WHAT OUR PATIENTS SAY Patient Experience Annual … · 1 WHAT OUR PATIENTS SAY Patient Experience...

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WHAT OUR PATIENTS SAY

Patient Experience Annual Report 2013/2014

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Contents

Foreword

1. Introduction

2. Sharing their experiences

3. What we measure

4. Innovation

5. Complaints and compliments management

6. Feedback results

6.1 Paramedic Emergency service

6.2 Patient transport service

6.3 Urgent care service

6.4 Feedback from community groups

7 Learning from experiences

7.1 Action Plans

7.2 How we learn

8 Summary and Future Focus

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Foreword by Director of Quality

I am delighted to present the Trust’s annual patient experience report for 2013/14. We are

committed to gathering and considering all the feedback we receive with a view to providing high

quality services which meet the needs of our patients.

This report seeks to present the feedback we have received from patients and the wider public

about their care and our services and identify key themes. Importantly, the report also focuses on

how we learn from these experiences and improve our services as a result.

The report is presented to the Board of Directors as well as being shared internally and externally

with all stakeholders, and published on our website.

Thank you for taking the time to read the report.

Sarah Faulkner

Contact details:

Sarah Smith, Assistant Director Corporate Communications [email protected]

Fiona Buckley, Head of Risk and Safety [email protected]

mailto:[email protected]

mailto:[email protected]

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1. Introduction

The experiences of our patients, their carers’ and their families are gathered from surveys, focus

groups, community engagement, complaints, concerns and compliments. This enables us to create

a full picture of our patients’ views and to understand the top issues, key themes and identify areas

of improvement.

The report is separated into the services we provided:

Paramedic Emergency Services (PES) – patients calling 999 who received a face to face

assessment response

Patient Transport Services (PTS) – patients who use our non-emergency service to take

them to hospital appointments or for discharge after a hospital stay

Urgent Care – patients calling 999 who are referred to our urgent care desk for further

assessment and those patients who contact the NHS 111 service.

There is also a section on the work we have undertaken with diverse groups in the communities to

understand service experiences which spans across all service areas.

A key section of the document is how we are learning from experiences which summaries the

actions and improvements we have identified and implemented as a result.

Finally, the report outlines the Trust’s future plans for gathering patient experience.

2. Sharing their experiences

Feedback has been received via:

This demonstrates the level of engagement, both proactive and reactive, the Trust undertakes and

we always ensure the activities are representative across the large geographical area we cover.

In total we engaged with over 7000 patients and members of the public to understand their views

and experiences, as well as broader feedback via social media, website enquiries and public

roadshows.

3661 surveys completed by patients calling 999, using patient transport services and referred

to our urgent care desk

2080 complaints received across the Paramedic Emergency Service, Patient Transport Service

and North West 111 Service

1082 compliments received

126 specialist patients attended focus groups

15 focus groups with community groups

12 public engagement events where feedback was collated

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3. What we measure

We set targets for the number of patients we wanted to receive feedback from, as part of our survey

programme, as well as ensuring this was representative across all service areas. The table below

summarises the different approaches in comparison to the previous year. Overall there is a

significant increase in the number of surveys issued and completed.

The Trust uses a number of sources to establish the questions and topics on which to seek feedback;

these include key themes from previous surveys, the Kings Fund’s published research “What Matters

to Patients”, complaint themes and service improvement needs.

Topics include

Friends and Family Test (FFT)

Overall Satisfaction

Communication and Information

Dignity and respect

Care and compassion

Both quantitative and qualitative data is collected and analysed across these themes.

Patient Experience Programmes

COMPARISON DASHBOARD

Service Area

Survey

Channel2011/12 2012/13 2012/13 2013/14

Face to Face 581 467 467

Postal 101 101 1545

Telephone 27

581 568 568 1572

Telephone 37

Postal 67 67 72

37 67 67 72

Face to Face 95 137 44.2% 137 95

Postal 31

95 137 137 126

PTS Observations Silent 203 87 57.1% 87 52 40.2%

203 87 87 52

Face to Face 259 236 9.9% 236

Postal 862

Telephone 199

259 236 236 1061

Telephone 52 5

Postal 120 120 1023

52 120 120 1028

OVERALL TOTALS 1227 1215 1.0% 1215 3911 321.9%

Paramedic Emergency Service - PES

2013/14 Survey - Postal

PES ALO, PRFs & PES

449.6%

Urgent Care Desk Service

2013/14 Survey - Postal130.8% 856.7%

8.0%

PTS Regular / Specialist User

2013/14 Survey

Focus Groups & Postal

Overall

Movement

Overall

Movement

PTS Outpatients


PTS 1%, PTS ALA & Cumbria

2.2% 276.8%

PTS Discharge Surveys


Postal & Discharge Vehicles

81.1% 7.5%

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Focus groups and community engagement sessions however have a much more fluid approach, with

users and members of the public raising issues on any topics they wish to.

The table compares three of the survey questions with last year’s results. Although this shows a

decrease in satisfaction, they are still relatively high levels. There was a substantial increase in the

number of surveys undertaken in 2013/14 and some variations in methods which give a more

representative position of satisfaction with services. Also the changes in the patient transport

service contract (and therefore patient expectations) may also be reflected in these results.

In terms of measuring complaints, each service line’s Senior Management Team is updated on a

monthly basis on the complaints received for their area along with identified trends. Trust wide

complaints data is reported to the Clinical Governance Management Group (bi-monthly) and to the

Quality Committee and Board of Directors (every six months) along with assurance reporting on the

process for complaint handling.

4. Innovation

The Trust has accessed CQUIN (in full) monies to support some of the innovative work in patient

experience including development of the board games, public education and behaviour change

projects, improvements to mental health services, patient stories and testing out different methods

to gain feedback, including the family and friends test.

Friends and Family Test

In anticipation of the Friends and Family Test question being introduced to ambulance trusts by the

end of March 2015, the Trust has actively tested the question through a number of routes:

On all its surveys in 2013/14

Using postcards on vehicles

Operating two Pathfinder projects on behalf of NHS England and Commissioners to test out

methodologies for the FFT to inform future guidance on this important test

More about the FFT is outlined in the Future Focus section.

The introduction of Datix web has allowed for the development of more detailed reporting of

complaints, focussing on the Trust’s ability to understand the outcome of investigations in more

detail in order to identify lessons to be learned.

2012/13 2013/142012/13

(Scored 8,9 or 10/10)

2013/14

(Extremely likely/Likely)

2012/13

(Strongly Agree / Agree)

2013/14

(Strongly Agree / Agree)

PTS OutpatientsPostal (1572)

89.6% 89.7% 89.4% 93.0% 97.4% 95.7%

PTS DischargePostal & Discharge Vehicles (72)

92.3% 88.7% 92.3% 94.5% 90.8% 94.4%

PTS Regular User Specialist (126)

92.4% 76.2% 93.4% 84.9% 99.2% 96.0%

PES Surveys ALO's/PRFs, Postal & Telephone (1061)

96.2% 95.0% 97.4% 95.9% 99.1% 97.1%

Urgent Care Desk Service Postal (1028)

89.2% 76.4% 89.2% 85.9% 92.5% 88.2%

2013/14

Patient Experience Programme

Survey Channels(Postal/Telephone)

SATISFACTION RESULTS

Overall Care - Rated Ambulance Service

8, 9 or 10 out of 10

(Percentage)

Recommendation to

Family or Friend

(FFT)

Cared for appropriately with Dignity,

Compassion and Respect

(Percentage)

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5. Complaints and Compliments

The Trust has a well-established complaints policy and appropriate processes in place to both

answer complaints as well as identifying areas where lessons can be learnt. The responsibility for

managing all such enquires sits with the Making Experiences Count (MEC) Team who act as a point

of contact for patients, relatives, carers, other NHS providers and members of the general public to

share their opinions, thoughts and concerns on their experiences of the service.

All enquirers have an assigned point of contact in the MEC Team who is responsible for ensuring the

investigation is appropriately completed and maintaining contact. All complaints are risk assessed to

guide the level of investigation and management approval.

In light of one of the recommendations arising from the Public Inquiry into Mid Staffordshire NHS

Foundation Trust, NWAS amended how queries being received are categorised. The previous Patient

Advice and Liaison Service (PALS) function was removed with all enquiries being recorded as

complaints or general enquiries.

During the year, nine complaints were referred to the Parliamentary and Health Service Ombudsman

as the complainant remained dissatisfied with the explanation offered by the Trust. The

Ombudsman did not uphold any of the complaints against the Trust. Two minor learning points have

been identified which have been addressed.

During the year ending March 2014, the Trust received 2080 complaints. The table below details

where the complaints were received each month:

Apr 2013

May 2013

Jun 2013

Jul 2013

Aug 2013

Sep 2013

Oct 2013

Nov 2013

Dec 2013

Jan 2014

Feb 2014

Mar 2014

Total

Cumbria and Lancashire (CAL)

72 47 49 68 47 69 74 62 51 60 86 79 764

Cheshire and Merseyside (CAM)

90 65 60 63 62 62 62 68 51 66 107 97 853

Greater Manchester (GM)

30 33 21 31 25 29 43 27 31 35 32 37 374

Trust Wide 0 1 0 0 0 0 0 0 0 0 0 0 1

111 Service Call Centres

0 0 0 0 0 0 0 9 21 26 19 13 88

Total 192 146 130 162 134 160 179 166 154 187 244 226 2080

As can be seen, with NWAS taking on the responsibility for the North West 111 provision from the

end of October 2013, those complaint numbers are also included.

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By combining the previously reported separate number of complaints and PALS received, it is clear

that the overall number of queries decreased for the second year running though the overall trend

over six years has slightly increased.

In comparison to the combined data for year ending March 2013, there was a 24% decrease in

complaints reported for year ending March 2014. (NOTE: Some queries previously categorised as

PALS, are now classed as general enquires and therefore are not shown in these figures.)

Upon receipt all complaints are risk scored using a 1-5 matrix. This is in line with the consequence

section of the Trust’s Risk Management Policy. The risk score can be amended as the investigation

processes. The chart below details the risk score of the complaints received in year by area.

The disparity between the overall total for Cumbria & Lancashire / Cheshire and Merseyside and

Greater Manchester is related to the provision of PTS Services as the Trust currently does not

provide this service for Greater Manchester.

Minimum Minor Moderate Major Serious Total

CAL 220 406 102 36 0 764

CAM 225 492 121 15 0 853

GM 53 177 110 31 3 374

Trust Wide 1 0 0 0 0 1


48 36 3 1 0 88

Total 547 1111 336 83 3 2080

Upon receipt, all complaints are categorised by a primary category, though there may be multiple

strands to one complaint. The figure below details the reason for complaints:

0

500

1000

1500

2000

2500

3000

3500

2008/09 2009/10 2010/11 2011/12 2012/13 2013/14

Complaints /PALS recevied

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The Trust also closed 2818 complaints and PALS records in the year, of which 434 were upheld or

partly upheld. Details of reasons why complaints were upheld is detailed in Section 6.

Alongside complaints and queries, the Trust also receives compliments which are detailed below.

Staff have been commended for the care, kindness, being respectful, helpful, attentive, calm,

friendly and professional. There were thanks for attending to dying patients, saving lives, helping

with births (both over the phone and face to face), making scary situation better and for caring for

the families of patients during often traumatic situations.

Thanks have also been received for multiple occasions of care and very long journeys – particularly

on PTS.

Apr 2013

May 2013

Jun 2013

Jul 2013

Aug 2013

Sep 2013

Oct 2013

Nov 2013

Dec 2013

Jan 2014

Feb 2014

Mar 2014

Total

Cheshire 9 5 6 18 20 6 14 13 7 16 11 10 135

Cumbria 18 15 18 22 18 9 23 20 12 8 13 5 181

Greater Manchester

18 14 19 20 13 14 15 13 16 21 25 17 205

Lancashire 32 23 27 30 26 20 31 26 27 35 36 29 342

Mersey 18 19 11 21 18 11 17 16 18 26 24 16 215


0 0 0 0 0 0 0 0 0 3 1 0 4

Total 95 76 81 111 95 60 100 88 80 109 110 77 1082

This amount of feedback gives us a comprehensive assessment of the quality of care our

patients feel they are receiving.

6. Feedback Results

493

282

120

19

135

2

791

221

12 5 Emergency Response

Staff Conduct

Communication andInformationNavigation

Driving Standards

End Of Life Care

PTS Transport

Care and Treatment

Damage or loss to property

Safeguarding

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6.1 Paramedic Emergency Service (PES) Survey Analysis and Complaints

Review 2013/2014

A survey is undertaken with members of the public following their need to contact our Paramedic

Emergency Service either through telephoning ‘999’, or their GP contacting our Service, or contact

made with the ‘111’ service and transferred to 999. Only patients who have received a response by

either a Rapid Response Vehicle or Ambulance are contacted for this particular survey.

Surveys have been previously undertaken by visiting a number of hospitals across the region and

surveying suitable patients face to face that have attended Emergency Departments by ambulance.

Whilst this method produces valuable feedback in terms of qualitative data, it is less representative

in terms of the number and type of patient accessing the 999 service. The Trust was keen to

increase the number of surveys undertaken in 2013/14 and two different methods have been

trialled to obtain feedback from over 1000 patients who have used the service. These included:

Ambulance Liaison Officers (ALOs)

The primary role of the ALO is predominantly to ensure the smooth handover of patients and to

work together with hospital colleagues to minimise any delays. They also had difficulties in

identifying suitable patients during the limited time that they spent in individual Emergency

Departments. The ALO’s were asked to hand out the surveys to patients within Emergency

Departments– the return rate for surveys handed out by the Officers was low, due to sufficient time

alongside their other commitments to identify suitable patients.

Postal Surveys

Patients were initially contacted by letter to obtain their consent to send a further postal survey

within the following two weeks, unless they opted out by either telephoning or returning a tear off

slip to a freepost address. We also offered patients the opportunity to participate in the survey over

the telephone. Both postal and telephone methods produced good results. This method remains the

most successful method to date in obtaining feedback from a more number of patients we treat and

care for throughout the North West.

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A total of 1061 patients were surveyed by 31 March 2014.

The Friends and Family Test (FFT) Question is a national requirement that allows patients the

opportunity to provide feedback on the care that they have received in ‘real time’. Current

guidance for eligible patients is that the question is asked in real time or within 48 hours of receiving

the care. Since April 2013, it has been mandatory all inpatient hospital wards and Emergency

Departments to ask their patients this question and this is set to be extended across all NHS services

in England, including ambulance services, mental health services, community nursing and outpatient

appointments, by the end of March 2015.

In readiness for this NWAS, as part of the 2013/14 Patient Experience programme, this FFT Question

forms the opening for all of our Patient Experience Surveys.

These results are also supported with comments such as:

In addition to the above question, patients were also asked a series of questions to obtain feedback

on their experience relating to dignity, care, compassion, reassurance, making the emergency call,

and communication. The themes are based on the Kings Fund What Matters to Patients research.

They were first class.

They were fantastic. They were brilliant, they made me laugh, they brought gas and air and

gave me morphine, and I think they even had the helicopter on standby as the crew member

in the back said to his mate to cancel it. I can't give them enough praise - it was like time did

not matter - I felt like I was the only person in the world that mattered to them.

It took 2 hours for the ambulance to turn up.

(Number in title reflects survey question numbers)

I would recommend them to anyone.

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Due to the serious nature of my mum’s condition, the crew treated my mum kind and caring in a

difficult situation as my mum was particularly uncomfortable, they transported her safely and

with care and compassion. It was such a life saver to know that I could telephone your service

and someone would come.

The Paramedic Emergency Service received a total of 1002 complaints in this reporting year. The

reasons for complaining are detailed below. Complaints are received through letters, telephone and

increasing via e-mail and through the Talk to Us section of the website. The overall number of

complaints received remains very low, in comparison to the level of activity as the Trust received

over 1.1m calls for assistance. This means that 0.09% of 999 calls received resulted in a complaint.

Despite this the Trust takes complaints very seriously and uses them as an opportunity to

understand what could be improved.

The charts below detail when the complaints were received by area and the reasons for complaints

against the Paramedic Emergency Service:

0

5

10

15

20

25

30

35

40

45

Apr2013

May2013

Jun2013

Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

CAL

CAM

GM

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Themes from Surveys and Complaints

Service users were asked what three factors were most important to them when telephoning for an

emergency ambulance. There are a number of themes highlighted in the feedback:

A fast response is one of the most important factors for our patients. Not only is it one of the most

common factors cited in the top three, to the individual making the emergency call it also impacts on

the satisfaction scores provided. However the feedback does show that there is a need to raise

awareness with the public as to what constitutes an emergency and what requires an immediate

response. For example, there are a number of comments about the time elderly patients who fall

sometimes have to wait for an ambulance and how age should be taken into account that although

the situation can be very distressing, it may not necessarily be an emergency situation. Where low

levels of satisfaction have been scored, this is predominantly followed by feedback that an

immediate response was not forthcoming.

The importance of a timely response was reflected in complaints made against the Trust, for year

ending March 2014. Complaints regarding emergency response time represent 49% (n=491) of all

PES complaints received in year and is the second most common reason for initiating a complaint

against the Trust. The chart below details when the complaints were received and historically, the

months of January and February receive more complaints due to the pressures in the winter months.

491

179

53

17

104

2

145

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Emergency Response

Staff Conduct


Navigation

Driving Standards

End Of Life Care

Care and Treatment


Safeguarding

1. Prompt response

2. Whether you feel as though

everything possible was done?

3. CPR Advice

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Why did it take over 2 hours to respond to my elderly father who was left lying outside

getting cold and wet?

Overall the Cheshire and Merseyside area received more emergency response complaints than the

other areas.

There were 2 complaints risk assessed as Serious (consequence score 5). Both were in the Greater

Manchester area and both involved patients who subsequently died. Greater Manchester also had

the highest number of identified major (consequence score 4) complaints (n=11). These complaints

are defined as having significant delays resulting in non-permanent harm to the patient involved.


CAL 8 75 51 6 0 140

CAM 9 99 75 6 0 189

GM 5 76 69 11 2 163

111 Service Call Centres 0 1 0 0 0 1

Total 22 251 195 23 2 493

Emergency response complaints include concerns about the primary response, ambulance back up

following the attendance of a solo responder on a car, transfers between hospitals and Healthcare

0

10

20

30

40

50

60

Apr2013

May2013

Jun2013

Jul 2013 Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Emergency Response Complaints recevied by month

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The call taker advised that because they were so busy there may be possible delays but said

that she would stay on the phone with me.

Professional booking delays. As can be seen from table above, most complaints were defined as

minor i.e. causing distress rather than harm.

Of the 456 emergency response queries closed within the reporting year, 94 were either upheld or

partially upheld. The most common reason for upholding emergency response time complaints was

that the response did not meet the caller’s expectation. Errors is call handling, dispatch, call coding

as well as staff attitude were identified for a small number of complaints.

Good communication is vital – this can be in the first instance between the call taker and the person

making the emergency call but also between the ambulance staff and the patient/patient’s family.

Feedback showed that when the call taker provided the patient with information such as whether

the service was particularly busy at that time or where there may be delays then this helped to

manage patient expectations surrounding response times, this also related to feedback from

relatives or carers who were also present and received information and reassurance themselves.

Being treated with dignity, respect, kindness and compassion is an aspect of care that is very

important to our patients, 97.08 % of patients surveyed either agreed or strongly agreed that they

were treated in this way.

Staff conduct queries were the second most common reason for PES complaints this reporting year

and represented 17.9% (n=179) of PES complaints received. The staff conduct category encompasses

complaints about attitude, behaviour and comments and relates to staff both in the Emergency

Operations Centre as well as on the road. The chart below when these complaints were received

detailing October and March as the highest reporting months.

0

5

10

15

20

25

30

Apr2013

May2013

Jun2013

Jul 2013 Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Staff Conduct complaints recevied by month

The two paramedics who cared for my father were wonderful. There kindness, professional

command of the situation, their genuine compassion was so reassuring and comforting to his

family and to my father.

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I didn't want to go to hospital and

once I was stabilised they spoke to

the A&E doctor and then respected

my wishes to let me stay at home.

Why did the ambulance crew make the

patient walk to the ambulance when he

has poor eyesight and is so unsteady on

his feet? During the transfer, he fell

sustaining an injury to his knee. The

patient was later diagnosed as having had

a stroke

Complainant felt that the attending crew

were dismissive of the patient’s family;

lacked empathy, respect and were rude.

This added to the stress of the situation.

Complaints about staff attitude were fairly evenly

distributed across each of the three areas with

Greater Manchester having the most complaints and

the most serious complaint. Staff conduct complaints

assessed at being either major or serious are those

where staff have displayed behaviour that would

warrant either general or gross misconduct.


CAL 14 22 14 1 0 51

CAM 12 40 10 1 0 63

GM 13 40 9 2 1 65

Total 39 102 33 4 1 179

The Trust also closed 302 staff conduct or attitude queries in the year, 32 were upheld. These were

mainly where it was found that the staff’s attitude did not reach the standard expected by the Trust.

Other findings included inappropriate staff comments, inappropriate staff behaviour and one case of

intimidation.

Patients were also asked to provide feedback on

whether they were involved with decisions about their

care and treatment options. Although the overall

score for this is lower than other responses, 86.42%

agreeing or strongly agreeing, there are a number of

reasons for this. Patients seem unsure of what we are

asking. Patients have a lot of confidence in the

paramedic crews and put their trust in the decisions that they

make, they don’t always feel as though they need to be involved in the decision making process as

the paramedic has the knowledge to make the best choices for them. Also, the emergency situation

or the medical condition of the patient may mean that it is not appropriate for the patient to be

involved with decisions and choices have to be made on their behalf.

Care and Treatment complaints represented

14.5% (n=145) of PES complaints received in year.

Receipt of these complaints varied throughout

the year with more being received in July and

November rather than other months. Given the

higher volumes in activity over the winter

months, there would be an expected rise in

complaints in February and March.

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Both Cumbria and Lancashire and Greater Manchester had more major level complaints than

Cheshire and Merseyside with slightly lower overall numbers. Some of the issues raised in the major

category have included patients falling in the crew’s care, patient sustaining injury in the crew’s care,

inadequate assessment of presenting injuries, poor dynamic risk assessment leading to poor manual

handling techniques undertaken and lack of immobilisation.

Minimum Minor Moderate Major Total

CAL 2 18 11 15 46

CAM 1 18 18 4 41

GM 2 22 19 15 58

Total 5 58 48 34 145

198 care and treatment complaints were also closed in the year, with 48 of them either upheld or

partly upheld. The reasons for upholding these complaints included inadequate assessment and

treatment, inappropriately leaving the patient at home, taking patients to an inappropriate

destination (e.g. Urgent Care Centre rather than Emergency Department), failure to employ

appropriate manual handling techniques and standard of completion of paperwork.

The Paramedic Emergency Service also received a further 187 complaints that were about the

following areas:

0

5

10

15

20

25

Apr2013

May2013

Jun2013

Jul 2013 Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Care and Treatment complaints recevied by month

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Our neighbour is a frequent caller of the

ambulance service, however the

attending crews often park

inappropriately causing disturbance.

Can this please be addressed?

Information for access to the key code

was given to the 999 operator – why

wasn’t this passed to the crew? The

patient had to crawl to the front door

to let the crew in.

As can be seen from the chart above, the most

common reason for other complaints is driving

standards (n=104). These complaints vary from

concerns about how vehicles are being driven, where

they are parked and the use of lights and sirens.

Communication and information complaints (n=55) included

concerns about information passed to and from the Emergency Operations Centre,

information being passed between healthcare providers, patients requesting attendance to a

particular hospital and not the nearest Emergency

Department, difficulties in locating patients and

length of time it took to pass a call from one

ambulance service to another.

There were 17 navigation complaints which included

crews attending incorrect addresses, difficulties in

finding specific addresses and addresses which can be

confused (i.e. different flats in communal living areas).

The 7 damage / loss of property complaints varied from personal items to damaged doorways, walls

and furniture in homes.

Both End of Life care complaints related to the transport provision and the one safeguarding

complaint concerned a previous safeguarding referral completed by ambulance staff.

Of the 163 other complaints closed in this year, 21 were upheld for a variety of reasons including

misuse of lights and sirens, poor driving standards, dispatcher error, delays with inter-hospital

transfer, sub-standard driving skills, inappropriate staff comments and attitude.

0

20

40

60

80

100

120

Communicationand Information

Navigation DrivingStandards

End Of Life Care Damage or lossto property

Safeguarding

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6.2 Patient Transport Service (PTS) Survey Analysis and Complaints Review

2013/2014

The North West Ambulance Service NHS Trust provides PTS in Cheshire, Mersey, Lancashire and

Cumbria areas. As part of the current contract we aim to obtain feedback from a minimum of 1% of

patients who have used the Service.

The Patient Transport Service (PTS) Survey is undertaken with patients who have used our PTS to

attend outpatient or hospital appointments throughout the North West area.

Key Findings

High levels of overall satisfaction are reported

Qualitative feedback suggests that some patients expect an immediate response

when calling 999 regardless of whether their condition is immediately life

threatening.

Low levels of understanding of the responsibilities and distance an ambulance can

cover within one shift.

Low levels of awareness of the role of Community First Responder.

Patients who have fallen and cannot mobilise have no alternative but to ring 999,

frequently they are uninjured and just need assistance. Some patients have

reported waiting a long time for an ambulance response and many are elderly.

The overall number of complaints received by the Trust has reduced this year in

comparison to last year (taking the combined figure of complaints and PALS for

2012/13).

Complaints arising from the work of the Paramedic Emergency Service remains very

low in comparison to the number of requests for assistance

Emergency Response time remains the most common reason for contacting the

Trust. In most cases, patients were attended to by the first available vehicle though

this did not meet the patient's expectation

The Trust upheld 10.4% of all the PES complaints and PALS enquires closed in the

year

A Community responder arrived first

and he didn't give me anything for the

pain, he didn't help me he just put

something on my finger. Crew came

from Cheadle to Macclesfield despite

an ambulance station being very near.

This took about 35 - 45 minutes (blues

and twos) - too long.

They are very good. Sometimes when my

husband is on the floor we have to wait a

long time for the ambulance to arrive,

although we understand why.

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During previous patient experience programmes Surveys have been undertaken by visiting a number

of hospitals across the region and surveying suitable patients that have attended Outpatient

appointments by ambulance. Whilst this method produces valuable feedback in terms of qualitative

data, it is less representative in terms of the number of patients the Trust provides services to.

During the 2013/2014 Patient Experience programme, the team have trialled two new methods to

obtain feedback from patients who have used the service. These included:

Ambulance Liaison Assistants (ALAs)

ALAs are based in hospital out-patient departments. The ALA’s were asked to hand out the surveys

to patients within Outpatient Departments – the return rate for surveys handed out by the

Assistants was very positive, with a total of 470 surveys being returned completed by 31 March

2014.

Postal Surveys

At the point of booking transport patients were informed that they may be contacted by the Trust

to obtain there feedback on the service they had received. A random selection of patient names and

addresses was provided to the team by Health Informatics and these patients were sent a letter and

survey, along with a Freepost envelope to use to return the completed survey. A total of 1120

completed postal surveys have been returned.

At 31 March 2014, in total 1572 surveys were completed by patients using PTS.

22




the care. Since April 2013, it has been mandatory for all inpatient hospital wards and Emergency






These results are also supported with comments such as:

In addition to the above question, patients were also asked a series of questions to obtain

feedback on their experience relating to dignity, care, compassion, reassurance, booking

ambulances, the assessment process and communication.

First Appointment told to be ready 1 hour

before. Further apps. 1 3/4 Hours to 2 Hours

to pick up before appointment. Arrived for an

afternoon appointment 1 ½ hours early. All

times Volunteer Drivers.

Always been treated with care and

respect. Some mornings I need more care

than others and it's always there for me.

All your staff treated me in a friendly and courteous manner and made the journey

interesting. I even had a chance to reacquaint with one of your civilian drivers who was an old

school mate last seen when we finished school in 1970.

23

The Trust received 982 complaints regarding the Patient Transport Service in this reporting year. The

number of complaints received remains very low in comparison to the level of activity undertaken as

0.09% of all journeys result in a complaint.

A small number of residual complaints were received regarding patients in the Greater Manchester

area although NWAS no longer provides this service. As can be seen, the start of the new PTS

contract in April 2013 did give rise to a significant number of complaints. Lancashire received most

complaints over the year (n=320) however this county has the highest level of activity. Complaints

represented 0.07% of all Lancashire journeys.

Themes from Surveys and Complaints

As can be seen from the chart below, it is clear that the overwhelming number of complaints are

related to transport issues (n=790 or 81%). This chapter will therefore concentrate on those

complaints.

The table below details the complaints received by area and risk score. As can be seen there are 4

complaints that were deemed to be major; these included one major patient injury, a lack of

0

5

10

15

20

25

30

35

40

45

50

Apr2013

May2013

Jun2013

Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

Greater Manchester

Lancashire

Mersey

Cheshire

Cumbria

24

transport leading to a loss of appointment and therefore delayed treatment which the complainant

felt impacted on the long term care of the patient, and two complaints regarding sub-standard

driving for Voluntary Car Service (VCS). These reach the major threshold as the standard for VCS

would be lower than for others aspects of the service.

The 12 moderate complaints included long delays, repeated transport issues, transport refused or

wrong transport sent causing loss of appointment.

It is clear however that most of the complaints are of a minor nature with 97.9% being score as

minimum or minor.

Minimum Minor Moderate Major Total

Greater Manchester

1 6 3 1 11

Lancashire 77 168 3 2 250

Mersey 62 118 2 0 182

Cheshire 101 139 2 0 242

Cumbria 46 57 2 1 106

Total 287 488 12 4 791

Service users were asked whether when making a booking were they taken through an assessment

process, 83.12% of patients agreed that they were taken through the assessment process, with

82.36% of patients confirming that they understood why they were asked these questions.

25

Patients were asked whether they were offered the option of the new booking reminder service, this

service was introduced as part of the new contact in 2013. Disappointingly only 20.95% of patients

were offered this service.

Despite patients not being offered the reminder service, reassuringly 91% of patients surveyed

confirmed that they are informed of a time to be ready when travelling with the PTS. However,

when analysing the qualitative feedback the actual information varies quite considerably. With

comments such as:

91% of patients surveyed confirmed that their call into PTS control was handled politely and

respectfully.

Being given a time would have helped

instead of being ready by 8 am and just

sitting waiting.

I’m always ready 1 ½ to 2 hours before &

Being ready to be picked up at 8.30am for

an appointment at 11:15 am is ridiculous,

or On several occasions the time to be

ready and the time picked up, there was

quite a gap in time.

26

Generally patients either strongly agree or agree that they are satisfied with the overall care

provided (96%), however there are still concerns that patients feel they are waiting too long prior to

the transport arriving and after their appointment waiting to go home. The Patient Transport Service

has quality standards to meet for collection times, however patients feel that these waiting times

are too long and most patients are not aware of what the quality standards are. Patients would

benefit from additional information prior to the journey.

I gave a score of 10 - as I am well looked after from being picked up from my door till I returned home.

They are all a great bunch of people who work on the transport. They treat me with respect and have a

lot of patience. Well done to all of them!

On the homeward journey you are kept waiting a long time.

No information as to when to expect ambulance.

27

Waiting for transport, either to or from appointments, is often cited in complaints to the Trust.

Complaints have varied though the most common reasons have been:

Vehicle not arriving at home destination to take the patient in

Vehicle arrive late at home destination to take the patient in

Transport not suitable for the patient’s condition

Vehicle did not arrive at the clinical destination to take the patient home

Vehicle arrived late at the clinical destination to take the patient home

Planning error in PTS control

One other significant issue, raised under the PTS Transport category, was issues relating to the

introduction of the eligibility criteria to decide whether patients could have transport or not. The

criteria was set by the Trust’s Commissioners and lead to transport being refused to more patients

where it was deemed that they were able to arrange their own transport.

There were 192 other complaints as detailed in the table below.

Staff Conduct


Navigation Driving Standards

Care and Treatment


Total

Greater Manchester

0 0 0 1 3 1 5

Lancashire 39 5 2 12 10 2 70

Mersey 14 2 0 4 14 0 34

Cheshire 21 4 0 9 12 2 48

Cumbria 18 3 0 5 9 0 35

Total 92 14 2 31 48 5 192

A 10 would be appropriate but sometimes I

have to wait until the vehicle arrives almost at

my appointment time and the waiting to go

home and not knowing when the ambulance

will arrive, makes me anxious

28

Care and Treatment complaints have included patient injuries where patients have being involved in

minor traffic collisions, sustained skin tears, patients being walked to and from the vehicle when

they should be in a chair, not carrying patient up steps when required and patients not being

appropriately dressed for discharge.

The Trust also closed 932 complaints and queries within the year, of which 206 (22.1%) were either

upheld or partly upheld. Reasons for upholding complaints have included planning errors, poor staff

attitude, comments or behaviour, inappropriate manual handling techniques, sub-standard driving

skills, insufficient information passed to patients, late transport and incorrect eligibility criteria

outcome.

Am happy but it should

be less time waiting to

return home

I had a taxi last time but I was not happy about

it, with one person wheelchair.

Key Findings

High levels of satisfaction with the Friends and Family Test question.

Low levels of patients received booking reminder service option

High levels of satisfaction when patients are liaising with PTS control

High levels of satisfaction and patients feeling reassured when travelling with operational

staff on ambulances

Low levels of awareness with standards and waiting times

Level levels of awareness of the PTS Charter and Information leaflets

Patients comments suggest that some taxi’s operating on behalf of NWAS do not provide a

good service.

The PTS Service continues to have a very low rate for complaints against the service.

The timeliness of attendance to patients both for journeys into and out of hospital is the

most common reason for complaining.

22.1% of complaints closed in year were upheld or partly upheld.

Patient reported that she asked the ambulance crew to help her but she states they were

extremely rude, unhelpful and made unnecessary comments which upset her.

Further transport had to be arranged. The patient reported this was totally different with a

helpful crew.

29

Specialist Patients who use Patient Transport Services

This specialist group of patients include service users of our Patient Transport Service (PTS) who are

either receiving haemodialysis or treatment for cancer. These patients attend their hospital clinics

regularly and use the PTS around three to four times per week.

As well as the survey work, the Patient Experience team have visited five hospitals (see below)

within the North West area to engage with this specialist group of patients who regularly use the

Patient Transport Service. In addition to the hospitals, the Trust also held focus groups with patients

and spoken to clinical staff. We have also visited the Brain Tumour Support Group in Liverpool and

the Head & Neck Cancer CNS in Lancaster. We used a variety of methods to engage with this group

of patients and staff including our new Patient Experience board game and also asked specific

questions to gain feedback on their experience of using our PTS, and also to gauge their

understanding of the new Enhanced Priority Service element of the Patient Transport Service

contract which was introduced in April 2013.

During the 2013/2014 Patient Experience programme a total of 125 patients or their relatives/carers

provided feedback on the service they have received using the Patient Transport Service to travel to

and from appointments for haemodialysis or treatment for cancer.

The graph shows the breakdown of areas in which we spoke to patients throughout the North West

area. Greater Manchester area is not represented as we no longer transport patients to their

appointments in this area.

30

All patients were asked the Friends and Family test question and the graph below shows the results.

Of the 126 patients that provided feedback, 84.92% stated that they are either likely or extremely

likely to recommend the ambulance service to their friends and family should they need similar care

or treatment. High levels of satisfaction are recorded with comments as follows:

Ambulance men and women are

brilliant with you. People like to

have the same drivers.

You get to know them, they use your first

names - nice and friendly & very helpful.

Ambulance staff are very considerate.

31

Themes

The majority of PTS bookings for this specialist group of patients are made by the hospital clinics,

this minimises the information that can be provided prior to transportation. However, a marketing

campaign raising awareness of the introduction of the next collection service could be implemented

to inform our Healthcare professional colleagues of this recently introduced service. Feedback

suggests that this patient group would prefer a telephone call or text to advise them when transport

will be arriving. Afternoon patients would particularly benefit from this service on both the inward

and outward journey.

Patients were happy to be invited to provide feedback on the service they are receiving; their

comments indicate that this makes them feel valued. Patients expect a reliable Service that will turn

up on time, with friendly, professional staff, the results indicate that most patient are receiving this

level of service with 89.63% of feeling that they are cared for appropriately with dignity, compassion

and respect.

Patients still feel as though the waiting time to go home is too long, however when entering into

discussions this specialist patient group feel as though 30 minutes is an acceptable time to wait.

Most patients said they had not waited more than 90 minutes.

Patients state that since April 2013 their transport experience has either improved or remained the

same (neither agree or disagree), but on expanding on this question most stated that they were

happy and grateful with the service we provide. Despite the Patient Charter and Information leaflets

being displayed in the waiting areas of the hospitals visited, patients reported they were not aware

of either of these publications.

Waiting time to go home - always a bit of a

bind when you have to go to the discharge

lounge. It would be good to know that you

don't have to wait longer than 15 minutes.

Everything's good - sometimes

you have to wait a while but

most of the time it is fine.

32

Key Findings

High levels of satisfaction with the services the operational crews provide.

Low levels of awareness of the new quality standards within the Enhanced Priority

Service for both staff and patients.

Low levels of awareness of the new PTS Charter and information available to

enhance the patients experience.

Low levels of awareness with Hospital staff about the Patient Transport Service who

requested training and awareness raising of the eligibility criteria and booking

system.

Low levels of awareness of the ‘Next Collection Service’

Patients feel valued when asked for feedback on their experience.

Low levels of satisfaction around waiting times to go home.

33

70.0%

15.9%

4.0%

2.4%

1.6% 1.5%

4.7%

Based on your experience of our service, how likely are you to recommend our Ambulance Service to friends and family if they needed similar care or

treatment?

1 - Extremely likely

2 - Likely

3 - Neither likely nor unlikely

4 - Unlikely

5 - Extremely unlikely

6 - Don’t know

No response provided

6.3 Urgent Care

The Urgent Care Desk Service (UCD) Survey is aimed at members of the public who have called 999

and based on the nature of their call, have been referred to the urgent care desk for further

assessment by a specialist paramedic.

The UCD Service will undertake further assessment and clinical triage and based on the medical

needs of the patient, advice or refer the caller to the most appropriate pathway or service for their

needs.

This ranges from Hear and Treat, See and Treat or Refer, See and Transport. Clinicians manually tag

their incidents using codes which are then grouped into the one of the three outcomes:

Hear & Treat See & Treat Conveyance (Transport)

ALTTRA

Alternative

Transport

Found

HATD

Hear &

Treat

Discharge

HATR

Hear &

Treat

Refer

SATR

See &

Treat

Refer

SATD

See &

Treat

Discharge

PESI

PES Response

Inappropriate

PTLIFT

Patient

Lift Only

GRA

Green

Response

Appropriate

UPGR

Upgraded

due to

Clinician

Concern

Previously in the 2012/13 Patient Experience Programme, over a four week period, users of the

Urgent Care Desk service were asked by Urgent Care Desk (UCD) Paramedics if they would consent

to taking part in a postal survey. For this year’s programme, to increase the survey sample size (in

2012/13 120 derived via the 351surveys sent out, a 34.2% return rate), a different approach was

taken to capture records that were suitable for survey purposes.

Every caller was advised that they may be contacted and asked about their experience. Where the

caller indicated that they wanted to be excluded, this was added to the notes. This has been

included in the UCD Service Standard Operating Procedure (SOP). Once all the clinical requirements

had been met, at the end of the triage process/call, the following was added to the script: “You may

be contacted and asked about your experience today”.

From July to December 2013 a total of 3,698 postal surveys were sent out which saw a yield of 1,028

completed returned surveys, a success rate of 27.8%, with completed returns still coming in up to six

months after surveys were initially sent out. Reponses were received from across all five areas that

34

29.4%

41.6%

8.9% 5.1% 2.9%

12.1%

When you called 999, you understood why you were not immediately provided with an ambulance and that you would be called within 60

minutes for further assessment.

Strongly Agree

Agree

Neither Agree or Disagree

Disagree

Strongly Disagree


make up the North West Ambulance Service (NWAS) geographical responsibility, with 0.5% of them

completed as telephone surveys.




the care. Since April 2013, it has been compulsory for all inpatient hospital wards and Emergency






In addition to the above national question, patients were also asked a series of questions to obtain

feedback on their experience relating to dignity, care, compassion, reassurance, awareness and

understanding of our service and communication. The following pie charts show the results:

The results show that a total of 71.05% of service users agreed that they understood they would not

immediately receive an ambulance and would be called back within 60 minutes for further

assessment. Analysis of the qualitative data demonstrated that patients have a good understanding

of why they were not receiving an immediately response, but were provided with reassurance and

felt confident that they would receive the appropriate care to meet their needs. This question is

supported by the following comments:

I received call back within 15

minutes – Great service.

The person who answered my

call was very helpful and clear in

his advice.

Care call made the 999 call. Ambulance

Service kept in touch all the time.

35

59.2% 29.0%

3.5%

0.8% 0.4% 7.1%

“The member of staff was polite and respectful.”

Strongly Agree

Agree

Neither Agree orDisagreeDisagree

Strongly Disagree

42.8%

40.7%

5.6%

1.3% 0.4%

9.3%

“I fully understood the advice provided”

Strongly Agree

Agree


Disagree

Strongly Disagree


A small percentage (8%) of patients who

provided a negative response to the above question provided feedback which would suggest high

levels of pain and discomfort and delays in providing a call back impacted adversely on the patient’s

experience.

88.22% of patients surveyed agreed that staff were polite and respectful. Patients report that they

were provided with care by helpful and caring staff, in a courteous and polite manner with

reassurance and support.

High levels of satisfaction are reported from service users that they both fully understood the advice

provided and that the staff listened to their concerns. However, the results show that there is still

an expectation that when calling the emergency service an immediate response will be provided and

that a small number of patients experienced anxiety at the prospect of receiving a call back.

Feedback provided suggests that if a patient’s condition is suitable for an alternative pathway of care

and this care or advice is not followed up within the agreed timeframe this has a negative impact on

the patients experience if they are not kept informed of any unexpected delays or call backs.

It was comforting

to have everything

explained.

I understood that my

case was not an

emergency and that is

why the wait was so

long.

Being told to phone back if

you get worse is pretty

depressing when you've

asked for help.

It took the Ambulance

longer to arrive than

advised on the Phone.

First call 1pm, 5 or 6 calls

made, ambulance came

about 8pm.

I did not know how long I

would have to wait.

36

44.4%

36.7%

5.9%

1.8%

0.5%

10.8%

“The member of staff who called you back listened to my concerns”.

Strongly Agree

Agree


Disagree

Strongly Disagree


22.8% 54.7%

0.6% 2.2% 0.2%

8.4%

0.8%

0.0% 2.4%

8.0%

What did actually happen next?

Received Ambulance straight away

Referred to A & E by ambulance

Referred to A & E by own transport

Referred to Urgent Care / Walk inCentre by ambulance

Referred to Urgent Care / Walk inCentre by own transport

Ambulance attended but I was nottransported

Referred to GP

Received self–care over the telephone

Other


This pie chart shows what pathway of care was provided for each patient who provided a completed

survey, based on their views. Just over 20% of patients surveyed were referred or advised to use

other services other than an emergency department. There were general high levels of satisfaction

with the advice and care provided by the urgent care desk.

Reassuring and prompt

telephone triage, careful

and considerate

assessment

I was directed by GP Practice on previous occasions

- I would like to find another way to save these

precious services for more serious cases

37

25.2%

20.2%

17.8%

14.9%

21.9%

What is important to you when you make an emergency call for an ambulance.

Getting an emergencyambulance

Professionalism - how yourcall was handled

Reassurance - listened toyour concerns

Assessment - of medicalcondition over the phone

Response time - howquickly you got to hospital

54.6%

30.2%

3.7%

1.4% 1.4%

8.7%

“I was satisfied with the help and care provided”

Strongly Agree

Agree


Disagree

Strongly Disagree


To assist with ongoing public education and the management of expectation, we also asked groups

of patients what was important to them when calling 999.

As we were told someone would be with us and then we

received the call - it would have helped if we were initially

told it would be a return phone call.

38

NHS 111

The Trust is currently operating the NHS 111 Service in

the North West. NWAS has been delivering the service

since October 2013. Patient surveys are also undertaken

with patients using the 111 service. These are sent to a

random sample of patients following consent provided

over the telephone.

Recent patient

surveys have

revealed that 69 percent of patients were very satisfied

with the NHS 111 service in the North West, currently

being run by North West Ambulance Service.

36 percent of patients would have attended A&E or rang 999 for an ambulance if the NHS 111

service was not available and 85 percent of patients were either completely better or their

conditions had improved seven days after calling NHS 111

The 111 Service also received 88 complaints from the end of October 2013 until end March 2014. As

mirrored across other parts of NWAS, the complaint rate for the 111 is also very low at 0.03%. The

chart below details the primary category and risk score of the complaints received. Being a

telephone based service it is understandable that communication and information is the most

common reason for complaining.

I did have to wait over an hour for

my ambulance with a dislocated

shoulder but realised that they

were VERY busy.

Scored 8 out of 10

Would have scored 10 for the guy on

the phone, but the Ambulance staff

were moody and very unhelpful, felt like

they just wanted to get rid of me.

Scored 4 out of 10

It seemed a lot of time was wasted waiting for phone calls and waiting

for the Ambulance when my mother needed to be in Hospital.

Scored 4 out of 10

Totally satisfied. Nurse was

knowledgeable about the

problem I had and also gave

me advice on the adverse

effects of previous antibiotics

My condition was experienced during the night time and was initially quite alarming.

Although NHS111 were unable to diagnose the problem they gave me the comfort of

knowing it was not serious and the directions to see my GP as soon as I could the next

day, enabled me to cope with the situation. The service was very thorough and

understanding.

I was just so glad that there was

someone I could talk to in my hour of

need

39

One major complaint has been recorded during this time. The case involved the assessment and

advice given to a mother regarding her new born baby. The advice was to attend the GP however

the baby was rushed to hospital some hours later with a serious condition that been the subject of

the 111 call.

The moderate complaints (n=3) included the ambulance sent as a result of the 111 call attending the

wrong house, inaccurate information on the call record passed to the Out of Hours service and the

lack of appropriate assessment by the Clinical Advisor leading to inappropriate advice.

Of the 85 complaints closed in the reporting year, 37 (43.5%) of the complaints were upheld.

Reasons for upholding complaints have included:

Talking over the caller or not listening fully to what is being said

Call handling not up to approved standard

Inappropriate attitude

Lack of appropriate assessment

Not following protocol in passing patient’s details to the Out of Hours Service

Inappropriate referrals to Social Services

0

5

10

15

20

25

EmergencyResponse

Staff Conduct Communicationand Information

Care andTreatment

Safeguarding

Minimum

Minor

Moderate

Major

Key Findings

1. High levels of satisfaction were reported across the core areas of experience in relation to making

the emergency call, communication, dignity, care, compassion, reassurance and advice provided

for both Urgent Care and the 111 Service.

2. Low levels of understanding that an ambulance may not be dispatched or delays may occur due

to the patient’s condition not being immediately life threatening.

3. Low levels of satisfaction that the elderly are not given priority.

4. Communication is vital to ensuring a positive patient experience – patients need to be listened to,

kept informed of any referral to another (such as GP or Out of Hours Service),

5. receiving a call back from a clinician or any potential delays in an ambulance attending

6. There is still reluctance for patients to consider using alternative healthcare providers. Patients

still believe that they will be seen in Emergency Departments quicker if they arrive by ambulance.

7. The 111 Service upholds more complaints than other parts of NWAS. These decisions are more

easily decided as the evidence is the recorded conversation.

40

6.4 Feedback from Community Engagement

NWAS uses the NHS Equality Delivery System (EDS) to set out its strategic equality objectives

including its plans to engage with its diverse communities. The community engagement programme

of 2013/14 has included attendance at a number of large scale equality and diversity events as well

as targeted engagement with the ‘vulnerable’ protected characteristic groups of people including:

those with mental health conditions

people with physical disabilities,

children and young people

the elderly

people with sensory and learning disabilities

representatives of populations in social deprivation areas

The Trust uses a Patient Experience Board Game to facilitate the majority of this engagement as an

aid to collect qualitative feedback on our services. The Game creates an engaging, informal setting

to give a voice to groups which may be less likely to engage through other methods such as surveys

or public meetings. This is usually in the form of face to face sessions or setting up the board game

on a stand at a themed event. A second board game was recently commissioned and has been in

use since April 2013. Where appropriate, further support to our engagement is provided by

operational staff and an Ambulance vehicle.

In addition to us receiving feedback on access to services and employment opportunities from these

groups, we also try to:

Give reassurance that all feedback we receive from our community engagement is valued and will be acted upon

Promote partnership working including volunteering opportunities and FT membership

Raise awareness of what to expect from the ambulance service and our commitment to equality and diversity

Where applicable, raise awareness of the Trust support to health inequalities in the areas of stroke, cardiac arrest, obesity and mental health.

Over 25 different community groups have been engaged with during 2013/14.

The patient experience board game has been played at focus group events with the following

seven community groups: Headway Brain Injuries Group, Preston; St Helen’s Carers Group,

Cheshire; Remind Mental Health, Merseyside; Manchester BME Network; Liverpool Arabic

Group; Bury Speak Easy Group; Rochdale Borough Wide Mental Health User Forum.

‘Group discussed issues that may be considered an emergency. One lady has children

who have a nut allergy. If a child had accidentally eaten nuts or their derivatives, she

wanted to know if this would be considered an emergency.’ (Liverpool Arabic Women’s

Group)

‘My dad died on our way to hospital. When we wanted to go home we had to catch a

taxi’. (St Helens Carers)

You never get any feedback after completing a survey – waste of time (Headway Brain

Injury Group)

‘Husband called the ambulance service – they were brilliant with me. I did not feel

stereotyped at all, as a woman, and as a black woman, they were kind, so human, the

experience was very positive.’

41

Eight themed events attended, have included: FT Monitor Focus Group held at NWAS Lancashire

Offices Broughton, Burnley College Health Fair (where we engaged predominantly with Black

and Minority Ethnic (BME) young persons to receive their perceptions on employment with the

Ambulance service); Blackpool Learning Disability Health Event; CODA (Children of Deaf

Adults) Emergency Services Open Day, Winsford, Cheshire; Asian Elders Association – Eid, Diwali,

Advent Event, Bolton; YAD - Year of Action on Dementia Event, Liverpool; Knowsley Health

watch; PENN National Workshop Event, Broughton, Preston.

I’m not scared of Ambulances. I went to an open day and they let me take a look around

an Ambulance (Blackpool Learning Disability Health Event)

As a patient you would love to be treated with dignity, for your views and opinions to be

respected – it is really important for a medical professional to respect your views even if

you are a patient with dementia, not all your views or opinions stem from the condition.(

YAD - Year of Action on Dementia Event, Liverpool)

Very rare you hear the Ambulance service has made a blunder. (Asian Elders, Bolton)

Twelve of the large footfall Public Events attended include: Spirit of Bolton; Disability

Awareness Day; Cheadle Mosque; Blackpool, Chester, Liverpool and Manchester PRIDE

respectively; Preston, Leyland, Bolton and Fylde Coast Health Melas respectively; Chinese New

Year Event, Blackpool.

‘I am writing to thank you for participating at Blackpool Pride Festival and for your feedback.

Overall we were pleased with the event in the Winter Gardens, particularly on the Saturday.

Certainly the public seemed to have enjoyed themselves’. (Tim Allan Blackpool Pride organiser)

Matt Dunn, Advanced Practitioner and Red Ashcroft, EMT were both in attendance at the Bolton

Health Mela. A PES Ambulance vehicle was available to view and many commented on how this

‘stole the event’. Mat and Red were gently peppered throughout the day by over 60 young

people to be given the opportunity to see and receive practical Ambulance demonstrations.

Matt commented on the Trust attendance at the Health Mela as being ‘a great way of having

fun with our NWAS communities, whilst also being able to provide some very important

Ambulance health messages to a number of young people’. (NWAS Regional Bulletin March

2014)

42

The charts below show the community engagement activities by NWAS areas and the differing

protected groups engaged respectively.

During 2013/14 targeted engagement using the board game has produced over 100 feedback

comments: measured against the six best framework categories of: Communication (22), Access

(19), Responsive Service (15), Information (29), Treatment as an Individual (27) and Quality of Care

(20) ‘Picker’ NHS

15%

13%

11%

11% 8%

8%

8%

6%

6%

4%

4%

2% 2%

2%

Protected Characteristics Engaged During 2013/14

Race

All

Learning Disability

Youth

Mental Health

Religion

Sensory Disability

Physical Disability

Socio Economic

LGBT

Older

Brain Injury

Dementia

Gender specific

43

7. Learning from Experiences

It is essential that the Trust learns from all the feedback it receives.

7.1 Action Plans

This section outlines the proposed actions and improvements to be undertaken as a result:

PARAMEDIC EMERGENCY SERVICE

Feedback Theme Proposed Improvement/Action Patients expectation of appropriate and timely response / clarity regarding the alternative pathways available

Expectations management features in the Team 999 campaign. Perception survey results show awareness is increasing but continual education is required.

Patient experience of timely attendance following 999 call

Review and redistribution of specific Emergency Operations Centres (EOC) procedures in light of complaint investigations Individual feedback provided to EOC staff regarding call handling to ensure calls coded appropriately, correct codes followed, listening for potential reason to upgrade the call and care provided to Trust standard

Communication , 17%

Access , 14%

Responsive Service, 10%

Information , 23%

Treatment as an Individual , 21%

Quality of Care, 15%

Feedback by Category 2013/14

Communication

Access

Responsive Service

Information

Treatment as an Individual

Quality of Care

44

Individual feedback provided to EOC staff regarding dispatch to ensure timely searches for vehicles completed, nearest available vehicle dispatched, importance of timely passing of information between hospitals and crews and calls upgraded as necessary More work regarding response categories required Information provided to hospitals to ensure transfer requests booked according to procedure Reminder sent to staff regarding adherence to second call procedure

Concerns raised about care and treatment provided to patients

Staff to undertake more training on pain management, care and dignity, manual handling, safeguarding referrals and application of paramedic pathfinder Individual feedback provided to individual staff in application of Cardiac Chest Pain policy including not walking patient to the ambulance and managing pain Individual feedback provided to staff in relation to completing falls referral and requesting appropriate back up befitting the presenting condition Bulletin issued for care of patients who are over 20 weeks gestation Reminder to individual staff about the application of seat belts as required Incident learning implemented to ensure treatment given is indicated for presenting condition

Recognising the need for good communication and information

Feedback to individual staff regarding the importance of ensuring patients attend the correct hospital and depending on clinical condition hospital of their choice Addresses flagged to provide more detailed information for the attending staff including access, medical and safety markers

Learning for individual clinical assessment raised

Guidance distributed to staff regarding application of the hyper acute stroke pathway Reflective learning implemented to variety of staff to ensure learning from individual incidents including pain management, application of diagnosis of death,

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completion of Electro-Cardiograms and recognition of hypostasis

Staff attitude Feedback provided to ensure staff were aware how they made patient feel, particularly for cases where difficult to draw definitive conclusion Customer care course identified

Issues with documentation The importance of accurate Patient Report Form (PRF) completion has been reiterated with a number of staff and completion monitoring and audit was implemented for a small number of staff

Requirement to provide more specialist vehicles for some patients

Provision and introduction of specialist ambulances for bariatric patients

Low levels of awareness of role of CFR

Team 999 has included a focus on community first responders. Explore what further promotional activities can be undertaken regarding the role.

PATIENT TRANSPORT SERVICE

Feedback Theme Proposed Improvement/Action Availability of booking reminder/next pickup notification

NWAS Control staff to be reminded about the need to offer this service and a guidance briefing provided

Low levels of awareness of the new PTS Charter

Create a new poster for hospitals which have information about the quality standards. Introduce new personal information cards for patients to help them understand what to expect from the service New marketing campaign to be launched in 2014 to help patients and carers understand more about the service. Charter booklet provided to complainants to explain service

Low levels of awareness of waiting times to go home.

Raise awareness of quality standards with all outpatient departments by introduction of new leaflets and posters which can be displayed in hospital areas Explanation provided to individual patients during complaints process

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Memo sent to control staff to ensure patient’s location for pick up is recorded on Cleric

Difficulties with incorrect transport provided e.g. taxis/VCS

Pictorial Mobility Guide to be produced Working with bookers to ensure correct information is given to provide correct transport Completion of individual risk assessment for patients Greater level of support identified and provided to individual patients Mobility status of patients changed to reflect individual needs

Difficulties between staff / volunteers and patients

Individual staff and volunteers no longer assigned to particular patients Small number of volunteers removed from service and some reminded of expected standards Individual notes added to patient records to avoid some patients travelling with each other

Issues arising during the journey Staff reminded of the importance of communication to patients in the event of a breakdown, delays with other patients or adverse conditions

Booking and allowing escorts Advice provided to complainant (on behalf of new patient) on when escorts are allowed and how they can be booked

SPECIALIST PATIENTS – PATIENT TRANSPORT SERVICE

Feedback Theme Proposed Improvement/Action Low levels of understanding of both the PTS Information leaflet and Patient Charter

Introduce new personal information cards for patients to help them understand what to expect from the service New marketing campaign to be launched in 2014 to help patients and carers understand more about the service.

Hospital staff stated difficulties with booking system.

NWAS to undertake further detailed work into usage and understanding of the online booking system and to develop improvements and materials to support this feedback. Individual feedback provided to staff further to complaint investigations

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Low level invitation to use the advance notification/reminder service

NWAS Control staff to be reminded about the need to offer this service and a guidance briefing provided

Patients say that they are asked to be ready to travel up to 2 hours before their appointment time.

NWAS Control staff to be made more aware of new quality standards for this specialist group and plan journeys accordingly.

Patients feel as though the waiting time to go home is still too long.

NWAS to continue to meet with this specialist group of patients and raise awareness of the quality standards.

PATIENT TRANSPORT SERVICE - OBSERVATIONS

Feedback Theme Proposed Improvement/Action Raise awareness of the needs of dementia patients with staff.

Dementia Patient story should be shared at staff forums and mandatory training days

Booking mobility concerns – the recently produced PTS pictorial guide to be made available to booking & hospital staff

Ensure that publication is available on the Trust website and emailed to hospital patient experience leads for distribution

Discharge Check list – Promote this checklist to all hospital contacts

Ensure this checklist is available on the Trust PTS microsite and available to hospital staff

URGENT CARE

Feedback Theme Proposed Improvement/Action Low levels of satisfaction when agreed action is delayed e.g. no call back within 60 minutes.

UCD to monitor call back rates and where possible keep patients informed of potential delays.

Lack of understanding of the Urgent Care Desk processes and the Emergency Service.

Address as part of the Team 999 campaign

Incorrect information being provided by EMD at the point of the initial emergency call.

Review information provided by EMD if patients are suitable for UCD intervention.

UCD call handling did not meet Trust standard

Use of UCD audit to provide feedback to individual staff Ensure appropriate upgrade applied to provide prompter response

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111 SERVICE

Feedback Theme Proposed Improvement/Action 111 staff not handling calls according to agreed procedure

Individual staff feedback, some increased audit monitoring where identified

COMMUNITY ENGAGEMENT

Feedback Theme Proposed Improvement/Action Patients who have health passports and personal health information

Raise awareness of NWAS staff of where these schemes exist and to check with patients on attendance

Feedback from their contributions Ensure groups understand feedback is valued and acted upon. Share examples of where this has happened.

Lack of awareness of ED tools Availability of ED communication tools e.g. language line, pictorial handbook is promoted more widely. Review any other tools or systems to improve communication further

Awareness of mobility guide by hospital staff

To be distributed more widely.

Awareness of what happens next when call 999

Explore the options for team 999 in terms of targeted work with diversity groups as well as the marketing materials being translated into other languages

What to expect at handover in hospital Individual patient information is available regarding this. Review if this is being widely used.

Saying thank you Ensure the public can easily let the Trust know they would like to compliment the care received.

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7.1 How we learn

Action Plans

The service improvement proposals are translated into action plans in partnership with service

delivery leads and regular progress reports are requested.

Where required, individual action plans are drawn up for individual staff members to ensure learning

takes place. Staff may also be required to undertake a reflective piece of work, go through a re-

training process or, in some cases, face disciplinary action.

Patient stories

The Trust has made extensive use of patient stories as an important learning tool. The Trust to date

has produced 24 stories. The stories are filmed using actors but all the stories are based on real life

situations. The stories come from the patient survey feedback, interviews with patients,

complaints, compliments and experiences shared via community groups across the region.

The stories are available on DVD, with learning points and briefing materials. They are played

regularly at board meetings and generate discussions and action points. They are also shared with

commissioners at their quality meeting. Service delivery managers use them in staff forums and

meetings to highly both best practice examples as well as situations which didn’t go quite so well.

The stories are using on the Trust’s mandatory training programmes as well as other learning

opportunities. The stories are also used externally with community groups and for public education

purposes. A number are available on the Trust’s website.

All managers are asked to complete a feedback form when the stories are used so there is a record

of who has watched them and the discussion that took place.

Public Engagement

The Trust launched #Team999 in 2013 as a direct result of feedback from patients and staff on

improving education and engagement with the public about what to expect from the ambulance

service. The campaign has been very successful to date, demonstrating high levels of awareness,

and reach of the campaign as well as evidence of improving public perceptions of the service. The

Trust uses the #Team999 brand to help share messages with the public and other partners which are

a direct result from learning from patient experiences. The campaign uses members of staff to

help explain to the public what happens when you call 999 and the alternative pathways available.

The campaign uses social media extensively to engage with the public as well as undertaking face to

face engagement with community roadshows and events. The campaign will continue to support

the Trust is engaging with patients and the public and this year is introducing a new campaign to

improve understanding of the Patient Transport Service.

The Trust will also explore how it integrates the NHS 111 role within its public education work in

conjunction with commissioners.

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Team 999 car sticker

Team 999 infographic

You Said We Did

This report and feedback received is published for patients and the public to view. In addition

feedback is shared through posters and leaflets in hospitals, on the website and with staff on

stations.

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Working in Partnership

Frontline staff involvement in how we improve the patient experience has always been an integral

part of the Trust’s patient experience programme:

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Each year, online ‘Talk to Us’ campaigns have been held to discuss with staff how we can improve

services for our patients. One example of feedback which has led to improvement is:

Top theme: More support for providing care for patients with mental health conditions.

Response: The Trust has introduced new training packages for frontline staff to support improved

awareness of mental health conditions. The Trust is also working with mental health partners to

identify alternative care pathways for mental health patients.

The staff working in the patient transport service have been coming together during 2013/14 to

discuss how the service can be improved and the results of these discussions will lead to a new

educational campaign for service users and health care professionals in 2014 to help them better

understand the service and how it works.

The Trust has worked closely with Health Watch organisations, other providers and commissioners

to elicit patient feedback and work together to improve service provision. This has included

reducing 999 call outs for fall in nursing homes, developing PTS patient information and a new

dedicated website, testing out the FFT in different settings, holding patient focus groups and

undertaking surveys.

Examples of learning in action

The Trust has undertake a number of service improvements as a result of learning and the following

are some examples:

Dignity posters

These have been produced based on patients’ views on dignity. The posters are being widely

distributed to staff across the Trust to highlight the importance of dignity and how patients want to

be treated.

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PTS personal information cards

New information cards in wallets have been produced to give to PTS patients to explain how the

service works, what the quality standards are and how they can contact us if they have any

questions.

8. Summary

The report demonstrates in the main high levels of satisfaction with the service but there is always

room for improvement and ensuring services meet the needs of our patients.

This report demonstrates that NWAS is committed to listening and learning from its service users

and most importantly is able to demonstrate how it is improving its services as a result.

We recognise there is always more work that can be done to gather more views and have more

engagement with the public and we continue to look at ways to do this effectively.

This report will be presented to the Board of Directors in July 2014 and subsequently published on

the Trust’s website. In addition a link to the report will be shared with our stakeholders in our

regular briefing document.

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9. Future Focus

A number of areas have been identified to improve our patient experience programme further:

1. Ensure the identified actions are shared with service delivery managers and there is

evidence of progress. This evidence is provided to the Quality Committee for assurance.

2. The Trust continues to foster a learning culture to ensure patients’ experience inform service

improvement.

3. The Trust will explore how it can ensure a sustainable programme of quantitative patient

feedback so the number of patients who give feedback is more representative of the

number of patients who use the service, but will always there are effective methods to

gather rich qualitative information also.

4. Family and Friends Test

The Family and Friends Test is being introduced in ambulance services by the end of March

2015. All NHS Trusts are expected to introduce the test to staff during 2014/15. By the end

of March 2015 all staff employed, front line and corporate, have to be offered the test.

The Trust has been piloting the FFT with patient groups for a couple of years and

particularly, recently, undertaken two Pathfinder projects funded by NHS England, for a

twelve week period, to test out the FFT in the ambulance sector to inform the national

guidance.

The Pathfinder projects will be completed and evaluated by 30 May and the results will be

shared with NHS England to influence the national guidance for ambulance patients.

WHAT OUR PATIENTS SAY Patient Experience Annual … · 1 WHAT OUR PATIENTS SAY Patient Experience...

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