Patient experience and feedback
Although not mandated to report on patient experience, as a Trust we feel that it is really important to tell people how we are continually improving our services as a result of our patient's experiences. Patients are at the heart of everything we do, and we understand the importance of learning from their voices. The following pages provide information on what our patients and their families have told us through complaints, concerns, compliments and surveys, what steps we have taken to improve and how we intend to improve further in the future.
The Patient Experience Team co-ordinate all complaints, concerns, compliments and comments for the Trust, in line with the NHS Complaints Regulations 2009 and local policy. All feedback, both positive and negative, is managed by the department and enquirers. Communication with patients or their families is maintained throughout the process and they are informed of the outcome of their feedback.
Compliments
Compliments always far outweigh the number of complaints received, and in 2022/23, 2,702 compliments were received regarding the service. - an average of 225 a month and an average ratio of 6:1. Compliments are reported to the Trust Board and also emailed to the individual staff members with the local management teams copied in so that they can be acknowledged and recorded on the staff members’ personnel file.
| Apr-22 | May-22 | Jun-22 | Jul-22 | Aug-22 | Sep-22 | Oct-22 | Nov-22 | Dec-22 | Jan-22 | Feb-23 | Mar-23 | |
| Compliment | 197 | 224 | 165 | 214 | 247 | 157 | 182 | 250 | 242 | 328 | 264 | 227 |
| Concern | 482 | 40 | 32 | 43 | 40 | 37 | 38 | 42 | 39 | 47 | 41 | 46 |
| Complaint | 32 | 39 | 40 | 46 | 58 | 23 | 45 | 29 | 34 | 34 | 31 | 43 |
Complaints
As a Trust we closely monitor the volume of complaints coming through, seeking any trends and themes to support service improvement and early intervention. All complaints and concerns receive a full, evidence based investigation. Responses to concerns raised by patients or their representatives are available in different formats and face to face meetings are arranged where complainants need further support. The number of reopened complaints remains very low, meaning that complainants are normally happy with the response to resolve their complaint.
In 2022/23, we received a total of 454 complaints and 482 concerns and although complaints and concerns account for less than 0.07% of the contacts we have with patients, throughout 2022-2023 we have seen clear themes through the complaints and concerns received by members of the public and their representatives. This has had a focus on delays in sending an ambulance and times when we have needed to ask patients to make their own way to hospital. This has been as a result of escalatory measures put into place by the Trust during sustained extreme pressures in the wider system. The Trust has developed a clear action plan and has been working with our system partners across the region to support patients as safely as possible.
Following the release of our fully revised Complaints and Compliments Policy at the end of 2022, consent is now requested and must be received before the investigation can be started. Once consent has been received, this allows our investigators to telephone the complainant/patient to discuss their concerns openly and share any initial findings, without breaching data protection regulations.
The CQC inspection in 2022 noted significant improvements in complaints handling, learning from complaints, investigations and the processes in place.
Parliamentary and Health Service Ombudsman (PHSO)
Although most complaints are successfully resolved through the Trust’s complaints process, complainants are able to refer their complaint to the Parliamentary and Health Services Ombudsman (PHSO) for an independent review. This happens if a complainant feels that their complaint has not been resolved and the Trust has exhausted all avenues of resolution. This provides complainants with an impartial, independent review of their complaint and gives clear guidance to the Trust on how to improve our investigations and responses.
In 2022/2023 the Trust received four cases which have been opened by the PHSO. Two of these cases were partially upheld and two not upheld. During 2022 the Trust was made aware that the PHSO are managing a backlog of investigations, meaning that the cases that are currently being investigated are from between 2019-2021.
The patient experience team have received training from the PHSO as an introduction to the new NHS Complaints Standards Framework 2022 and hope to move forwards to working with this framework throughout 2023. This will support the Trust to try to resolve complaints at an early resolution stage with more complex cases being supported through a nationalised process.
The PHSO have introduced a mediation service which supports complaints and their representatives to meet with Trusts to work through their concerns. In 2022/2023 we have had one case go through this service which supported the complainant to understand the information shared with them in a compassionate and supportive environment.
Patient surveys
The annual patient survey programme includes continuous surveys for Emergency Service (ES)/Emergency Clinical Advice and Triage Service (ECAT) and the Patient Transport Service (PTS), along with planned survey projects in line with the Trust’s priorities and strategies. Planned survey projects are designed in collaboration with the service/clinical leads and may also be co-produced with experts by experience to ensure people and our community are treated as equal partners in service design, development, and evaluation.
The continuous online surveys are signposted using various methods, including the Trust’s social media channels, patient information cards and invitation to feedback letters, which are posted to random samples of ES and PTS patients each month. Listening to the patient voice enables the Trust to identify what is working well but also to highlight areas for learning and service improvement. The feedback received through surveys is continually monitored and triangulated with the themes identified through complaints, patient engagement, and patient safety to ensure appropriate governance and learning.
All patient surveys include the national Friends and Family Test (FFT) question, ‘Overall, how was your experience of our service?’ as good practice. The FFT is a method of calculating the overall satisfaction of the patient and is used as a benchmark across the Trust.
The FFT result is calculated by dividing the proportion of ‘very good’ and ‘good’ responses (numerator), by the overall number of responses (denominator). The FFT is a national directive, and the Trust is required to provide all PTS patients with the opportunity to respond to the FFT question, with results reported to NHS England each month.
The table below shows the rolling overall satisfaction results for the ES/ECAT and PTS continuous surveys:
| Trust patient experience results (April 2022 to March 2023) | Overall satisfaction (Friends and Family test) | |
|---|---|---|
| Number of patients | Overall satisfaction | |
| Emergency service / emergency clinical advice and triage service | 827/909 | 91.0% |
| Patient transport service | 405/466 | 86.9% |
| All services | 1232/1375 | 89.6% |
Since April 2022, 1,375 patients have responded to the overall satisfaction question, with 89.6% of these patients rating their experience as ‘good’ or ‘very good.’
Patient feedback has continued to be overwhelmingly positive, highlighting the professionalism, kindness, and care delivered by staff and demonstrating that patients are treated with dignity, respect, privacy, and compassion.
Survey projects
As well as surveys described for patients within our local priority set for last year, page 33 of this report, a number of further specific surveys were completed within the year.
Maternity
The maternity survey remained available throughout 2022/23 and enabled patients to provide feedback following their maternity related 999-emergency call. Overall satisfaction generally remained high (87.0%), and patients mostly reported a positive experience of the service received. However, the main areas of dissatisfaction were in relation to clinical treatment/assessment and attitude.
No Send
During 2022/23, a no-send survey was designed to capture feedback from Category 2 - 5 patients who had not received an ambulance response due to unprecedented demand. Overall satisfaction with the service received was low; however, patients had generally understood the instructions provided by the call hander and 67.6% had followed the advice given. The feedback received in relation to non-attendance/delays has been included as part of the wider work relating to the current urgent and emergency care situation.
Safeguarding
During 2022/23, there was a second mailout of the safeguarding survey, with the aim being to obtain feedback from patients who had consented to a safeguarding referral (e.g., mental health services, falls team, GP, local authorities and the Fire and Rescue Service). Patients were generally satisfied with the service received from the Trust (91.7%) and 85.7% felt included to at least ‘some extent’ in the referral discussions. Following referral, 77.8% of the patients went on to receive additional support. The main areas of dissatisfaction related to ambulance delays and staff attitude.
Skin Tear
A second mailout of the skin tear treatment survey was undertaken during 2022/23, with the aim to obtain feedback from patients who had received skin tear wound treatment. Overall satisfaction was high (97.0%) and non-conveyed patients were generally satisfied to have been left at home following their treatment. The main area of dissatisfaction related to ambulance delays.
Young patient mental health
During 2021/22, an Instagram survey was co-designed with the Youth in Mind group at the Mancroft Advice Project, to capture feedback from patients who had called 999 in relation to a mental health crisis. This survey has gone ‘live’ on three occasions and received a combined 4,825 views, highlighting the benefit of social media as a feedback mechanism.
The combined results generally demonstrate satisfaction with the service received from the Trust. However, the feedback has highlighted a deficit in mental health service and support availability, and a lack of awareness in relation to services/support available, 75.8% of respondents advised that they were unable to access mental health services prior to their 999 call, with a quarter of these respondents unaware of services/support available. A third of respondents (32.4%) also did not feel that their needs were understood or that they had been listened to during their emergency call.
The survey results have been shared widely to ensure 360 feedback. Going forward, call handler engagement sessions with young mental health ambassadors are planned, lists of area specific mental health services/support have been shared and plans are in place to better communicate the 999 call-handling process.
Easy Read
During 2022/23 an EasyRead survey was co-produced with the D.R.A.G.O.N.S at the Norfolk and Norwich SEND Association (NANSA) and is now available for patients to complete. This survey project has highlighted the importance of co-production and working with experts by experience as equal partners.
All patient survey reports are now published in line with the Accessible Information Standard and the online surveys can be completed using the ReachDeck Toolbar Everything function, with alterative survey formats also available as options (e.g., large print, Braille or in a different language).
Next steps
The Trust is committed to developing its patient experience and engagement activity and continually explores new methods for the patient voice to be heard. Co-production and working with experts by experience will continue, ensuring people and communities are treated as equal partners in service design, development, and evaluation.
The 2023/24 survey programme will include the continuous surveys and various planned projects, ensuring incorporation of the Trust priorities and the Patient and Public Involvement strategic objectives. Key survey results and themes will continue to be reported as part of the Trust’s quality and assurance reporting channels, with the monthly PTS FFT figures reported to NHS England.
Planned survey projects 2023/24
- Planned survey projects to be undertaken during 2023/24 include: maternity, safeguarding, skin tear, no-sends, a PTS partner survey, and the co-production of a children’s survey.
- A complaint handling survey to measure satisfaction in relation to the Trust’s complaints handling process.
- The implementation of an SMS survey for PTS and CallEEAST’s Birmingham Community Healthcare Call Handling Service
- The co-production of a video to explain how to complete the EasyRead survey and the importance of patient feedback.
Patient survey reports are available on the Trust’s public website.