My appointment was at 2.30 pm and at 6.15pm, now have not seen by anyone very disappointing too much to wait!” Clinic 4

2.2 Compliments forwarded to PALS or from social media The PALS department received or were forwarded 40 compliments during quarter three, the majority by letter or email and some in person, wanting to ensure that their appreciation was registered. Too few to be used as a quantitative measure, they are forwarded to staff when received. Many reflect the themes noted in other patient feedback. Comments on sites such as twitter, Facebook and NHS Choices have a more public audience and perhaps a greater effect on how people perceive the trust. Though the use of the NHS Choices and other patient websites has not grown as expected, Moorfields still receives around 15 comments a quarter, split evenly between good and bad comments.

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Card received into St Ann’s. “The patient would like to thank the Cataract team at St Ann’s for their professional approach and their dedication. The patient would also like to thank the cheerful and dedicated workforce.”

“The patient came into the PALS Office to express how happy she was with the care she had received in the A&E and External Disease Departments. The staff were all kind and caring and were empathetic.”

“She also recently visited A&E and a follow up appointment prior to yesterday's appointment. On each occasion the professionalism and expertise of the doctors she has seen but the doctor yesterday went that 'extra mile' and in the very busy clinic in which he worked his compassionate nature was evident. She said that she would be grateful if her comments could be fed back to this doctor as the hard work of NHS professionals is often underrated and unfortunately often goes unacknowledged.”

Two further examples are:-

“I visited Moorfields Eye Hospital (City Road) due to having a foreign body in my eye which was agonizing. I was informed it would be a 2 hour wait and was booked in quickly. Saw a triage nurse within 5 minutes. A second, 10 minutes later to do a basic eye test and take a few details. I then waited just over an hour for the nurse who removed both objects in my eye and gave me a prescription for drops. I was out in the 2 hours and more importantly the treatment was top class. This is definitely worth the extra travel over going to a normal A&E.”

“Really appreciate being treated at Moorfields, especially under the NHS and don’t mind waiting. However, having arrived for a 10.15am appointment apart from a brief eye test, my partner was still waiting to see the doctor at 12.30 when I had to leave them to get back to for another appt. The waiting is not the issue but if it can be foreseen by the staff, we may have been able to have stretched our legs for a short while or have a much needed cup of coffee while we waited. Had I known that this appointment would possibly take that long I would have rescheduled my appointment in order to stay with my partner who sometimes needs my assistance. My comments are in no way a criticism of the ophthalmology department.”

The compliments posted on Facebook and via Twitter tend, by their nature, to be succinct:-

@Moorfields what an amazing hospital, staff and advice line. The service I have received over past 24 hours has been fantastic. Thank you!

@Moorfields thanks from mum and me. Yet again excellent service. Merry

Christmas. Gawd bless the @NHSEnglandLDN

can I just say that the fabulous #nurses #doctors #consultants who have been so caring for my mum this week @Moorfields you are amazing! X

No words to describe how great this place is XXX

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Thank you for looking after my daughter. She's been with you all night with an eye injury. She was very frightened but thanks to your wonderful care is feeling much better and now waiting to be discharged. You do a fantastic job. From the bottom of my heart, thank you xxxx

3.0 Complaints Q3 2015/16

An average of 16 complaints a month was received by the trust during Q3, down slightly on the previous quarter, with the total number of complaints received being 49, compared to 54 previously, however the number of complainants stays the same. The numbers of complaints received are in line with historical trends and also reflect the seasonal drop in December. The number of clinical complaints was 23, around the same as previous quarters and suggests that issues where patients are at risk, these are being identified and treated appropriately as formal complaints. The number of complaints concerning appointments has reduced following two quarters where there was a notable increase. However there was a disappointing rise in the number of complaints around staff attitude. Of special note is the fall of complaints regarding transport, from 23 in 2011 and 19 in 2013 to only one in 2015. There has also been a 40% fall in PALS enquiries over the same period. This has been due to the work of the transport team and also possibly due to the introduction of a Transport Committee, part of whose role is, with the provider, to examine all transport complaints, PALS concerns and incidents and address the underlying causes. All complaints and PALS enquiries are reviewed on a weekly basis by the risk and safety team and where appropriate the safeguarding leads. 3.1 Complaints received Q3 2015/16

(Fig. 1) Complaints received by quarter 2014/15 and 2015/16

Q4 2014/15 Q1 2015/16 Q2 2015/16 Q3 2015/16

33 45

(40 complainants) 54

(47 complainants) 49

(47 complainants)

Percentage of patients seen who went on to complain

0.02% (163,959

patients seen)

0.02% (167,127 patients

seen)

0.03% (167,410 patients

seen)

0.02% (166,672 patients

seen)

Complainants per 10,000 patient contacts

2.0 2.6 3.2 2.9

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(Fig. 2) Number of complaints received 2014/15 -2015/16: actual (grey) 12mth rolling trend (red)

3.2 Complaints by type

(Fig. 3) Complaints received by type Q3 2014/15 to Q1 2015/16

Clinical complaints Clinical issues continue to be the most common cause of formal complaints, with the number received staying around the same for the past several years. More than other types of complaint, it is difficult to identify themes that can be addressed in the wider context due to the individual nature and circumstance of the concerns raised. Reviewing by the directorate, site, service or individuals involved also fails to suggest any pattern that might be addressed ahead of time. They do tend to suggest that at some point communication, understanding and clarification were not as they might have been, but identifying the 0.01% of patients in the clinical setting to whom this might apply, is difficult and it is beholden on each individual clinician to ensure that their patient understands, is involved, and is happy with the care and treatment choices they receive. Eight of the complaints were in regard to what was perceived as a poor outcome of treatment or surgery and a further three felt they were misdiagnosed. Three questioned the course of treatment they had received over time and a further three had issues (i.e. allergic reactions, to the medication they received). Four raised issues about the management of

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Clinical Appointments Communication

Waiting times Customer care /attitude transport

Other

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how their operations were handled, and a final two concerned a surgical error (a needle left in situ) and an endophthalmitis infection following surgery. All responses to patients who make clinical complaints are reviewed by the Medical Director to ensure that all points have been addressed.

Other complaints The number of complaints regarding appointments fell back to their previous level following an increase over the past two quarters. These three were to do with appointments not being booked as they should, each from a different service. Of the eight complaints categorized under communication, four involved a failure to communicate with patients about their appointment or surgery dates, two were from patients who felt they were not involved in decision making about their care, and one from a patient who left their consultation confused as to the outcome. A further complaint related to what the patient was a possible IG breach upon receipt of a Moorfields Charity mail shot. Disappointingly, poor staff attitude has increased on the previous two quarters, with complaints relating to what they felt was rude or off hand behavior on the part of three doctors, two nurses, two receptionists, a security guard and an optometrist. One patient disliked the tone of a letter they received. Of the other complaints, two concerned waiting times in clinic or surgery and two for the time it took to be referred. One other complaint concerned a patient’s need to pay for aspects of their treatment. There were three meetings arranged between complainants and hospital staff during quarter 3. Another two were offered but declined. Moorfields Private Three complaints were received by Moorfields’ Private during quarter 3. One related to an injury due to a faulty door closure mechanism (which was subsequently replaced). Another related to the waiting environment for surgery and the delay in going to theatre and a third was about their private room and information given by staff. Complaints breakdown by type (Directorate) and type (Ophthalmic Service) can be found in appendix 1. The only notable anomaly is the increase of clinical related complaints from Moorfields North, from four the previous two quarters to twelve in quarter three Three concerned the nursing care they received and two were in regard to cancelled surgery due to process not being followed. Each incident was at a separate site. Two related to pharmacy issues regarding allergies and a change of medication, again at different sites. The remaining six were concerns about clinical treatment received, again they were each from different satellite sites and no causal link is indicated. The Cataract service also had a notable increase in complaints. Again they were from seven different sites and seven different categories.

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3.3 High Risk complaints There were no complaints risk rated as ‘High’ (based on the risk matrix that measures the consequence of an event by its likelihood) during quarter 3. One case was discussed at the Serious Incident (SI) panel, regarding a patient who had a needle left in their brow following surgery. It was not deemed an SI due to the fact that a needle was noted to be missing at the time of surgery and a decision was made and that it was clinically preferable to inform the patient and leave it in situ.

3.4 Re-opened cases

During quarter three there were three complainants for whom their case was re-opened. These were for further details about how we would prevent a reoccurrence of their concern (prescribing error), one who challenged the trusts findings (financial issue; it was not upheld), and one who felt we had not addressed all their concerns (regarding a subsequent visit).

3.5 Response time

Where the final response breached the 25 day limit, this was due to several complaints requiring multiple medical staff involvement and two that were sent for further investigation as not all points we addressed. 100% of complainants were acknowledged within the three day target.

(Fig 4) 25 day response rate Q4 2014/15 to Q3 2015/16

3.6 Litigation

Only one claim was received during quarter three. This was non-clinical and involved an environmental injury to a member of staff. There were three claims settled during quarter 3; one regarding a failure in diagnosis, one an injury due to poor maintenance (no award) one due to an injury caused by repeated manual handling.

3.7 Ombudsman referrals

There was one referral to the Parliamentary and Health Service Ombudsman during quarter three. This concerned a patient who had post-op complications and who felt the risks were not explained fully and that their follow up care was inadequate.

Complaints answered within 25 days Q3

Q4 14/15 73%

Q1 15/16 89%

Q2 15/16 87%

Q3 15/16 78%

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4.0 Response to complaints

Not all of the issues raised in complaints during the second quarter allow for specific service change. Many of the clinical complaints require an explanation of care and treatment given. Many complaints were resolved in quarter three by the offer of a further appointment or to see a specific consultant to discuss their issue in more depth.

Other specific service changes are:-

A flexible re-payment plan was agreed by Moorfields for a patient who was prevented from leaving the country due to unpaid healthcare costs.

Staff have been reminded of the importance of recording all patient allergies on paper and electronic records, following the prescribing of drops with preservative to a patient who had highlighted their allergy.

Following a patient who had surgery cancelled due to the appropriate scan not being undertaken, MEH North is looking at the procedure for referring patients to ultrasound at City Road to ensure that there is a more robust process in place.

A patient who received a charitable mailing was re-assured that our mailing did not breach data protection act criteria and that her name has been removed from subsequent mailings.

A patient felt her care was below standard on one of the overnight wards. The issues they raised will be used in future nurse training.

The booking team have been reminded of the importance of calling patients when changing appointments in order to avoid any unnecessary confusion should the amended appointment letter not arrive following a patient attending for a cancelled appointment.

As a result of a patient being booked for surgery at a satellite site (rather than City Road) where the particular procedure could not be carried out, the case was discussed at the Clinical Governance meeting and all staff informed of the correct process.

As a result of a parent complaining about the number of times the consultation was interrupted by telephone calls, the reception staff now handle all incoming calls.

Following a patient’s frustration at not being able to get through to the Bedford satellite site, a process has now been implemented whereby the telephones are manned at all times, and the answering machine is checked several times a day, with all telephone messages returned in a timely manner.

5.0 PALS and Complaint team activity In light of the findings from the patient survey discussed in the quarter two report, the template parts of the letters sent to patients have been re-written, stressing the availability of complaints staff support at any time during the process. There is also a leaflet included in acknowledgement letters explaining how their complaint will be investigated. The final response letters now also include a paragraph explaining that we seek the patient’s full satisfaction and if there are any aspects of the complaint that we have not addressed, they are encouraged to contact the complaints manager to discuss. The complaints manager has also started to call complainants two to three weeks after the receipt of the final response to ask if there are any areas they feel we have not addressed. This may result in an increase in re-opened cases in the short term, but should, it is hoped,

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engender the sense that we are trying to resolve their issues together. Patients will continue to be surveyed to monitor any improvement in satisfaction. The complaints team have also updated the content on the Moorfields’ website to make it easier to submit their complaints on line and helping them to be specific about the issues they would like addressed and outcome they would like to see.

6.0 PALS enquiries

The majority of PALS concerns are dealt with, as they happen, either by the two PALS officers or in liaison with the directorate teams. All PALS enquiries and outcomes are circulated on a weekly basis so that directorates can identify the themes and issues and address them at service performance meetings. PALS’ enquires are classified as one of three types: compliments, general enquiries for information or advice and concerns or informal complaints. The latter two are somewhat similar as most of the concerns and informal complaints are at root, requests for information or a resolution of an issue but the frustration caused to the patient by the problem is such that it presents as a concern or informal complaint. How these are recorded is left to the discretion of the PALS officer taking the call or enquiry. 294 PALS enquiries in were received in quarter three. This compares with 673 for the previous quarter.

(Fig 5) PALS activity Q4 2014/15 & Q1 - Q3 2015/16

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Compliments Information orenquiries

Concern or informalcomplaints

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7.1 PALS Information and enquiries

(Fig 6) PALS Information and enquiries Q4 2014/15 and Q1, Q2, & Q3 2015/16 by number and percentage

Whilst there was relatively little change in most categories there was an increase in the number of communication related enquiries. The majority of these were general medical/clinical/research and enquiries or regarding reports, test results and questions for staff. Other questions in this category related to trust services, questions about admissions and general advice.

7.2 PALS Concerns and informal complaints The notable change was the reduction in appointment concerns and increase in administrative issues, but otherwise there is no real change in any category.

All PALS enquiries and concerns and their outcomes are circulated to all the directorate management teams on a weekly basis so that trust wide learning can take place.

(Fig 6) PALS Concerns and informal complaints Q4 2014/15 and Q1, Q2 and Q3 2015/16 by number and percentage

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Administration Appointment issues Cancelled Appts Cashiers Clinical IssuesCommunication Optometry Transport Waiting time Other

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The Board is asked to note the content of this report.

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Appendix 1

Complaints received by type / DirectorateQ4 2014/15 and Q1, Q2 and Q3 2015/16

Complaints received by type / Satellite Q4 2014/15 and Q1, Q2 and Q3 2015/16

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Complaints received by type / Service - Q4 2014/15 and Q1, Q2 and Q3 2015/16