Paper 5
Complaints and Compliments Report
Second Quarter July - September 2014/15
Presented by: Tracy Luckett
Director of Nursing and Allied Health Professions
Produced by:
Tim Withers, Practice Experience Manager
Thursday, 18th December 2014
Action for Board:
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For information
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For consideration
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For decision
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1.0 Introduction
This report provides an overview for the board of complaints and compliments received by the
trust between 1 July 2014 and 30 September2014 (Q2 2014/15) 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.
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.
If themes can be drawn from the Q2 report, it is that where patients are moved to compliment
the service Moorfields provides it’s for the things that staff of all levels would like to see
appreciated. The kindness and friendliness of the staff, the effectiveness of the clinical
interventions and long term care, and the professionalism and support offered.
Where there is room for improvement, the complaints recorded in this report suggest that
clinical issues still dominate and that the majority appear to be due to the patient’s lack of
understanding of their condition, treatment or its implications. Though each of the clinical
complaints was individual in nature and judging patients understanding (or misunderstanding)
is not always easy, if a lesson is to be learned it is to ensure as much as possible that patients
comprehend what is happening and that sources of further information and clarification are
available and accessible. As noted below, making GP letters more ‘patient friendly’ and the
enlarging of the ‘Moorfields Direct’ help line might go some way in addressing this.
The other identifiable theme in several of the complaints was that of poor staff attitude, and
though investigation showed that the staff mentioned did not set out to be deliberately rude,
they appear not to make the effort to be friendly. The Moorfields Way project is designed to
address this and it will be interesting going forward to see if it affects the number of complaints
received on this subject.
Communication issues increased slightly, though this might have been a result of the
administration changes being undertaken during the period.
2.0 Compliments
There were a great number of compliments received by the trust during the second quarter and
though they came from a variety of sources, some themes were consistent throughout, highlighting
especially the competence and approach of the staff, the level of information given and the efficiency
of the service. The genuine expressions of gratitude suggest that Moorfields delivers an effective and
compassionate service on a daily basis across the trust, however the evidence from other sources of
patient feedback suggests this is not consistent on every occasion.
2.1 Friends and Family Test (FFT) comments
One of the factors behind the introduction of the FFT was to give patients a voice and ask them to
express an opinion they would not have previously expressed. It also gave patients the opportunity to
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thank the staff in writing where as previously they might have just given a verbal appreciation, or sent
a card or letter. During quarter two over 20,000 patients (17% of those seen) completed the FFT, of
whom 97% responded extremely likely or likely as to whether they would recommend the trust. Of
those, 84% (16,644) left a positive comment. They expressed appreciation of the professionalism,
friendly and caring attitude of the staff, the clear explanations given, the efficiency of the service and
the reassurance of being cared for. Typical examples are:
“Everyone extremely nice with a smile on their faces and that make me feel very warmly welcomed. I do not
wish to come back with eye problems but if I have to I would be happy as I know I will be very welcomed and
taken care of. Thank you very much.” A&E
“Their kindness attendance was superb. You cannot fault anyone in any way. Thank you all so very much will
certainly recommend to everyone. Surgery was exceptional too. Thank you” Potters Bar
“Staff extremely helpful and informative. Everyone I saw from reception to medical staff were highly efficient.
The whole experience reassured me and made me feel comfortable and confident. Thank you very much” NWP
“Quality of care is absolutely brilliant. Cannot be faulted. All staff are extremely professional and caring.
Nothing is too much trouble for anyone! Excellent throughout. Many thanks to everyone.” Mackellar ward
“I always find the reception staff friendly and welcoming and the clinical staff most thorough, efficient and
professional. I have been attending Moorfields for many years now and would never go anywhere else. Thank
you” Clinic 2 Glaucoma.
2.2 Compliments received by or forwarded to PALS
The PALS department received 52 compliments during quarter two, the majority by letter, email or
cards forwarded from sites within the trust. Though some described overall good treatment and staff,
many of these cited particularly good care from individual staff members, outlining in detail their
particular qualities. These letters and emails were passed onto the staff involved. For example:
“MW (Sister in A&E) made a great impression on me as she was extremely professional, thorough and
meticulous in examination and treatment, observant of hygiene, clear in her instructions and at the same time
friendly and caring in her attitude and manner. Without doubt the most outstanding NHS practitioner I have
encountered in nearly 20 years.”
“At every contact with Dr. AE, I have noticed him to be very experienced and knowledgeable. The kindness and
professionalism he exhibited made me feel secured and comfortable during my hard times, especially when my
vision was reduced to nothing, his words of reassurance gave me hope regarding (the) regaining of my vision
and built my courage during the time of my operations.”
Comments are also received via the trust website or sent to staff as part of their role.
“I had an emergency operation at Moorfields on Thursday the week before last,7th August, and felt I had to
write in to express my deepest thanks for the absolutely superlative service that was given to me by every
member of staff that I came into contact with…I am just one of many thousands of people that have used the
services of Moorfields in the past few months, but it is important to me that I write in to let you know, and I can
only hope that somehow this filters down to the superstars in the Mackellar Ward.”
“This is not so much an enquiry as a thank you. I attended casualty today and was overwhelmed by the staff at
all levels. Directions to the casualty department were clear and courteous, the welcome at the casualty
department was like no other I have come across in London (or any) hospitals. 'Welcome to Moorfields,' said
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with absolutely sincerity and warmth. Treatment was second to none. Easy going, pleasant professionals who
obviously knew their stuff with exceptional abilities to communicate and engage.”
What is particularly satisfying is when change is made and recognised. The Chair of Croydon Vision
wrote:
“Thank you for your invitation to the Official Opening of the Moorfields eye centre (at Croydon)…So many of our
members, who use the centre of course, tell me what wonderful improvements have been made since Moorfields
took over management.”
2.3 Compliments from Patient feedback websites
Compliments, as with complaints, are no longer private between the patient and the trust, but can be
seen in the public domain on patient feedback sites such as NHS Choices and Patient Opinion. Of the
19 comments left on these sites during quarter two, 15 comments were in praise of the good care
received at Moorfields. Aspects singled out for praise included fast, efficient care, the quality of the
treatment and the skills and courtesy the staff and how their ophthalmic conditions were resolved.
“Having heard of Moorfields Eye Hospital, I just walked in to the A&E department. I was greeted courteously and
asked to complete the necessary information which was then processed and I was asked to wait…..I was
impressed by an atmosphere of calm efficiency and sense of purpose by all the staff that I observed as they went
about their work….I have had very good experiences in NHS hospitals beforehand but my treatment at
Moorfields was outstanding. I was treated courteously and efficiently by a dedicated team of staff who all went
about their tasks with commitment and dedication. I am extremely grateful to them all.”
“In June I suffered tears in the retina of my right eye. This caused blood to enter the eye obscuring my vision. This
has been rectified thanks to the brilliance of the nurses, doctors and surgeons at the wonderful Moorfields. I am
now back to umpiring cricket and refereeing football matches. I cannot find adequate words to describe my
gratitude to you all so I will just say ... thank you”
2.4 Social Media
Patients also post compliments on Facebook and via twitter, though these are naturally short and pithy:
On #WorldSightDay thanks to excellent @Moorfields for such superb A & E care last night- a beacon of
good practice
Just spent an hour at Moorfields Eye hospital. Great service, fab nurses. Jade you rock! Thank you. xx
How brilliant is #MoorfieldsEyeHospital and our wonderful #NHS - which must be preserved. Great staff,
excellent eyeball-saving service...
3.0 Complaints Q2 2014/15:
An average of 18 complaints a month were received by the trust during Q2, up slightly on the
previous quarter with the total number of complaints received being 52, compared to 41
previously. This was in part due to an increase in the number of complaints received in July. This
spike has also occurred in July in the previous two years, but analysis of the type of complaints
received do not reveal why this should be.
The number of clinical complaints was seven higher at 26 compared to the previous quarter.
This is similar to the number of clinical complaints received for previous quarters and suggests
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that issues where patients are at risk are being identified and treated as formal complaints.
Other categories of complaint remained roughly the same, though there was an increase in
issues relating to communication. All complaints and PALS enquiries are reviewed on a weekly
basis with the risk and safety management team and circulated to the directorate management
teams to ensure that concerns are being handled appropriately.
3.1 Complaints received Q2 2014/15
(Fig. 1) Complaints received by quarter 2013/14 and 2014/15
Percentage of patients seen who
went on to complain
Complaints per 10,000 patient
contacts
Q4 2013/14
Q1 2014/15
Q2 2014/15
35
41
52
0.02%
(146,147 patients seen)
0.02%
(147,198 patients seen)
0.03%
(150,171 patients seen)
2.3
2.7
3.4
(Fig. 2) Number of complaints received 2014/15: actual (blue) 6mth rolling trend (red)
3.2 Complaints by type
(Fig. 3) Complaints received by type Q1 2014/15 and Q2 2014/15
As with previous quarters, clinical complaints were, and continue to be, the most common
cause of complaints. Half of these focused upon what the patient felt were problems caused by
the wrong treatment, diagnosis or surgical outcome. Five felt that they were not given the
treatment they thought they should have received and another three felt that cancelled surgery
or appointments led to an adverse outcome. Other concerns included misinterpreting things
overheard during the operation or outpatient consultation. Each of these complaints was
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distinctive and no underlying root cause is noticeable, except perhaps for ensuring that patients
understand fully the course of their treatment and prognosis at each visit.
Of the four clinical complaints that were risk rated as ‘High’ (based on the risk matrix that
measures the consequence of an event by its likelihood), the complaint was found to be valid in
the three clinical cases, two for delayed diagnosis and one for a lost appointment. There was
one other high risk when a patient fell over misplaced equipment. The latter, and the lost
appointment were the only complaints referred to the serious incident panel (SI) in quarter
2, though upon review neither were deemed to be an SI. All complaints are now copied in to the
Risk and Safety team for review and PALS enquires are reviewed with them on a weekly basis to
ensure that incidents are reported effectively.
The number of complaints regarding customer care and staff attitude was the same as the
previous quarter. Most of these were in regard to what was perceived as unprofessional or
offhand behavior on the part of the doctor (four), nurse, or optometry dispensing staff. One
complainant felt ignored during a day care visit and another long standing Moorfields patient
was upset at being informed that they could no longer be treated by Moorfields as they had
moved to a different part of the UK through receipt of a GP letter.
Appointment issues that were dealt with as complaints were the result of patients having their
appointment referrals lost or appointments being cancelled and the patient not being informed
or not being told why.
Complaints about communication included test results not being sent, no information given in
the RDCEC clinic, inappropriate information in a patient’s medical records, being unable to get
through to the VRE clinic, a patient receiving a copy of another patient’s letter and a patient
frustrated that they were not being communicated with by email, despite several requests.
Other complaints concerned waiting time in clinics and lack of information, one patient with
dementia who was brought to the hospital despite their appointment being cancelled and two
concerns about difficulty in arranging and the late arrival of transport. One further complaint
concerned a patient who was injured by equipment in one of the satellite clinics.
Complaints breakdown by type (Directorate) and type (Ophthalmic Service) can be found in
appendix 1.
3.3 Re-opened cases
During quarter two there were three complainants for whom their case was re-opened, the
same number as quarter one. Two who requested further information not previously
mentioned and one who requested clarification of parts of their initial response.
3.4 Response time
Where the final response breached the 25 day limit, a slight increase on the previous quarter,
this was due to further information being requested by the complainant whilst the investigation
was ongoing, investigations taking longer than expected and due to the season, waiting for key
staff to return from annual leave so that statements could be given and clarified.
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(Fig 4) 25 day response rate Q2
Complaints answered
within 25 days Q1
Jul-14
80%
Aug-14
75%
Sept-14
80%
Q2 average 79%%
Q1 average 85.4%
3.5 Ombudsman referrals
During quarter two, one new complaint was referred to the Parliamentary and Health Service
Ombudsman (PHSO) regarding incorrect treatment.
One long standing referral involving the ability of a patient to consent to treatment was
adjudicated and the trust was asked to change the Moorfields Consent Policy to ensure that
capacity assessments are recorded and that staff consenting patients are made aware of the
importance of doing this. One complaint with the PHSO made in June 2014 was withdrawn by
the patient. They declined to investigate one case regarding a clinical outcome due to the
length of time since the incident occurred.
4.0 Response to complaints
Many of the issues raised in complaints during quarter two do not allow for specific service
change, but the patients concerns are addressed through clarification of their treatment,
explanation of the reasons underpinning their treatment or apologising for what the patient
felt should have been more appropriate staff behavior. This includes meeting with patients to
better explain perceived misunderstandings.
Where organizational weaknesses were identified, some of these are being addressed through
trust wide initiatives aimed at addressing the underlying process and behavioral issues that
give rise to patient frustration. The Moorfields Way project is bringing staff and patients
together to identify shared beliefs and values that will inform future staff training, appraisal,
recruitment and behaviors. The Transformation project, Surgical Services review (which is
addressing issues around the day care pathway) and telecommunication projects will address
issues such as delays, appointments handling, telephone access, customer service etc.
Other, specific changes included:
 Exploring the possibility of having multifocal glasses lens available to patients through the
voucher system (currently not allowable under Department of Health guidelines).
 A review of the effectiveness of the air conditioning in the City Road clinics.
 Closer monitoring of clinic activity in the Saturday clinic a St George’s to allow for longer and
more effective consultations.
 Expansion of the Moorfields Direct helpline with more staff and improved promotion of the
telephone number.
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Increasing provision of onsite dispensing so that medications can be dispensed on patients
return from surgery and reduce discharge delays.
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The medical director has issued guidelines for how patients should be informed if patients are no longer
eligible for Moorfields’ care (rather than only receiving a copy of the GP letter).
More effective devices are being issued to drivers to keep them better informed of changes to transport
arrangements when they are in the field.
Exploring the possibility of having a ‘flagging’ system on Open Eyes that alerts staff when a patient has a
pacemaker and might be booked to an inappropriate surgical list, to reduce unnecessary cancellations.
The experience of a patient whose condition might have been mis-diagnosed will be used on the SpR’s
training program.
More leaflets are being made available in braille so the patients do not have to wait should they request
one.
Exploring the possibility of enabling appointment and GP letters on PAS and Open Eyes to be emailed
directly (currently they can only be printed as a hard copy) if the patient so requests.
Improved guidelines for the recording of capacity assessments as part of the consent process are to be
included in a new Metal Capacity, Deprivation of Liberty and Patient Restraint policy. All clinical staff are
to receive a pocket prompt dealing with mental capacity.
An alert from Risk and Safety team was sent to all areas stressing the importance of clearing trip
hazards from floors following a patient fall.
Copies of GP letters are being reviewed to ensure the patient is made aware of the importance, to
them, of the contents of the letter.
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5.0 PALS and Complaint team activity
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The PALS and Complaint team have been promoting the service with the aim of
establishing an identity both at City Road and the satellite sites. New posters and a rewritten patient information booklet and trust website page have been launched. The
booklet and website make clear how the PALS team can support patients, but also
outlines in a detailed way, how to make a complaint, how to write the letter and how
their complaint will be managed. It also gives clear advice regarding the independent
advocacy services available, should they wish to use them. This has been supported by
a programme of visits to the satellite sites to explain the service to staff and to
establish contact with the host trust PALS departments.
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From December, the trust website will include a summary, in general terms, of the
type of complaints received over the previous quarter and stress the actions taken in
response. The balance is to make patients feel that complaining will result in change
and is therefore worth making the effort, but not raise anxieties about being treated at
Moorfields.
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Complaints training sessions began in September 2014 covering the national and local
contexts of complaints handling, the process at Moorfields and stresses the
importance of trying to resolve issues for patients at the time. It is primarily aimed at
staff who investigate complaints or who might be asked to make statements. So far
around 30 staff have or are planning to attend the sessions this year. These sessions
are to be held on a monthly basis and numbers growing at each session. 16 medical
staff who became consultants in the past two years were also given a session on their
role in the handling of complaints involving themselves or their teams.
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The PALS and complaints team also held regular meetings with service managers
across the trust on three occasions during quarter two to ensure that a team approach
can be maintained in resolving the concerns of patients and to identify how this can be
made more effective.
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To try to capture the concerns from Moorfields Private patients and gain a better
understanding of the nature of their complaints and concerns compared to the NHS
side of Moorfields, a template and shared drive has been created to capture the same
complaint information as is currently recorded for NHS patients and to support them in
maintaining response times. This will be reported in future reports.
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In order to better support patients through their complaint and to encourage a sense
of openness, the contact details for the NHS Complaints Advocacy service is now
included in all complaint acknowledgement letters sent by the Moorfields complaint
team.
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The possibility of using a web based Ulysses reporting tool (similar to the web based
incident reporting) is being explored, this will possibly allow staff to record
compliments and PALS type issues that are resolved locally but are not currently
reported and so the learning opportunity is lost.
6.0 Transformation project
The Transformation project and its associated programs such as the Moorfields Way and
telecommunication projects aims to put the patient at the center of service redesign and deliver a
highly visible focus on customer service over the coming years. The effect this will have on
complaints will be to change not so much perhaps the number of complaints received (as barriers to
complaining are overcome the number should remain the same or increase) but more the nature of
complaints received. Patients’ expectations and natural concern at the poor outcome of their
treatment will presumably continue to be a source of patient complaints.
Current non-clinical complaints tend to stem from system failures that prevent patients being
communicated with in a timely and effective manner or allowing them to communicate effectively
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with the trust. Others are due to the manner in which patients feel they are spoken to and treated.
The effectiveness of the transformation programme in addressing the underlying system weaknesses
and staff behaviors will, over time, be expected to reduce these types of complaint, even though
each is specific in nature. The communication project, which commenced in September, will address
many of the problems patients currently have in contacting the appropriate person or department
within the trust by providing more lines, transfer if a line is engaged and eventually patient call back.
This coupled with management changes and the ability to monitor call activity on a real time basis
should eliminate many of the frustrations that lead to patients making formal complaints.
Because of the specificity and relatively low number of formal complaints, their use as a measure is
somewhat limited. More useful would be to monitor PALS enquiries as an indication (rather than a
quantitive measure) over time, as communication and especially appointment issues make up the
majority of PALS episodes.
7.0 PALS enquiries.
541 PALS enquiries in were received in quarter two. This compares with 580 for the same
quarter the previous year.
(Fig.7) PALS enquiries by broad category Q2 2014/15
A quarter of PALS enquiries regard appointment issues. These ranged from patients wishing to
change the date, location, time, re-book, or cancel their appointment to concerns about cancelled or
postponed appointments, the short notice given and patients feeling they should be seen sooner.
A third of the issues classified as communication were to do with callers being unable to get through
on the telephone. Other communication issues cover a wide number of topics from patients feeling
they were given poor information, to requests for information about conditions, treatments, hospital
services and procedures or interpreters.
The clinical enquiries were regarding the effects, availability, or appropriateness of their medication
or questions about diagnosis or treatment. Others involved questions about referrals for treatment
Poor staff attitude was due to perceived and inept behavior by staff. In these cases the manager of
the person involved would be contacted who in turn contacted the patient involved to appologise or
explain. If outright rudeness was suspected the patient would be encouraged to formally complain.
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Other myriad issues were around administrative issues such requests for notes of reports, waiting
times in clinics, eligibility pick up arrangements or lateness of transport. Optometry concerns were
around contact lens and spectacle orders and payment.
TPW/CC/Q2/10/14
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Appendix 1
Complaints received by type / Directorate Q1-Q2 2014/15
Complaints received by type / Service Q1-Q2 2014/15
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Complaints received by type / Satellite Q2 2014/15
The two complaints catagorised as ‘Other’ included a patient who fell over equipment and one who questioned the DNA status on PAS
TPW/Com/Q2/10/14
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