Making Experiences Count Procedure

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MEC Procedures Page :

Author : Head of Risk and Safety Version : 1

Date of Approval : June 2013 Status : Approved

Date of Issue : June 2013 Date of Review : June 2015

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Making Experiences Count Procedure

“When a mistake happens, it is important to acknowledge it, put things right quickly and learn from the experience.”

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2 Contents Page 1.0 Purpose 3 2.0 General Information 3 3.0 Definitions 4 4.0 Recording Compliments 4 5.0 Making a complaint 4

5.1  Complaints raised with staff 4

5.2  Receipt of a complaint 5

5.3  Complaints involving more than one organisation 7

5.4  Receipt of a complaint via a Member of Parliament 7

5.5  Conducting the investigation 8

5.6  Witness accounts 9

5.7  Concluding the investigation 10

5.8  Potential disciplinary proceedings 11

5.9  Communicating the Outcome 11

5.10  Resolving the complaint 12

6.0 Independent review 12

6.1  Request to the Parliamentary and Health Service Ombudsman

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6.2  Decision on handling of concern/complaint 13

6.3  Complaining to a Clinical Commissioning Group about the NHS provider

14 Appendix 1 Externals flowchart

Appendix 2 Categorisation and Complexity Risk Table Appendix 3 MEC Notification Form

Appendix 4 Complaint Resolution Plan

Appendix 5 Joint Complaint Handling flowchart Appendix 6 MEC Clinical Advice Proforma Appendix 7 MEC Record Closure Process

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1. Purpose

The purpose of this procedure is to explain how complaints will be acknowledged, investigated and responded to.

This procedure will document how compliments will be recorded and shared with staff. This document will detail how the Trust will handle those queries that fall outside of the complaints legislation (e.g. from fellow healthcare providers or professional bodies). The Trust will adopt the Parliamentary and Health Service Ombudsman’s Principles of Good Complaint Handling –

http://www.ombudsman.org.uk/__data/assets/pdf_file/0005/1040/0188-Principles-of-Good-Complaint-Handling-bookletweb.pdf

 getting it right;

 being customer focused;

 being open and accountable;

 acting fairly and proportionately;

 putting things right;

 seeking continuous improvement.

2. General Information

The approach to complaints handling within the Trust aims to reduce risks, facilitate learning and drive improvements in the quality and safety of services. The process will deliver a consistent, integrated and responsive service to users that is both accessible and simple to use.

The overarching principle behind the complaints handling process is that every possible action to investigate and resolve the complaint will be completed at local level i.e. within the Trust.

The primary aim of local resolution is not to apportion individual blame; it is to determine what happened, with subsequent actions then being taken, including appropriate remedies.

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4 3. Definitions

For the purposes of this document, any reference to complaints will also mean concerns previously handled through the PALS process and high risk external incidents. An external incident is one reported by a fellow professional body that do not meet the criteria set out in Local Authority Social Services and National Health Service Complaints Regulations 2009.

More detailed information on the handling of externals is detailed in Appendix 1.

4. Recording Compliments

All compliments received by the Trust will be recorded on the Trust’s Risk Management system (Datix) within the MEC module. Local staff receiving and processing the compliment will be responsible for informing the staff involved and for producing any correspondence from the staff’s manager.

5. Making a complaint

5.1 Complaints raised with employees

Often patients, carers, their representatives, other members of the public or other healthcare professionals complain directly to ambulance personnel regarding aspects of their experience.

The immediate response of staff to verbal complaints made at the time of care is often critical to satisfying concerns. Employees are often able to fully explain why an ambulance is delayed for example, or why care does not meet the patient’s expectations. The attitude towards people making complaints may determine whether a formal complaint is subsequently raised. Staff should listen sympathetically to complainants, and whenever possible, offer an explanation.

Any complaints handled in this manner must be reported to the respective Control Centre who will pass details onto the MEC team by e-mailing the details to [email protected]. This will ensure adequate recording, monitoring and due consideration can be given to implementing any changes that might avoid a repetition of the circumstances leading to the complaint.

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5 Where patients, carers, their representatives, other members of the public or other healthcare professionals are concerned about an aspect of the services provided by the Trust, a brief explanation and apology (if appropriate) may be all that is required. However, there will be occasions when a patient remains dissatisfied with the explanation given. In such cases the complainant must be referred by e-mail to the Trust’s Making Experiences Count team. The e-mail should contain, name and contact details of the complainant, the time and date of the incident, who was the person affected by the incident , a brief summary of the complaint and where if appropriate was the journey from and to. Leaflets for both staff and patients regarding Making Experiences Count are available on the intranet and by request to the Making Experiences Count team.

Should a complaint escalate outside of normal office hours, staff should advise the respective Control Centre as soon as possible. The Duty Manager will assess the situation and may contact the on-call Commander or Executive Director for advice or support. In such circumstances, the MEC team must be contacted via [email protected].

5.2 Receipt of a complaint

The MEC team can be contacted by e-mail, telephone and postal address at Making Experiences Count Team

North West Ambulance Service 449-451 Garstang Road Broughton Preston PR3 5LN Telephone number: 0345 112 6500. E-mail: [email protected] or [email protected]

The MEC administrator will record the details of the complaint on the Trust’s risk management system (Datix). Depending on the route of submission the complaint will receive initial acknowledgement either verbally, by e-mail or in writing.

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6 The MEC administrator will complete a risk assessment using the Categorisation and Complexity Risk Table (Appendix 2) based on the complaint information received. Risk assessing a complaint will ensure that the subsequent handling and associated investigation are appropriate and proportionate to the severity of the complaint and the related risks.

The MEC administrator will create a MEC Notification Form (Appendix 3). The form will be e-mailed to the allocated MEC team member and relevant Trust personnel as per the Categorisation and Complexity Risk Table.

A member of the MEC team will contact with the complainant to discuss the content of the complaint, request consent to progress the complaint if necessary, communicate the investigation plan, discuss timescales for resolution and seek guidance on what the complainant would like to see happen as a result of the complaint.

At this time the member of the MEC team will complete the Complaint Resolution Plan going through any necessary sections with the complainant (Appendix 4). It is essential at this stage that the complainant has a realistic expectation of when and how their complaint will be resolved; this is particularly relevant in times of high activity.

After initial acknowledgement the complainant will be forwarded, where necessary, a consent form, an ethnic monitoring form and details of the advocacy services. The complainant will also be given the details of the MEC team member handling their complaint.

On receipt of complaints from other organisations, the MEC administrator will complete a risk assessment and record the complaint. The complaining organisation will be sent an acknowledgement of receipt of their complaint. Depending on the severity of risk the complaining organisation will be contacted by a member of the MEC team or alternatively the organisation will be contacted by a local service delivery manager to resolve concerns.

If a complaint is considered high risk, the allocated MEC team member will notify the MEC Manager who will assess whether any immediate action needs to be undertaken, e.g. Steis reporting and will action these in accordance with Trust procedure. A Root Cause Analysis (RCA) will be undertaken as part of the complaints investigation for serious adverse incidents. RCA is a recognised investigative methodology used to establish what led to the occurrence of an incident and what can be done to prevent a recurrence. Steis reports can only be made with the authorisation of the Director of Performance and Patient Experience or Medical Director.

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5.3 Complaints involving more than one organisation

When the Trust receives a complaint from a patient, their relatives, representative or a member of the public about one or more organisation, the Trust is committed to providing a single response with the other organisation/s involved.

If, on receipt of a complaint, it is found to be entirely in relation to another organisation, with the consent of the patient/complainant the complaint will be passed to the other agency.

Alternatively if the complaint is partly in relation to the Trust and another organisation, then with the appropriate patient/complainant consent the complaint can be shared with the other organisation.

When determining the lead organisation the following factors should be taken into account;

 which organisation has the most serious complaint about them,

 which organisation has the most issues related to it

 which organisation originally received the complaint

 whether the complainant has a clear preference for which organisation takes the lead

The subsequent investigation and resolution will be carried out jointly between the agencies and a single co-ordinated response sent from the lead organisation. Appendix 5 outlines the guidance which will be followed by the Trust under these circumstances. A number of inter-agency procedures are also in place within the region and where these exist the Trust will work in accordance with them.

5.4 Receipt of Complaints via Members of Parliament

On receipt of complaints via Members of Parliament the Chief Executive’s Office will forward the complaint to the MEC team who will be responsible for acknowledging the complaint on behalf of the Chief Executive. . The MEC team member allocated to the case will advise the MP’s office that in line with good practice the Trust will contact the patient or their family to discuss their concerns and, were necessary, gain the appropriate consent.

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8 5.5 Conducting the Investigation

The investigation of any complaint will follow the principles detailed in the Trust Incident Reporting and Investigation Policy. The MEC team member will consider the following before conducting the investigation to make sure both the complainant and the Trust are clear on what is being investigated:

a) What should have been provided? What was expected? b) What was provided? What actually happened?

c) Is there a difference between a) and b)? d) If the answer to c) is yes, why?

e) If the answer to c) is no, why does the complainant think otherwise? f) What was the impact of d)?

g) What should be done to put things right? h) What should be done to avoid a recurrence?

Ref: Investigation Guidance, Listening, Responding, Improving 2009

The investigation plan will determine;

a) Who needs to provide a recollection of events b) What records need to be considered

c) What background information is required d) What further advice is needed

e) If there are any equality or diversity issues which need to be addressed.

The MEC Team Lead will use the Complaint Resolution Plan (Appendix 4) to record how the complaint needs to progress.

The MEC team will request the assistance of the line (or local) manager to act as the investigating manager. Investigating managers are responsible for the geographical area where the complaint has been generated. For some complaints, the MEC team will require expert opinion from staff within the appropriate field or expertise (e.g. clinical leadership, fleet or health and safety). Where necessary, contact will be made with other NHS professionals.

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9 In the event of a high risk complaint the Head of Service / Head of PTS, Director of the service line or Medical Director may need to nominate a Manager/s to become the Investigating Manager.

Notes should be made at all stages in the investigative process, such as:-

 When a search or collection of evidence is conducted

 During interaction with anyone involved in the incident..

 At the scene of an incident

 During a telephone call

 Meetings

The MEC team will also seek advice from relevant sources within the Trust, as appropriate to assist in their investigation. This may include advice from Health and Safety, Clinical Governance, Human Resources, Health Informatics or Learning and Development. Any advice should be recorded in writing with reference to Trust publications and/or policy and procedures, as appropriate.

Should the complaint be in relation to the clinical care and treatment of a patient clinical advice should be obtained. Clinical advice can be requested from senior clinicians within the clinical leadership structure. Any advice should be provided on the MEC clinical advice proforma (Appendix 6).

5.6 Witness accounts

The MEC team lead will assume responsibility for ensuring that all elements of the investigation are documented within the MEC module of the risk management system. Any statements or interview documentation should be approved by the individual who has provided that account.

As soon as is practicable and when relevant, members of staff involved in the incident will be approached to discuss the matter. Staff members will provide individual accounts of their own recollection of the events. Staff will be made aware of the nature of the complaint through the provision of the MEC Notification Form.

Other issues may arise during the course of the investigation and in such circumstances the Trust has a duty to consider other aspects of the individual’s actions other than those submitted as part of the complaint.

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10 whether they think that their actions were appropriate, and what they believe should ideally have happened. The approach of the MEC team is intended to seek an honest account and opinion from staff involved in the incident.

If the MEC team are not able to obtain a recollection of events due to staff sickness or other, then this will be recorded in the investigation log.

A member of staff may be accompanied by a trade union representative or friend although this should not be allowed to delay the investigation. The appointed investigating Manager is responsible for liaising with the MEC team lead and organising a time and place for the interview to take place and giving the member of staff an adequate notice period of 7 days prior to the meeting.

On occasions where the complaint is related to a coroner’s inquest or criminal investigation the complaint investigation may be held in abeyance. In other circumstances where the complaint is closed a second statement may be required by the legal team to explore other aspects of the case.

5.7 Concluding the Investigation

The completed investigation should include the following: 1. The actual complaint and any associated evidence. 2. A copy of the Complaint Resolution Plan

3. A copy of the acknowledgement letter.

4. All supporting evidence that has been gathered. This may include details of; clinical records, incident logs, statements, meeting or interview notes, transcripts form recordings, external or expert advice, photographs etc.

5. Details of any investigation techniques used, including RCA tools.

6. The Investigation Officers report where necessary. This should include (as a minimum) the summary of the complaint, evidence, findings, conclusions, recommendations and actions required.

7. The findings must include a decision about whether the actions of the staff involved were reasonable

8. The findings must also include a decision about whether the complaint was upheld.

There will be occasions when the information and evidence is not always clear enough to form a decision that is ‘beyond reasonable doubt’. In these circumstances the Department of Health advocates making a decision based on the ‘balance of

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11 probabilities’ as long as all avenues have been exhausted trying to obtain more conclusive evidence. Three key questions to ask in the decision making process are:

 Was the Trust at fault?

 If so, how did this disadvantage the patient?

 If the patient was disadvantaged through fault of the Trust, what does the Trust need to do to put things right?

5.8 Potential disciplinary proceedings

The investigation of complaints is entirely separate from the disciplinary process. Any action taken against staff as a result of a complaint will be made in accordance with the Trust’s disciplinary procedures.

5.9 Communicating the Outcome

Following investigation the MEC team lead will liaise with the complainant to provide feedback. This may be either verbal, written or at a meeting and will be detailed on the Complaint Resolution Plan.

Where a meeting is deemed to be appropriate, the MEC lead will offer to visit the complainant to discuss the findings of the complaint investigation. Although a meeting with the complainant in these circumstances is useful in providing a full explanation prior to the written response letter being sent, this can be a difficult and distressing meeting.

Responses must identify the issues raised in the complaint; provide a brief summary of the investigation, the outcome of the investigation, any actions taken as a result, and a summary conclusion.

The risk score will determine the level of involvement of managers in the process and which manager will be required to sign off responses.

Complaints with Risk score 1 & 2 – response may be given verbally (file note will be made of conversation and date provided). The appropriate template will be used if a written response is requested. Where the complainant requires a written response this will be signed off by the Head of Risk and Safety or nominated deputy

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12 Risk score3 - response will be signed by the Head of Risk and Safety, or nominated deputy

Risk score 4, and 5 – responses will be signed by the Chief Executive, or nominated deputy

The final response will be available to the staff involved, on request.

Once the response has been sent, the MEC lead will ensure that the Datix record is closed in line with the MEC record closure process (Appendix 7).

5.10 Resolving the Complaint

When forwarding the written response to the complainant an opportunity to discuss their concerns further should be included.

If there is dissatisfaction with the response then further work may be undertaken locally to resolve the complainant’s concerns such as a review of the original investigation by a senior manager, further investigative work, or a meeting.. Consideration should be given to sharing the Complaint Resolution Plan (CRP) with the complainant in the meeting.

When all avenues have been exhausted and it is clear that local resolution cannot be achieved, then the complainant must be informed of their right to ask the Parliamentary Health Service Ombudsman (PHSO) for an independent review of their complaint if they remain unhappy with the response. This step must be considered as a last resort.

6. Independent Review

If dissatisfied with the outcome of local resolution, enquirers have a right to request an independent review from the Parliamentary and Health Service Ombudsman (PHSO), though they do not have an automatic right to insist that one be set up. The PHSO provides a service to the public by undertaking independent investigations where an NHS body has not acted properly or fairly or has provided a poor service.

The MEC lead is responsible for recording all contact with the PHSO on the Datix record using the PHSO section.

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6.1 Request to the Parliamentary and Health Service Ombudsman

A request may be made in any case where:

 An enquirer is not satisfied with the result of an investigation at local level

 The Trust has decided not to investigate a complaint because it was not made within the specified time limits.

6.2 Decision on handling of complaint

The PHSO must assess the nature and substance of the issues that the complainant feels are unresolved.

Once the case has been assessed they will determine if any further action or investigation is required. In some circumstances the PHSO may decide not to investigate but ask the Trust to take further action.

6.3 Complaining to a Clinical Commissioning Group about the NHS provider

Complainants can lodge complaints with the Clinical Commissioning Group (CCG) rather than with the Trust.

If a complaint lodged with the Trust is not resolved locally, the complaint cannot then be referred to the CCG, although it can still be referred to the PHSO.

Where the CCG receives a complaint about NWAS, it will work with the complainant to determine how to handle the case.

Decisions will be taken on an individual case basis, but will always involve a discussion with the complainant, and will ultimately reflect the complainant’s wishes.

In some cases, the complainant may agree that NWAS as the provider of the service is best placed to deal with the case. In other cases, the CCG may decide that it is best placed to handle the complaint itself.

When the commissioning body receives a complaint about the Trust, it will contact the complainant to see if they have lodged the complaint with the Trust. If so, the commissioning body should dismiss handling with the Trust and the complainant. In all cases, the commissioning body will be expected to retain an overview of how the complaint is handled. A complaint cannot be properly investigated unless the Trust has the opportunity to respond.

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APPENDIX 1

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MEC EXTERNAL HANDLING FLOWCHART

Submitted to [email protected] or [email protected] Input incident into MEC module of DATIX Web; scan and add documents

SEVERITY SCORE

Reporting information will be made available on your Datix Web dashboard

Using the categorisation table, risk score the incident Acknowledge enquirer by email/letter or telephone

External incidents with a risk score 4/5 will be processed as per the Categorisation and Complexity Risk Table

1 or 2 – Low

Local Manager to

Answer & close by either;

 Conversation (with file note)

 Local liaison meetings (with file note)

 Email

 Formal Letter

Send to appropriate Local Manager (appoints staff to complete response)

Close the record in Datix

Send any relevant documentation to the MEC team by e-mailing [email protected] Please include evidence of action

Sign off by Sector/Area Manager Send any relevant documentation to

the MEC team by e-mailing [email protected] Please include evidence of action

Close on database and file Answer external body by either;

 Conversation (with file note)

 Local liaison meetings (with file note)

 Email

 Formal Letter

3 – Medium

Send to Sector/General Manager (appoints staff to complete response)

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APPENDIX 2

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17 Categorisation and Complexity Risk Table

Category Description On receipt, inform Aspects to be

considered

Level of Investigation

approval

Serious 5

 Serious adverse incidents  Grossly substandard care  Professional gross misconduct

 Serious patient safety incident, including significant patient injury or death

 Delayed emergency response resulting in permanent injury or death

 Deputy Chief Executive  Head of Service

 Head of PTS  Director PPE  Director of relevant  service delivery line  Head of Risk and Safety  Sector Manager/General Manager  Medical Director  Consultant Paramedic  MEC Manager  Investigating Officer  Head of Legal Services  Consider StEIS  Consider multi-agency review  AMD / Consultant Paramedic review of clinical aspects  IO report approved by Director (responsible service delivery line) Major 4

 Significant sub-standard care.  Professional general misconduct

 Delayed emergency response resulting in non-permanent injury or illness

 Patient injury arising from care

 Director PPE  Director of relevant

service delivery line  Head of Service  Medical Director  Consultant Paramedic  Head of PTS  Sector Manager/General Manager  Investigating Officer  MEC Manager  Head of Risk and Safety  Head of Legal Services  Consider StEIS  Consider multi-agency review meeting  AMD / Consultant Paramedic review of clinical aspects  IO report approved by Head of Service (responsible service delivery line) Moderate 3

 Non arrival of transport causing loss of appointment or care

 Verbal abuse or discriminatory action by staff

 Professional misconduct

 Delayed emergency response resulting in delayed treatment

 Director PPE

 Head of Risk and Safety  MEC Manager

 Investigating Officer

 Operations Manager/Advanced Paramedic/Delivery Manager  Sector Manager/General Manager

 Sector Manager or equivalent  Investigation proportionate and appropriate to resolve complaint speedily and efficiently

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18  Complaints received from Members of

Parliament (minimum risk score dependant on incident described)

Minor 2

 Inappropriate comments / unprofessional conduct / behaviour

 Inappropriate clinical care

 Late transport causing distress and/or loss of appointment

 Delayed emergency response causing distress

 MEC Manager  MEC Case Worker

Operations Manager or equivalent investigator Investigation proportionate and appropriate to resolve complaint speedily and efficiently Minimum 1

 Unhappiness with staff attitude  Unprofessional behaviour

 Late transport causing minimal disruption  Use of lights and sirens / driving

standards with no consequences

 MEC Manager  MEC Case Worker

Operations Manager or equivalent Investigation proportionate and appropriate to resolve complaint speedily and efficiently

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APPENDIX 3

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20 MEC NOTIFICATION FORM

MEC ID Record type

Date received:

Primary categorisation: Initial risk score:

Role: Area:

MEC Lead: Incident date: Description :

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APPENDIX 4

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MEC RECORD RESOLUTION PLAN

MEC ID Sector: Name SM notified

Date received: Target completion date:

Consent

Any special requirements (Language Line, Braille etc)

Expectations of complainant: (use this this section to inform the complainant of any info you feel relevant to manage expectations)

Evidence checklist, tick all appropriate General

Audit Maps

Call recordings Policies / Procedures

CCTV Statement(s)

Coroner’s report Vehicle checklist

Expert Opinion Weather reports

Interviews

PES PTS

Airwaves Cleric information

Clinical review Eligibility audit

EOC report Journey sheet

Medical records

Patient Report Form required SOE

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UCD information Other (please give details)

Communication Plan

Method of response

Verbal / Letter / Face to face meeting / E-mail Review

Date of contact Summary of issues

Reviewed by Outcome of review

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APPENDIX 5

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MEC JOINT COMPLAINT HANDLING FLOWCHART

Receipt of complaint

Receiving organisation reviews the content of complaint and identifies other care providers involved

Receiving organisation makes initial contact with the complainant to explain the process and obtain consent to forward to other care providers within three working days

 Receiving organisation contacts other care providers referred to in complaint within three working days.

 A decision between care providers is required as to which is the ‘Lead Organisation’ (LO) who will then manage, co-ordinate and provide the written response to the

complainant.

 All care providers to discuss timescales – the lead organisation to feedback and agree timescales with complainant.

1. Investigation of complaint

2. LO facilitate multi-agency joint meeting with complainant if required 3. LO to provide regular progress reports to complainant

4. Other care providers forward written responses to LO 5. LO formulates written response

6. Draft response agreed by all care agencies before final letter sent to complainant

1. Each agency to implement recommendations and action plan following

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APPENDIX 6

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Clinical Advice Template

Background Information

MEC record reference number:

Name of MEC Caseworker/Investigation Officer:

Name, HCPC registration number and qualifications of the Clinician providing advice:

Conflict of Interest (i.e. are there any conflicts of interest which mean you cannot provide clinical advice):

Documentation Reviewed (i.e. medical notes, PRF, staff statements etc):

Evidenced used to support clinical advice (i.e. JRCALC guideline, Trust Policy/Procedure, text, reports, publications etc):

Clinical Advice

Questions and Responses:

Conclusions:

Name & Signature: Date:

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APPENDIX 7

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MEC RECORD CLOSURE PROCESS

The Complainant

1. Has feedback been approved and provided to the complainant?

2. Is there more than one complainant requiring feedback –have all complainants received feedback? 3. If applicable – has the signed response been added to Datix?

Datix record - Name & Reference

1. Populate with a closed date

2. Has the investigating manager (this is the PES/PTS/EOC manager that has provided you with assistance throughout the investigation) been recorded?

Details of MEC Record

1. Final risk score (recorded in risk score field)

2. Have you recorded the incident number? This is the C3 or Cleric ID 3. Populate outcome field

4. What is the complaint outcome?

 Upheld – all aspects of the complaint are upheld.

 Partly upheld – some aspects of the complaint are upheld.

 Not upheld – no part of the complaint has been

**Wherever possible one of the above options should be used however there will be occasions where another option is more applicable **

Location

Have all of the location details been inputted?

Subjects & sub-subjects

1. Select one of the ten subjects (Please see primary subject and sub-subject links) 2. Identify a sub-subject

3. Populate as many areas as possible including staff group/area and outcome.

**You can add as many subjects as you like, this is important to make the organisations MEC data as informative and accurate as possible. This function is also helpful in identifying areas for learning/improvement

4. Compliments should also be recorded within this section, i.e. if within the complaint there are aspects where the complainant has expressed a compliment, this should be included within the subject and sub-subjects

People Involved

1. Depending on the outcome of the investigation, are the individuals who caused the failure in the employee section of the record?

2. Whoever provided you with information throughout the course of the investigation should be featured in the other person involved section

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30 ** For any part of the record that is not upheld, the employee should feature in the other person involved section NOT employees**

Details of investigation

1. What recommendations have been made?

2. If no recommendations have been made – please select the ‘No recommendations options from the drop down list 3. Has any action been taken as a result of the recommendations?

4. If so, please select the appropriate action from the action taken box.

5. If you feel that more specific details are required, please add these within the free text box of actions taken.

Communication & Feedback

This section can be used to provide feedback to the investigating manager or the staff involved –this is especially useful when the case has not been upheld.