Building healthier communities

Patient Experience Quarterly Report 2018-19

Quarter 3: 1st October 2018 to 30th December 2018

Created by the Leeds CCG Clinical Governance and Patient Experience Team

January 2019

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Introduction and purpose of the report

Leeds CCG is committed to delivering healthcare using an integrated approach with our local partners to improve not only the safety and effectiveness of care but the experience of care for patients and service users.

The patient experience framework describes how we commission quality care by listening, capturing and responding to feedback on experiences, views and opinions on a range of health and care services.

This report provides:

• An overview of patient experience intelligence by sector

• Overview of patient experience within Leeds health and care system

• Patient Insight Group update

• Next Steps

• Appendix A: NHS National Quality Board Patient Experience Framework

• Appendix B: Criticality Scoring

To enable the CCG to understand ‘what are people telling us?’ a range of data from a number of patient experience sources needs to be collected, reviewed and analysed. This includes a number of text based feedback services and reports. Sources includes Care Opinion posts (online anonymous feedback forum), CCG complaints and patient feedback, CCG Patient Advice and Liaison Service (PALS) by eMBED, Provider patient experience reports and Healthwatch reports.

The report includes all intelligence received between 1st October to 31sth December 2018, Quarter 3.

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Planned Care and Long Term Conditions – Care Opinion data

Care Opinion published 44 posts during Q3 relating to LTHT, 66% of those were positive. Of the rest, 25% (11 posts) were negative and covered communication, attitude of staff and waiting times. Care Opinion states that no changes have been made as a result of the online posts. However, following an online post LTHT requests that the person contacts the PALS service with more detail. Therefore any changes or service improvements are reported directly to the patient and via the Trust’s patient experience report and not directly onto Care Opinion.

0

change

41 responses

3 read not responded

10

2

5

3 2

1

4 3

7

1 1 1 2

1 1

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12

Total number of comments received via Care Opinion by Estate and CSU

1 4

74

14 10 13 12

17 15

0

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80

April May June July Aug Sept Oct Nov Dec

Total number of Care Opinion stories per month

Source: Care Opinion

Long wait in eye clinic. “Been waiting over an hour today in the eye clinic. Perhaps more

people could be seen at a weekend when it is

quiet”

“I have just returned home after a total hip replacement at Chapel Allerton hospital. I have complex needs in that I have difficult to control rheumatoid arthritis and take a

lot of drugs. Words are not enough to describe the wonderful care and treatment

I received.”

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Planned Care and Long Term Conditions

“Made my first visit yesterday after being referred from my local hospital who did not specialise in the treatment I need following a severe facial injury, damaged teeth and broken jaw. My initial impression was that it was friendly but it soon appeared to be similar to a college break out room in the waiting area. Students were strolling around, talking openly about patients well within ear shot of the waiting area, mocking some of them, making jokes of others which I found appalling, I challenged with the receptionist and her reply was "well they are students."

The CCG received seven complaints during Q3 relating to LTHT. These

included waiting times, cancelled operations and

fertility centre

Healthwatch Leeds (HWL) also receive complaints & concerns relating to providers across Leeds which they share with the CCG. Complainants are signposted to the relevant provider for investigation. In Q3 they received 11 which included, staff attitudes, care and treatment, communication and waiting times.

Source Care Opinion

Care Opinion online feedback portal asks users to state what aspects of their experience was good (green) and what areas of their experience could be improved. 70% of users did not comment on areas for improvement during Q3 however, the 30% of users who completed this section were happy with the service. Users also stated positive feelings of using the services.

You said…. We (LTHT) did…

interruptions during their procedure on the ward

Trolleys have been purchased to hold dressings and equipment at the bedside. This will prevent staff needing to interrupt patient procedures within the treatment room to obtain these items. Work has also taken place to create a separate treatment room and a clinical store room.

The process for booking out-patient appointments through RBS was leading to a large number of PALS concerns being raised

The process required a GP electronic referral which had to be activated by the patient. Activation required a telephone call to RBS which typically took 5 minutes. Patients found it very difficult to get through to the service. RBS changed to a new process on 30 November 2018. This process requires GP referral but activation can be done by the RBS team, thus removing the requirement for patients to telephone the service just to activate the process. Although only introduced very recently PALS have already noticed a reduction in concerns raised regarding RBS.

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Friends and Family Test is published monthly by NHS England. These figures demonstrate the number of patients who would recommend the services against the national average as well as the response rate, highlighted in blue on the graphs.

Planned Care and Long Term Conditions – Friends and Family Test

In November 2018 and again in December 2018, a box of FFT cards was lost by the courier service supporting the FFT process. This has been investigated and actions have been taken to address this. However, response rate performance for those months have been affected, as in the region of 1400 cards were lost on both occasions. As it is not possible to identify where in the Trust the cards originated from this should be taken into account when reviewing the figures. Despite the loss of responses. With this in mind, most areas have managed to maintain a performance above internal response targets.

Overview of Planned Care and Long Term Conditions During Q3 there has been a slight increase in the number of comments posted on Care Opinion regarding LTHT services but the CCG has seen a decrease in the number of complaints received. Feedback themes remain similar to previous themes identified regarding communication, staff attitude and access. A&E department has received the highest number of formal complaints and Chapel Allerton Trauma and Orthopaedics has received the highest number of online feedback.

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45

94.4

94.6

94.8

95

95.2

95.4

95.6

95.8

96

96.2

Dec Nov Oct

% recommended

% national average

response rate

Inpatient

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1

1.5

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2.5

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3.5

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4.5

93.4

93.6

93.8

94

94.2

94.4

94.6

94.8

95

95.2

Dec Nov Oct

% recommended

% national average

response rate

Outpatient

“I Received excellent care from all staff that I came into contact with, including Surgeons, Nurses, Health Workers, Porters and Catering staff.

I always felt involved, and was treated with respect.”

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Planned Care and Long Term Conditions – Leeds Teaching Hospital NHS Trust

Source LTHT quality report

A&E SJUH, radiology and elderly medicine are the clinical speciality areas that have received the highest number of complaints during Q1 and Q2. Treatment, Communication, Administration/access/admission/transfer/discharge remain the three highest complaint themes for the Trust.

You Said… We (LTHT) did…

When accompanying my wife to a physiotherapy appointment in Chancellor Wing, SJUH, I was advised to use the disabled toilet and change my baby on the toilet floor.

Estates and Facilities reviewed baby change facilities within the department and are to install a new baby change unit in the male toilets in the physiotherapy department.

Delays for a patient referred for Physiotherapy Physiotherapy are introducing an electronic referral system which will reduce the time it takes for referrals to be received into the department and shorten the overall waiting time for patients

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Unplanned Care - Care Opinion and FFT data

Care Opinion received two positive comments during Q3 relating to A&E services . The CCG received two negative postings regarding treatment and staff attitudes at walk in centres, within Leeds. These have been shared with the service as well as commissioning /contracting leads for investigation and response. In Q3 Healthwatch also received 3 complaints regarding care and treatment, the complainants were advised how to make a complaint directly with the provider for investigation.

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2

1 1

0

1

0

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3.5

Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18

Care Opinion Stories

21

22

23

24

25

26

27

84

85

86

87

88

89

90

Dec Nov Oct

LTHT A&E FFT

% recommended

% national average

response rate

NHS England FFT data which is published on line is currently stating that, foe Leeds, only 6 responses to the national FFT survey See and Treat have been submitted out of a potential of 47446 eligible patients in Q3. In the same period the Patient Transport Service received a response rate of 6 from 231477 eligible contacts. However, YAS conducts internal patient experience feedback mechanisms as well as FFT which includes a survey being sent to service users and an online patient feedback mechanism.

88

90

92

94

96

98

100

Hand Hygiene Premises Vehicle

How likely are you to recommend YAS to friends and family if they needed similar care or treatment?

(A&E & PTS only)

Airedale, Bradford andLeeds

YAS overall

During Q3 570 questionnaires were sent to service users and 190 responses received – 33.3% response rate. All patients who are attended to but not conveyed to hospital are given the opportunity to complete FFT survey. • 83-89% of responders find the 999 call

takers reassuring and the length of time waiting for the ambulance to arrive acceptable.

• 92% were positive about the treatment received from the crews and felt them reassuring.

87 narrative comments were made in Q3, 73 positive and 14 negative. Positive comments were in regard to positive customer services and being treated with dignity, respect, care and compassion. Negative comments were related to speed of response or clinical call back instead of an immediate ambulance response.

“I have attended the A&E department advised by the 111 phone service. I have received wonderful care from the beginning to the end. The doctor and the rest of the staff have provided amazing care. A service to be proud of.”

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Unplanned Care - YAS and 111 data

53%

18%

29%

0% 0%

0%

YAS Q3 Feedback by subject

Attitude

Operations

Clinical/Patient Care

Delayed Responses

Call Handling

Other

53%

10%

5%

16%

16%

111 Q3 Feedback

Complaint Concern Comment Compliment Service to Service

0

1

2

3

4

5

6

7

8

111 Q3 Feedback by subject

11

9 9

7

16 15

6

0

2

4

6

8

10

12

14

16

18

Complaint Concern Comment Service toService

Compliment Lostproperty

PALS request

YAS Q3 Feedback

Source: 111 Governance reports

92% were happy with the service overall whilst 93% felt they were treated with dignity and respect.20% of the feedback received regarding YAS and 111 was positive. However, Staff attitude is a common recurring theme for both YAS and 111.

“I went to the Minor injuries unit at SJUH today with a knee injury and I was very impressed with the treatment that I received. Thank you to all the staff who helped me today, I really appreciate everything you did for me”

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Mental Health and Learning Disabilities: Care Opinion

2

8

2

4

11

4

9

3 3

0

2

4

6

8

10

12

April May June July Aug Sept Oct Nov Dec

Number of Care Opinion Posts per Month

3

1 1

4

1

0

1

2

3

4

5

Becklin Centre Malham House Millfield House Newsam Centre St Mary's Hosp1

Two of the negative posts were relating to the Service User Network (SUN). The Group encourages people to express their views, share their experiences and explore what works well in the Trust to provide valuable feedback around areas which may need improvement.

The Trust advised that the Group referred to was the SUN Annual Question Time which is an open invitation to all service users, carers , public and stakeholders to facilitate a conversation with the Trust Executives. The Trust advises there will be an end of year review of the format and advised that the feedback would be included in the review (with poster’s consent)

LYPFT remain an outstanding responder on care opinion (100% response rate to service user’s posts) and are actively listening to patient feedback to implement changes to the services they provide. Care Opinion received 15 posts during Q3, three of which were positive comments

Towards the end of 2018, LYPFT commissioned a review of how the organisation enables service user experience and involves service users. The report highlighted significant examples of good practice in involving service users such as the Patient Advice and Liaison Service (PALS), the Learning Disabilities Service employing “experts by experience” and the Personality Disorder user involvement and feedback network. The main recommendation is to put in place an over-arching group to oversee the development of a clearer strategy on experience and involvement. Other recommendations include better sharing of good practice and a stronger focus on carers.

Mental Health Crisis in Leeds - Healthwatch Leeds are conducting a survey in Leeds regarding people’s experiences of mental health crisis services, what works and what could be better. Survey closes March 2019.

“My family member was admitted to the Becklin Centre. The care provided to her during her stay was not very safe and professional at all. She was sectioned under the Mental Health Act however always managed to get out of the hospital on her own. We was very concerned about her wellbeing and had no idea where she was. The staff was very rude when speaking to them on the phone and did not reassure us at all”

“I believe the staff at Mill Lodge really cared about me, every single one of them, especially my MDT team. I wouldn’t be in the position I am now in, living in my community placement if it wasn’t for them. So, thank you Mill Lodge!”

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Mental Health and Learning Disabilities: FFT and CCG Complaints

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Dec Nov Oct

% recommended

% national average

response rate

Mental Health FFT - LYPFT

The CCG received three complaints in Q3 regarding treatment from an Out of Area provider , waiting times to access services and gaps in the services in Leeds. Two of the concerns were dealt with by commissioners and the third complaint was passed to the relevant services for investigation to understand the causes.

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Dec Nov Oct

% recommended

% national average

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Mental Health FFT - LCH

Following discussions around the complexity of complaints being received, the Trust is reviewing the KPIs it is currently using to monitor the quality of complaint management and responsiveness. This review will be completed during Q4. There are now no overdue complaints from the April backlog. Performance against the KPI for sending a response to the complainant within 30 days has risen considerably over the last couple of months from 20% in September to over 60% in November (the highest percentage for the year to date).

The Patient Experience and Involvement Coordinator at LYPFT is working with ward managers to try and improve uptake in the Friends and Family Test (FFT). The dip in response rate occurred whilst handover and training for new lead took place as well as some issues with services ‘running out’ of FFT cards.

The Community Mental health survey 2018 results were published in November. The survey looked at the experiences of people receiving community mental health services involving 12,796 participants with a 28% response rate. The national survey showed declines across several areas including people’s perceptions of: • Seeing someone from NHS services often

enough • Being involved in agreeing their care • Their agreed care taking personal

circumstances into account • Receiving help with finding support for physical

health needs and financial advise. People’s experience was reported more positively in some areas including knowing who to contact during a crisis and who the person in charge of their care was. People aged 18-35 and people diagnosed with non-psychotic chaotic and challenging disorders consistently reported poorer experiences.

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Children and Maternity: Care Opinion, FFT & CCG data

Care Opinion received two posts regarding Maternity services during Q3 both of which were positive experiences.

0 2 1 0 1 1

July Aug Sept Oct Nov Dec0

5

Care Opinion Posts

“Following the birth of my grandson at the Clarendon wing. I would love to say a big thank you to the midwife and student midwife who were there to deliver the baby. They were kind, patient and very supportive of my daughter, her partner and me! In the excitement of the baby arriving it's not always possible to thank everyone so I am hoping you can pass on our thanks and praise to two brilliant midwives. Thank you”

“I went to the maternity assessment centre at LGI today as I was concerned about my baby's movements. I was so

grateful and pleased with the care I received. The midwife who looked after

me was so reassuring and thorough”

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20

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40

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85

90

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105

Dec Nov Oct

Antenatal

% recommended

% national average

response rate

0%

10%

20%

30%

40%

50%

97%

97%

98%

98%

99%

Dec Nov Oct

Birth

% recommended

% national average

response rate

160%

170%

180%

190%

200%

210%

220%

92%

93%

93%

94%

94%

95%

95%

96%

Dec Nov Oct

% recommended

% national average

response rate

Postnatal Ward

0

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95%

96%

97%

98%

99%

100%

101%

Dec Nov Oct

% recommended

% national average

response rate

Postnatal Community

Healthwatch Leeds in partnership with Healthwatch England and mental health services in Leeds, are conducting a survey to understand new mums’ and their partners’ experience of mental health support before, during and after pregnancy. Survey closes March 2019.

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Continuing Healthcare & Neighbourhood Care: Care Opinion, CCG Complaints and FFT

Neighbourhood Care Overview: There were no posts for Q3 on Care Opinion regarding Leeds Community Healthcare NHS Trust services. However, the CCG has received a number of concerns relating to neighbourhood care which included Care Homes, Continuing Healthcare and LCH services. Families raised concerns regarding the quality of care and treatment being provided within some care homes. Concerns have also been reported regarding the provision of dental services for the homeless. The number of complaints and concerns raised have remained static compared to previous quarters.

17

3

5

Q3 CCG Complaints and Feedback

Care Homes

LCH

CHC

A number of safeguarding alerts and patient complaints were received relating to community care bed services within Leeds. The Quality Surveillance Tool (QST) was instigated where appropriate. ACTION An intensive review of the Community Care Bed pathway was completed. In addition to this a number of intensive support visits were instigated with one provider and progress has been made but follow up visits will continue over next 6 months. A recent night unannounced visit was completed and was very positive. OUTCOME No further negative experience has been received and the provider will be continually monitored via the QST

The above chart shows the complaints/feedback received during Q3.

Care Home themes include care & treatment, lack of completed care plans, Primary Care Advice Line (PCAL) issues, giving more meds to patients, than required

CHC themes included complaints around assessments, appeals for funding

LCH themes include dental provision for homeless people, staff attitude for podiatry services and support for people on service waiting lists.

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Dec Nov Oct

% recommended

% national average

response rate

Community

The response rate of the Friends and Family Test is variable month on month. However, the majority of responses received are positive. When negative comments or a negative response is identified, these are highlighted to the service for review and where possible investigation and action plans agreed. No concerns were raised within the October returns.(LCH Patient Experience Report)

“My problems were taken seriously and the methods provided to deal with them were extremely

helpful. It was very helpful and has helped me deal with my struggles and feel like a happier

person. There have been many positive changes in me from this service.” LCH Service User

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24%

51%

9%

15%

0% 1%

LCH Patient experience activity in October 2018

Complaints

Concerns

PALS Enquiries

PALS Signposting

Clinical Claims

Non-clinical

Claims

Highest Complaint Categories in last 6 months for LCH

Clinical judgement / Poor treatment

Appointments

Attitude, conduct, cultural and dignity issues including Staff attitude and communication

Communication

Access and availability

The FFT results for LCH demonstrate an overall positive response to the FFT question with 96.2% of community service users and 96.36% of in-patient user saying they would recommend LCH services. The chart above highlights the positive nature of the 8947 comments received so far this year. Negative comment responses are primarily recorded under the themes of Waiting, Communicating to patients, Comfort, Parking and Feeling Safe which mirrors the results of the previous report. Following the recent internal Complaints audit, the Patient Experience team within LCH has now implemented a new step in the process of sharing learning across the Trust using the lessons learnt template. This will align the process with learning from incidents with a collective aim to ensure that the Trust is a ‘learning organisation.’ The actions and learning on the new process will be provided in the annual report. The PSEGG meeting is currently being reviewed to include focus on learning from patient experience from services and the Trust.

Continuing Healthcare & Neighbourhood Care: Leeds Community Healthcare “My wife recently passed away. The nurses that looked after her when she was at home were the best, nothing was too much for them. If there was a problem they could not treat, they went out of their way to solve it”

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Primary Care Within Leeds: Friends and Family Test

FFT average response rates for Q3 fluctuate between 100% recommended and 0%. There are still some providers that are reporting as nil return and these have been shared with the primary care team. Response rates have also varied slightly and will remain a focus for 2019/20. This data is analysed in more detail at the Primary Care Quality Surveillance Group and discussed with practices where required.

% Response Rate % Recommended

0%

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40%

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120%

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Primary Care Leeds: Care Opinion Data

50 57

24

0

20

40

60

Oct Nov Dec

Number of Care Opinion Posts per Month

Care Opinion published 131 posts during Q3 relating to Primary Care, 74 were positive 57 were negative . In Q3 the response rate was 72% .

0

change

95 responses

31 Read but no response

5 unread

0 5 10 15 20 25

Thank you

Amazing

Fantastic

At ease

Brilliant

Reassured

Most Common Tags Assigned to Care Opinion Stories

4 3 3 3 3 4 3

35

3 4 5 3 3 6

05

10152025303540

Care Opinion Data - over 3+ posts

Over the past year I have been to the doctors regularly for an undiagnosed condition. I have seen 7 different doctors, several nurses and met every receptionist. I never have a problem getting an appointment and every single person I have seen has been extremely helpful.

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Primary Care Leeds: CCG Complaints Data

3

2 2

1

2

Flu Vaccination concerns

Healthwatch concerns

Concerns re lack ofappointments

Attitude of staff

Prescribing

NHS England is the organisation that has statutory responsible for primary care complaints. During Q3 the CCG received 10 primary care complaints. These were either responded to by the CCG or, following consent, passed to NHSE or the GP practice for investigation and response.

Service User’s Post:

“I am 68 years old requiring an 0ver-65's flu jab, I called at my doctor's to be told they had run out of supplies. They referred me to local pharmacies, but they too had no vaccine left. I was told some more 'might' be available in November. This cannot be satisfactory - we are encouraged to have the jab but cannot do so. What will happen when NHS beds are blocked by pensioners full of flu because no vaccine was available when needed?”

Practice Response: Unfortunately, practices are experiencing some operational difficulties with vaccination deliveries as the vaccine stock is being received in a number of separate deliveries rather than in one order. Although very inconvenient for patients but this is unfortunately beyond the control of the practice. Practices have confirmed that they are holding additional clinics and advising patients of the expected date of delivery. If patients do not wish to wait for this date then many community pharmacies are also offering flu vaccinations to eligible patients to ensure our vulnerable populations are protected.

Primary Care Overview: NHS England has started to share raw data with the CCG in regards to primary care complaints but this contains limited information and is still being reviewed to understand how we can use the information effectively. In Q3 the main themes highlighted in the raw data were: • Clinical treatment errors 10 • Communication issues 5

I am on weekly chemotherapy for secondary breast cancer and my GP is monitoring my BP and medication. If it is too high, I might not get my chemo. I went online on Friday 23rd Nov and there were no appnts until Monday 24th Dec. Only after speaking to the Dr did I get an appt. prior to my chemo date.

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Leeds Clinical Commissioning Group:

The CCG received 21 but above graph shows differnet amount? comments, concerns and complaints during Q3 which related directly to commissioning activity. The most common area of complaint for Q3 Individual Funding Requests including IVF and Continuing Healthcare was the second highest theme.

Source: CCG Datix

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Continuing Healthcare Medication Individual Funding Request

Highest Reported CCG Complaint Themes Q3

The CCG Patient Experience team use Care Opinion, which encompasses NHS Choices, Social Media, Datix and any other relevant feedback mechanisms to provide reports for Commissioners, Contract Managers and Quality Managers when they attend meetings with our providers. This ensures that feedback is provided in real time.

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Leeds Health and Care System: Care Opinion

Source: Care Opinion

What are patients telling us in Leeds? Care Opinion provides a forum for patients, families and carers to provide feedback (negative and positive) anonymously. The website asks users to post or tag words to describe ‘what was good?’ and ‘what could be improved?’. The bubb les show a summary of the feedback provided during Q3 for all providers in Leeds. The size of the bubble represents the level of feedback within that area. During Q3 ‘kind’ was reported as a good area, and this quarter shows positive feedback for the first responder service. There has been a significant reduction in the negative feedback for this quarter.

The Care Opinion site enables the CCG to monitor the feedback being posted for all services within Leeds. It also enables the CCG to monitor the service response rates and how changes have been implemented as a result of the feedback. In Q3 205 stories were published on Care Opinion (or NHS Choices). This shows that there is a high level of patient feedback being provided. 162 stories have been responded to which is a positive response , 7 stories have still not been read. In Q3 no changes have been planned or initiated as a result of the postings for any of the services or providers The CCG will continue to work with providers during 2019/20 to capture changes that are initiated via CO posts.

Q3 Care Opinion overview – Status report

205

7 36

162

0 Stories have been added

stories have not beenread

stories have been readonly

stories have been readand a response provided

story has been read,responded and a changein practice confirmed

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Leeds Health and Care System: The Big Leeds Chat

The Big Leeds Chat is a way of listening to people in Leeds, bringing together decisions makers across health and social care, to work together as one system to talk to people about what matters to them. An event was held on Thursday 11 October 2018 at Leeds Market and was attended by an estimated 500 people. Key themes from the event include: • People generally love living in Leeds • Many people know what they need to do to stay fit and healthy • Families and communities are important in maintaining health and wellbeing • GP practices are important places to promote health and wellbeing • Self-care and wellbeing are sometimes restricted by other commitments • The cost of healthy activities is a barrier to health and wellbeing • There is not enough information about what activities are available in

communities • Poor public transport is a barrier to health and wellbeing • The environment that people live in has a direct impact on their health and

wellbeing • Healthcare services need to be accessible • Mental health services in Leeds are important • Employment has a significant impact on health and wellbeing • Stable housing has a significant impact on health and wellbeing • Schools should be more involved in promoting health and wellbeing The full report can be found here and the People’s Voices Group will lead on ensuring that the feedback is analysed and shared with relevant decision makers.

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Leeds Health and Care System: CQC System Review

During Q3 the CQC conducted a review of the system within Leeds. The purpose of the review was to understand how people move through the health and social care system in Leeds with a focus on the interfaces between services. The local system review considered system performance along a number of ‘pressure points’ on a typical pathway of care with a focus on older people aged 65 and over. The CQC looked at the interface between social care, general medical practice, acute and community health services, and on delayed transfers of care from acute hospital settings. Using specially developed key lines of enquiry, they reviewed how the local system is functioning within and across three areas:

• Supporting people to maintain their health and wellbeing in their usual place of residence • Care and support when people experience a crisis • Supporting people to return to their usual place of residence and/ or admission to a new place of residence following a period in

hospital.

The Partnership Executive Group(PEG) has reviewed the report in detail and created a detailed action plan to address the recommendation within the report, including the experiences of older people in health and care. One of the primary focus areas for action is how as a city do we hear the experiences of patients/people that we deliver health and care interventions to. This work is being led by Paul Bollom and supported by Healthwatch Leeds. As this work progresses updates will be provided to the committee.

The review identified a number of key findings which related to patient experience, including but not limited to: There were opportunities to improve people’s experiences, particularly with regard to improved working between care homes and the ambulance service where different professional

boundaries could cause conflict and impact on people’s care. This also impacted on some people’s experience at the time of crisis. A lack of clarity of roles and accountability at the point of crisis resulted in negative experiences for people when arguments between professionals took place in front of them

Some people and carers reported poor experiences and gave examples of waiting in A&E in excess of eight hours on trollies. Poor experiences of discharge from A&E was reported and some people were discharged during the night. One person was discharged after midnight, they had no relatives with them and

no way of getting home. They had to book a taxi for themselves and had found this experience extremely distressing. There were multiple examples of people having a poor experience while in hospital. Examples including people not having their privacy and dignity respected, a person being moved five

times in two months, another person had been moved at five in the morning prior to an operation People were more likely to get better support at the end of their lives, as professionals worked together to facilitate this. There was an opportunity to develop this work more widely so

that people’s experiences throughout their care pathways improved. People using services, relatives and frontline staff reported concerns with the discharge process, which at times was not well coordinated. People experienced delays due to waiting for

medicines and transport. People were sometimes discharged at inappropriate times. Sometimes people were discharged inappropriately dressed. On the day of our visit to the hospital we saw four people waiting in the discharge lounge in pyjamas and one was in a hospital gown.

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Patient Insight Group Update

IAPT work

Subject Overview PIG Actions

Role of Patient Participation Groups in primary care

How the groups can utilise patient experience information to improve patient experience within their practices

Engagement and patient experience team to meet to discuss in more detail about how systems and reports can be shared. Patient experience team to share a previous patient experience report for information. Following this discussions will be had with PPG reference group to understand how this information can be utilised.

Care Homes in Leeds Poor patient experience A significant number of safeguarding alerts and patient complaints were received which related to a number of community care beds. The Quality Surveillance Tool (QST) was instigated and the number of utilised beds capped, weekly intensive support visits underway and patient experience activity reviewed carefully. ACTION An intensive review was completed and progress has been made but will follow up on 4 weekly visits over next 6 months. A recent night unannounced visit was completed and was very positive. OUTCOME No further negative experience has been received and the provider will be continually monitored via the QST

Lack of flu vaccines in Leeds

High number of complaints A high number of complaints/pt feedback received via various mechanisms with the following actions being agreed: • Collate patient feedback and share with Public Health England(PHE) for future reference • Review datix to identify any GP incidents relating to the flu vaccine availability or other incidents • Datix information shared with primary care development team for discussion • Awareness shared in GP Bulletin

A proposed new approach to using the Equality Delivery System (EDS) in Leeds in 2018 was presented and approved by the CCG Quality and Performance Committee.

The new Leeds approach means that rather than gathering a lot of evidence across a very broad range of services as done in previous years until 2018, more detailed information is collated for a smaller number of services. This will mean that all NHS organisations in Leeds can hopefully make real and measurable improvements that will benefit particular groups of patients, staff and /or communities.

Nationally Equality Delivery System (EDS) 3 is being developed and will take a similar approach to the one we are now using. In addition, rather than reviewing and grading all four EDS goals every year, it will now be completed on a three year cycle, Goal One in 2018, Goal Two in 2019 and Goals Three and Four in 2020. The information collated by each NHS organisation is presented to our "trusted partners" (Voluntary Action Leeds; Leeds Involving People; Forum Central; Healthwatch Leeds; and Leeds City Council) at an annual Engagement and Assessment Workshop where any gaps and areas for improvement are identified. A performance update is then provided the following year on all gaps and areas for improvement.

The Patient Insight Group receives and reviews all intelligence received within the CCG, as well as our providers, and considers what action needs to be taken. A summary of the work that is being reviewed at the Patient Insight Group is included below

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Ongoing Work of Patient Experience Team

The Patient Experience team continues to work on a number of areas to support the patient experience function, especially on a West Yorkshire and Harrogate Health and Care Partnership footprint.

Leeds Healthwatch Complaints forum: This group consists of all Leeds providers and commissioners (CCG, social care and NHS England) and is chaired by the Chief Executive of Healthwatch Leeds. The group ensures that we are applying consistent processes to support the Leeds ‘no wrong door’ policy when patients are providing feedback.

National Complaints Managers Forum: Support network for complaint managers with two national events each year. Information about the forum can be found online.

Heads of Patient Experience (HOPE) Network: The network is open to people working in NHS trusts or clinical commissioning groups (CCGs) whose role includes significant responsibilities for patient experience. The network:

• offers peer learning and support to members in their work, by enabling them to meet with others working in similar roles with similar challenges

• provides an opportunity to learn from innovations and best practice • provides members with an opportunity to collectively develop solutions to the problems and challenges they face in

their work. • provides opportunities to meet national and international experts in the field of patient experience research and

improvement. Information regarding the HOPE network can be found here.

West Yorkshire Patient Experience Network: This forum is led by NHSE and is made of 2 parts; local on a West Yorkshire footprint but also forms part of the Yorkshire an Humber forum. This group aims to share good practice for patient experience and engagement.

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Next Steps

Reporting: The report will continue to be developed throughout the year. A number of areas have been identified which require changes to our internal systems and processes to further align our reporting of patient experience: • Review internal CCG systems and processes to align all patient feedback, including complaints, to the themes within the Patient Experience

Framework • Review internal CCG systems to ensure a criticality score is assigned to all patient experience information • Continue to develop , collate and report patient experience data aligned to pathways rather than individual organisations • Review of current CCG PALS service post March 2019 • Integrate annual complaints report and patient experience report with a focus on the changes that have been made in year.

Quality and Performance Committee The CCG Quality and Performance Committee is asked to: a) Review and note the contents of the report b) Consider the report alongside the other information reviewed by the committee to support further triangulation c) Comment and make recommendations on layout and contents of the report d) Request deep dive reviews, when appropriate, of patient experience following identification of concerns

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Appendix A NHS National Quality Board’s Patient Experience Framework

Patient and carer feedback is to be analysed against the themes of the NHS National Quality Board’s Patient Experience Framework. The eight themes are as follows:

Number Theme Detail

1 Respect for patient-centred values, preferences, and expressed needs

Respect for patient-centred values, preferences, and expressed needs, including: cultural issues; the dignity, privacy and independence of patients and service users; an awareness of quality-of-life issues; and shared decision making

2 Coordination and integration of care Coordination and integration of care across the health and social care system

3 Information, communication, and education

Information, communication, and education on clinical status, progress, prognosis, and processes of care in order to facilitate autonomy, self-care and health promotion

4 Physical comfort Physical comfort including pain management, help with activities of daily living, and clean and comfortable surroundings

5 Emotional support Emotional support and alleviation of fear and anxiety about such issues as clinical status, prognosis, and the impact of illness on patients, their families and their finances

6 Welcoming the involvement of family and friends

Welcoming the involvement of family and friends, on whom patients and service users rely, in decision-making and demonstrating awareness and accommodation of their needs as care-givers

7 Transition and continuity Transition and continuity as regards information that will help patients care for themselves away from a clinical setting, and coordination, planning, and support to ease transitions

8 Access to care Access to care with attention for example, to time spent waiting for admission or time between admission and placement in a room in an in-patient setting, and waiting time for an appointment or visit in the out-patient, primary care or social care setting

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Appendix B Criticality Scoring Criteria

Score Title Examples

0 No critical content Entirely positive or neutral postings with no hint of criticality.

1 Minimally critical

Mention of dissatisfaction with non-clinical non-personal aspects of care, typically “facilities” issues such

as food, parking, or waiting.

2 Mildly critical

More specific but still mild criticism, which may also include non-clinical but interpersonal issues such as

attitude of staff, compassion, politeness. This might include the timely nature of the service whether in

hospital or in the community where it has caused distress, eg carers not turning up on time

3 Moderately critical

Criticism which may include alleged shortcomings in clinical or non clinical aspects of care, the author

may not say what the effect of these are. Also includes serious comments about facilities: ‘never

cleaned’; and where people’s essential basic care needs are not being met, eg inadequate nutrition and

hydration, development of bedsores.

4 Strongly critical

Serious criticisms of specific unnamed staff or groups of staff, or of clinical or other care or facilities. This

might have had very serious consequences for physical or emotional health. These will be described by

the author. There might also have been social consequences that have increased the risk or vulnerability

of an individual

5 Severely critical

Posting alleges or describes actions or events which may be illegal, grossly negligent, or allege serious

misconduct by named members of staff or organisations.

Criticality scores adopted by Care Opinion