Report Complaints and Patient Advice and Liaison Service (PALS) by nyq12247


									                          ENFIELD PRIMARY CARE TRUST

Report:       Complaints, Patient Advice and Liaison Service (PALS) and
              Incident report – 4th Quarter January to March 2005

No:           EP 49/05

Date:         April 2005


Quarter 4 report gives details of the 62 complaints, 372 PALS inquiries and 69 incidents
occurring between January to March 2005. The incident report is manually prepared this
quarter because of inability to access SAFECODE information. The new DATIX computer
system to replace SAFECODE is bought and paid for and is currently being installed.
Implementation plans are in progress in partnership with other organisations also making
the transition – Barnet, Enfield and Haringey Mental Health Trust and Haringey Teaching
Primary Care Trust. This system is also now in use at Barnet and Chase Farm Hospitals
and North Middlesex University Hospital.

Financial Impact:

No direct financial impact.

Patient Perspective and Equality Impact:
Information from PALS, complaints and incidents help us to improve services. Investigations
and reports are carried out with service leads.

Workforce and Training Impact:
Training implications have been flagged as part of actions to improve the services.


Members are asked to note the information on complaints, the Patient Advice and Liaison
Service and incidents.

Submitted by:                 Anita Grabarz
Authors:                      Anita Grabarz, Julie Howes and Yasmin Jaffer
                                                                          Enfield Primary Care Trust

Complaints, Patient Advice and Liaison Service (PALS)
and Incident report – 4th Quarter January to March 2005

Contents                                   Pages

    1.   Staff Changes                       2
    2.   Complaints                          3
    3.   Conciliation                        5
    4.   Independent Reviews                 5
    5.   Claims against Enfield PCT          6
    6.   PALS Activity Report                6
    7.   Incidents                           8

1. Staff Changes re PALS, Complaints and Incidents
The complaints, PALS and incidents sections of the Corporate Affairs Directorate have
undergone changes in staff management. The roles of Assistant Director and Support
Services Manager have been combined to create one managerial post, Head of Facilities
and Risk Management.

The previous manager for Complaints and PALS has transferred to the Primary Care
Directorate retaining her remit for information governance, including freedom of information

This report is therefore completed by the Senior Officers for PALS and Complaints, Julie
Howes and Yasmin Jaffer.

Savings from the two managerial posts has been invested to boost front line support to
patients and staff as follows:
           full time complaints and PALS officer;
           six additional hours for Senior PALS and Complaints Officer;
           full time health and safety officer;
           part time patient and public involvement assistant

The functions of PALS and complaints have been merged so that officers can triage
telephone calls to enable quicker resolution of problems.

The Board has previously agreed to investment in a new computer incident reporting
system (DATIX) and part-time administrator to ensure accurate inputting of incidents. This
post has now been recruited to and will commence work in May.

May 2005                                                                    Page 2 of 10
                                                                                         Enfield Primary Care Trust

2. Complaints
Our complaints procedures were not recognised by the recent Risk Pooling Scheme for
Trust inspection as we could not evidence that the policy we have been following had ever
been to the Board. We are therefore taking the opportunity to revise our complaints policy.
The new version will be presented to the July Board after internal consultation has been
agreed with the Joint Staffside Committee.

This report below highlights the work of the complaints department for the fourth quarter,
January to March 2005.

Table 1            Complaints received and outcomes

Total              Responded          Response         Outstanding          Independent          Ombudsmen
number of          to within          over the                              Reviews              enquiry
complaints         time limit         time limit
62                       44                14               4 (1)                   4

----------------   ----------------   --------------   ------------------   ------------------
FHS: 40                  31                 9                                       4
EPCT: 21                 12                 5                  4
Others: 1                 1

( ) Number indicates case outstanding from previous quarter.
FHS: Family Health Services or independent contractors

Details of Outstanding Complaints

Cases outstanding from previous quarter have had responses and are ongoing because the
complaint has not been resolved.

Details of cases

        complaint concerning the podiatry service.

Cases outstanding from current quarter relate to:

        provision of out of hours service for Forest Road
        service provided on Magnolia ward
        provision of respite care
        decision about NHS Funded Continuing Care.

May 2005                                                                    Page 3 of 10
                                                                                   Enfield Primary Care Trust

Table 2 - shows the complaints by Directorate and the different category of
complaints within each Directorate/Service

 Total      Directorate/                 Category            Lessons Learned
               Service                                       (From replies actioned)
  40      FHS:

                 GP 29            Treatment      (9)        In line with National Guidelines for
                                   Admin          (3)        FHS complaints, all complaints are
                                   Attitude       (5)        passed to the appropriate practitioner
                                   Access         (9)        for investigation in accordance with
                                   referral        (1)       the practice based complaints
                                   Prescribing     (2)       procedures action with a request to
                                                             copy the PCT into their response.
                 Dentist 11
                                   Treatment      (8)
                                   Attitude       (1)        .
                                   Referral        (1)
                                   Removal        (1)

   9      Patient Services

                 Nursing 3        Treatment (2)             Improve communications skills;
                                   Attitude   (1)            ensure consistent approach to
                                                             recording treatment
             -------------------      -------------------         --------------------------------------
               RASH

          Town Clinic (1)          Attitude     (1)          Communicate sensitively

             -----------------        -----------------           ------------------------------------------

                 Podiatry (2)     Access (1)                Both these are ongoing
                                   Health & safety (1)
             -------------------     -------------------         ---------------------------------------------

                 Speech &
                  Language         Access (2)                Review allocation of appointments
            --------------------    ----------------------         ----------------------------------------

                 Magnolia
                  Unit (1)         Treatment (1)             Being processed

May 2005                                                                    Page 4 of 10
                                                                                   Enfield Primary Care Trust

  10      Primary Care

                 Patient &         Admin         (2)         Provided explanation
                  Practitioner      Provision of dental       Provided list of NHS dentists and
                  Services (3)      services (1)              informed about dental access centres
            --------------------     ----------------------         ------------------------------------

                Ophthalmic         Admin (2)                 Explained that proper procedures
                 Advisor (2)                                  were followed and will review issue
           ----------------------      ------------------         -------------------------------------------

                Forest Road        Communication (2)         Review procedure for communicating
                 (5)                Emergency Service         with patients.
                                    Home Visit (1)            1 case outstanding

   2      Commissioning
          (2)                       Provision of respite      Currently being processed
                                    care (1)
                                    Continuing Care (1)
   1      Other Trust               Treatment (1)             Forwarded to Haringey Teaching PCT

3. Conciliations

Currently we have one case that is going through the conciliation process and one that is
waiting to be allocated.

4. Independent Reviews

      In July 2004 The Healthcare Commission took over the responsibility for processing
       independent reviews of complaints. Since then they have received a total of seven
       independent reviews concerning complaints about services provided in Enfield.
       Below is a table giving an overview of these.

May 2005                                                                    Page 5 of 10
                                                                            Enfield Primary Care Trust

Table 3
Independent Review for the period 1 July 2004 to 31 March 2005

Date    Service Nature of             Outcome             PCT Action
of IR           Complaint
12/7/04 GP      Diagnosis             Referred for        Conciliation took place;
                                      Conciliation        complainant not satisfied
16/8/04 Forest      Treatment         Referred for        Conciliation took place
        Road        /complaints       conciliation        complaint resolved.
                    handling                              Reviewed systems in
                                                          place for handling
                                                          complaints at Forest
                                                          Road and implemented
16/8/04 GP          Services          Ongoing
                    provided by
4/3/05    GP        Removal/          Ongoing
7/3/05 GP           Treatment         Ongoing
11/3/05 GP          Treatment/        Ongoing
22/3/05 GP          Diagnosis         Ongoing
7/4/05 GP           Diagnosis         Ongoing

5. Claims against Enfield PCT

A personal injury claim has been made against the Trust by a member of staff. This has
been reported to the NHS Litigation Authority and evidence has been supplied.

6. PALS activity report from January– March 2005
Table 4: PALS activity report from January - March 2005
  Total                                                 Category        Service
    1      Waiting time                                              Audiology
   12      Access (1), Dispensary (1), Communication (1),            BCFHT
           Interpreter (2), Maternity (4) MRSA (1), Report (1),
           Waiting times (1)
    4      Complaint (1), General Information (1), Unhappy with      BEHMHT
           Treatment (2)
    3      Funding (1), General Information (1), Medical Card (1),   BPCT
           Stoma Care (1), Treatment (1).
    2      Communication (1), General Information (1).               Continuing

May 2005                                                                    Page 6 of 10
                                                                               Enfield Primary Care Trust

    1      Funding for laser treatment                                  Commissioning
   14      Access (3) Complaint (2), General Information (2),           Dental
           Referral (1), Unhappy with Treatment (6)
    1      Access                                                       Dermatology
    1      Treatment                                                    District Nursing
   55      Appointment (1), BCG (1), Cancer Screening (1),              General
           Counselling (2), Expert Patient Programme (3),               Information
           General Internal Information (2), General NHS
           Information (36), Language Line (1), Medical Card (1),
           NHS No (1), Patient Choice (1), Prescription (2),
           Training (3)
   65      Access (15), Access to Travel Vaccs (4), Attitude (1),       GPs
           Blood test (1), Charges (3), Complaint (1), Family
           Planning (1), General Information (11), Home visit (1),
           Interpreting (1), Maternity (1), Prescribing (5),
           Protected Learning (1), Records (1), Referral (8),
           Register (2), Report (1), Results (1), RNID access (1),
           Telephone system (1), Unhappy with Treatment (3),
           Vaccinations (1).
    6      GP (1), General Information (3), Referral (1),               HTPCT
           Vaccination (1).
    1      Unhappy with Treatment (1)                                   Health Visitors
    2      Waiting time (1), Unhappy with Treatment (1).                Magnolia Unit
   22      Access to GP (2), Access to Dentist (1), Access to           MP Letters
           Podiatry (4), Continuing care (2), Counselling services
           (1), Dental treatment (2), General Information (2),
           Registering with GP (3), Referral (1), Rehabilitation (1),
           Social Services (1), Telephone system (1), Wheelchair
           services (1).
    3      Discharge (1), Physio (1), Sick Certificate (1).             NMUHT
    3      Access (2), General information (1).                         Out of Hours
    3      Access (1), Waiting time (2)                                 Paediatric
    1      Cardiac Rehab                                                Patient Forum
   155     Allocation (2), Attitude (1), Audit Letter (100), General    Patient &
           Information (2) Information on Registering (45),             Practitioner
           Medical Card (2), Medical records (3)                        Services
    1      General Information                                          Pharmacy
    2      General Information                                          Physiotherapy
    6      Access (4), Attitude (1), Waiting time (1)                   Podiatry
    2      Access to Termination of Pregnancy Service (TOPS)            Reproductive &
                                                                        Sexual Health
    2      Transport (1), Unhappy with Treatment (1)                    Royal Free
    1      Hygiene                                                      St Michael’s
    2      General Information (1), Referral (1)                        SEH PCT
    1      Access                                                       Walk-in Centre

May 2005                                                                    Page 7 of 10
                                                                          Enfield Primary Care Trust

Table 5: Response time for cases

                Cases                                    Resolved on
                   281                      Same Day
                   38                       1 – 3 Days
                   11                       4 – 6 Days
                   12                       7 – 10 Days
                    4                       11 – 15 Days
                    9                       16 – 20 Days
                   11                       Over 20 Days
                    6                       Outstanding since March
                                                3 MP Letters – Premium rate
                                                   calls, Provision of Lancets,
                                                   Access to Podiatry
                                                Housing and Mental Health
                                                Dental treatment, advice still
                                                   being sought (on-going case)
                                                Access to TOPS
Barnet & Chase Farm Hospitals NHS Trust (BCFHT)
Barnet Primary Care Trust (BPCT)
North Middlesex University Teaching Hospital NHS Trust (NMUtH)
Barnet, Enfield 7 Haringey Mental Health Trust (BEH MHT)

This quarter the total of calls has risen substantially from last year’s 4th quarter which was
137. The majority of enquiries that we receive still remain to be around GPs. The officers
work closely with Locality Mangers to address these. More serious concerns are also taken
to the shared intelligence group.

The newly merged PALS and complaints teams will enable most calls to be dealt with as
PALS unless the caller specifically asks for their concern/complaint to go through the formal
process. The aim is to resolve patient difficulties as quickly as possible in the most
appropriate way. Officers will, when necessary, give relevant information about the
complaints procedure.

A full time PALS and Complaints Officer has been appointed which means there will be
three officers dealing with the calls with the Senior PALS and Complaints Officer overseeing
work loads. In appointing another Officer, this will free up time for the Senior PPI Officer to
work on Patient and Public activity.

May 2005                                                                    Page 8 of 10
                                                                               Enfield Primary Care Trust

7. Incident report for January to March 2005

7. 1 Trends from Quarter 4 Incidents

There were 69 incidents reported by staff over the three month period as follows:

Table 6: Quarter 4 incidents

 Location                                      Total   Comments on incidents occurring 4
                                           Incidents   times or more
 Learning Difficulties                           38    19 assaults by clients who are
                                                       being treated for their challenging
                                                       behaviour. 12 of these assaults on
                                                       staff and 7 on fellow patients or
                                                       visitors to the wards.

                                                       7 patient falls – but in variety of
                                                       circumstances and environments.
                                                       No trend evident.
 Reproductive and Sexual Health                   5
 Podiatry                                         1
 Physiotherapy                                    3
 Occupational Therapy (OT)                        1
 Magnolia Unit                                    7    4 of these were patient falls but only
                                                       one patient required minor
                                                       treatment at A&E for a cut eyebrow.
                                                       Policy observed for follow-up with
                                                       GP, blood pressure checks, etc.
 Community Nursing - Southgate                    3
 Community Nursing Enfield North                  2
 Community Nursing Edmonton                       7
 Holbrook House                                   1
 Primary Care – Enfield Island                    1

Patient assaults on staff at the Learning Difficulties continued to be tightly monitored to
ensure risk assessments are as accurate as possible. All the incidents are followed up with
immediate action at the location, with client and staff member supported by senior staff as
appropriate. The assaults to staff (and other patients and visitors) frequently result in minor
injuries from punches, scratching, bruising and on one occasion, biting.

7.2 Actions resulting from Incident reporting.

A summary of incidents, by service, has been forwarded to the Service Managers.
Incidents are reviewed by individual services and actions to remedy are often taken on the
spot. In addition to this, incidents are shared with clinical governance teams for the purpose
of ensuring effective policies and procedures. Examples are as follows:

May 2005                                                                    Page 9 of 10
                                                                          Enfield Primary Care Trust

   the importance of accurate community health records has been be reinforced to
    community nursing staff to minimise medication errors;

   Reproductive and Sexual Health Services dissatisfied with vasectomy service so this
    has been stopped until alternative service provider can be found;

   attention to health records retrieval systems will be generally flagged up in the newsletter
    to remind people of the need for notes to be appropriately filed and securely stored;

   near misses or incidents concerning patient safety are reported to the National Patient
    Safety Agency by the Clinical Governance Manager;

   it should be noted that three incidents this quarter, at three different service locations,
    related to patients who became unwell or arrived unwell. These symptoms were not
    related to their treatment at the Trust but on each of these occasions the service
    summoned appropriate support promptly and effectively.

7.3 SAFECODE replacement - DATIX
EPCT together with Haringey PCT and BEMHT have bought the new system EPCT
currently awaits installation by the Health Informatics Service and are in the process of
setting up training courses for key personnel.

This incident report has been compiled manually from incident reports as SAFECODE
system is now very unreliable.

Anita Grabarz
22nd April, 2005

May 2005                                                                   Page 10 of 10

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