Complaints Conference Introductions Speaking Up Project Peer Review Panels Survey programme

Speaking Up

Health Foundation Closing the Gap: Changing Relationships The Patients Association, Mid Staffordshire NHS Foundation Trust, the National Confidential Enquiry into Patient Outcomes and Death, Pilgrim Projects 2 year programme  Digital stories  Complaint support service  Peer Review Panels  Complainant survey

What is the challenge?

The Committee finds that in the absence of clear national standards for complaints handling, and with no one organisation taking the lead on assessment of performance, it is extremely difficult to ascertain which organisations are performing well on complaints. There is significant potential for duplication by different regulators and for failing organisations to be overlooked. Complaints & Litigation, Health Select Committee 2011

The signatory organisations have agreed there is a clear need for meaningful, comparable complaints information which can be used to help drive improvement in healthcare and strengthen the quality of services for patients and the public. The Department of Health, The Health Service Ombudsman, the NHS Information Centre, National Voices, Monitor, the Care Quality Commission, 2011

Current measures?

Complaints survey Every complainant will be asked to complete a survey asking about the quality of the complaints process Developed from scratch with Trust’s Complaints Focus Group 5 Trusts including Mid Staffordshire actively using the survey since October 2011 Benchmarking group in existence since December 2011 A group of 10 Trusts since July 2012

Complaints survey 22 questions in total including: Were you worried that the quality of your care [or that of a friend or relative if you are complaining on their behalf] would be reduced if you complained? Do you feel the response to your complaint explains how the Trust will take appropriate action to prevent the same thing happening again? Do you feel you have been told the truth in the response to your complaint? If your complaint involved the behaviour of an individual member of staff, were you given a clear explanation as to how the hospital has dealt with this?

Complaints survey – Results Experimental data – not quite ready for publishing – low numbers limit value Bear in mind the subject matter - people who return the surveys may be less likely to be happy Comparison is key Aggregate results......

Peer Review Panels Methodology Panels meet every quarter over the 2 years to review a sample of complaints Retrospective activity – complaints closed within the last 3 months Mixture of low, medium and high cases Panels consist of clinicians [nurses and hospital consultants], complaints managers from other organisations, magistrates, community members They use a complaints handling scorecard to assess each case against 8 standards of good complaints handling Reports pull together themes of good and poor practice

Standard 1: The investigation of the complaint is impartial and fair. Standard 2: Individuals assigned to play a part in a complaint investigation have the necessary competencies. Standard 3: The roles and responsibilities of the complaints handling team are clearly defined. Standard 4: The governance arrangements regarding complaint handling are robust. Standard 5: The Complainant has a single point of contact in the organisation and is placed at the centre of the process. Standard 6: Investigations are carried out in accordance with local procedures, national guidance and within any legal frameworks. Standard 7: The investigator reviews, organises and evaluates the investigative findings. Standard 8: The judgement reached by the decision maker is transparent, reasonable and based on the evidence available. Standard 9: The complaint documentation is accurate and complete. The investigation is formally recorded, the level of detail appropriate to the nature and seriousness of the complaint. Standard 10: Responding adequately to the complainant and those complained about. Standard 11: Learning lessons from complaints occurs throughout the Organisation. Standard 12: Recording, analysing and reporting complaints information throughout the organisation and to external audiences

Standard 1: The investigation of the complaint is impartial and fair. Standard 3: The roles and responsibilities of the complaints handling team are clearly defined. Standard 5: The Complainant has a single point of contact in the organisation and is placed at the centre of the process. Standard 6: Investigations are carried out in accordance with local procedures, national guidance and within any legal frameworks. Standard 7: The investigator reviews, organises and evaluates the investigative findings. Standard 8: The judgement reached by the decision maker is transparent, reasonable and based on the evidence available. Standard 9: The complaint documentation is accurate and complete. The investigation is formally recorded, the level of detail appropriate to the nature and seriousness of the complaint. Standard 10: Responding adequately to the complainant and those complained about.

The complainant was given contact details for a named person with whom they could liaise throughout the process. Yes □ No/Not recorded □ Best thought of as a ‘case worker’, complainants should be able to establish a working relationship with a named person who can act as their liaison throughout the process. References to “on behalf of the team” or similar would not constitute a named person. If a case worker is absent then ideally complainants should be informed of an alternative point of contact.

There is evidence of a clear management plan for the investigation. Yes □ Partly□ No/Not recorded □ It is critical that one person be responsible for the conduct of the investigation and thus for establishing the framework for the investigation. Ensuring that the planning stage is well done will have a major influence on the ultimate success of the investigation. Has the investigator identified what questions need to be answered, what information is required to answer those questions and the best way to obtain that information? If there is evidence of an individual simply dividing up the complaint and requesting responses from the relevant departments or individuals (for example through internal s or proforma) select ‘Partly’. A ‘Yes’ requires evidence of an overall and complete plan in terms of evidence required from each area and bringing that together for review.

There is sufficient evidence to show that statements were obtained from relevant members of staff involved with (or witnessing) the complaint. Yes □ Partly □ No/not recorded □ Statements will form a key part of an investigation and are relatively easy to obtain in comparison to interviews. They may include accounts of events but also opinions on the appropriateness of treatment provided. Collecting statements from all those involved or able to act as witnesses is particularly important where there is an apparent dispute over events. In some circumstances where accounts are provided on behalf of a junior (e.g. Consultant giving a view on behalf their registrar who gave treatment) you may select ‘Partly’ but only when the statement is complete and comprehensive and has no apparent need for further clarification. However generally, the threshold should be high for selecting ‘Partly’ or ‘Yes’. If the investigator was unable to obtain a statement from a key member of staff, this should have been recorded with reasons why. A staff member being on night duty is not an acceptable reason for not conducting an interview. Where they are a crucial witness the organisation should evidence they have made efforts to contact ex-employees. Where they are regulated professionals (e.g. nurses and doctors) they have a duty to cooperate.

Where necessary, there is sufficient evidence to show that relevant members of staff involved with (or witnessing) the complaint were interviewed. Yes □ Partly □ Not applicable □ No/not recorded □ In certain circumstances, an interview may be warranted. This may be because of a serious complaint with conflicting accounts being provided by staff or third party witnesses. Use your judgement as to whether an interview was warranted for this complaint. Where only some people who think should have been were interviewed select ‘Partly’. Where you think an interview was not warranted select ‘Not applicable’.

Appropriate further independent opinion was secured on complaints relating to clinical issues Yes □ Partly□ No/Not recorded □ Not applicable □ This sub standard relates specifically to independent opinion from those divorced from the handling of the complaint and the issues complained about. Where the complaint relates to serious harm or death, opinions from clinicians from outside the Trust (e.g. another Trust, a medico legal review, a Royal College review) will likely be required to secure a ‘yes’-for lesser complaints a Consultant colleague providing an opinion on an anonymised scenario may suffice. Where, in your opinion, insufficient attempts have been made select ‘partly’. If you feel independent opinion of some form was warranted but none obtained select ‘no’. If it was not warranted select ‘not applicable’.

Scored Level 1 Poor practice Level 2 Less than satisfactory Level 3 Satisfactory Level 4 Good practice Level 5 Excellent practice

Lynne Birchall Complaints Manager Nottingham University Hospitals NHS Trust

Susan Riddle Self employed Complaints Consultant & Magistrate

Common pitfalls 1. Documentation (who did what, when and why) 2. Formality of investigation 3. Independent opinion/challenge 4. Explanations to complainants 5. Apologising.....and not apologising

Going forward