West London Mental Health NHS Trust
“Listening to Service Users & Carers”
Complaints Report Q1 & Q2, April 2009 to September 2009
1.0
Purpose of the Report
1.1
The purpose of this paper is to update the Quality and Risk Committee
on the number and nature of complaints received during the reporting
time period, alongside lessons learnt and actions taken.
1.2
The report concludes with a summary of steps being taken to improve
the Trust’s response to complaints, particularly in respect of Core
Standard C14c for which ‘not met’ has been declared for April to
October 2009.
2.0
Complaints Received from Service Users & Carers
2.1
105 complaints were received during the report period, 40 in quarter 1
and 65 in quarter 2. The distribution of complaints received across the
five SDUs is noted in Chart 1.
2.2
The two forensic SDUs received the greater proportion of complaints,
which is consistent with data from previous years. The increase for
both forensic SDUs from Q1 to Q2 requires greater scrutiny in terms of
previous trends.
30
25
25
20
16
16
Q1
15
10
11
7
6
Q2
5
7
6
6
5
0
WLFS
HSS
H&F
Ealing
Hounslow
Chart 1
2.3
In terms of the 105 complaints received, 64 relate to forensic services
and 41 to Local Services SDU, within which the majority relate to adult
services.
3.0
Complaints Received from the Parliamentary & Health Service
Ombudsman
3.1
During the reporting period 8 referrals were open from the
Ombudsman’s Office, of which 2 were closed. One was upheld and
one was closed with no further action.
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3.2
Six cases are currently open, 1 from 08/09, 1 from Q1 and 4 from Q2.
At this stage the figures are too small to identify whether or not this
represents a real increase. However, there has clearly been a drop in
the number of complaints not addressed by the Trust locally.
4.0
Responding to Complaints Received from Service Users &
Carers
4.1
The Trust seeks to liaise with complainants at the point a complaint is
received and agree a response timeframe.
The Trusts overall
performance for Q1 and Q2 collectively is 67%.
Whilst the
performance for Q1 was 88%, the performance for Q2 was 54%, which
when combined gives an overall performance of 67%. This is below
the Trust target of 80%.
4.2
Chart 2 below provides an overview of the performance of each SDU in
terms of responding to complainants within the agreed timeframe. This
clearly demonstrates that performance within quarter 2 has dropped.
Whilst the number of complaints has increased in quarter 2 the drop in
performance is not wholly accounted for by an increase in numbers.
Each of the local service SDUs have had some complex complaints to
resolve, which has not been possible within an agreed timeframe.
Lessons have been learnt in terms of working with complainants to
identify realistic timeframes for detailed and complex complaints.
Within time
Overdue
Active
100%
80%
60%
40%
20%
0%
WLFS WLFS HSS
Q1
Q2
Q1
HSS
Q2
H&F
Q1
H&F
Q2
Eal
Q1
Eal
Q2
Houns Houns
Q1
Q2
Chart 2 1
5.0
5.1
Listening to Service Users & Carers
105 complaints is a rich data source for listening and learning from the
experiences of service users and carers. For each SDU the top 4 or 5
overall complaint headings are described below. This provides an
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% have been used whilst recognising that at times the numbers of complaints may be low at this stage of the year
for reporting.
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overview at an SDU level whilst recognising that many individual
complaints may raise several individual issues.
5.2
West London Forensic Services

Staff attitude: this related to the way staff spoke to service userss
and dealt with service user requests.

Trust Policy: in the main this related to the smoking policy

Property: loss of property

Care & treatment overall, including the removal of leave, lack of
progress and feeling ‘unheard’

Hotel Services: food, bathroom facilities.
5.3
High Secure Services

Other category which included the following, alleged bullying,
excessive force whilst being restrained, inappropriate behaviour,
breach of confidentiality, visits, verbal / physical abuse, telephone
access

Care & treatment overall, including disagreement regarding ward
moves, feeling unheard

Staff attitude: this related to the way staff spoke to service users
and dealt with service user requests

Trust policy: this related to the seclusion policy, service users
possessions policy and the smoking policy.

Service user property and expenses: this related to a delay in the
reimbursement of travel expenses for a carer
5.4
Ealing Service Delivery Unit

Care & treatment overall, including family’s upset following new
admission, feeling unheard, confusion regarding medication.

Other category which related to excessive force used during
restraint

Staff attitude: this related to staff being rude and unhelpful

Service user’s privacy and dignity

Personal records and information.
5.5
Hammersmith and Fulham Service Delivery Unit

Care & treatment overall, including disagreement regarding
treatment of family member, feeling unheard, test results not being
provided in a timely manner

Other category which related to dissatisfaction with the service
users bank and an alleged assault

Attitude of staff, relating to staff being rude.

Communication, relating to information provided to service users.

Service user’s property and expenses.
5.6
Hounslow Service Delivery Unit

Care & treatment overall, including review of diagnosis, injuries
sustained whilst being unsupervised.
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



Staff attitude including not being treated with respect
Admission, discharge and transfer arrangements including a
declined referral and admission process not made clear.
Communication relating to incorrect details on letter and difficulties
communicating with service.
Hotel services relating to dirty wards and poor food.
6.0
Identifying and Addressing the Key Themes arising from
Complaints
6.1
Staff attitude remains a consistent key theme of complaints, and is
referred to in each SDU. In terms of outcomes, when staff attitude
complaints are upheld the associated recommendation relates to the
individual e.g. improved supervision or access to customer care
training. The ‘Time to Care’ project which includes dignity and respect
as a component, alongside Productive Wards and Star Wards
Programmes will seek to impact on these types of complaints.
Monitoring via Patient Experience Trackers will provide an opportunity
for services to receive direct and ‘live’ feedback, with the longer term
impact to be seen via service user surveys and complaints.
6.2
Trust Policy relating to the Smoking Ban was a continued theme. This
specifically related to inconsistency in information for service users.
These complaints have informed changes to the Trust policy and we
seek to respond to complainants and share information directly in
terms of updating on progress to establish smoking areas.
6.3
Care & Treatment may be an overarching description, but it
encapsulates concerns which in the main relate to clinical aspects of
care, linking to concerns that both service users and carers are not
listened to / heard, or involved in decisions about care.
6.4
Duty of Care & Safety covers complaints relating to incidents, PMVA
and allegations of assault, abuse or violence. The violence reduction
workstream continues and a need to review complaints jointly with risk
colleagues has been identified.
6.5
Service user’s property whilst in the main an issue for Forensic
services identifies the need for continued review of associated
processes for monitoring service user possessions. Further analysis
will be undertaken with links to information held separately by
colleagues who oversee losses and compensations.
7.0
Learning from Service User & Carer complaints & making
changes as a result of complaints – at the level of the individual
7.1
The actions described above seek to address overarching complaint
themes. At the same time, actions are undertaken at an individual
complaint level and these may range from expediting a payment to a
carer, to retrieving and delivering property, to apologising for
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inappropriate / unprofessional behaviour. Examples of individual
complaint recommendations / actions / outcomes are noted below. In
turn these provide a clearer picture of service user complaints.
Additional key points are noted for each SDU when relevant.
7.2
West London Forensic Services
Specific changes include talking and explaining things to individual
service users – about their care, leave status, detention, changes in the
ward. Purchasing a fridge for Rollo May ward. Consider a ‘post out’
book for the Orchard Wards. Provide staff training with respect to
privacy and dignity.
The majority of complaint outcomes focus on arranging for staff to talk
and explain things to service users and / or carers.
7.3
High Secure Services
Specific changes include talking and explaining things to individual
service users and their carers. This was the main outcome for the
majority of complaints. Additional changes identified were with respect
to reviewing the storage facilities for service users and reminding staff
for the need to complete electronic incident forms.
Of the 41 complaints received over this six month reporting period over
half, 22 are from service users in the DSPD unit. The others are
distributed evenly across the two remaining men’s directorates.
7.4
Ealing SDU
Of the 12 complaints received, 10 relate to Adult Services, 2 for Older
people’s Services. 9 have been closed of which two have produced
the main recommendations. The first was with respect to Older
People’s Services which identified the need to review places on the
TVU Dementia Course, the Dementia training needs of staff, the way in
which the clinic operates, the establishment of a Carer’s Forum and
increased information on dementia to be available. and one within
Adult Services. The second complaint related to adult inpatient care
and the recommendations focussed on the admission process and the
need to ensure information is shared with service users at relevant
points in time, and record keeping needs to be improved.
7.5
Hammersmith & Fulham SDU
17 complaints were received, of which 12 related to adult services and
5 to the Gender Identity Clinic. Specific actions relating to adult
services concerned processes relating to service user finances, talking
and explaining plans with service users and the system for taking
messages. GIC complaints highlighted the need to ensure that service
users were aware of the need to disclose information, the filing of
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correspondence and the inclusion on the GIC website of the GIC
pathway.
7.5
Hounslow SDU
Of the 12 complaints received, 2 related to Child & Adolescent
Services (CAMHS), 3 to Older People’s Services and 7 to adult
services. The adult services complaints identified improving practice
via written communication, developing further the ‘respect and dignity’
project, providing better information to service users and carers,
consider how email is used to communicate and documenting
decisions. The older people’s services complaints have contributed to
an action plan for the older people’s ward, linked to the outcomes of
incident reviews. This action plan covers all aspects of the provision of
care, including communicating with and listening to, families and
carers. The CAMHS complaints recommended the Trust should
consider developing a policy on how to communicate and engage with
parents who are separated.
8.0
Next Steps
The Trust’s processes for managing and responding to complaints is
being revised with a focus on greater ownership at SDU level of
complaints, in terms of investigating, responding and liaising with
complainants. This work will continue in Q3 and Q4. This will also
include processes for regular reviews of complaints and outcomes at
an SDU and Trust level.
At the same time a greater emphasis is being placed on listening to
service users and carers and ensuring that we learn from their
complaints, so that we can share learning and demonstrate
improvements to service delivery and changes in practice. This links
with the action plans to ensure compliance with Core Standard C14c
by February 2010.
9.0
Conclusion
Service Users and Carers in the main know how to share with the Trust
their concerns via Complaints and PALS. The Trust is able to
demonstrate that it receives, investigates and responds to complaints.
We need to continue to improve how we learn from complaints and
demonstrate and share learning.
Finally, all Trust staff need to be reminded that the key action that
would improve the experiences of service users and carers would be to
spend more time explaining, involving, sharing and listening to service
users and carers.
Dr Elizabeth Fellow-Smith Maria Harrington
Medical Director
Associate Director, Clinical Governance
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