Written evidence submitted by Sue Ryder (CRC0054)

 

About Sue Ryder

 

  1. Sue Ryder provides incredible care for people with life-changing illness. We treat everyone in our care as an individual, taking the time to see the person not the condition. We enable people to live the life they want, and do everything we can to ensure their time with us is the best it can be. We do this in our hospices, in our neurological care centres, in the community and in people’s homes.

 

  1. We welcomed the publication of the Francis report in February 2013 and subsequent reviews focussing on the quality of care. We believe that the recommendations are applicable for everyone working in health and social care.  As a charity, we have our own complaints systems which are different in some ways that we explain below, to those used by NHS Trusts. Learning from complaints is something that we take very seriously as an important way in which we can drive up the standards of care that we offer. We believe the Committee would gain valuable insight into the approach used by a voluntary sector provider of NHS health and social care.

 

  1. This submission details how we have recently developed our concerns and complaints processes and procedures, and our recommendations on how these can be improved across the NHS system.

 

Executive summary

 

  1. A robust concerns and complaints system should be founded on the principle that any health and social care provider should aim to deliver the highest quality of care that meets the needs and preferences of users of that service and their families and carers. To meet this aim, providers should be open about promoting, receiving, investigating and analysing complaints and concerns, to ensure that services are responsive and effective. There is a need for a positive culture in delivering care which has open and honest culture towards managing complaints and raising concerns at its heart. This is something that Sue Ryder has embedded across all of our services.

 

  1. This submission provides evidence on the following:

 

 

Incorporating recent inquiries into the complaints process

 

  1. Sue Ryder has welcomed all of the reviews looking into complaints and concerns recently, particularly the Francis report and the Clwyd review. They serve as strong reminders of how important complaints systems are in delivering high quality personalised care. We see all of these reports and their recommendations as an opportunity to uphold our own standards of care in addition to sharing best practice.

 

  1. Sue Ryder responded to the Francis report with full affect. We established an action plan and working group to respond to the themes of the recommendations most pertinent to our service delivery, including putting the patient first, standards of behaviour, culture, effective complaints handling, openness and transparency and candour, leadership, and information. We have been working with our frontline staff from all of our services to ensure that they are aware of the Francis report’s findings and to identify ways in which we can improve our own systems.
     
  2. We also welcomed the government’s response, and approach to developing a new complaints system including quarterly complaints reporting and better complaints information. We also welcomed the recommendations in Ann Clwyd’s review that all NHS boards and Chief Executives should receive regular reports on complaints, learning and subsequent action.

 

  1. At Sue Ryder we report at least twice yearly to our Health and Social Care Governance Committee and Trustees on the number of complaints, response times and whether local resolution has been reached as part of a user experience report. We look at any themes and we present any learning and actions taken as a result. Our policy is now to publish the learning from upheld complaints on our website and within our Quality Account in consultation with complainants and with their agreement.   This process is used to ensure that our trustees and executive team have a clear understanding of satisfaction levels regarding care delivery and any actions for improvement that are needed . It also assures members of the public that we welcome feedback and take complaints seriously.

 

Complaints handling

 

  1. At Sue Ryder we have very precise definitions of what constitutes a formal or informal complaint and we have a process in place to ensure that complaints are dealt with swiftly. If a complaint can be resolved within 24 hours or the next working day then it may be considered informal. Where this is not the case then the complaint is seen as a formal complaint. Personalisation is at the heart of everything that we do, and this is reflected in the way that we address complaints. We expect all complaints to be acknowledged within three working days, whether in person or by letter (dependent on individual circumstances).

 

  1. As well as addressing complaints on a local level, we also ensure that we are able to scrutinise complaints across the organisation by using the Datix web based system to log all complaints received. This enables our Clinical Quality Team to look at all complaints received across Sue Ryder health and social care services as a whole and monitor how they are responded to and addressed. The Clinical Quality Team work in regions to support the investigation of and response to complaints and a twice yearly report is presented to the Health and Social Care Governance Committee to provide assurance that the targets set out in policy are complied with and to highlight the learning. The Sue Ryder process for monitoring complaints helps the organisation to identify patterns should these occur which enables cross-organisation learning

 

  1. Operating alongside our complaints system, our revised Complaints Policy (April 2013) identifies a process for logging concerns.  We are working on ways to encourage those who use our services to let us know when they are not happy, particularly where an individual might not feel that they want to make a complaint. Where the same concerns appear repeatedly, then our service managers are then able, for example, to investigate and identify a problem with regard to an individual staff member or an issue relating to quality that would need addressing and therefore incorporating into the quality improvement plan. In the case of both concerns and complaints we ensure that the person raising the issue is provided with feedback about the action we have taken in response and is given information about where to go if they are not happy with the final response. Serious complaints are always investigated by our Clinical Quality Team who are able to take an objective view and have the appropriate skills and expertise to carry out these investigations. We advertise our openness to received complaints on our website and using a leaflet held in public access places within our services.

 

Recommendation

 

  1. We suggest that a dual system of recording and investigating both concerns and complaints would be useful to the NHS as a whole. We recommend that Quality Managers should work closely with individual services to ensure that concerns and complaints are investigated and responded to in line with policy and that identified learning is then incorporated into Quality Improvement Plans in order to ensure that learning is not lost.

 

Support for patients and staff who wish to raise concerns

 

  1. We believe that there should be multiple gateways in which people are given the opportunity to feedback.  We have a number of systems in place to ensure that we gather as much feedback as we can about the standard of care that we offer, which go above and beyond our complaints and concerns mechanisms.
     
  2. At Sue Ryder, we carry out surveys with all of our service users on a regular basis to gather feedback on their experiences of the care that we offer. The responses to these are dealt with by the individual care centres as soon as they receive them with themes being included within service based Quality Improvement Plans. We also offer all of our service-users the option of discussing any of the issues they have raised with a member of staff. This helps to ensure that there is identification of issues before they become a concern or complaint.

 

  1. On a six-monthly basis we collate and evaluate the findings of the service user surveys across the whole organisation so that the charity as a whole, including the trustees and executive leadership team, have a clear idea of the level of satisfaction with the standard of care provided and where improvements need to be made across the organisation. This is used to influence the initiatives incorporated into our Quality Account. We are currently looking at information technology solutions to gaining ‘real time’ feedback from service users.

 

  1. Another important way in which we monitor the quality of care provided in our care centres is via our quality improvement groups (QIG). Each of our care centres has one of these groups, and the membership is comprised of the care centre senior leadership team (including the inpatient ward manager, the head of care, a member of the medical team and a member of the community team at day hospices) and representatives of front line staff. These groups have clear terms of reference where the agenda is focussed on service improvement and informed by incident learning and the reported experience of service users. Despite nationally agreed terms of reference, each group has the autonomy to approach the agenda in the manner that its members feel is most appropriate and that works best in that locality. Local service user involvement groups have a reporting line into these QIGs.

 

  1. At Sue Ryder we have a large team of volunteers who support the work of our paid staff in all of our care centres. Our volunteers play a vital role in ensuring that we treat all of our service users with the dignity and respect that they deserve. We believe that it is really important to receive feedback from our volunteers, as they may notice things that our staff have missed, or which service users do not wish to raise with staff directly. We have processes in place to ensure that our volunteers are able to contact senior staff members quickly and easily should they discover a problem that needs to be addressed. For example, in one of our hospices, Thorpe Hall, the volunteers report directly to the ward sister. This makes it really easy for them to notify her if they have any concerns about standards of care, meaning that if there are concerns they are dealt with swiftly. We also have a Sue Ryder Whistleblowing Policy and accompanying leaflet, which makes the process clear and straightforward for staff or volunteers who wish to raise a concern.

 

  1. We also obtain feedback from our patient groups and residents’ forums based at our care centres in addition to our National Service User Advisory Group. These groups enable the people who use our services to influence the ways in which our individual services operate and how we could improve the services that we provide.
     

Recommendations

 

  1. The NHS already makes use of patient surveys but the combined local and national approach used by Sue Ryder could help to ensure these surveys are used more effectively. The opportunity for service users to request further discussion with staff post-survey would help to improve the personalisation of care within the NHS.

 

  1. It would be possible to introduce groups similar to our QIG into hospital settings, perhaps on a ward by ward basis. We believe this would empower front line staff to take responsibility for monitoring and improving the standard of care within their specific area of work.

 

  1. Given that there are a number of volunteers within hospital settings, we suggest that a method of harnessing their feedback should be devised to ensure that everyone who comes into contact with service users has a way of raising concerns. This system should be designed in a way that not only junior staff, but senior leadership, are made aware of problems as quickly as possible.

 

  1. We suggest that service user forums that are linked to specific localities should be introduced across the NHS, to ensure that local feedback can be used to improve services.

 

Leadership

 

  1. We believe that the best way to ensure that complaints are addressed appropriately and used as a way to drive up standards is to have strong clinical and managerial leadership. We felt that one of the key recommendations from the Francis report was in relation to strong leadership and its role in developing a culture where people feel able to raise concerns and complaints feeling confident that they will be taken seriously and that there will be a demonstration of learning. At Sue Ryder we have clinical professionals on both our Board of Trustees and our Executive Leadership Team which helps to ensure that our staff culture is truly focussed on the care of people who use our services.

 

  1. However, we are not complacent about our approach and, following the publication of the Francis report we are examining what training our Executive Leadership Team may need to undertake to further embed understanding of the learning from this report.  We are also reflecting on whether our senior nurses have a strong enough voice at governance level.

 

Recommendation

 

  1. Government should look at the development of leadership structures that are designed to best ensure they help to drive a culture of compassionate care.

 

Embedding a culture of transparency and honesty

 

  1. We welcome the introduction of a new statutory ‘duty of candour’. Care providers, across health and social care, must take responsibility for all instances when a patient has cause for concern and complaint.  Only in doing this can people and their families trust in the duty of care the NHS and other care providers pledge to us in times of need.

 

  1. We have embedded a learning culture and we invest in training to ensure our staff have those difficult but necessary conversations when needed.  We have now explicitly included that we expect an individual to have a duty of candour in all of our job descriptions. We also have a clear and thorough complaints handling procedure which is supported with training for our staff on how to handle complaints when raised.

 

Openness and accessibility of information

 

  1. People must be assured that they have a voice which will be listened to and acted upon. When revising our complaints policy to promote openness we realised that our existing complaints leaflet to those in our care and their families wasn’t as easy to use as it could be. This meant that people would be less likely to read the leaflet and feel they could make a complaint because they didn’t know the process or access the right information.

 

  1. We redeveloped the leaflet with our national advisory user group, and focused on usability for individuals, family and friends. This includes a flowchart which clearly sets out the complaints process and FAQs.

 

  1. We have seen an increase in the numbers of complaints reported. This is due to the fact that we have made the process simpler, and we are actively encouraging people to report so we can make improvements. We are now looking at hosting our complaints reports on to our website so we can demonstrate a record of complaint, how it was upheld and what action we have taken to resolve it.

 

Recommendation

 

  1. Investment in technology solutions for real time feedback to ensure prompt response to affect service changes.

 

 

3 June 2014