Health and Social Care Reforms … Implications for

Complaints Handling

Mr Hugh McCaugheyChief Executive

25 November 2009

Programme • Context and scale of reform • The new HSC Complaints Procedure • SET approach to new Complaints in Health &

Social Care standards (April 2009)• What this meant for SET• Chief Executive’s observations • Personal Reflections

The context and scale of reform since April 2006

Phase one:• From 19 Trusts to 6 in 12 monthsPhase two:• HSC Board from 4 • A Patient and Client Council• A new Public Health Agency • A new Business Support Organisation • A reformed and reshaped Department

South Eastern HSC Trust• A “joining together” of Ulster Community Hospitals Trust

and Down Lisburn Trust• Three large acute hospitals –Ulster, LVH and Downe• Serves a population of 440,000• Annual turnover of £430m per annum• Staffing in excess of 10,000• A mix of urban and rural populations and quite diverse

cultures• Major service change an imperative

South Eastern HSC Trust

Pre RPA...the misconceived notion of the NI Health and Social Care Service?

Complaints … need for reform• Department issued Complaints in the

HPSS for public consultation – 20 Nov 2006• Aim was to provide a unified + streamlined

complaints process• To simplify for users and HSC organistions

Key principles

• Openness and accessibility• Fairness and independence • Responsiveness • Learning and development

New HSC Complaints Procedure – changes • The new single tier process aimed at:

– a strengthened, more robust local resolution stage;

– An enhanced role for commissioners in monitoring, performance management and learning; and

– Improved arrangements for driving forward quality improvements across HSC

New HSC Complaints Procedure - changes

• The removal of Independent Review• The introduction of Standards for Complaints

Handling• The introduction of an “Unacceptable Actions” policy

for unreasonable, vexatious or abusive complainants; and

• Clarity on the application of the Children Order Representations and Complaints Procedure

SET Approach – Implementatiom

• Project Managed• New Policies and Handbook• Training + Awareness• Publicity and PR• Prison Healthcare

What were SET Objectives• Being on top of complaints• Trying to ‘read’ where the complainant was

coming from • Are there helpful indicators or trends? • How do we truly learn from the complainant’s

experience • Does our process work effectively and is the

quality of our response fulsome

Impact of RPA and new HSC Complaints Procedure on SET• Response times pre April 2007:

Traditionally both legacy Trusts had achieved 65% - 75 % in terms of the 20 working day response target

Response times for SET by quarter from April 2008

40%

31%31%

53%64%

52%

0%

10%

20%

30%

40%

50%

60%

70%

Apr - Ju

n 2008

Jul -

Sept 2

008

Oct - D

ec 200

8

Jan - M

ar 200

9

Apr - Ju

n 2009

Jul -

Sept 2

009

Number of complaints for SET per quarter from April 2007

193

117 114121 124

116128

150

169 162

0

50

100

150

200

250

Apr -

Jun 2

007

Jul -

Sep

t 200

7

Oct - D

ec 2

007

Jan

- Mar

200

8

Apr -

Jun 2

008

Jul -

Sep

t 200

8

Oct - D

ec 2

008

Jan

- Mar

200

9

Apr -

Jun 2

009

Jul -

Sep

t 200

9

Interpretations

• System less efficient vs Bedding in.Probably both!

• Poorer services vs Better procedureMore Accessible/comprehensive system

Observations + Questions• Volume and complexity of complaints

– Social care issues/housing ….. major medical surgical interventions

– Car parking ….. Misdiagnosis of cancers• Single Undifferentiated Process• Ownership of Response• “Sorry...” – But are we?

MODERNISATION

Copernicus (1473-1543)

Copernicus was a Polish astronomer, best known for his

theory that the sun and not the earth was at

the centre of the universe.

21st C Copernican view

NI HSC SYSTEM

The Institution is no longer the centre of the

universe but is merely part of a

HSC system with the person at the

centre.

Vs

Observations + Questions

• Learning – mechanismsHow do learn the lessons?

• Learning – cultureDo we want to learn the lessons?

Relationship with Politicians + Public

• Local Accountability – 108 pairs of eyes– Proximity to local Assembly and constituent

issues. Is it an enquiry or complaint?• Need for closer working relationships with local

politicians• Relationship with PCC

Summer 2009 Issues

• Backlog of complaints• Poor Response times • Quality of Responses• Organisational Culture

Backlog as at August 2009• Backlog went back as far as Dec 2008

– Complaints – 136– Reopened complaints – 21– Enquiries – 16 – IR & Ombudsman cases – 16

• Total =189• Figures included current workload (ie, 2/3 months) =

approximately 75 cases

What did we do about it ?

• Reduce backlog (temp add. Resources)• Reviewed processes + systems• New process map• Monitoring• Leadership

Where are we now in terms of backlog?

• Complaints – 7 • Reopened – 2

Current Position (16 Nov 2009)• Complaints – 86• Reopened – 20 • IR & Ombudsman cases – 18 • Total = 124 (plus 9 backlog cases)• 20 working days target – 65% (62) of the 106

current complaint cases have met the 20 day target (span time period Aug to Nov 2009)

Response times per month –April to Sept 2009

37%31%

23%

29% 32%

60%

0%

10%

20%

30%

40%

50%

60%

70%

Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09

Still to do !

• Mainstream into Accountability system• Complaints writing training• Seek evidence of Improvement• ? Improvement of the month?• Re-Review process map – early 2010

My Contribution

• Challenge the process

• Inspire a shared vision

• Enable others to act

• Model the way

• Encourage the heart

Insights from Elsewhere

“If Disney ran your Hospital”9 ½ things you would do differently

By FRED LEE

If Disney ran HSC

• Make Courtesy more important than efficiency

• Measure to improve, not impress• Create a climate of dissatisfaction

Climate of Dissatisfaction

Dissatisfaction with “as is”+

Dream of “could be...”+

Knowledge of “how to...”Is greater than

Organisational Inertia

Personal Reflections

• Some of the best ideas for improvements come from patients and clients and from those who are delivering services day and daily

Personal Reflections …• Building blocks in place, still a way to go• Still a number of challenges … main

one is to ensure complaints are used as an improvement tool

• Our staff want to deliver better outcomes to our patients and clients

We have to start living our values

HSC MISTAKES

“ The fact is that virtually everyone who cares for hospital patients will make serious mistakes, … every year.”

ATUL GAWANDE Complications

MY MESSAGE -It is not a crime to have errorsbut it is unforgiveable to repeat them!