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Feedback and Complaints Annual Report

2014-2015

Person Centred

Complaints

Feedback

Action

Improvements

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Background and Introduction

There is a requirement for NHS Boards to produce an annual report on the use of feedback,

comments, concerns and complaints, which stems from The Patient Rights (Feedback,

Comments, Concerns and Complaints) (Scotland) Directions 2012 and the ‘Can I help you?’

guidance (national guidance around the handling of complaints and feedback).

NHS Highland values and welcomes comments or suggestions on how we can improve our

services and to hear when things do not go so well.

This report provides a summary of the feedback and complaints received, the learning and

the actions/improvements made in response to the feedback and complaints we received

between 1 April 2014 and 31 March 2015.

NHS Highland uses many different methods to obtain patient feedback to influence patient

care and improve services. Examples and case studies are used throughout this report to

illustrate changes and improvements.

In 2012 the National Person Health and Care Programme was launched with a clear aim to

make demonstrable improvements in patient experience by 2015. NHS Highland has been

actively involved in promoting this programme and taking forward a number of initiatives to

ensure that we are delivering Person Centre Care for every patient, every time

This is NHS Highland’s second annual report covering the time period 1 April 2014 – 31

March 2015.

If people wish to feedback or make a complaint they can visit

www.nhshighland.scot.nhs.uk/Feedback or can contact our Feedback Team on Telephone

01463 705997 or by e-mail nhshighland.feedback@nhs.net

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Section 1 - Encouraging and Gathering Feedback

This section describes the methods NHS Highland uses to encourage and gather feedback

from patients, carers, relatives and the general public, about their experiences of our

services.

1.1 How NHS Highland Encourages your Feedback

Real time Feedback – “How Did We Do”

Running since 2011, 42 sites in NHS Highland have taken on the How Did We Do? Patient

feedback tool and used in some capacity. Based on scores collated centrally, 15 sites

actively used the tool in 2015. In 4 years, over 12,000 patients have provided feedback of

their stay in the hospital. Based on the rating system used in the tool, the average score for

NHS Highland is 4.8 out of 5 which reflects a positive patient experience. Information on

feedback is displayed on Hospital Quality Boards. Plans to review the questions asked are

in place and will be taken forward in 2015/16.

“Nursing good but not always available when needed, initially some difficulties”

“Apart from waiting for medication to take home everything was first class”

Revalidation

To support medical revalidation, a large-scale programme of patient feedback is ongoing

based on the CARE questionnaire. Over 6700 questionnaires have now been collated for

doctors undergoing revalidation. Findings from the feedback are discussed in individual

revalidation and appraisal meetings. Another aspect of the ongoing medical revalidation

support is provision of reports on incidents, complaints and claims data from Datix for

doctors’ yearly appraisal meetings and five-yearly revalidation meetings

“I was scared until I met them. They were brilliant and I couldn’t ask for better!! Even with

everything so busy they still had time to make me smile. First class! I can’t thank them

enough”

“The attention I receive is always excellent. I doubt that the care and welcome given by your

staff can be bettered anywhere”

NHS Highland News

NHS Highland produces a hard copy newspaper which goes to all 150,000 homes across

the Highland area. The newspaper provides various ways to make contact for example via

Executives, Communication Team and the Feedback Team and is accompanied by positive

encouragement to readers to ‘get involved, get in touch, get informed’

Public Engagement Work

As part of the formal consultation into modernising health and social care services across

Badenoch & Strathspey and Skye, Lochalsh and South West Ross, surveys were designed

to capture formal feedback on the proposed changes, options and sites and also the

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consultation process. Key themes were identified for questions and questionnaires were

drafted covering:

• Proposed changes, options and sites

• The consultation process

• Information about the respondent

The questionnaires were considered and tested by members of the steering group and

adaptations were made prior to the final agreed versions being issued. The surveys were

issued in hard copy with freepost address and envelope and taken to consultation meetings.

An online version (via SurveyMonkey) was also designed. The link to this survey was

placed on the home page of NHS Highland website. It was promoted extensively though a

range of means including on the summary consultation document which was delivered to all

homes in the area. In Skye, hard copies were sent to households in the relevant areas.

Large scale public consultations were undertaken around proposals to redesign services in

both Badenoch & Strathspey and Skye, Lochalsh and South West Ross. Feedback was

sought from people who had attended local healthcare facilities in the respective areas

within the last 12 months about their means of transport.

In addition there has been public engagement in other area including Caithness, Islay, Mull,

Lochgilpead, Lawson Memorial, Green Space Projects and testing new ways of working in

remote and rural areas to name a few. Service users are involved in a wide range of

improvement work such as breast clinic, pre-operative assessment, endoscopy services,

community mental health. More information can be found on our website.

http://www.nhshighland.scot.nhs.uk/AboutUs/HQA/Pages/News.aspx

Rapid Process Improvement Weeks

As part of NHS Highland quality improvement work, Rapid Process Improvement Weeks

take place. These are events undertaken across the organisation take place over a 5 day

period and include stakeholder feedback. Patient feedback is collected before and after the

week to measure the effect of the changes on the service provided.

Case study

During one piece of improvement work the process to support a group of

patients suffering with Macular Degeneration was investigated with the aim to

ensure that all patients using the ophthalmology outpatient service at

Raigmore Hospital are treated in a safe and timely manner and that all clinic

facilities are used effectively to meet the demands of the service.

A patient representative was present throughout the improvement work and

support was given by the local Sight Action charity, and feedback sought from

the local Macular Society Inverness Support Group.

All patients (100%) requiring a follow up appointment within 6 weeks

are now given this appointment prior to leaving the clinic – this is an

improvement against a baseline figure of 15%. This ensures that

any appointment given suits the patient’s needs e.g. by fitting with;

public transport, the patients normal routines or carer support.

The average time patients have to wait to attend a clinic has improved by 41% -

and feedback from patients has been positive around the changes to the service.

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Case Study

Social Media

NHS Highland has increased its social media output significantly over the last two years,

and this has resulted in an increased number of ‘followers’ and ‘likes’ on Twitter and

Facebook: the board now has 5,195 followers on Twitter and over 1,000 likes on

Facebook.

It is now standard practice that all of our press releases are placed on the NHS Highland

website and social media platforms, ensuring that our proactive releases reach a

guaranteed audience. We have increased our use of short videos on social media –

including each of our ‘festive messages’ over the Christmas period being produced in

video format. This proved extremely successful, with several thousand views, likes and

‘shares’ on Facebook.

A series of short films about the Learning Disability service for the NHS Highland

YouTube channel are also in development. These are due to be completed in June 2015.

We have also produced a series of live tweets from events such as our annual review;

enabling those who are unable to attend to follow the key points of discussion online.

Most of our key meetings, including all of our quarterly Board meetings, are streamed live

on an external website. It is hoped that the update of the NHS Highland site will enable us

to host these in the future. Evaluation of this is still required to assess the impact of these

improvements on equality groups and whether this has made our approach to communication

more accessible.

A team were asked to support a small Community Mental Health Team

comprising a core of 5 members who, along with other specialists, support a

vulnerable client group from the geographic area of Mid Argyll. It had been

recognised that the waiting times for patients within the service was 34 weeks,

due to the variation in the way referrals were made into the service and variation

in the methods used to process referrals once received. Clients were allocated in

accordance with need, priority, specialty and available capacity (gender

preference also a consideration).

Working alongside a patient representative the average wait slowly decreased to

an average figure of 20 weeks. Clients are experiencing improvements in access

to the service, which is benefiting from a team approach to their well-being.

The team were nominated and received a HQA Quality Award in August 2014 for

their efforts to improve the care of their community client base.

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Raigmore Hospital Patient Council

Monthly patient council meeting is in place which is jointly chaired by Lead Nurse and

Director of Operations. The minutes of this meeting reflect issues that council members

bring to the meeting on behalf of patients which are then dealt with. The patient council

members then provide feedback to the patients/patient groups. Patient council members

also participate in working groups where new services are being developed to improve

service as they are the voice for the patients.

1.2 New Initiatives

Patient 365

In the Argyll and Bute

Operational Unit they have been

piloting a feedback booth in the

Out Patient Departments, Lorn

and Islands Hospital, Oban and

Cowal Community Hospital in

Dunoon. The booth is a touch

screen with web technology to

gather real-time intelligence. In

Oban in a four month period

there were 258 responses with

83% satisfaction rate. The

Operational Unit is working with

the supplier to develop reports

that can be used to inform

improvements.

Formic Pilot

As a result of Feedback from a service user, a pilot to capture feedback in the Out Patient

Department of Raigmore Hospital using a lap top. Prior to the start of the trial period, the

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project was discussed with the Outpatients Charge Nurse and arrangements were made to

provide invitation slips to patients attending the clinics. Only two patients who completed the

survey were happy with using the laptop and the online feedback method, but volunteered

the information that they were familiar/comfortable with using pcs and laptops. Another

patient who stopped to speak to the facilitator could not be persuaded to try the online

system, even with support, but would have been happy to complete a paper questionnaire.

A key observation during the facilitated sessions was that nearly all patients who had been

attending clinics were very focussed on leaving the hospital, making straight for the exit

without pausing or looking at the feedback area. There is no plan to pilot this method again.

Business Cards – Consultant Feedback

A test was undertaken in Raigmore Hospital to see if patients following a consultation with a

consultant would go onto survey monkey and give feedback on their consultation. Business

cards from the consultant were handed out asking for feedback and giving instruction on

how to access the survey. There was very poor uptake and decision was made not to

continue with this. Plans are now being worked on to pilot a survey link on discharge letters.

This will be tested in summer 2015.

1.3 Compliments

All services receive compliments in many different ways such as cards, chocolates. letters

etc. In clinical areas thank you letters and cards are displayed.

At the present time compliments are not recorded on the Datix system, however copies of

compliments received by the Feedback Team are kept. Since the beginning of 2015, the

Feedback Team have observed an increase in the number of compliments being received

via the Feedback mailbox. This is averaging 2 per week. As a result of a significant number

of compliments received in early January an article appeared in the monthly staff newsletter

“ Highlights” to feedback to staff about the positive feedback.

I went into Raigmore to get my

wisdom teeth taken out. I would

just like to say that all of the staff

who looked after me were brilliant.

I was feeling nervous about the

operation and everyone put me at

ease. The nurse I had on ward 1A

was especially lovely, I

unfortunately didn't get her name

but she put me at ease as soon as I

walked into the ward.

McKinnon Memorial Hospital, Broadford, Skye is

a little gem, valuable both to Skye’s residents and

to visitors like ourselves. Congratulations on

keeping it open in these difficult times - long may

such an NHS presence continue on the island.

I had an appointment at the

Podiatry Clinic and would like you

pass on my sincere thanks to the

podiatrist who treated me for the

wonderful care and attention that

she showed to me during my

treatment. It made my visit to the

clinic such a pleasant and

beneficial experience.

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1.4 Promotion on ways to give feedback

In the Spring of 2015, following feedback that

patients’, carers and the public were unclear how

to give feedback, new posters were designed.

New posters for hospitals have been distributed

and over the summer new posters for

community settings will be distributed.

1.5 National Sources of feedback

Patient Opinion

Patient Opinion is an independent, not for profit, organisation which offers a platform for the

public to provide feedback to health services. Members of the public can visit the Patient

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Opinion website (www.patientopionion.org.uk) where they can share a story about their

experience of the health care they, a relative or friend received. These stories are then

shared with NHS Highland who will respond to the feedback.

During 2014/15, there were 76 stories published on Patient Opinion with 127 responses. 60

stories were responded to in less than 3 days. Patient Opinion is promoted through the NHS

Highland website and on the new Feedback Posters. Promotion of Patient Opinion

continues.

In Patient Survey 2014

An amended survey questionnaire was sent out in January 2014 to 4,251 people who had

stayed overnight in an NHS Highland hospital between 1 April and 30 September 2013. The

amendments made were to incorporate some feedback which could be used for the SPSP

programme, adverse event national framework and the Person Centred Health and Care

Collaborative.

The survey asked questions about people’s experiences of admission, the hospital ward and

environment, care and treatment, operations and procedures, staff, leaving hospital, care

after leaving and medicines.

2,170 people responded (51%) and overall the feedback was extremely positive with better

results than in previous years.

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Question % Positive 2014 Change from

2012

Difference from

Scotland 2014

Overall rating of care and treatment received in A&E 95 +5 +8

Overall rating of hospital/ward environment 94 +4 +6

Overall rating of care and treatment during hospital

stay

95 +4 +6

Beforehand, a member of staff explained the risks

and benefits of operation/procedure*

83 +3

Overall rating of staff patients came into contact with 95 +3 +4

Overall rating of arrangements for leaving hospital 85 +7 +6

Overall rating of care or support after leaving

hospital

86 +7 +3

*New Question

Top Five Responses

Question 5 Positive 2014 Change from

2012

Difference from

Scotland 2014

In A&E patients had enough privacy when being

examined or treated*

99 +2

Patient understood how and when to take their

medicines

98 0 +1

The main ward or room patients stayed in was clean 98 +2 +3

Patients were happy with the visiting hours* 97 +2

Information received before attending hospital

helped patient to understand what would happen

97 0 +1

*New Question

Bottom Five Response

Question 5 Positive 2014 Change from

2012

Difference from

Scotland 2014

Patients saw/received information on how to

provide feedback or complaint about the care they

received*

39 +3

A member of staff discussed any clinical errors with

patients*

29 +8

Patients know which nurse was in charge of the

ward*

48 +6

Patients were satisfied with how these clinical errors

were dealt with*

32 +7

Patients were not bothered by noise at night from

other patients*

58 +4

*New Question

Improvements

Noise at night – night guidelines have been developed to agree times for ward lights

to be dimmed and reduction in activity.

Nurse in charge – Raigmore Hospital have introduced the red nurse in charge badge

in all areas based on feedback that patients/relatives did not know who nurse in

charge was. This has been a big success and feedback to date has been positive

from patients.

Patients know how to complain/feedback – Updated patient information booklet for

Raigmore Hospital is now available which includes the relevant information.

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1.6 Examples of feedback received

A feedback tool has been developed to gain patient satisfaction from patients who have

been in contact with the chaplaincy services in NHS Highland. The questionnaire was

piloted in two wards before Highland-wide distribution. Paper copies of the questionnaire

have been distributed to all NHSH hospitals, with a freepost envelope for return. Data

collection is ongoing and a report will be prepared in Summer 2015.

Feedback has been sought from a sample of Care at Home Service Users in North &

West and South & Mid Highland. Questions cover issues such as timeliness, courtesy,

dignity and person-centred care. The questionnaire is compatible with the 2013/14

version to enable comparison of satisfaction levels over time. Feedback received is

generally very positive. Reports will be shared with service leads for their consideration.

“The Care at Home service is excellent. All workers are extremely courteous and thorough.

The service given allows the family to feel confident that Mum is able to stay where she

wants to be”

“It is an excellent service and without it I would be unable to live at home”

On an annual basis feedback is sought from a sample of patients attending endoscopy

units across NHS Highland. Questions cover issues such as arranging appointments;

understanding of procedures; the environment; comfort levels. Feedback is generally

very positive. Reports are provided to service leads to review findings and identify where

improvement are required. As an example of changes made, some patients had

commented on waiting time prior to going in for a scope. Endoscopy Unit staff reviewed

admission times and adjusted the theatre lists accordingly to resolve the issue.

“I was very pleased with my experience and all the staff were very courteous and I was

looked after very well. I don't see how you could improve service. I only know how I was

treated. I have no complaints whatsoever”

“I am very satisfied with all parts of the service and acknowledge the kindness and

consideration shown to me by all concerned, thank you”

In spring 2015, a plan was developed to launch a ‘Community Ward’ in Raigmore

Hospital on a short-term basis from 4 February to 31 March 2015. As this was a new

initiative, it was evaluated from a variety of perspectives, one of which was to seek

feedback from patients and their carers. Questionnaires were developed, with an option

for face to face interviews and phone interviews. Themes covered understanding of the

purpose of the ward and involvement in decision making. Feedback was sought on what

worked well and what could be improved. The feedback received is being considered in

conjunction with staff feedback, case histories and activity data.

“It’s been such a great thing for my mother – she is so much more comfortable in the

Community Ward”

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“I see a big difference in my mum – for the better, and that is thanks to the dedication,

experience and skills of the staff in the Community Ward”

As part of the Scottish Government’s project “A Right to Speak – Supporting Individuals

who use Augmentative & Alternative Communication (AAC)” there was a requirement to

collect feedback from AAC users and their carers about the satisfaction with the AAC

service they receive. A questionnaire was designed incorporating statements liked to the

AAC Quality Indicators which were developed by Talking Mats in association with AAC

users. Staff used their knowledge of users and carers to consider how best to present

the questionnaires to them. The feedback has now been analysed and a report returned

to service leads for local consideration.

“We have received an outstanding service largely, I believe, due to the commitment and

professionalism of the therapist. We are very thankful for the ten years [therapist] has

worked with my daughter and supported the family”

“I like being able to practice my speech with my i-Pad. I think people have been quite

accepting of my i-Pad”

1.7 Work and Feedback from Equality Groups

NHS Highland recognises that there is a need to ensure that there is a feedback mechanism

in place to hear the views of all the patients and clients we serve. There is extensive work

going on across all our operational units and examples are as follows:

Accessible information

NHS Highland has a dedicated Accessible Information Officer (AIO) post which is part

of the NHS Highland Learning Disabilities team. This role includes creating or finding a

wide range of information that is accessible for people with a learning disability.

Primarily health information is produced but does include other information that,

although is not directly health related, can impact on peoples well being. The AIO works

alongside 3rd Sector agencies such as People 1st Highland and Health & Happiness.

The AIO is supported by our in-house Medical Illustrations team who format and

design our materials. Easy read guides have been produced and include Making a

Complaint about NHS Highland.

Interpretation and translation support

NHS Highland continues to promote the interpretation services (both face to face and

telephone for foreign languages and BSL interpreting services). The comprehensive

guidance on accessible communication remains available to NHSH staff on our intranet

site. This guides staff in relation to how to access interpreters and translation services

along with helpful guidance around accessible information across the board.

As a result of feedback and discussions with the local Deaf community, in April 2014

Highland Council introduced new arrangements to provide communication support for

people who are deaf, deaf-blind, deafened and hard of hearing to support access to

Council and NHS Highland services. NHS Highland has a long standing history of

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partnership work with the Highland Council and now accesses this service for clients in

their care:

A BSL/English interpreter is employed by the Council and the Council arranges access to

the interpreter on behalf of NHSH via the Council’s Customer Services team. Additional

support is procured from local, skilled freelance Language Service Professionals who

were known to the Deaf community.

1.8 Public Partners Network

Across Highland there has always been a strong ethos of public engagement shown. There

are public reps on nearly every committee and group. For example in Argyll and Bute this

includes Reshaping Care for Older People (RCOP), Older People in Acute Care (OPAC),

hospital cleanliness inspections and Integration Communication and Engagement groups. All

of these actively engage with the public not only to try to format future policy but also to

obtain feedback. We have a considerable number of Public Partnership Forums and some

Patient Participation Groups. At each and every committee the public rep has a right to ask

questions and raise issues and to ensure there is correct governance and accountability.

1.9 Support Available to help people wishing to give feedback and complain

Anyone wishing to speak to someone for advice or help with giving feedback or making a

complaint is provided with details about the independent Patient Advice and Support

Services (PASS). Contact details for PASS are provided in leaflets and on the NHS

Highland website. The Feedback Team staff have attended national events with PASS to

ensure close working relations. NHS Highland contributed to the evaluation of the PASS

service.

1.10 Summary

NHS Highland has developed and is using many methods to gather feedback for our service

users. During 2015/16 the questions in “How Did We Do” are going to be reviewed and a

fresh approach in using the tool is going to be taken.

Section 2 – Encouraging and handling Complaints

NHS Highland received a total of 729 formal complaints during 2014/15. This is an

increase of 15.9% from 2013/14 where 629 complaints were received.

42 of the 729 formal complaints were later withdrawn by complainants or not taken

forward due to lack of appropriate consent.

In addition the Feedback Team has received and processed approximately 700

informal complaints from patients/families. These informal complaints are passed

directly to the relevant services to respond to, in order to encourage early resolution

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of the complaints, as they usually relate to concerns over appointments, admission

dates, signage, parking rather than communication and clinical treatment issues.

The following tables breaks down the complaints received into Operational Units and

whether the complaints were formal or received via the Family Health Service (FHS)

independent contractor returns.

Operational Unit NHS Highland Formal Complaints

Argyll & Bute CHP 82 (11.2%)

Corporate Services 23 (3.2%)

Estates 1 (0.1%)

North & West Highland 74 (10.2%)

Pharmacy

Raigmore 429 (58.8%)

South & Mid Highland 120 (16.5%)

Total 729

The following run charts show trends over each month for the last financial year for NHS

Highland formal complaints only, it excludes FHS independent contractor data.

71

52 59

52

67 73

67 61 65

42

67

53

0 10 20 30 40 50 60 70 80

Ap

r-1

4

May

-14

Jun

-14

Jul-

14

Au

g-1

4

Sep

-14

Oct

-14

No

v-1

4

Dec

-14

Jan

-15

Feb

-15

Mar

-15

Highlandwide Formal Complaints Received 2014/15

10

8

6

11

7

3

5 4

9 8

10

1 0

2

4

6

8

10

12

Ap

r-1

4

May

-14

Jun

-14

Jul-

14

Au

g-1

4

Sep

-14

Oct

-14

No

v-1

4

Dec

-14

Jan

-15

Feb

-15

Mar

-15

Argyll & Bute CHP Formal Complaints Received 2014/15

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Compliance with the National 20 Working Day Target

The % is based on the number of complaints answered within 20 working days,

out of the total number of complaints received and investigated. The 42

withdrawn / consent not received complaints are excluded from this analysis and

20 day performance is calculated on the 687 formal complaints that were

investigated and responded to by NHS Highland. 245 of the 687 formal

complaints were responded to within 20 working days, representing 35.7%

performance against the national target.

6

4 5

2 3

12

8 9

5 4

9

7

0

2

4

6

8

10

12

14

Ap

r-1

4

May

-14

Jun

-14

Jul-

14

Au

g-1

4

Sep

-14

Oct

-14

No

v-1

4

Dec

-14

Jan

-15

Feb

-15

Mar

-15

North & West Highland Formal Complaints Received 2014/15

37 33

39

27

40 44

42

30

39

27

40

31

0

5

10

15

20

25

30

35

40

45

50

Ap

r-1

4

May

-14

Jun

-14

Jul-

14

Au

g-1

4

Sep

-14

Oct

-14

No

v-1

4

Dec

-14

Jan

-15

Feb

-15

Mar

-15

Raigmore Formal Complaints Received 2014/15

14

4

8

10

15

13

11

15

11

3

6

10

0

2

4

6

8

10

12

14

16

Ap

r-1

4

May

-14

Jun

-14

Jul-

14

Au

g-1

4

Sep

-14

Oct

-14

No

v-1

4

Dec

-14

Jan

-15

Feb

-15

Mar

-15

South & Mid Highland Formal Complaints Received 2014/15

Page 16 of 32

The continuing rise of complaints, together with an increase in the complexity of

complaints received, have affected the Board’s ability to meet the 20 day working

target. Some complaints are put on hold pending outcomes of significant adverse

event reviews. The quality of response and patient / complainant satisfaction is

valued over speed of response and patients / complainants are advised of delays

in investigations when the 20 day working target cannot be met.

Operational Unit NHS Highland Formal Complaints – responded to in 20

working days

Argyll & Bute CHP 10 (12.2%)

Corporate Services 8 (34.8%)

Estates 0 (0%)

North & West Highland 26 (35.1%)

Pharmacy n/a

Raigmore 152 (35.4%)

South & Mid Highland 49 (40.8%)

Total 245 (35.7%)

The following run charts show the percentage of complaints being responded to within 20

working days for each month of the last financial year. This is for formal complaints only

and excludes the FHS independent contractor data.

40%

33%

41%

25% 21% 21%

42% 39%

45%

33%

45% 41%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Ap

r-1

4

May

-14

Jun

-14

Jul-

14

Au

g-1

4

Sep

-14

Oct

-14

No

v-1

4

Dec

-14

Jan

-15

Feb

-15

Mar

-15

Highlandwide Formal Complaints % Responded to in 20 working

days

0% 0%

40%

13%

29%

0%

25%

0%

22%

13% 13%

0% 0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Ap

r-1

4

May

-14

Jun

-14

Jul-

14

Au

g-1

4

Sep

-14

Oct

-14

No

v-1

4

Dec

-14

Jan

-15

Feb

-15

Mar

-15

Argyll & Bute CHP Formal Complaints % Responded to

in 20 working days

Page 17 of 32

Key Themes of Complaints Received

For NHS Highland formal complaints, each complaint received is coded against at least one

issue code. For complex complaints, more than one code can be assigned, hence the

overall figure of issues raised in NHS Highland’s Formal Complaints column is greater than

the total number of complaints received that year. The percentage in brackets, after each

figure, is a calculation against the number of complaints received.

A total of 915 issues were reported for the 729 formal complaints received. The

percentage, in brackets, after each figure is calculated against the total number of

complaints received.

33%

50%

20%

50%

33%

17%

43%

67%

50%

33%

67%

17%

0%

10%

20%

30%

40%

50%

60%

70%

Ap

r-1

4

May

-14

Jun

-14

Jul-

14

Au

g-1

4

Sep

-14

Oct

-14

No

v-1

4

Dec

-14

Jan

-15

Feb

-15

Mar

-15

North & West Formal Complaints % Responded to in 20 working

days

50%

40%

51%

19% 20% 16%

37%

46% 44%

36% 40%

43%

0%

10%

20%

30%

40%

50%

60%

Ap

r-1

4

May

-14

Jun

-14

Jul-

14

Au

g-1

4

Sep

-14

Oct

-14

No

v-1

4

Dec

-14

Jan

-15

Feb

-15

Mar

-15

Raigmore Formal Complaints % Responded to in 20 working

days

42%

67%

13%

30%

21%

50%

64%

17%

70% 67%

83%

60%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15

South & Mid Formal Complaints % Responded to in 20 working days

Page 18 of 32

Issues Raised NHS Highland Formal Complaints

Admissions / transfers / discharge procedure 18 (2.5%)

Aids / appliances / equipment 11 (1.5%)

Attitude and behaviour 140 (19.2%)

Bed shortages 1 (0.1%)

Catering 1 (0.1%)

Cleanliness 5 (0.7%)

Clinical treatment 329 (45.1%)

Communication (oral) 45 (6.2%)

Communication (written) 33 (4.5%)

Competence 5 (0.7%)

Consent to treatment 1 (0.1%)

Date for appointment 92 (12.6%)

Date of admission / attendance 62 (8.5%)

Failure to follow agreed procedures 17 (2.3%)

Mortuary / post mortem arrangements 1 (0.1%)

NHS board purchasing 5 (0.7%)

Other 46 (6.3%)

Outpatient and other clinics 23 (3.1%)

Patient privacy / dignity 4 (0.5%)

Policy & commercial decisions of NHS board 48 (6.6%)

Premises 6 (0.8%)

Shortage / availability 4 (0.5%)

Test results 11 (1.5%)

Transport 7 (0.9%)

Grand Total 915

Page 19 of 32

Outcomes / Actions Taken as a result of Complaints

Access

Dental nurse manager working with administration team to ensure that where an appointment is not available within a reasonable timescale with a patient's registered dentist, an alternative earlier appointment with another dentist should be offered.

Paediatric and ophthalmology review care and pathway for children with Juvenile Idiopathic Arthritis to ensure safe and consistent standards of care.

Reduction in number of staff and hand offs in patients requesting access to their clinical records.

Action plan

Action plan for upgrading of disabled facilities, working in partnership with local community disabled access groups and a commitment to future partnership working when upgrading disabled facilities.

Action plans instigated and monitored following Significant Adverse Event Reviews.

Communication

Consider how to communicate with GPs and patients when there is a change in the referral priority status of a patient.

Improve communications with patients so an explanation is provided about what management plan has been put into place for each patient, to minimise anxiety.

Safety brief adapted to include, on a daily basis, patients awaiting transfer, to ensure they have been fully assessed and an escort is provided where indicated.

Education

Doctor's educational supervisor has been involved so that the complaint can be including in training.

Learnpro medicines management module to be completed and staff to undergo supervision of medicines management.

Patient centred care training.

Practice issues of staff member to be addressed.

Record keeping and documentation training.

Refresher training for Patient Focus Booking Team to ensure all staff are aware of booking processes in the new patient administration system.

Refresher training for administrative / secretarial teams on procedure to follow when patients check for an appointment date or make contact due to worsening symptoms.

Refresher training in the implementation of the Missing Persons Protocol.

Staff reminded of policy and procedure for hearing aid repair, and referral routes to senior members of staff.

Staff training / staff to undertake a reflective learning tool to support improved communication and compassion.

Supervision of staff during patient / client contact to ensure a high standard of care is being delivered and communication is appropriate.

Supervision of staff to ensure breach of confidentiality does not reoccur and all staff reminded of the requirement to be careful when using mobile technology to communicate with patients/clients.

Policy

Anaesthetic Department reviewing and re-issuing the guidelines for fasting prior to an operation. A multidisciplinary group have also been set up to look at fasting times for patients, particularly in vulnerable groups of patients.

Page 20 of 32

Cascading of process for scanning all documents received and process for rejecting requests throughout the Radiology administrative team.

Clarify process for provision and administration of Subcutaneous Denosumab when Clinically indicated for patients residing in Argyll & Bute.

Following discussion at MRI Safety Group, safety checks have now been altered to include a set of questions explicitly seeking information on previous operations and the use of pacing wires.

Orthotic pathways and referral processes for patients unable to access services due to NHS Board boundaries, thereby ensuring consistency of service access for all patients whether they receive treatment within the NHS Board or by a neighbouring NHS Board.

Paediatric scales moved to A&E area and are ready for use in future paediatric cases. All children should be weighed prior to administration of medication.

Practice to move towards providing a service for minor injuries.

Review of patient information leaflet.

Review of laundry system.

Travel expenses policy under review and to be subject to a Fairness for All assessment to ensure the policy does not disadvantage protected groups.

Share

Meetings held with complainants to address reasons for complaints, provide clinical reasons and explanations and to share improvements / actions taken.

Complainants to share their patient stories with staff and describe the impact it has had on them and their families.

Complaint to be shared within and outwith teams to allow sharing of learning and reflection on the impact of staff actions on patients and their families.

System

Alarm system updated and an additional keypad installed.

Cardiology Service Improvement Group to look at the cardiology outpatient clinic capacity and co-ordination of diagnostic tests and appointments.

Change to appointment reminder system, shorter reminder time window and introduction of text messaging functionality.

Changes to theatre rota to minimise impact of trauma theatre activity on elective procedures.

Community staff working in remote areas of the Board to have remote access to their landline voicemail, in addition to mobile voicemail to ensure continuity of service and receipt of messages.

Project group addressing misleading information sent to patients with their appointments, as a result of moving to a recently installed patient administration system.

Review of clinical work allocation.

Waiting

Improve waiting times for psychology services.

Page 21 of 32

2.1 Complainants Feedback Survey

In January 2015, feedback questionnaires were sent to all complainants who had made a

formal complaint in November and December 2014. The questionnaire contained 9

statement with complainants being asked to indicate the extend they agreed with these.

They had the opportunity to give detail as free text. The questionnaire was sent to 42

complaints and offered the opportunity to feedback using a paper form or through survey

monkey. 10 questionnaires were returned.

Results

Statement Strongly Agree/ Agree %

Neutral %

Disagree/Strongly disagree %

It was easy to make a complaint. 90% 10%

I was given enough information on the complaints procedure. 50% 40% 10%

The Feedback Team were helpful and supportive of my complaint.

60% 20% 20%

The Feedback Team made me aware of independent sources of advice and support to help make my complaint.

50% 30% 20%

NHS Highland understood the key issues of my complaint. 40% 30% 30%

I received the written response to my complaint within the agreed timescales.

60% 10% 30%

Although I may not have agreed with the outcome of my complaint, the explanation in the written response was clear.

40% 30% 20%

The written response to my complaint explained how NHS Highland would take appropriate action to prevent the same thing happening again.

40% 10% 50%

I was satisfied with the way my complaint was handled. 50% 20% 23%

As a result of the feedback received and the comments made by complainants who

responded, the following action is being taken forward:-

Operational Units will be encouraged to contact complainant to identify areas that

they wish investigated.

The Complaints Investigating Officer Resource Pack has been reviewed and

updated. This includes model complaints responses.

Investigating Officers are asked to complete the NES/SPSO on line complaints

modules and to refer to the SPSO materials on giving a meaningful apology.

All improvements and actions identified in response letters are logged onto Datix.

2.2 Investigating Officer Feedback Survey

In February 2015, a feedback survey was sent to 62 members of staff who are involved in

dealing with complaints to identify how the existing process could be improved. The

questionnaire contained 12 statements with staff members indicating to what extent they

Page 22 of 32

agreed with these. They were given the opportunity to give detail in free text. 19 members of

staff completed the survey.

Statement Strongly Agree/ Agree %

Neutral %

Disagree/Strongly disagree %

The Feedback Team sends the majority of formal complaints ready for investigation within 1 working day.

58% 26% 16%

The key issues of the complaint have been identified allowing investigations to commence straight away.

26% 48% 26%

I am confident in understanding a comprehensive investigation into all formal complaints.

73% 16% 11%

I am aware of the due date of response for each complaint. 95% 5% 0%

Meetings with complainants are offered as part of my investigation process.

21% 58% 21%

The Feedback Team is informed where the timescale for response cannot be met, giving a reason for the delay.

74% 21% 5%

The Feedback Team advises when a complaint requires a multi operational / agency investigation and outlines my role in this.

26% 43% 26%

The Feedback Team was helpful and supportive during the course of my investigation.

63% 32% 5%

For each complaint investigated I receive or have access to on Datix, the Final Response signed by the Chief Executive.

68% 11% 21%

Actions which have been identified as a result of a complaint are implemented.

78%

0%

22%

The Complaints Resource Pack is a useful resource. 56% 38% 6%

I have completed the online training on LearnPro - NES Feedback & Complaints.

26% 21% 63%

As a result of the feedback received and the comments made by investigating officers who

responded, the following action is being taken forward:-

Complaints Investigation Officer Resource Pack has been published on the Clinical

Governance Support Team webpage.

Training materials and presentations are being developed on Frontline Resolution

and will be available in Autumn 2015.

Encourage Investigating Officer to complete the NES/SPSO on line training modules.

Action and improvements made as a result of complaints made are now recorded on

Datix and monitoring of progress is undertaken by the Clinical Governance Support

Team.

Family Health Service Independent Contractor Complaints

As required NHS Highland gathers and reports on feedback and complaints from

independent contractors (GPs, Dentists, Opticians and Community Pharmacists). This

information is collected quarterly by using a survey monkey link for practices to record the

information.

Independent contractors are responsible for managing and responding to feedback including

complaints about their services. Although the Feedback Team does deal with some

Page 23 of 32

complaints as honest broker the majority of complaints are dealt with by the independent

practice.

Complaints Received by Independent Contractors between 1 April 2014 and 31 March 2015

GP DENTIST PHARMACIST OPTICIAN TOTAL

Number of

contractors

replying

99 53 66 50 268

Number of

complaints

received 220 42 67 22

351 (Avg 1.3

complaints

per

contractor)

Number of

complaints

responded to

within 20 days

171 32 46 14 263 (74.9%)

Number of

complaints

acknowledged

within 3 days

189 31 31 19 270 (76.9%)

Number of

open

complaints

21 13 1 2 37

Number where

alternative

dispute

resolution was

used

10 9 0 0 19

Complaint issue recorded Count

Other (Examples: accuracy of dispensing, out of

stock medicines) 79

Treatment - Clinical 62

Communication 40

Attitude and behaviour 38

Appointment - waiting times / delay 33

Policy / procedures 19

Competence 15

Consent and confidentiality 15

Patient records 8

Premises (incl cleanliness) 6

Patient privacy / dignity 3

Appliance / equipment 2

Staff shortages 2

Page 24 of 32

Some examples of improvements reported by Independent Contracts:

“Program to improve Patient communication - staff training review.”

“Dentists being more time aware when working. Dentists communicating with patients and

other staff members better.”

“As detailed above, each complaint or feedback received is investigated and appropriate

actions taken as detailed in the section above. Staff are always reminded of any policy

changes. Communication within the team is important. Accuracy is key when dealing with

prescriptions and staff have been reminded of this.”

“Information put on practice website regarding opening hours and Laboratory pick up times.”

“Result of patient survey has led us to review appointments system. Piloting more fixed

appointments and reduced the length of open surgeries for three month period after which we

will review.”

2.3 Dealing with complaints through the Significant Adverse Event Process

NHS Highland considers some complex and high risk complaints to be serious adverse

events and manages these through the Board’s Significant Adverse Event Review process.

The Board Significant Adverse Event Review process was reviewed following the publication

of the National Framework “Learning from adverse events through reporting and review”.

The revised policy and procedures were formally authorised by the Clinical Governance

Committee in July 2014. A workshop to formally launch the revised arrangement was held in

January 2015, to ensure a standardised and consistent approach to managing significant

adverse events. Supporting materials have been developed.

Patients, families and carers are provided with the opportunity to be involved in the

Significant Adverse Event process. Prior to the Significant Adverse Event Review meeting

they are invited to meet with the chair to discuss the issues they would like addressed at the

meeting. After the review meeting they will be offered the opportunity to meet with the chair

to discuss the report.

The final report will be downloaded on Datix and any actions to be taken will be logged.

Actions are monitored by the Clinical Governance Team to ensure completion. Reports on

Significant Adverse Event reviews are discussed at the relevant Operational Unit Quality and

Patient Safety Groups and reported to the Clinical Governance Committee as part of the

reporting arrangements.

2.4 Scottish Public Services Ombudsman Office

During 2014/15, 33 complainants took their complaint to the Scottish Public Services

Ombudsman Office. 17 complaints were closed during 2014/15, 7 were upheld and 10 were

not upheld. All SPSO cases are reported to the Clinical Governance Committee and reports

are issued to each of the Operational Units to ensure that these cases are shared.

Case 1

The complainant raised concerns that the Board failed to provide him with adequate care

and treatment following his admission to A&E at Raigmore Hospital. The complainant had

suffered a stroke.

Page 25 of 32

The SPSO made the following recommendations:-

The Board to feedback the SPSO decision on the complaint to staff involved.

The Board to review their care pathway for identification of patients with suspected

stoke and escalation of care in A&E to ensure patients with suspected stroke are

appropriately triaged and assessed in line with SIGN guidance.

The Board provides a written apology for failings.

The Chief Executive sent out a formal apology. A meeting was held with staff involved in

this case to feedback failings identified in the report. The care pathway was reviewed and

amended to ensure it is in line with SIGN guidelines.

Case 2

The complainant raised concerns about inadequate consultation and involvement of her as

carer for her husband during his admissions to hospitals in the Board.

The SPSO made the following recommendations:-

Apologise to her for the repeated failures to adequately and properly involve her in

decision making around her husband’s care and treatment.

Review approaches to carer communication and participating with people with

dementia and to take account of national dementia standards.

Review current documentation of carer involvement in light of record keeping failures.

The Chief Executive sent out a formal apology. The Board has recently undertaken a review

of its documentation and this review has led to the development of standardised nursing

documentation across the Board. This has been implemented and being reviewed. The

report was shared with clinical staff and managers.

Section 3 – The Culture including staff training and development

3.1 NHS Highland Vision

The Highland Quality Approach

The Highland Quality Approach captures the spirit of how NHS Highland is working to

improve care and outcomes for people in Highland. It describes our ways of working, values

and behaviour. It recognises how important it is to improve the health of the population and

get the experience of care right for individual people, every time. We will deliver this by

focussing on providing person-centred care while at the same time eliminating waste,

reducing harm and managing variation.

This approach places an explicit emphasis on how we will make best use all of our

resources. It is founded on the evidence that by focusing on quality and being person

centred we will achieve better health, better care and better value.

Page 26 of 32

The Blue Triangle - Capturing the key elements of the Highland Quality Approach

The framework starts to describe the Highland Quality framework and is captured in our blue

triangle. It has been designed to place the individual at the top, with everything else we do

supporting this purpose. In developing our approach we have drawn from the best learning

we could find. The framework is adopted from Virginia Mason Medical Centre.

The key elements of the Highland Quality Approach are summarised in the blue triangle and

include our Mission, Vision and Values. It also describes how services and care will look in

the future as well as how we are approaching changing the way we deliver services and

care.

3.2 Training and Education

ILM

Management development programmes have been designed to meet the needs of staff who

have the Knowledge and Skills Framework (KSF) General Dimension 6: People

Management within their KSF outline at level 1, 2 or 3. NHS Highland is an accredited

Page 27 of 32

centre for the Institute of Leadership and Management (ILM) and participants undertaking

the whole programme can work towards ILM qualifications. The Clinical Governance Support

Team delivers training sessions on Quality and Patient Safety at each level. Within each

session Feedback and Complaints are covered. Recently the training session has been

reviewed to include frontline resolution and the power of an apology using National

Education Scotland and Scottish Public Services Ombudsman materials.

FY1 Medical Staff

On a yearly basis managers in the Clinical Governance Support Team deliver sessions on

legal issues and complaints. This is well received and often leads to discussion on individual

cases and making an apology

Quality and Patient Safety Workshop, Raigmore Hospital

In June 2014 a workshop was held for managers and clinical staff to look at quality and

patient safety issues in Raigmore Hospital. It focussed on “Can I Help You” covering

encouraging and valuing feedback, promoting learning and improvement and training and

support. One session entitled “Learning from Feedback” was well received, especially the

film clips on patient stories. As a result of this more patient stories are being used in

different fora including Quality and Patient Safety Groups, quality and patient safety

workshops.

National Education Scotland and Scottish Public Services Ombudsman

The promotion of NES and SPSO e-learning training modules have been promoted and

shared widely across the organisation. In March 2015, 20 staff from across NHS Highland

attended a workshop delivered by NES “Can I Help You? The Way Forward – Patient

Experience, Feedback and Early Resolution”. The presentations were recently shared at an

operational unit Quality and Patient Safety Group and it has been agreed that the Feedback

Team will develop a training package on frontline resolution based on the NES and SPSO

materials. This will be available in the autumn 2015.

Resource Pack

In 2012 a resource pack for complaints Investigating Officers was developed to provide

useful guidance on how to investigate complaints and prepare responses. During 2014,

NHS Highland Complaint policy and procedures were reviewed and updated to reflect “ Can

I Help You”. As a result the resource pack was reviewed and updated. Two new

Investigating Officers were asked to use the pack and provide feedback. The feedback was

positive and the pack was distributed to Operational Units and published on the Clinical

Governance Support Team webpage.

Role of the Clinical Governance Support Team

The Feedback Team are available to all staff involved in dealing with feedback and

complaints to give support and advice as required. This includes communicating with

complainants and families, consent and legal issues, information about the Scottish Public

Page 28 of 32

Services Ombudsman and interpretation of the internal complaints procedures. Each of the

three managers in the Clinical Governance Support Team is aligned to the three operational

units in North Highland. Argyll and Bute has their own team. They update operational unit

Quality and Patient Safety Groups on issues relating to feedback and complaints.

Person –Centred Health and Care Programme

The Person-Centred Health and Care Programme is a key part of the NHS Scotland Quality

Strategy and is an important strategic priority for Scotland.

“The objective of the programme is that, by December 2015, for each test team and the

people using their services, 90% of people will have a positive experience of care and get

the outcomes they expect”

The collaborative aims to bring together people from every NHS board area in Scotland to:

Raise the profile of person-centred approaches to care across Scotland including staff health and wellbeing.

Develop and test a range of evidence based interventions and approaches designed to improve person-centred care.

Focus on what can be done now to improve services.

Provide reliable opportunities to personalize support for every person all of the time.

Encourage sharing ideas and approaches between people who use services and people who provide them.

Promote the use of approaches for obtaining feedback from people who use services.

Utilise feedback from people who use services to drive improvement

Provide a framework to measure improvement.

The approach being taken is to promote the support systems for listening to the experiences

of people who use services and to use this feedback to drive improvement and make care

more person centred.

Practical improvements to person centred care are being promoted and supported through

five key ‘Must Do With Me’ areas

What Matters to You?

Who Matters to You?

What Information do you need?

Nothing about me without me

Personalised contact

A Person Centred Care Experience Improvement Group, chaired by the Broad Nurse

Director has been established to ensure the implementation and roll out of the programme.

This includes oversight and links to the OPAH/dementia standards. The membership of this

group includes the lead nurses, representatives from 3rd Sector organisations and Practice

Education. The group reports to the Clinical Governance Committee

Page 29 of 32

To engage health and social care staff, 3rd sector and users in this programme an event was

held on the 7 August 2014 with the aims to provide participants with the opportunity to hear

about the Person Centred Health and Care Collaborative by:

Hearing about people’s perspectives of the care they are receiving and to embed

person centred care.

Share knowledge and approach for person-centred care in Highland.

Identify people’s contributions and priorities for person centred health and care.

Identify and agree test teams in each operational unit.

The event attended by about 70 people from across the organisation was externally

facilitated by Audrey Birt and Garth Adkins the Implementation and Improvement Team Lead

contributed to the event.

Individuals who attended were asked to commit to introducing an initiative back in their

workplace. Some examples of these commitments are as follows;-

Promoting Getting to Know Me in GP Practices.

Arrange for 300 pre-registration student nurses to have “Hello my name is …….”

Badge on the first day of their course (across Highland and Western Isles

campus, Stirling University).

To ensure at least 5 people understand the importance of the 5 Must Do’s in the

next month.

Feedback to staff regarding good practise.

Discuss with Home Support “Please ask my permission….”, “Hello my name

is....”.

Use teach back in my work as lead nurse.

Gain greater understanding of improvement methodology techniques to support

introduction of changes within ward settings.

It has been agreed that there will be 9 test teams in Highland. These teams are at different

stages in development and are as follows:-

1. Opening? Visiting at Raigmore Hospital. Two wards will be identified from a medical

and surgical speciality.

2. “Getting to Know Me” implementation will be monitored at Town and County Hospital

in Nairn and Belford Hospital in Fort William.

3. COPD Discharge Care Bundle Implementation at Caithness General Hospital.

4. Delirium Care Bundle at Caithness General Hospital.

5. Value Based Reflective Practice at Lorn and Islands Hospital in Oban.

6. Compassionate Connections.

7. Hello my name is ….. introducing of initiative School of Nursing Stirling University

(Western Isles, Inverness and Stirling Campus) and within district nursing team in

Fort William locality.

8. Person Centred Care Planning.

9. Use of feedback to make service improvement.

Page 30 of 32

Section 4 – Improvement to Services from Feedback and Complaints

In addition to the examples given throughout this report, detailed below are further examples

of the improvements that have been made as a result of complaints.

Complaints Process

During the year changes were made with the complaint process. A review was undertaken

of how the Board was dealing with Adult Social Care complaints. The process was changed

to enable more complaints to be dealt with at the frontline though local resolution.

An additional Feedback Facilitator has been appointed to support the increasing activity.

This has also enabled concerns and issues to be handled by the Feedback Facilitators thus

avoiding the need to process through the formal complaints process.

In Raigmore Hospital the performance for responding to complaints within 20 working days

has been dropping during the course of the year. A decision was made in March to appoint

a member of staff to co-ordinate all informal and formal complaints for the hospital. Early

indications suggest that this new post is resulting in improved performance with responses.

Case Study - Psychology Waiting Times

During the year a number of complaints were received on psychology waiting times. A

number of actions were put in place to address this and some of these actions are as

follows:-

A Psychological Therapies Waiting Times meeting and Steering Group have been

established which are chaired by a Director of Operations in order to proactively

performance manage and lead the work to achieve the waiting times target. This has

proven to be effective in managing other waiting times.

‘Opt In’ letters have been introduced to help maximise clinic attendance. Self-help /

preparatory work websites are provided to patients within their letter.

LEAN improvement work, designed to stream-line and avoid waste and duplication,

is consistently applied across Psychological Services as well as Community Mental

Health services.

Clinician job plans are being continually reviewed to include referral activity,

appointment lengths, discharge processes and skill mix opportunities - all things

which can help to reduce waiting times and improve the overall care and experience.

Fixed term additional support and staff relocations have taken place to prioritise

areas with high numbers of referrals.

Groups have been established to take patients with low self esteem and for

Mindfulness. These have been steadily increased outwith Inverness.

Ongoing contact with the Scottish Government team is in place to determine whether

all techniques and approaches have been properly adopted to improve our services.

This has been confirmed.

A single point of referral has been introduced and working via Community Mental

Health Teams (CMHTs) to triage referrals and ensure patients are seen as quickly as

possible by the most appropriate clinician.

Page 31 of 32

Group work for patients with trauma is now established in Inverness and will be

reviewed in terms of its impact ahead of any potential wider roll out.

STEPPS groups are being proactively and successfully ran within CMHTs. These

have been increased to accommodate the number of referrals received and steadily

increased.

Additional investment has been made in a Band 7 Clinical Psychologist and a

Professional Lead post.

The option for clinicians to do additional hours to assist with achievement of the

target is consistently explored in response to peaks in service.

Breathing Space and telephone advice services are continually promoted as referral

options for GP practices and CMHTs.

As a result of the above range of initiatives, NHS Highland’s waiting times performance has

significantly improved. Our figure at the Governments target date of 31 December 2014 was

recorded as 91.3% of patients commencing their treatment within 18 weeks. These figures

were included in the Governments published information and compare well with other Health

Boards across Scotland. For comparison, the percentage of people seen within 18 weeks

in December 2013 was 71%, and in May 2013 was 56%.

Case Study – Discharge Arrangements

An elderly patient was discharged home and this became a failed discharge as he was re-

admitted to hospital shortly afterwards. On investigation it was identified that he had been

incorrectly assessed that he would manage at home with his current support package. The

following action was taken:-

All discharges need to be discussed with the senior charge nurse or senior nurse on

duty.

All aspects of the patient’s care must be assessed. New nursing documentation has

been developed and implemented across the Board which will support this process.

Case Study - Casualty

A patient presented at a casualty department with a history of constipation. After being seen

he was sent home and informed to consult his doctor if his symptoms did not resolve. He

went on to develop a serious condition which required hospital admission. The learning from

this case :-

Patient presenting to hospital with a history of constipation should be fully assessed

by a doctor.

Additional training was put in place for casualty staff.

Patients will be asked how they travelled to the hospital to ensure that they have a

means of returning home.

Page 32 of 32

Section 5 - Accountability and Governance

NHS Highland has robust processes in place for the management, monitoring and

assurance for feedback and complaints.

The Clinical Governance Committee, which is a standing committee of the Board meets five

times year. The Committee receives a performance report on complaints at every meeting

which includes details of performance against 20 working day target, number of complaints

received, issues complained about and cases open and closed by the SPSO.

At the start of each meeting a case study is presented by one of the Operational Unit Clinical

Directors. This case study is either based on a Significant Adverse Event or a complex

complaint. This provides an opportunity for discussion, sharing of learning and the

identification of action that requires to be taken forward.

At Operational Unit level, complaints are discussed at each of their Quality and Patient

Safety Group meetings. Reports are prepared detailing performance (shown by graphs) and

actions outstanding following complaints. In addition general information about feedback

and the complaints process is included such as revised complaints policy and procedures,

NES/SPSO e-learning modules and updates on any national initiatives/developments on

complaints.

All complaints received by NHS Highland are logged onto Datix, the Board’s risk

management system. This enables a consistent approach, monitoring of progress, trends

and the recording of improvements and actions taken as a results of complaints.

In January 2015, all informal complaints were recorded on Datix for a trial period to see what

the benefits would be and impact on workloads of the Feedback Team. It is planned that

later in 2015, all informal complaints received by the Clinical Governance Support Team will

be logged on Datix.

As a further development to enhance sharing of learning from complaints, learning

summaries for complaints will be prepared. These will be similar in format to the learning

summaries that have been prepared for Significant Adverse Event Reviews.