THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST Board Paper - Cover Sheet Date 3 rd December 2015 Trust Board Agenda Item A5(iv) Report Title Patient Experience Lead Director Report Author Nursing & Patient Services Director Helen Lamont, Nursing and Patient Services Director Andy Pike, Head of Patient Experience Frances Blackburn, Deputy Nursing and Patient Services Director, Freeman Classificat ion NHS Unclassified Purpose (Tick one only) Approval Discussion For Information Links to Strategic Objectives To put patients and carers at the center of all we do and to provide care of the highest standard in terms of both safety and quality. To continue to be recognised as a first-class teaching hospital, counted amongst the top 10 in the country, which promotes a culture of excellence, in all that we do. Links to CQC Domains/ Fundamental Standard(s) Regulation 9, 10, 16. CQC Domains responsive to people’s needs, well led and effective. Identified Risk? (If yes, risk reference) No. Resource Implication s No additional resource implication. Legal This paper does not highlight any specific
Transcript
THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST
Board Paper - Cover Sheet
Date3rd December 2015
Trust Board Agenda Item A5(iv)
Report Title Patient Experience
Lead Director
Report Author
Nursing & Patient Services Director
Helen Lamont, Nursing and Patient Services DirectorAndy Pike, Head of Patient ExperienceFrances Blackburn, Deputy Nursing and Patient Services Director, Freeman
Classification NHS Unclassified
Purpose (Tick one only)
Approval Discussion For Information
Links to Strategic Objectives
To put patients and carers at the center of all we do and to provide care of the highest standard in terms of both safety and quality.
To continue to be recognised as a first-class teaching hospital, counted amongst the top 10 in the country, which promotes a culture of excellence, in all that we do.
Links to CQC Domains/Fundamental Standard(s)
Regulation 9, 10, 16.CQC Domains responsive to people’s needs, well led and effective.
Identified Risk? (If yes, risk reference)
No.
Resource Implications
No additional resource implication.
Legal implications and equality and diversity assessment
This paper does not highlight any specific equality and diversity implications. Work is ongoing to analyse data in relation to protected characteristics where this is available.
Benefit to patients and the public
Provides assurance that the Trust has robust and transparent systems for collecting and acting upon patient feedback from across the Trust.Demonstrates culture of continuous improvement.
Report History
Monthly report on published complaints data. Also, has recently been developed as a more comprehensive patient experience paper bringing together a range of issues all of which relate to the patient experience.
Next steps To read, discuss and approve this paper.
THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST
PATIENT EXPERIENCE MONTHLY REPORT – NOVEMBER 2015
EXECUTIVE SUMMARY
This monthly paper presents key Patient Experience data to the Board including:
The Complaints Management Dashboard as presented to the Complaints Panel in December 2015
The Real Time Patient Feedback information for November (up to 27th November)
The Friends & Family data for October have yet to be published and will be detailed with November’s data in the January 2016 report.
In terms of this month’s report, key points to note are:
An overview of Complaints for the Trust and details of changes to related Management Information. An overview is provided on monthly performance as well as year on year comparison.
Survey activity, with positive results for Ward 37 Critical Care at the Freeman Hospital, which was involved in a national ‘Family Satisfaction in Critical Care’ survey including 20 adult Intensive Care Units.
The introduction of a ‘feedback centre’ by Healthwatch Newcastle and how the Trust will ensure that responses are provided to user feedback on the website.
The Trust’s work with Carers and the ongoing work to increase support and their inclusion in care provision where appropriate.
Positive feedback regarding the Trust’s discharge performance from the Picker Institute.
An update on work to achieve the Accessible Information Standard with which the Trust must be compliant by June 2016. Immediate progress and the development of an implementation plan is awaiting confirmation from IT regarding the required system changes.
RECOMMENDATION
To (i) receive the briefing and (ii) support the work outlined.
Helen LamontNursing and Patient Services Director
Frances BlackburnDeputy Nursing and Patient Service Director, Freeman
Andy PikeHead of Patient experience
3rd December 2015
Agenda item A5(iv)
THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST
PATIENT EXPERIENCE MONTHLY REPORT – DECEMBER 2015
1. INTRODUCTION
This monthly report on Patient Experience highlights the current data, key developments, risks and actions arising from this area of work.
2. FRIENDS AND FAMILY TEST (FFT) AND REAL TIME PATIENT FEEDBACK (RTPF) RESULTS COMMENTARY AND ANALYSIS OF CHANGES IN PROCESS
The Friends & Family data for October has yet to be published and will be detailed with November’s data in the January Board report.
We continue to work with Emergency Department and other areas to improve the response rates and we have presented at the Band 2 to 4 Healthcare Assistant forum to highlight the FFT and how they can help as they are seen as a key group in encouraging patient engagement.
The Trust has historically performed very well in terms of patients who would recommend its services. However, to ensure that opportunities to learn from those who would not recommend the Trust. This was discussed at the December Matrons’ Forum and an audit process for ‘closing the loop’ agreed.
The number of RTPF responses has increased for the fourth consecutive month from 508 in October to 546 in November (to 27th November). Appendix 1 shows the RTPF reports for November. Responses from main Outpatients showed a recommendation level of 95.82% which is an increase from 92.15% the previous month. When adult and children’s results are combined the recommendation level is 93.7% with 2.75% stating that they would not recommend. As shown in Appendix 1b ‘Access to Care’ is the main area with low scores (81.26% average across all services) whilst ‘Emotional Support’ was the highest (96.74%).
3. COMPLAINTS MANAGEMENT
Appendix 2 shows the November 2015 Complaints Management Dashboard.
The Trust has received 339 formal complaints this year to date. This remains 7% below the number of complaints received over the same period 2014/15. This drop is largely due to a low number of complaints received in August.
During September 2015 the Trust received 48 complaints, 91% of which were responded to within the negotiated or re-negotiated deadline. This is the same result as the previous month and short of the expected 95% local expectation. General Medicine, Surgery and Neuro Sciences generated the highest volume of complaints (33%, 16% and 15% respectively).
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Agenda item A5(iv)
New targets for response turnaround times will be proposed to the Complaint Review Panel in January 2016 which would make our reporting comparable with other Trusts of a similar size nationally. These Trusts work to set deadlines dependent upon complexity; for example, the most basic and straightforward complaints are targeted at 25 days and this timescale increases in five-day increments as the complexity / severity increases up to a maximum of 40 days. This can be identified when the complaint is triaged by the Complaints Officers at the point of receipt using an established matrix. Also, only one extension is permitted per complaint.
Over the course of the first six months of this year (April – September 2015) the Trust has received an average of one complaint per 2,644 patient contacts (generated by the total FCEs and OP attendances). The best performing Directorate during this period was Cancer Services which generated one per 6,990.
A monthly ‘Patient Experience Dashboard’ for Directorates is currently being finalised which will include information relating to Friends & Family responses, PALS contacts, Real Time Patient Feedback, Complaints analysis and details of the Directorate’s Complaints turn-around performance. As an example of the information contained in the report, the MSU Directorate dashboard data is broken down and shown in Appendix 3a, 3b and 3c. The Directorate report will be produced displaying this information on one A3 dashboard as shown in Appendix 4.
We are currently meeting with Directorate Managers, Clinical Directors and Governance leads to discuss the dashboard and ensure that all the information which they would find useful is included. All Directorates will be met with by the end of January 2016 and the finalised dashboard will be rolled-out monthly from February. This information could be produced by quarter and included in the Directorate’s Quarterly Performance Review and an overview produced for the Patient Experience Steering Group.
4. DEVELOPMENTS
i) Survey Activity
Ward 37 at the Freeman Hospital has undertaken a ‘Family Satisfaction with Intensive Care’ survey. This work began as a Newcastle initiative and became a national research collaboration with the Intensive Care Audit and Research Centre (ICNARC) involving 20 adult ICUs. Between May 2013 and June 2014, 941 family members were recruited on Ward 37.
Key findings from the survey included:
Families of patients receiving end of life care overwhelmingly felt included in decision making process and felt that communication during this time was excellent
Symptom management (pain and breathlessness) was reported as either Excellent or Very Good by between 90-95% of those surveyed.
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99% of responses stated that the skill and competence of the ICU staff was either Excellent or Very Good.
There was a high level of emotional support provided by staff.
As a result of the survey (in particular the free text comments) the unit has developed an action plan to improve family experience which includes:
Further improve communication with all families. Although families of patients receiving end of life care felt that communication was excellent, those of less critically ill patients were not so satisfied.
Improve the visual identification of staff – roles and names – to families. Several free text comments alluded to confusion about who staff were and what part they played in the care of the patient. There is an immediate effort to improve this with a greater emphasis on of the ‘Hello my name is’ campaign on the unit.
Some families asked for more consistency in the nursing personnel caring for their relative. This is particularly challenging with the shift patterns in ICU however an assessment is underway to identify how this could be implemented where possible.
Appendix 5 illustrates the unit’s performance in comparison to the other 20 participating ICUs in funnel plots and also performance in key areas such as satisfaction with the level of healthcare provided, information sharing and emotional support. This shows that the unit performed well and that the unit is not an outlier in any key area.
ii) Healthwatch Newcastle’s Feedback Centre
Healthwatch Newcastle will shortly be launching a new online feedback centre that will allow people to comment on all social care and health services in Newcastle. The intention is to share the information they receive with commissioners and providers of social care and health services to identify positive practices and also where improvements can be made. The feedback centre will invite people to rate the service they have received and to give information that backs up their rating.
All feedback will be moderated by Healthwatch Newcastle and their proposal is that all positive feedback will be published as soon as possible. They will not, however, instantly publish any negative feedback. They will check to ensure that the comment does not name any individuals and that language is appropriate. Following this they will share the feedback with the Trust and ask for a response within five working days. After five working days the feedback will be published along with the Trust’s response. If the Trust does not provide a response within the agreed timescales the comment will be published and the Trust will be given the opportunity to add a response at a later date.
The Trust has requested that Healthwatch liaises with staff within the Trust who manage responses to NHS Choices comments. The Trust has also requested that they are given the opportunity to post responses to both positive and negative comments. It is not anticipated that there will be a high volume of comments via Healthwatch and this mechanism should enable responses within the timescales, although this will be kept under review in case change is needed in the future.
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iii) Work with Carers
A Carer is defined as someone who provides unpaid care and support to a family member, friend, partner or neighbour who has a disability, an illness, is frail, has mental health difficulties or has alcohol or drug related problem. In Newcastle 25,644 people are providing unpaid care; 2234 of which are young carers (Census 2011).
The Trust has undertaken work with Newcastle Carers Centre over a number of years particularly in relation to supporting carers of people who have Dementia. However, the enactment of the Care Act 2014 introduced new duties to health and social care providers:
Helping to prevent people developing care and support needs Providing Information and Advice Assessing need for support and providing services Improving the range and quality of services Discharge - carer involvement
The Equality, Diversity and Human Rights (EDHR) Working group, chaired by the Deputy Director of Nursing and Patient Services (Freeman), is working in partnership with the Council, Newcastle Carers Centre, Barnardo’s Young Carers and Trust staff to review how the Trust currently supports Carers and where the Trust can make improvements. Some initial work includes:
Producing a poster illustrating our commitment to carers such as the ‘Carers are Welcome Here’ posters which are used in other Trusts.
Providing information for Carers about Carers’ Assessments and support available to them in the community
Developing a systematic approach to identifying carers Education / Information / Training for staff
Although the work with Carers is ongoing this task and finish group is aiming to complete its work by August 2016.
iv) Feedback on Discharge Performance
The Trust has been contacted by the Picker Institute (the research company who undertake the national patient survey programme on behalf of the Trust) regarding the Trust’s discharge performance based on the Inpatient survey results last year. They noted that the Trust is particularly strong in this area (in fact it is currently the highest ranking non-specialist trust in the country on discharge) and wanted to know if the Trust could provide any information on how it achieves its high performance. This was to inform a discharge improvement workshop in another Trust that Picker work with.
In response, Picker were informed about the development and introduction of a Discharge Wallet which gives patients a place to keep all of their information at discharge as well as including contact details for the ward, information on how to give feedback and a useful checklist so that patients are engaged with, and under their discharge arrangements. Although the wallet has not been formally evaluated, informal feedback from staff and patients is that it is a useful resource.
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Despite this positive assurance about Trust performance, the Discharge Working Group is keen to further improve the patient experience at discharge and, as such, are currently carrying out a survey of patients about their discharge experience. The questionnaire has been designed around the questions in the national inpatient survey around ‘Leaving Hospital’ but also gives the patient the option of including free-text comments.
5. ACCESSIBLE INFORMATION STANDARD
As reported to the Board previously, the Trust will need to be compliant with the new Accessible Information standard by July 2016. A working group led by the Head of Patient Experience has been established to consider how this standard can be implemented and how to ensure the processes and practices are in place to meet the communication needs of all individuals; this will pose systematic and procedural challenges.
It has been identified that the most significant challenges relating to this project relate to IT changes and limitations of the current systems. The working group is awaiting an update from IT on progress made in the discussions with software providers and an indication of timescales for work to be completed. Once these have been provided a wider project plan, including staff training and discussions with third parties, can be agreed.
In preparation for this work the Trust has met with third parties (several groups representing people with a range of needs) and also the CCGs and Newcastle City Council to understand how other organisations are planning to meet the requirement and identify areas where collaborative working may be possible.
6. RISKS AND MITIGATION
In December 2015, the key risks to the Trust’s Patient Experience arrangements are:
Managing the potential reduction in reported compliance of the number of complaints responses provided within the negotiated or re-negotiated timescale following the introduction of the new reporting mechanism from January 2016.
The requirement for the Trust to be compliant with the Accessible Information Standard by July 2016. A working group is addressing the challenges this presents and ongoing updates will be provided to the Board monthly via this report.
Having recognised that there is work to do to enhance the support provided to Carers there is a risk that Carers needs are not being responded to appropriately. Alongside the work in progress, awareness raising has been undertaken at key professional forums to highlight Carers’ needs.
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7. SUMMARY
The Board report has detailed the Trust’s performance relating to complaints management with a continued reduction in overall complaints, changes to the management information which is being produced detailing Directorate performance and proposed changes to the reporting of response turnaround times to bring the Trust’s reporting in line with similar sized Trusts nationally and affording the Trust greater flexibility when responding to the most complex complaints.
Friends and Family results are not available at this time. However, the Trust has received positive feedback from patients via Real Time Patient Feedback and a national ‘Family Satisfaction with Critical Care’ survey which Ward 37 at the Freeman Hospital participated in. Patient feedback will also be provided in the future via the new Healthwatch Newcastle online feedback centre. Although it is not anticipated that there will be high volumes of responses the Trust has agreed a process to give feedback to all responses when they are posted.
8. CONCLUSION
The Trust continues to collect, analyse and report patient experience feedback. Work is now becoming well established to emphasise a ‘You Said We Did’ approach to demonstrating learning and practice development arising from the feedback received.
This report highlights key results, actions and issues from December 2015.
9. RECOMMENDATION
To (i) receive the briefing and (ii) support the work outlined.
Helen LamontNursing and Patient Services Director
Frances BlackburnDeputy Nursing and Patient Service Director, Freeman
Andy PikeHead of Patient Experience
3rd December 2015
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Appendix 1: Real Time Patient Feedback
The OPD FFT scores (combining results from the adult and children’s questionnaire) were:
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Appendix 1b: Departmental Summary
The benchmark to achieve ‘green’ for each question was internally agreed. For the Overall score – a level of 90% is required.
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Appendix 2: Complaints Panel Dashboard December 2015
Count of IssueSource Total %Friends & Family Test (FFT) 842 92%PALS 36 4%Complaints 15 2%Patient Related Enquiry (PRE) 12 1%NHS Choices 7 1%Patient Experience 2 0%Informal 1 0%Grand Total 915
%Values Total Emotional support 542 42% Access to care 173 13% Information, communication & education 113 9% Co-ordination & integration of care 320 25% Physical comfort 111 9% Respect for patient-centred values, beliefs and preferences 19 1% Welcoming the involvement of family & friends 6 0% Transition and Continuity 7 1%Total Comments 1291
The above word clouds are generated using the free text comments from all sources relating to that department, split into positive and negative. These sources include Friends and Family, PALS, Complaints, Enquiries and NHS Choices
