Patient Complaints
Annual Report
2015/16
Compiled October 2016
Sophie Dalton
Head of Patient Relations and Complaints
King’s College Hospital NHS Foundation Trust
Denmark Hill
London
SE5 9RS
[email protected]
CONTENTS
Page
Executive Summary
3
Overview of complaint numbers
4


Denmark Hill
Bromley sites
Complaints and PALS contacts Trust wide for 2015/16
5
Complaints by Service Area
6

Complaints measured against Trust activity
8
Complaints by Division
8
Divisional Complaints measured against Trust activity
12
Causes of complaint
13
Grading (severity) and outcomes
19
Ethnicity, age and access
20
Parliamentary and Health Service Ombudsman
21
Learning from feedback
23
2 | King’s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16
Executive Summary
This report provides a summary of patient complaints received between 1 April 2015
and 31 March 2016. It includes details of numbers of complaints received during the
year – both for the Denmark Hill and Bromley sites, performance in responding to
complaints, Parliamentary and Health Service Ombudsman investigations and
actions taken by the Trust in response to the complaints.
The report aims to provide assurance that the Trust is responding to patient
complaints in line with its procedures, Department of Health legislation, and service
standards expected by the Parliamentary and Health Service Ombudsman.
Patient Experience reports provide integrated quarterly data on complaints, PALS
contacts, HWRD survey results and the Friends and Family test survey.
Points to note:





In 2015/16, the Trust received 803 complaints – Denmark Hill 464 and
Bromley sites 339. Overall, an organisational decrease of 21% compared to
2014/15 (974).
20% reduction in complaints (Denmark Hill) and 14% reduction on the
Bromley sites.
9,236 PALS contacts recorded - 10% increase from 2014/15.
End of year performance of 45% in responding to complaints within 25
working days (Denmark Hill 44% and Bromley sites 47%)
2% of complaints were referred to the Parliamentary and Health Service
Ombudsman.
Written Complaints - King's College Hospital NHS FT since 2010/11
(incorporating complaints on Bromley sites from 2013/14)
1400
Bromley site
1200
Denmark Hill
1000
435
800
395
339
600
400
768
560
588
639
579
464
200
0
2010/11
2011/12
2012/13
2013/14
3 | King’s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16
2014/15
2015/16
The table below provides the recent comparative data on the numbers of complaints
received amongst the Shelford Group of NHS Foundation Trust Hospitals.
Organisation
%
Complaints
increase/
2014/15
decrease
803
974
-21%
519
523
1%
1160
1023
13%
1122
938
16%
1145
1242
8%
629
717
-14%
1378
1354
2%
680
775
-14%
712
833
-15%
Complaints
2015/16
King's College Hospital
Addenbrooke's
Central Manchester
Guy's and St Thomas'
Imperial College
Newcastle upon Tyne
Sheffield Teaching Hospitals
University Hospitals Birmingham
University College London
*Nationally, there was a 4.5% decrease in complaints received 2015/16 – data provided by NHS
Digital
Overview of Complaint Numbers
Denmark Hill
464 complaints were received in 2015/16 which is a 20% reduction compared to the
previous year (579) and the lowest number of complaints recorded for Denmark Hill
since 2010. 9% of complaints (43) were re-opened during the year for further
response which is consistent with previous years. The end of year performance in
responding to complaints within 25 working days was 44% which is improved on
2014/15 (35%). The ratio of complaints during the year, to patient activity (per 1000
patient attendances) was 0.4 compared to 0.6 in 2014/15 and 0.8 in 2013/14.
4 | King’s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16
First
received
Complaints
responded to
within 25
Days
% Response
Rate within 25
Days
15/16 Q1
90
38
42%
15/16 Q2
136
50
37%
15/16 Q3
129
57
44%
15/16 Q4
109
57
52%
Totals
464
202
44%
Bromley Sites
339 complaints were received in 2015/16, a 14% reduction compared to the previous
year (395). 12% of complaints (42) were re-opened during the year for further
response which is an increase on the previous year (34). The end of year
performance in responding to complaints within 25 working days was 47% which is
improved on 2014/15 (37%). The ratio of complaints is 0.5 to 1000 patient
attendances compared to 0.76 in 2014/15.
First
received
Complaints
responded to
within 25 Days
% Response
Rate within 25
Days
15/16 Q1
68
29
43%
15/16 Q2
90
34
38%
15/16 Q3
89
50
56%
15/16 Q4
92
46
50%
Totals:
339
159
47%
Complaints and PALS contacts Trust wide for 2015/16
The number of complaints received on all Trust sites significantly reduced in 2015/16
(803) and has continued to fall since 2013/14 (768 Denmark Hill, 435 Bromley sites).
Compared to patient activity within the Trust, this is measured to 0.5 complaints per
1000 attendances.
Complaints received have ranged between 43 and 83 a month (a monthly average of
67 complaints), with Denmark Hill receiving on average 39 complaints per month,
while Bromley sites received 28 complaints per month. The Trust has a challenging
target of responding to complaints within 25 working days given the complexity of
cases it often receives. We know we can do more to improve the quality and
timeliness of our complaint responses and in the coming year we will continue to
improve our complaints handling and this is a priority for the Board. In 2015/16 the
average response rate at Denmark Hill was 51 working days and at the Bromley
sites 48 working days.
All new complaints are triaged by the central complaints team with the aim of
providing complainants with the opportunity to have their experience addressed by
PALS, where intervention is felt possible. This approach has consistently been
applied since October 2014. It is generally felt that concerns relating to the Denmark
Hill site have been more successful to defuse than those concerning the Bromley
sites; in part this reflects the type of experiences coming to our attention, but also the
expectations of the complainants in how they wish their concerns to be handled.
PALS contacts increased by 10% during the year which is a smaller increase than
that seen in the previous year.
5 | King’s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16
The Trust also regularly receives positive patient experience stories via patient
opinion websites, HRWD, through social media networks, Twitter and Facebook.
From January 2017, the Trust will start to record compliments in addition to
comments, complaints and concerns.
Complaints by Service Area
The charts below illustrate the distribution of complaints between the service areas
of patient care over the past few years. On the Denmark Hill site, the decrease in all
categories is evident; a total of 256 inpatient complaints (including maternity) which
is 55% of the total complaints at Denmark Hill and outpatient complaints is 208
(45%). On the Bromley sites, a total of 184 inpatient complaints (including maternity)
were received (54%) and outpatient complaints is 155 (46%). Denmark Hill
Maternity complaints have remained static since 14/15 (27 from 31) while conversely
on the Bromley sites, there is a significant reduction compared to the previous year
(a 67% decrease from 27 to 9). Complaints about emergency care have also
encouragingly reduced across both sites in 2015/16 (DH, 48 from 90; PRUH, 54 from
73).
6 | King’s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16
7 | King’s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16
Complaints measured against Trust activity
Denmark Hill
Inpatient attendances
Number of inpatient
complaints
Inpatient episodes
Complaints per 1000
attendances
Outpatient attendances
Number of outpatient
complaints
Outpatient episodes
Complaints per 1000
attendances
Bromley sites
Inpatient attendances
Number of inpatient complaints
Inpatient episodes
Complaints per 1000 attendances
2013/14
2014/15
2015/16
415
296
256
137,298
131,409
130,049
3.0
2.3
2.0
265
203
160
667,421
689,461
818,203
0.40
0.29
0.2
2014/15
2015/16
203
184
82,983
86,433
2.45
2.1
118
101
371,143
488,703
0.3
0.2
Outpatient attendances
Number of outpatient complaints
Outpatient episodes
Complaints per 1000 attendances
Complaints by Division
Each complaint is assigned to a principle Division regardless of other specialities that
may be involved in another aspect of the complaint. The following tables illustrate
the distribution of complaints by the key Division during 2015/16 for Denmark Hill
and Bromley sites and also complaints received over a two year period.
8 | King’s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16
9 | King’s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16
The following table provides each Division’s responsiveness to complaints in
2015/16. Divisions achieving 60% and above are highlighted.
DIVISION
Ambulatory
Sexual Health
Dental
Critical Care & Theatres
Clinical, Scientific & Diagnostic
Services
Day Surgery
Liver
Renal
Surgery
Cardiovascular
Neurosciences
Clinical Haematology
Medical Specialties
Therapies
Emergency Department
Women's Services
Maternity
Child Health
CEF (Capital, Estates & Facilities)
Corporate Affairs
Other Trusts
Totals:
53
4
25
13
No.
Responded
Within 25
Days
22
4
14
8
12
8
67%
4
5
54
9
148
36
73
19
107
7
87
39
53
29
28
1
1
803
1
19
5
51
22
32
9
36
1
34
25
36
16
15
1
0
361
20%
35%
56%
34%
61%
44%
47%
34%
14%
39%
64%
68%
55%
54%
100%
0%
45%
4
25
4
84
13
38
9
66
6
49
14
17
12
12
0
1
406
Complaints
% Response
Rate Within
25 Days
No.
Responded
Late
42%
100%
56%
62%
30
0
12
6
10 | King’s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16
It is worth noting in particular that:
Ambulatory and Local Networks (including Dental) had an overall 32% reduction
of complaints compared to 2014/15 (119, 81). This reduction is due to fewer
complaints at the Denmark Hill site (50 from 92) in most ambulatory specialities;
however Ophthalmology saw a small increase (15, 11). Complaints on the whole
related to medical treatment (including dental outcomes and complications) and the
administrative processes (appointments, communication, and admissions for
treatment).
Liver, Renal and Surgery (LRS) had an overall 16% reduction in complaints across
all hospital sites compared to 2014/15 (211, 252). The distribution of complaints
has remained relatively unchanged with Surgery receiving 3 complaints per 1000
patient attendances and 0.3 outpatient complaints per 1000 patient attendances.
Complaints relating to a surgical waiting list or patient discharge were quite high at
both sites (13 DH, 16 Bromley sites) and concerns relating to clinical treatment
(surgical decisions/outcomes) were higher at the Bromley site than at Denmark Hill
(41, 17).
Medical Specialties notably at the Bromley sites, there was a higher number of
complaints relating to patient discharge planning and arrangements. This included
communication of plans with family/carers, challenges on medical fitness to be
discharged from hospital and the after care information/social services input.
Networked Services Complaints about Clinical Treatment were the highest at
Denmark Hill within Neurosciences (32). Complaints are often complex and are
linked to surgical decisions and dissatisfaction with outcomes, however less than half
of these were found to be well founded when investigated. Inadequate
communication with patients was often identified as a cause for patients not feeling
satisfied with care.
11 | King’s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16
Divisional Complaints Measured against Activity
Denmark Hill
Inpatient
Complaints
15/16
Patient
episode
Complaint
per 1000
episodes
14/15
Patient
episodes
complaint
per 1000
episodes
13/14
Patient
episodes
complaint
per 1000
episodes
Ambulatory
6
13,948
0.4
9
13,104
1
5
14,346
0.3
11,891
0.3
6
11,943
1
11
13,346
1
Dental
4
Liver
17
12,328
1.4
26
11,125
2
44
10,576
4
Renal
3
1,413
2.1
2
1,412
1
4
1,583
3
11,803
3.1
47
13,641
3
66
13,977
5
Surgery
37
Cardiac
23
3,446
3.6
18
6,557
3
16
6,587
2
Haematology
10
14,347
0.7
9
13,218
1
9
12,995
1
Neurosciences
33
8,402
3.9
49
8,560
6
54
8,615
6
TEAM
47
17,360
2.7
37
17,584
2
68
18,911
4
Child Health
16
14,356
1.1
19
13,870
1
18
13,871
1
4,563
1.8
11
4,736
2
10
5,147
2
Gynaecology
8
Obstetrics
33
11,045
3.0
31
13,385
2
54
16,869
3
Outpatient
Complaints
15/16
Patient
episode
Complaint
per 1000
episodes
14/15
Patient
episodes
Complaint
per 1000
episodes
13/14
Patient
episodes
Complaint
Per 1000
episodes
Ambulatory
22
150,571
0.1
46
134,654
0.3
32
134,266
0.2
Dental
18
134,189
0.1
31
111,618
0.3
29
118,791
0.2
Liver
23
46,687
0.5
17
36.639
0.5
27
40,986
0.7
Renal
6
18,347
0.3
4
15,158
0.3
5
21,657
0.2
Surgery
26
85,909
0.3
34
82,574
0.4
38
91,235
0.4
Cardiac
2
34,781
0.1
5
27,486
0.2
8
30,445
0.3
Haematology
5
65,085
0.1
3
48,282
0.1
1
22,388
-
Neurosciences
25
41,683
0.6
18
40,326
0.5
40
43,953
0.9
TEAM
6
39,632
0.2
8
81,651
0.09
5
118,788
-
12
31,845
0.4
14
37,995
0.4
10
103,494
0.10
39
106,856
0.4
Child Health
5
46,485
0.1
Women’s Health
7
107,446
0.1
Bromley Sites
Inpatient
Complaints
15/16
Patient
Episodes
Complaint
per 1000
episodes
14/15
Patient
episodes
complaint
per 1000
episodes
Ambulatory
2
11,947
0.2
5
11,153
0.45
Dental
1
1,653
0.6
0
1322
0.00
Liver
6
7,528
0.8
3
4,903
0.61
Surgery
20,694
2.95
51
18,913
2.7
61
Cardiac
7
1,979
3.5
3
2223
1.35
Haematology
0
5,971
4
6,077
0.66
Neurosciences
11
2,025
5.4
9
1,702
5.29
TEAM
61
17,995
3.4
59
16,486
3.58
Child Health
5
6,675
0.7
4
6,262
0.64
Gynaecology
15
3,560
4.2
13
3,782
3.44
17
5,795
2.9
30
5,807
5.17
Obstetrics
12 | King’s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16
Outpatient
Complaints
15/16
Patient
Episodes
Complaint
per 1000
episodes
14/15
Patient
episodes
Complaint
per 1000
episodes
Ambulatory
26
146,121
0.2
19
126,724
0.15
Dental
2
24,901
0.1
3
21,726
0.14
Liver
8
11,232
0.7
7
8,416
0.83
Renal
0
2,981
1
1,607
0.62
Surgery
34
117,932
0.3
50
97,060
0.52
Cardiac
4
16,536
0.2
3
11,030
0.27
Haematology
4
57,515
0.1
4
63,198
0.1
Neurosciences
4
7,139
0.6
3
6,029
0.50
TEAM
6
36,670
0.2
4
27,995
0.14
Child Health
3
13,013
0.2
4
10,683
0.4
11
44,410
0.2
13
36,543
0.4
Women’s Health
Causes of complaint
In April 2015 changes were made to the National Complaint framework (K041) and
there is now a quarterly data set return rather than an annual one. The information
obtained from the KO41 collection monitors written hospital and community health
service complaints received by the NHS.
Each complaint is considered on a case by case basis to ensure the issues raised
are carefully and appropriately considered. Whereas some complaints relate to a
single episode of care or experience, others can be multi-faceted and may involve
multiple clinical specialities and/or require comments from another NHS hospital or
service. All complaints are allocated against subject areas, as set out by the
Department of Health.
Our top 5 subject categories of complaint in 2015/16 are:
Clinical Treatment (provided by a doctor/dentist)
Patient Care (nurse led care)
12%
Admissions, discharge and transfers
Communications
11%
10%
Values and Behaviours (staff)
5%
13 | King’s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16
45%
Denmark Hill
Direct comparison with last year is difficult because of the subject category changes
introduced in 2015/16. Clinical treatment now refers only to contact and care
provided by a clinician whereas in past years it encompassed all clinical treatment
provided by the full clinical multi-disciplinary team. A separate category for nursing
led care is also now applied, which includes patient nutrition and hydration.
However, clearly a complaint relating to clinical treatment (doctor led care) is the
predominant cause of a complaint being made (206 - 44%), while 52 (11%) concern
care provided by nursing/midwifery staff. Complaints relating to admissions,
discharge and transfers have doubled in 2015/16 (50) compared to 25 complaints
last year, but this may reflect the broader range of issues which now fall within this
category.
Denmark Hill - Primary subject of complaint
Clinical Treatment (doctor led care)
Patient Care (nurse led care)
Admissions, discharge and transfers
Communications
Values & Behaviours (Staff)
Appointments including delays and cancellations
Transport (Ambulances only)
Access to treatment or drugs
Trust Administration
Waiting Times
Facilities Services
Prescribing errors
Privacy, dignity and wellbeing
Integrated Care
End of Life Care
Other
Totals:
2015/16
206
52
50
50
27
23
11
10
6
6
5
4
4
3
2
5
464
% of
complaints
44%
11%
11%
11%
6%
5%
2%
2%
1%
1%
1%
1%
1%
1%
0%
1%
100%
Denmark Hill - Primary subject of
complaint
2014/15
% of
complaints
2013/14
% of
complaints
Admissions, discharge and transfer
arrangements
Aids and appliances, equipment and
premises
Outpatient appointments –
delay/cancellations & delay in clinic
Inpatient – delay/cancellations
Attitude of staff
Clinical Treatment – all aspects
Communication – oral and written
Consent to treatment
Privacy and Dignity
Patient’s property and expenses
Personal records
Transport (ambulances and other)
Hotel Services (including food)
25
4%
33
6%
8
1%
10
1%
27
7%
54
5%
31
46
339
46
3
11
4
5
15
0
7%
10%
51%
10%
0%
2%
1%
1%
2%
0%
54
80
390
76
3
13
7
9
15
1
4%
9%
56%
9%
0%
3%
0%
2%
2%
0%
14 | King’s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16
Just under half of the inpatient complaints received at Denmark Hill relate to clinical
treatment (doctor led care), with concerns raised in all specialities, but slighter higher
in Obstetrics, Neurosurgery, cardiology, and orthopaedics. Because complaints
reflect a personal experience, it is difficult to be precise about any common themes
but some of the issues raised include a perceived delay or failure in treatment or a
procedure (medical and surgical patients), inappropriate surgical management,
post-operative management either a developed complication or outcome not as
expected, and obstetric management (labour). Running throughout most complaints
are communication issues and the negative impact this has had. Poor attitude and
behaviour is a trigger for a complaint when staff do not display empathy and
compassion or are brusque and do not appear to be willing to give the patient the
voice to speak.
Outpatient complaints include the Emergency Department cases and therefore the
number of clinical treatment complaints is reflected in the overall number.
Complaint issues include missed or incorrect diagnosis in the Emergency
Department, for instance when an x-ray is not ordered and an undiagnosed fracture
is later confirmed. Missed or incorrect diagnosis (surgical patients, which includes
neurosurgical), post-treatment/procedural complications raised by dental patients,
and delays in treatment commencing in medical specialties.
The following tables illustrate the main complaint themes by quarter for both inpatient
and outpatients.
15 | King’s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16
Bromley sites
Just under half of the complaints received in 2015/16 related to an aspect of clinical
treatment (doctor led care) – 159 (47%) which is significantly down in terms of
number received compared to 2014/15 (224), even taking into consideration that
patient care (nurse led care) is now captured separately. Complaints concerning
admission, discharge and transfer have increased to 38 from 28 in 2014/15,
representing 11% of the total number of complaints. Communication likewise went
up to 32 from 24 last year but complaints about the behaviour of staff decreased to
12 from 34 in 2014/15.
Bromley sites - Primary subject of complaint
Clinical Treatment (doctor led care)
Patient Care (nurse led care)
Admissions, discharge and transfers
Communications
Values & Behaviours (Staff)
Appointments including delays and cancellations
Waiting Times
End of Life Care
Prescribing errors
Access to treatment or drugs
Facilities Services
Trust Administration
Privacy, dignity and wellbeing
Transport (Ambulances only)
Integrated Care
Consent to treatment
Totals:
2015/16
% of
complaint
159
43
38
32
12
11
9
7
7
4
4
4
3
3
2
1
339
47%
13%
11%
9%
4%
3%
3%
2%
2%
1%
1%
1%
1%
1%
1%
0%
100%
16 | King’s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16
Primary subject of complaint
Admissions, discharge and transfer
arrangements
Outpatient appointments – delay/cancellations
& delays in clinic
Inpatient – delay/cancellations
Attitude of staff
Clinical Treatment – all aspects
Communication – oral and written
Consent to treatment
Privacy and Dignity
Patient’s property and expenses
Personal records
Transport (ambulances and other)
2014/15
% of
complaints
6 months
Oct-Mar
2013/14
% of
complaints
28
7%
9
5%
25
6%
11
6%
28
34
224
24
1
2
0
9
6
7%
9%
55%
6%
0%
1%
0%
2%
2%
20
15
106
25
1
1
1
3
2
10%
8%
54%
13%
1%
1%
1%
2%
1%
Complaints concerning clinical treatment (doctor led care) represent 47% of the total
number received; of these 55% relate to an outpatient episode or Accident and
Emergency attendance. Patient concerns include missed or incorrect diagnosis
(including missed fractures), delay or failure to provide surgical treatment or
procedure and inadequate clinical assessment. Like Denmark Hill, communication
issues run through most complaints, and concerns in regard to a discharge have
increased. This includes the involvement of carers/family in the discharge planning,
medical fitness for discharge, and home care support.
17 | King’s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16
18 | King’s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16
Grading and outcomes
Complaints are triaged and graded on receipt for severity using the Department of
Health’s grading guide. The initial grading is determined by the Patients Complaints
team based on content of the complaint and is reviewed by the receiving Division for
appropriateness. Complaints graded as high priority (amber) have continued to
decrease on the Denmark Hill site over three consecutive years – 138 cases in
2013/14, 90 in 2014/15 and 59 in 2015/16. High severity cases have likewise
decreased on the Bromley sites from 50 in 2014/15 to 40 cases. Low severity
complaints have also decreased on both sites which reflect the local resolution work
we have continued to focus on this year. By managing an unsatisfactory experience
promptly, the overall complaint numbers have reduced.
Complaints that raise serious concerns are routinely reviewed by senior clinical
colleagues and are linked to a patient safety investigation under Duty of Candour,
where appropriate. In 2015/16, 8 serious complaints were received (2 Denmark Hill
and 6 Bromley sites). At Denmark Hill, the cases were in Cardiology and
Neurology, and at Bromley; Ophthalmology, Cardiology, Gynaecology, Stroke and
Haematology (2).
Grading
Low unsatisfactory experience
Medium service or experience
below reasonable expectations
High significant issues regarding
standards and quality of care
Serious serious failure causing
serious harm
Denmark Hill
Number of complaints &
% of total received
134 (29%)
Bromley sites
Number of complaints &
% of total received
68 (20%)
269 (58%)
218 (66%)
59 (13%)
40 (12%)
2 (0%)
6 (2%)
19 | King’s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16
During 2015/16, about half of the complaints investigated have issues (either in full
or in part) which were considered to be substantiated. Denmark Hill – 50% were
upheld which is better than 2014/15 (54%). Bromley sites – 53% were upheld which
is also an improved position to 2014/15 (61%).
Ethnicity, age and access
The Trust widely promotes the opportunity for patients to raise concerns or provide
feedback through many communication mediums; for example, all patient letters and
patient information all now provide details for the PALS service. We provide an online form for submitting an enquiry, concern or feedback and PALS is located in an
accessible location at both the Denmark Hill and Princess Royal University Hospital
sites. We signpost patients/carers to free NHS advocacy services where support
may be required, and Easy Read literature and translations are also available.
The percentage of a patient ethnicity which is captured when recording complaints,
is fairly consistent with previous years, on both sites. However comparing the profile
of the age of patients who are affected by concerns raised with the Trust, there are
differences between Denmark Hill and Bromley sites. At Denmark Hill, there is a
relatively constant representation of concerns relating to patients aged between 20
and 80, whereas on the Bromley sites, complaints relating to patients aged 60 and
over are higher.
Denmark Hill % Bromley sites %
of complaints
of complaints
Ethnicity
White - British
White - Irish
White - other white
Mixed white and black Carribean
Other mixed
Indian
Black Carribean
Black African
Other Black
Other ethnic category
Not stated
Age
under 20
46%
1%
5%
1%
1%
2%
5%
6%
12%
3%
16%
Denmark Hill % of Bromley Sites % of
complaints
complaints
38 (8%)
21 (6%)
20-40
124 (27%)
62 (18%)
40-60
130 (29%)
69 (20%)
60-80
114 (25%)
87 (26%)
47 (10%)
98 (29%)
80+
66%
3%
1%
0%
0%
1%
3%
0%
3%
3%
20%
20 | King’s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16
Complaints sent by Email were
the predominant method of
contact on both sites (46% and
47%).
11% of complaints relating to
Bromley sites were passed to
patient complaints when local
resolution opportunities were
either rejected or unsuccessful.
Complainants who submitted a
Complaint Form (Denmark Hill
11% - Bromley sites 13%) have
first sought advice from PALS
about making a complaint as
these forms are provided by the
service as a convenient method to
raise a concern.
Method
Denmark Hill
Bromley Sites
Email
212 (46%)
158 (47%)
Letter
93 (20%)
87 (26%)
Complaint Form
52 (11%)
45 (13%)
Telephone call
67 (14%)
8 (2%)
Escalated from PALS
36 (8%)
38 (11%)
Parliamentary and Health Service Ombudsman
The Parliamentary and Health Service Ombudsman (PHSO) investigate complaints
where an organisation has not been able to resolve the complaint at a local level.
The PHSO have broadened their review process and have considerably increased
the numbers of cases that they consider. In 2015/16, they handled 29,000 enquiries,
of which 6,815 cases were looked at in depth and of these, 5,058 were investigated.
In 2015/16, the PHSO have recorded 124 complaints against King’s College Hospital
– of these 17 cases went forward for investigation; a decrease from 22 in 2014/15.
This represents 2% of the total complaints received. This highlights that a high
number of enquiries are made to the PHSO prematurely (i.e. before making
complaint to the Trust, or the complaint is open and awaiting a response).
The PHSO have reported that of the cases investigated in 2015/16, 10 complaints
were either upheld or partially upheld, with recommendations to provide an apology,
and/or an action plan to put things right. Seven complaints were not upheld.
The following table details the outcomes and actions from the 17 cases investigated.
21 | King’s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16
Division
Date Complaint
concluded
PHSO
received
PHSO
concluded
Decision
1
Dental
Dec-13
Dec-14
Apr-15 Partly upheld
2
Corporate affairs
Dec-13
Mar-15
Apr-15 Upheld
3
Dental
Sep-14
Dec-14
Jun-15 Not upheld
4
Dental
Apr-14
Nov-14
Jul-15 Not upheld
5
Obsetrics - PRUH
Jun-14
Aug-14
6
Medicine
Mar-14
Jul-14
7
Neurosciences
Aug-14
Dec-14
Jul-15 Partly upheld
Outcome
Dental anaesthesia insufficient to aid pain control
Department of Oral Surgery discussed the case at a monthly departmental audit
meeting for shared learning.
NOK w ere not located/identified before a hospital contract funeral w as arranged.
Shared complaint w ith local Council.
Checklist put in place, volunteer recruited to help with enquiries, next-of-kin
tracing service now used in all similar cases.
Patient feels they w ere not given continuity of treatment betw een 2011-2014
Care planning & communication betw een w ard and Theatre Recovery
Patient w ith high BMI. Patient had still-birth at 39w eeks but there w as a failing to
discuss a possible admission at 37w eeks and a change to planned rescheduling of
caesarean section.
Post natal care was appropriate and in line with national guidance. The still-birth
was unavoidable. The original planning of C-Section was however too early and
contrary to NICE guidance. Failure to communicate timing changes caused
parents to believe something could have been done sooner to have prevented the
still birth.
Doctor met with Clinical Supervisor to discuss case. Staff reminded of the
guidance that women with high BMI have a re-weigh at 36 weeks. Case
anonymised and used for cross site medical learning.
Jul-15 Not upheld
Medical and nursing care appropriate and Trust response considered reasonable to
all issues.
Sep-15 Partly upheld
Consent - up-to-date MRI should have been offered before Surgery w as scheduled
to allow for all risks to be discussed w ith patient to give informed choice.
Doctors will be prompted to state date of previous scans on waiting list form made mandatory.
8
Liver
Mar-14
Aug-14
Sep-15 Partly upheld
Failure to consider clinical significance of the patient's presentations w hen referred
from another NHS Trust. Failure to treat urgently w ith suspected cancer from the
outset, meant the patient's condition became inoperable. Delayed complaint
handling.
Case discussed with clinicians involved to improve management of patients.
Robust patient level tracking completed and improved monitoring of patients on
cancer pathways - both monitored through the Trust's Cancer Waiting Times
meeting . Training for coordinators completed to ensure appointments are
booked appropriately. A MacMillan Cancer Helpline was been set up for when the
clinical nursing team are unable to take calls from patients.
9
Surgery
Oct-13
Jan-15
Nov-15 Not upheld
Surgical outcome - no service failure identified
10 CCTD
Jul-14
Feb-15
Nov-15 Not upheld
11 TEAM
May-14
Mar-15
Dec-15 Partly upheld
12 Surgery
Jun-14
Apr-15
Dec-15 Not upheld
13 Neurosciences
Nov-14
Feb-15
Jan-16 Partly upheld
14 Liver
Feb-15
Aug-15
Feb-16 Partly upheld
15 Surgery - legacy
Sep-14
Jan-15
Feb-16 Partly upheld
16 TEAM
Nov-13
Sep-15
Feb-16 Partly upheld
17 Neurosciences
Feb-15
Sep-15
Feb-16 Not upheld
Legacy care complaint - The patient's balance and hearing problems w ere not
caused by inappropriate treatment.
Excessive delays in March 14 in ED & delay in doctor treating; cold cubicle;
documentation of fluid charts and updates on treatment plan to be more regular.
Significant changes within the ED since complaint was made; e.g. increased
clinical establishment, opening of a Clinical Decision Unit, new ED nursing
documentation, rapid assessment of patients who attend by ambulance during
peak time (12 noon - 5pm).
Communication w ith family - no failings identified
Distress caused by poor communication and updates on treatment plans
Consultant rounds have improved communication and consultant of the week
introduced to ensure a point of referral for any concerns.
Poor provision of information before sigmoidoscopy and inadequate monitoring of
patient during procedure to assess and top up pain relief.
Nursing documentation improved to include monitoring and recording of pain.
Care shared for learning.
Post-operative care and rehabilitation information
New Trust rehabilitation guidelines for patients who are undergoing micro fracture
surgery of the knee.
Missed opportunity to admit patient to hospital on second presentation to the ED, for
investigations.
The Clinical Decision Unit (CDU) has improved its clinical rota and cover Actions completed since 2014 include:
• Daily ward round, including weekends by an ED consultant for decision making
and support of junior staff.
• All ward rounds are documented on the electronic patient record.
• Locum doctors are not placed on CDU (unless regular and with CDU experience
at KCH).
• Consultant support is available from 8am – midnight 7 days a week.
Transfer to another NHS hospital and lost property - no failings identified
22 | King’s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16
Learning from feedback
Complaints present an opportunity to review patient care, our services, and the way
we interact and provide information to our patients. Once we have investigated a
complaint, we tell the complainant where we will be taking action to ensure the
events leading to their experience, are put right. Often this may involve individual
staff members reflecting on the way they have provided care, team discussions for
wider group learning, staff training or use of the complaint as a case study. If
complaints are investigated as a Duty of Candour, the final report is shared with the
complainant and will include an action plan.
Complaints monitoring is a standing agenda item for each divisional governance
meeting and a 6-month complaints report is provided for discussion and shared
learning. This includes any specific actions and required monitoring/audit.
Trust-wide issues are highlighted in the integrated Quarterly Patient Experience
Report and all complaints which refer to end of life care are shared with the Trust’s
End of Life Committee where they are reviewed for themes.
Below are some examples of the actions that have been taken as a result of the
complaints presented to the Trust in 2015/16.
Suture glue entered a head wound causing pain and distress to the child
 Teaching sessions arranged for clinical staff in the paediatric Emergency
Department on wound assessment, closure and tissue adhesive use.
 A paediatric sedation policy is to be written for use within the paediatric Emergency
Department.
 A new formulation of adhesive glue is being used for paediatric patients.
Patient attending Neurophysiology arrived on stretcher transported by hospital
transport service. Presented difficulties for the treating clinical team and resulted in
patient not undergoing the procedure.
 Neurophysiology drafting a procedure for managing stretcher patients.
 Hospital transport service reviewing the use of trollies to take stretcher patients to
clinic.
Patient with dementia attending the Emergency Department (DH) fell and sustained an
injury.
 A ‘special’ or Healthcare Assistant will be allocated to provide 1 on 1 care.
 We are developing dementia distraction techniques for patients that are admitted
onto our Clinical Decision Unit.
 A meeting with the Trust’s falls team was held to discuss bespoke falls prevention
training and falls sensor mats.
23 | King’s College Hospital NHS Foundation Trust Complaints Annual Report 2015/16