Gloucestershire Independent Health Complaints Advocacy Service Annual Report 1st April 2015 – 31st March 2016

1

Overview Gloucestershire County Council commissioned seAp Advocacy to provide the statutory Independent Health Complaints Advocacy (IHCAS) to any resident of Gloucestershire, supporting them to understand and navigate through the NHS Complaints procedure and empower them to raise complaints with regard to any NHS funded service. seAp has been providing Health Complaints Advocacy across the South of England since 2004. Since 2013 Independent Health Complaints Advocacy has been a function of Healthwatch. seAp has worked very closely with Healthwatch Gloucestershire since 2013 and Healthwatch Gloucestershire is now the majority referrer in Gloucestershire.

seAps key aims are:  



To ensure that anyone wishing to make an NHS Complaint are aware of the statutory Independent NHS Complaints Advocacy service at the point of need. To ensure that complainants are provided with excellent self help independent information regarding the NHS Complaints procedure to support them to self advocate if they are able to, and if not, have access to fully qualified advocates who can provide dedicated advocacy support. To ensure that any common themes and trends we identify through supporting clients in Gloucestershire are reported and shared with Healthwatch Gloucestershire, NHS Organisations across the county and Commissioners enabling all our partner organisations to learn from any potential service issues including gaps in services.

Case overview for 2015/16 New referrals Active cases at end of year Cases closed

149 94 149

The total referrals are a little lower than the 170 recorded in 2014/15, however as can be seen later in the report, we are supporting a higher proportion of clients with a self declared vulnerability, so we remain confident that the service is supporting those people that need it most i.e. those unable to advocate for themselves.

2

NHS Organisation overview Oxford Health NHS Foundation Trust 1% Outside SEAP Area 5%

Focus of NHS Complaint Oxford University South Western Ambulance Service NHS Foundation Hospitals NHS Trust Trust 2% 2%

North Bristol NHS Trust 3% NHS South Gloucestershire CCG 1%

2gether NHS Foundation Trust 11%

NHS Oxfordshire CCG 1%

University College London Hospitals NHS Foundation Trust 1%

Gloucestershire Care Services NHS Trust 9%

NHS Gloucestershire CCG 15% NHS England 2% Milton Keynes Hospitals NHS Foundation Trust 1%

Gloucestershire Hospitals NHS Foundation Trust 45%

Great Western Hospitals NHS Foundation Trust 1%

The above chart represents the focus of complaints – what proportion of clients were accessing the advocacy service to complain about a particular NHS organisation. It is important to recognise that seAp do not see this chart as a measure of overall Trust performance in terms of number of complaints, but as a means of ensuring that the NHS Trusts are making complainants aware of their rights to accessing advocacy if they wish to make a complaint. Although the chart may appear similar to last year, we are pleased to have seen an increase in the proportion of clients with complaints regarding 2Gether from 8 – 11%. This is the highest proportion that we have seen since the commencement of the contract.

3

Summary of new cases Equality of Access

Ethnicity/Vulnerable Access 80 70 60 50 40

Proportion of clients with vulnerability (%)

30

Proportion of clients from BME groups (%)

20 10 0 2013/14

2014/15

2015/16

It is important for the IHCA service to ensure that it is accessible to those people who most need it – those who are less likely to speak up if they have a concern due to fear of losing services, or where there might be language, or other communication barriers or lack of cultural awareness. The above chart illustrates how each year since the contract began we have seen an increase in the proportion of clients accessing the service with vulnerability. We are particularly pleased with the increase in vulnerable access year on year and that BME access is well above the demographic proportion in Gloucestershire. The below two charts demonstrate the breakdown of BME and Vulnerable/Disabled groups accessing the service.

4

Unseen (eg diabetes) 2%

Disability/Vulnerability Cognitive Impairment Carers 3% 1% Carers - Older 1%

Substance misuse 1% Sensory (Sight) 4%

Serious Physical Illness 9%

Sensory (Hearing) 2% Reading/Writing difficulties 1%

Combination/Multiple 1% Complex Medical Needs 2% Learning Dementia / Disability Alzheimer's 1% 1% ME/Chronic Fatigue 1%

Mental Health Problem 17% Physical Disability 20%

No disability 30%

Other (specify) 5%

Asian or Asian British Indian 1%

Ethnicity

White - Other 5% White - Irish 2%

Asian or Asian British Other 1%

Black or Black British - African 1% Decline d to give 2%

Black or Black British Caribbean 3% Mixed - Other 1% Mixed - White and Asian 1%

White - British 83%

5

Themes and trends Over the course of the year the main areas of complaint have been as follows –   

Quality of treatment – this is a widely reported issue and not confined to a specific service. Patient pathway – this includes access to service, diagnosis, waiting times and co-ordination of services and is generally with regard to the transfer between primary and secondary NHS services. Staff Attitudes – again this is another widely reported issue.

One of the most concerning areas of complaint and this is not confined to Gloucestershire, but more of a national issue, is the access to Mental Health treatment and care, often patients are deteriorating to the point of crisis before they receive treatment and we have had a number of complaints with regard to premature discharge from the Mental Health Care to Primary Care. Another area of concern is complaints handling – many Trusts still operate a written complaints procedure, this is disempowering and frustrating for some patients who then rely on support in order to engage with the process. Whilst a minority of clients prefer to correspond via letters, the majority would rather discuss their concerns face to face. We know through supporting clients that meetings are far more likely to lead to a satisfactory outcome and significantly reduce the duration of the complaints process in most cases. As we continue to build an evidence picture supporting this approach we will be using this information to influence NHS organisation to evaluate their complaints handling policies. Referral Source: The below chart illustrates who is referring to the IHCA service. We are particularly pleased to see that the highest referrer is Healthwatch Gloucestershire, this is the first year that HWG has been the highest referrer and this clearly illustrates that both our services are have an excellent working relationship. On the whole there is a good diversity of referrals, but we would like to see an increase in the number of referrals from some areas, particularly GPs.

6

Referral Source 40 35 30 25 20 15 10 5 0

Closed Case Length and Time Bands: The below 2 charts illustrate the period of time cases are taking comparatively over the last 3 years and also the total amount of advocacy time that has been input during 2015/16. The case length chart shows that the length of cases have been very similar to last year, with the majority of cases being closed in under 6 months and then a gradual decrease to only a few cases being closed in over 24 months. The case duration chart demonstrates that 47% of cases were closed in under 2 hours. This means that either the client was signposted to another organisation as their issues were not within the service remit, or they were enabled/empowered through initial self help information to proceed with the case themselves.

7

Case Length 120 100 80 2013/14

60

2014/15 2015/16

40 20 0 Under 6 months

Between 6 - 12 months

Between 12 - 24 months

Longer than 24 months

Closed Case Duration 80 70 60 50 40 30 20 10 0 Under 2 Between 2 Between 5 Between Between Between Between More than hours and 5 and 10 10 and 15 15 and 20 20 and 30 30 and 50 50 hours hours hours hours hours hours hours

8

Client satisfaction with Complaints Outcome The chart below demonstrates clients’ satisfaction with the outcome of the complaints process where we had supported them to the completion of the process. Of the 43 cases where we were aware of client satisfaction 27 (63%) clients were satisfied with their NHS outcome. This is higher and much better than anticipated we would normally expect around 50%. Where a Local Resolution Meeting had occurred 94% of clients were satisfied. We believe that this chart tells us 2 things – 



Where clients receive advocacy support throughout the process they are more likely to receive satisfactory outcomes as they have reasonable expectations of the process and the advocate can provide experienced, independent and objective insight into the outcomes received. Where a Local Resolution Meeting (LRM) takes place there is a far greater likelihood that the clients will be satisfied because – o They can discuss their issues frankly and openly and not have to wait for weeks for a written response. o They feel that they are being listened to empathetically and that the NHS professionals do care.

Client Satisfaction with NHS Complaints Outcome 30 25 20 15

Yes

10

No

5 0 Client satisfied with NHS Complaints outcome

Client satisfied with outcome where LRM had occurred

NHS Complaints Outcomes Most people who make complaints want to ensure that their experience doesn’t happen to anyone else. Complaints outcomes can range from a simple explanation of what happened to an apology if something was wrong and in some cases considerable service improvements. Over the course of the year we have seen some excellent outcomes for service users that should have a positive impact for other patients going through similar processes.

9

Service Evaluation Compliments from 2015 - 16

"Thank

you again for all your help. You've helped me so much, and have tolerated all my rants, and patience seems to be angelic and you've been really supportive and kind when i have been really low. If you hadn't been there and helped the way you have i would not have been able to recover “Thank

you for all your help and good advice”

“Thank you for a wonderful letter it’s clear lots of effort has gone into it". "We have been very grateful for all your support".

“I found this phone call very helpful and feel much more confident with regard to the meeting - seAp have provided more support this morning than we have received from the X Advocacy service with regard to his son in all the years we have received the service.”

Evaluation Matrix and Survey feedback The below charts demonstrate client experience against 5 outcomes at the beginning and the end of the advocacy process. The below charts show that on average client experience improves greatly across all of the outcomes demonstrated. Where there have been decreases in experience this is directly linked to a poor NHS outcome from the complaints process

10

Outcomes Star Do you feel listened to? 4 3.5 3 2.5 2 1.5 1 0.5 0

Do you feel confident to speak up?

Do you feel in control?

Do you feel respected?

Average experience and opening of case Average experience at case closure

Do you feel informed?

Client development against outcome 14 12 10 Improvement in experience at case closure

8 6

No improvement in experience at case closure

4

worsened experience at case closure

2 0 Do you feel Do you feel Do you feel Do you feel Do you feel listened to? respected? informed? in control? confident to speak up?

11