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Northern Devon Healthcare NHS Trust Trust Board – 6 December 2016 Incorporating community services in Exeter, Mid and East Devon

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CUSTOMER RELATIONS PERFORMANCE REPORT

As part of new key performance indicators being reported to the Trust Board and Executive team, the customer relations performance report has been revised. Complaints activity and report sections will now reflect the established KPI’s and all report sections will be traffic lighted to provide an overview of the status of the specific activity in line with the following thresholds:

Red 89.9% or less

Amber 90% - 94.9%

Green 95% or more

1. Complaints Activity

During the period 1 July – 30 September 2016, 73 issues were received, which is slight increase on the activity for Q1 (80). This section has been RAG rated as green to reflect the small decrease in activity level, as the year to date figure (153) is indicative that if activity levels stay at the same level the annual figure will be below the 10% increase threshold. Of the 73 issues received in this quarter, 5 were re-opened complaints, equating to 7% of activity. This is a slight decrease from the 9% seen in Q1, and this performance indicator has continued to decrease from the 25% seen in Q2 of 2015/16, indicating the quality of our complaint responses have significantly improved as a result of the increased support from our Customer Relations team to the operational directorates in respect to complaint investigations and responses. The graph below shows the number of complaints received in this reporting period broken down by financial quarters, and the table below shows the quarterly breakdown by directorate, which has been kept under the old directorate operational structure for 2015/16 reporting. To assist with the monitoring of investigation quality, re-opened activity has been separately drawn out of the overall activity figures in the graph below.

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Complaints Activity by reporting period1 April 2015 - 30 September 2016


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22 complaints have been received cumulatively within the year for Multiple Directorates and these have involved the following directorates:

Planned Care and Surgery (12)

Unscheduled Care (10)

Health and Social Care (3)

Facilities (5)

1.1. Local Resolution Meetings

During the period July - September 2016, 18 local resolution (face to face) meetings took place. An increase in the number of meetings has been seen this reporting period.

2013/ 2014

2014/ 2015

2015/ 2016

Apr-June 2016

July-Sept 2016

Oct – Dec 2016

Jan – March 2017

Accumulative total 2016/17

No of Meetings undertaken

83 84 82 17 18

35

1.2. Risk Rating of complaints All complaints are risk rated according to their complexity and severity. The table below displays the reporting period’s data alongside the calendar year’s data. Those which are deemed as High usually relate to an incident being investigated in parallel as a SIRI.

2. Complaints Key Performance Indicators

2015/2016

April - June

2016

Jul- Sept

2016

Oct - Dec

2016

Jan - Mar

2017 Total

Low 281 73 55 0 0 128

Minor 33 5 13 0 0 18

Medium 11 2 3 0 0 5

High 11 0 2 0 0 2

Total 336 80 73 0 0 153

April - June

2016

July - Sept

2016

Oct - Dec

2016

Jan - April

2017 Total

Overall Complaints activity 80 73 0 0 153

Planned Care and Surgery 21 19 0 0 40

Unscheduled Care 24 25 0 0 49

Community Hospital 3 5 0 0 8

Health & Social Care 12 10 0 0 22

Specialist Services 6 1 0 0 7

Director of Facilities 2 0 0 0 2

Medical Director 0 0 0 0 0

Director of Nursing 0 0 0 0 0

Director of Finance 0 0 0 0 0

Director of HR 1 0 0 0 1

Director of Strategy and Transformation 2 0 0 0 2

Multiple Directorates 9 13 0 0 22


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There are set key performance indicators the Customer Relations team report on to meet both statutory and Trust requirements in the management of complaints. These KPI’s are monitored monthly by the Trust’s Executive team and our Commissioners, NEW Devon Clinical Commissioning Group. A breakdown of these KPI’s by directorate can be seen at Appendix A on page 13. 2.1 Acknowledgement All complaints are required to be acknowledged within 3 working days, in line with Trust policy and statutory legislation. The formal performance target is 80% set by our Commissioners and internally the team strives to acknowledge 95% of complaints within 3 working days. For the period 96% of complaints were acknowledged within 3 working days. 2.2 Complaints performance During the period 96% of complaints were responded to within the timeframe agreed at the outset of the complaint, or within an agreed extended timescale. This performance met the Trust’s expectations for this key performance indicator. 2.3 Complaints investigation timeliness During the period 69% of complaint investigations were returned to the Customer Relations department within the allocated timeframe. Whilst this has improved slightly on the previous quarters data, it still remains below the Trust’s accepted threshold and work therefore continues to be undertaken to improve this situation. 2.4 Complaints investigation quality One indicator of investigation quality is the number of complainants that approach the Trust for a second time following a response to their original complaint. Sometimes complainants can engage a second time as they continue to have questions surrounding the care and treatment received, or the explanations have created additional questions; however on most occasions complainants are usually unhappy with the information they have been provided with. The Trust saw a gradual increase in the number of re-opened complaints in the first two quarters of 2015/16 and in the most current quarter this has reduced significantly. This is believed to be as a result of increased involvement of the Customer Relations team in the management of individual complaints, which has supported more collaboration between the team and the operational/clinical teams, alongside the continuation of Local Resolution Meetings as a way to resolve issues face to face. The following two graphs show the number of re-opened cases this financial year by Directorate and service area.


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Breakdown of re-opened complaints by Directorate 1 April 2016 -30 September 2016

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Breakdown of re-opened complaints by Specialty 1 April 2016 -30 September 2016


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2.5 Ombudsman referrals Within the reporting period, two new Ombudsman referrals were received. One related to care provided by the cancer services team within the Unscheduled Care directorate and one related the general surgery team in the Planned Care and Surgery Directorate. Two Ombudsman cases were closed within the period, both with an outcome of Not Upheld, and this related to the community nursing service and the care and treatment a palliative patient received.

3. Organisational Learning

1.3. Outcomes and Remedial Actions from closed complaints

During the financial year to date, 163 complaints have been closed following investigation. Examples of remedial actions undertaken can be seen below.

Learning and improved communication identified as a result of complaints this financial year:

The Community Occupational Therapy team have undertaken work with local care home providers within the Exeter locality to educate them on positioning and the use of equipment to help move and turn patients. Work is also being undertaken with the providers to include the physiotherapy/occupational therapy action plan to be written into the care homes plan to improve communication amongst staff

Service Improvement work has been undertaken with the Clinical Commissioning Group on the Continuing Healthcare (CHC) assessment process to improve timeliness of assessments and the involvement/communication with relatives and patients. A review of the correspondence sent by the CHC administration hub has been undertaken and additional letters introduced to explain the steps in the process

Considerable work has been undertaken to improve the waiting time for initial musculoskeletal (MSK) appointments following referrals within the Eastern area to improve timeliness. This work has been undertaken alongside our Commissioners and has included an increase in service capacity via additional clinics and staff, and reviewing appointment length of time

The management team at the Linden Day Centre at Ottery St Mary Community Hospital, which is a day center for patients suffering Dementia, have undertaken a number of action points to improve communication with relatives and carers, to include a review of their handover process to ensure relevant information is shared between staff

A patient’s experience will be discussed at the Directorate’s clinical governance day

The Divisional Nurse for Planned Care & Surgery will share a patient’s experience anonymously with all Ward Managers on the surgical wards and Surgical Sisters at the team meeting. They will highlight the importance of contacting the liaison nurse when a patient has a purple sticker to flag the patient is under the care of the Oncology service and awareness of purple sticker will be undertaken within appropriate forums in the Unscheduled Care directorate

The Divisional Nurse for Planned Care & Surgery will speak with Ward Mangers to discuss medication concerns that arose from a complaint


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A Consultant in Emergency Care has presented a power point presentation at the emergency department (ED) clinical governance meeting to include slides addressing the differences between the information from the ED notes and the time line provided by a patient, highlighting the significances for discussion, reflection and learning

Staff have been reminded to always be courteous and respectful to patients and/or relatives that attend the emergency department

Clarification was sought from an agency who provide temporary staff to work within the Rapid Response Service and Hospital at Home (H@H) service surrounding the level of training they receive. Assurance was sought from the agency that before allowing the staff member to conduct any Rapid Response or H@H shifts they have to prove to the Manager that they are able to work under their own initiative, able to provide a high level of care with minimal information, able to identify risks and know how to report these risks, able to work under pressure and cope with short notice changes whilst still remaining calm and professional, alongside established competences with medication

A ward manager discussed with their staff what patients should be offered in terms of food and fluids, who are recognised to be coming to the end of their life following a relatives experience

4. Quality of responses

4.1 Care Quality Commission Complaints

During the period no complaints were received by the Care Quality Commission (CQC).

5. Issues raised from complaints

Breakdown of complaints by the top 5 subject matters The following two pie charts identify the top 5 subject and sub-subject matters for the complaints received within the period.

Communication 20%

Clinical Care and Treatment

39%

Attitude of staff 15%

Access to Clinical Services 16%

Discharge arrangements

4%

Top 5 subjects for complaints received between 1 April 2016 - 30 September 2016


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6. Trend Monitoring

Difficulty in contacting the Clinical Management Centre (CMC) A trend was noticed during the reporting period January – March 2014 (Q4 2103/14) for the number of contacts made with the PALS team surrounding difficulties patients have experienced in contacting the CMC. The Planned Care and Surgery directorate are monitoring capacity within the CMC team and additional resources were implemented to assist with this operational situation. This trend is continuing to be monitored through the graph below.

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6Activity levels surrounding difficulties experienced in contacting CMC

by quarter for 2013/14, 2014/15, 2015/16, and YTD 2016/17

Dissmissive Behaviour

5%

Communication to patients,

parents or carers 17%

Lack of empathy 4%

Delay at the time of treatment

5%

Delay at the time of treatment/care

4%

Top 5 sub-subjects for complaints received between 1 April 2016 - 30 September 2016


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Continuing Healthcare (CHC) Funding A trend has been emerging through PALS and complaints surrounding Continuing Healthcare (CHC) assessments. The graph below shows a breakdown of activity by quarter and this is continuing to be monitored by the Operations directorate and CHC team. Issues of concern can relate to the outcome of an assessed need, considerations from relatives about a lack of involvement in the process, and the timeliness in which the assessment is completed. In relation to the latter, the Trust has undertaken significant work to address both capacity issues and quality issues through a quality improvement initiative. This has included a training programme, structural re-organisation of the central CHC team and an improved internal quality assurance review process to verify assessments prior to a final review and ratification by the Clinical Commissioning Group.

7. PALS activity

There were 707 PALS enquiries received within the reporting period, which is a slight decrease position from the 771 contacts received from 1 April 2016 – 30 June 2016. A breakdown in enquiries can be seen below.

7.1 Summary of Main Themes of PALS The table below shows the number of PALS by subject matter and Directorate for the reporting period. PALS activity continues to be represented by acute services and there are low levels of activity within community services. It is recognised PALS issues within community services are often managed and resolved directly by staff and work is being undertaken with the teams to capture this information onto Datix.

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Apr -June2014

July -Sept2014

Oct - Dec2014

Jan -March2015

April -June2015

July -Sept2015

Oct - Dec2015

Jan -March2016

Apr-June2016

July -Sept2015

Activity levels surrounding Continuing Healthcare (CHC) by quarter - 2014/15, 2015/16, and YTD 2016/17


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PALS by Directorate PALS by Subject matter Information Provision is a core function of PALS and represents the information that is provided via the Information Centre. The tables below show a further breakdown of the top four issues raised via PALS, as highlighted in grey in the above table, by more detailed sub-subjects within that category. The breakdown is using quarter two data.

Apr-June

2016

July - Sept

2016

Oct - Dec

2016

Jan - Mar

2017

Accumulative

total 2015-16

Access to Services - Clinical 252 246 0 0 498

Access to Services - Physical 14 8 0 0 22

Admission arrangements 3 0 0 0 3

Attitude of staff 30 32 0 0 62

Benefits 0 0 0 0 0

Bereavement 1 0 0 0 1

Clinical Care and Treatment 49 40 0 0 89

Communication 133 118 0 0 251

Compliments 2 1 0 0 3

Confidentiality issues 4 4 0 0 8

Discharge arrangements 16 8 0 0 24

Equality and Diversity 0 1 0 0 1

Quality of Facilities 3 6 0 0 9

Hotel Services 3 4 0 0 7

Information Provision 224 219 0 0 443

Medical Records 22 9 0 0 31

Patient's Property 10 8 0 0 18

Privacy and Dignity 1 1 0 0 2

Security 1 0 0 0 1

Transport 3 2 0 0 5

Totals 771 707 0 0 1478

Apr-June

2016

July - Sept

2016

Oct - Dec

2016

Jan - Mar

2017 YtD

Planned Care and Surgery 329 304 0 0 633

Unscheduled Care 313 291 0 0 604

Community Hospital 10 4 0 0 14

Health & Social Care 21 30 0 0 51

Specialist Services 12 12 0 0 24

Director of Facilities 42 31 0 0 73

Medical Director 0 0 0 0 0

Director of Nursing 33 28 0 0 61

Director of Finance 2 3 0 0 5

Director of HR 2 2 0 0 4

Strategy and Transformation 4 2 0 0 6

Trust wide 3 0 0 0 3

Totals: 771 707 0 0 1478


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Breakdown of enquiries for Clinical Care and Treatment

Poor/ unexpected outcome 5 Drug/medication errors 2

Poor medical care 7 Delay in clinical diagnosis 2

Delay in obtaining results 7 Poor AHP care 1

Poor unexpected outcome 4 Injury through treatment 1

Poor nursing/ midwifery care 4 Delay in obtaining medication 1

Failure to refer on to another service 3 Delay at time of treatment or care 1

Slips, Trips, and Falls 2 Totals: 40

Breakdown of enquiries for Information Provision

Information leaflets 172

PAS enquiry 18

Ward enquiry 14

Information on how to complain 7

Other 7

Clinical information inadequate 1

Totals: 219

Breakdown of enquiries for Communication

Communication to patients, parents or carers 112

Interpreting services 2

Other 2

Corporate communications 1

Communication between staff regarding patients 1

Totals: 118

Breakdown of enquiries for Access to Clincal Services

Difficulty contacting department by phone 153

Length of wait for outpatient 48

Length of wait for surgery 11

Errors booking outpatients 9

Difficulty booking appointment 7

Cancellation of OPD 6

Waiting time A&E 3

Cancelled operation 2

Delay at time of treatment or care 2

Cancelled Clinic 1

Waiting list equipment and funding 1

Lack of information on waiting times 1

Service transferred 1

Unnecesary appointment 1

Totals: 246


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Appendix A - Complaint Key Performance Indicators (KPI’s)

Red 89.9% or less

Amber 90% - 94.9%

Green 95% or more

Acknowledgement Performance

Complaints Response Performance

April -

June 2016

July- Sept

2016

Oct- Dec

2016

Jan- March

2017

Overall acknowledgement performance 88% 96% 0% 0%

Planned Care and Surgery 82% 95% 0% 0%

Unscheduled Care 81% 96% 0% 0%

Community Hospital 33% 80% 0% 0%

Health & Social Care 100% 100% 0% 0%

Specialist Services 100% 100% 0% 0%

Director of Facilities 100% n/a 0% 0%

Medical Director n/a n/a 0% 0%

Director of Nursing n/a n/a 0% 0%

Director of Finance n/a n/a 0% 0%

Director of HR 100% n/a 0% 0%

Director of Strategy and Transformation 100% n/a 0% 0%

Multiple Directorates 100% 0% 0% 0%

April -

June 2016

July- Sept

2016

Oct- Dec

2016

Jan- March

2017

Complaint response performance 94% 96% 0% 0%






Director of Facilities n/a 100% 0% 0%


Director of Nursing n/a n/a 0% 0%


Director of HR n/a n/a 0% 0%

Director of Strategy and Transformation n/a 100% 0% 0%



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Timeliness of complaint investigations

April -

June 2016

July- Sept

2016

Oct- Dec

2016

Jan- March

2017

Complaint investigation response performance 78% 69% 0% 0%






Director of Facilities 100% 100% 0% 0%


Director of Nursing 100% n/a 0% 0%


Director of HR n/a n/a 0% 0%

Director of Strategy and Transformation 50% n/a 0% 0%



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Appendix B - Ombudsman Complaints During the Quarter 2, two new requests were received from the Ombudsman and two cases were closed. Details of the two current open Ombudsman cases this financial year are below.

Directorate Details of complaint Status Date

received

9622 – Unscheduled

Care

The complainant is unhappy about the care and treatment their late wife received from the Cancer Services team

This complaint is currently being reviewed by the Ombudsman and we are awaiting

further instruction.

24 August 2016

9363 – Planned

Care

The complainant is unhappy about having their operation

cancelled twice as they are in a great deal of pain and feel that their situation is being

ignored

This complaint is currently being reviewed by the Ombudsman and we are awaiting

further instruction. 28 July 2016

7759 – CSDU –

Health and Social Care (Eastern)

The complainant is concerned about end of life care and

treatment provided to a loved one and the way in which their

complaint was handled

The complaint was Not Upheld and the Ombudsman considered the care and

treatment had been appropriate, alongside the complaint handling by

NDHT. This was a joint Ombudsman investigation with NHS England (GP

involvement) and an upheld outcome was attributed to this part of their review.

Closed: 15 September

2016

Received: 8 March 2016

8462 – Unscheduled

Care

The complainant is concerned about the care and treatment

their late mother received when she was admitted to

hospital where she died and communication with staff

The complaint was Not Upheld and the Ombudsman considered the care and

treatment, together with communication with the family, had been appropriate.

Closed: 1 September

2016

Received

20 April 2016

Details of current OPEN Ombudsman cases

Directorate Details of complaint Status Date received 9622 –

Unscheduled Care

See above See above 24 August 2016

9363 – Planned

Care

See above See above 28 July 2016

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