WHAT OUR PATIENTS SAY
Patient Experience Annual Report
2013/2014
1
Contents
Foreword
1.
Introduction
2.
Sharing their experiences
3.
What we measure
4.
Innovation
5.
Complaints and compliments management
6.
Feedback results
7
6.1
Paramedic Emergency service
6.2
Patient transport service
6.3
Urgent care service
6.4
Feedback from community groups
Learning from experiences
7.1 Action Plans
7.2 How we learn
8
Summary and Future Focus
2
Foreword by Director of Quality
I am delighted to present the Trust’s annual patient experience report for 2013/14. We are
committed to gathering and considering all the feedback we receive with a view to providing high
quality services which meet the needs of our patients.
This report seeks to present the feedback we have received from patients and the wider public
about their care and our services and identify key themes. Importantly, the report also focuses on
how we learn from these experiences and improve our services as a result.
The report is presented to the Board of Directors as well as being shared internally and externally
with all stakeholders, and published on our website.
Thank you for taking the time to read the report.
Sarah Faulkner
Contact details:
Sarah Smith, Assistant Director Corporate Communications sarah.smith@nwas.nhs.uk
Fiona Buckley, Head of Risk and Safety fiona.buckley@nwas.nhs.uk
3
1.
Introduction
The experiences of our patients, their carers’ and their families are gathered from surveys, focus
groups, community engagement, complaints, concerns and compliments. This enables us to create
a full picture of our patients’ views and to understand the top issues, key themes and identify areas
of improvement.
The report is separated into the services we provided:



Paramedic Emergency Services (PES) – patients calling 999 who received a face to face
assessment response
Patient Transport Services (PTS) – patients who use our non-emergency service to take
them to hospital appointments or for discharge after a hospital stay
Urgent Care – patients calling 999 who are referred to our urgent care desk for further
assessment and those patients who contact the NHS 111 service.
There is also a section on the work we have undertaken with diverse groups in the communities to
understand service experiences which spans across all service areas.
A key section of the document is how we are learning from experiences which summaries the
actions and improvements we have identified and implemented as a result.
Finally, the report outlines the Trust’s future plans for gathering patient experience.
2.
Sharing their experiences
Feedback has been received via:
3661 surveys completed by patients calling 999, using patient transport services and referred
to our urgent care desk
2080 complaints received across the Paramedic Emergency Service, Patient Transport Service
and North West 111 Service
1082 compliments received
126 specialist patients attended focus groups
15 focus groups with community groups
12 public engagement events where feedback was collated
This demonstrates the level of engagement, both proactive and reactive, the Trust undertakes and
we always ensure the activities are representative across the large geographical area we cover.
In total we engaged with over 7000 patients and members of the public to understand their views
and experiences, as well as broader feedback via social media, website enquiries and public
roadshows.
4
3.
What we measure
We set targets for the number of patients we wanted to receive feedback from, as part of our survey
programme, as well as ensuring this was representative across all service areas. The table below
summarises the different approaches in comparison to the previous year. Overall there is a
significant increase in the number of surveys issued and completed.
Patient Experience Programmes
COMPARISON DASHBOARD
Service Area
PTS Outpatients
2013/14 Survey - Postal
PTS 1%, PTS ALA & Cumbria
Survey
Channel
Face to Face
2011/12 2012/13
581
2013/14 Survey - Postal
Postal & Discharge Vehicles
PTS Regular / Specialist User
2013/14 Survey
Focus Groups & Postal
PTS Observations
Paramedic Emergency Service - PES
2013/14 Survey - Postal
PES ALO, PRFs & PES
Telephone
OVERALL
467
2.2%
568
37
67
Postal
Face to Face
101
Face to Face
1545
37
67
95
137
81.1%
44.2%
568
1572
67
72
67
72
137
95
31
Postal
Silent
95
137
203
87
203
87
259
236
57.1%
9.9%
137
126
87
52
87
52
862
Telephone
199
236
52
236
5
130.8%
120
1023
52
120
120
1028
1227
1215
1215
3911
1.0%
7.5%
8.0%
40.2%
449.6%
1061
120
Postal
TOTALS
276.8%
236
Postal
Telephone
Overall
Movement
27
259
Urgent Care Desk Service
2013/14 Survey - Postal
2012/13 2013/14
Telephone
581
PTS Discharge Surveys
467
101
Postal
Overall
Movement
856.7%
321.9%
The Trust uses a number of sources to establish the questions and topics on which to seek feedback;
these include key themes from previous surveys, the Kings Fund’s published research “What Matters
to Patients”, complaint themes and service improvement needs.
Topics include





Friends and Family Test (FFT)
Overall Satisfaction
Communication and Information
Dignity and respect
Care and compassion
Both quantitative and qualitative data is collected and analysed across these themes.
5
Focus groups and community engagement sessions however have a much more fluid approach, with
users and members of the public raising issues on any topics they wish to.
The table compares three of the survey questions with last year’s results. Although this shows a
decrease in satisfaction, they are still relatively high levels. There was a substantial increase in the
number of surveys undertaken in 2013/14 and some variations in methods which give a more
representative position of satisfaction with services. Also the changes in the patient transport
service contract (and therefore patient expectations) may also be reflected in these results.
2013/14
Patient Experience Programme
Survey Channels
Overall Care - Rated Ambulance Service
8, 9 or 10 out of 10
(Percentage)
(Postal/Telephone)
SATISFACTION RESULTS
PTS Outpatients
Postal (1572)
PTS Discharge
Postal & Discharge Vehicles (72)
PTS Regular User
Specialist (126)
PES Surveys
ALO's/PRFs, Postal & Telephone (1061)
Urgent Care Desk Service
Postal (1028)
Recommendation to
Family or Friend
(FFT)
Cared for appropriately with Dignity,
Compassion and Respect
(Percentage)
2012/13
2013/14
2012/13
(Scored 8,9 or 10/10)
2013/14
(Extremely likely/Likely)
2012/13
(Strongly Agree / Agree)
2013/14
(Strongly Agree / Agree)
89.6%
89.7%
89.4%
93.0%
97.4%
95.7%
92.3%
88.7%
92.3%
94.5%
90.8%
94.4%
92.4%
76.2%
93.4%
84.9%
99.2%
96.0%
96.2%
95.0%
97.4%
95.9%
99.1%
97.1%
89.2%
76.4%
89.2%
85.9%
92.5%
88.2%
In terms of measuring complaints, each service line’s Senior Management Team is updated on a
monthly basis on the complaints received for their area along with identified trends. Trust wide
complaints data is reported to the Clinical Governance Management Group (bi-monthly) and to the
Quality Committee and Board of Directors (every six months) along with assurance reporting on the
process for complaint handling.
4.
Innovation
The Trust has accessed CQUIN (in full) monies to support some of the innovative work in patient
experience including development of the board games, public education and behaviour change
projects, improvements to mental health services, patient stories and testing out different methods
to gain feedback, including the family and friends test.
Friends and Family Test
In anticipation of the Friends and Family Test question being introduced to ambulance trusts by the
end of March 2015, the Trust has actively tested the question through a number of routes:



On all its surveys in 2013/14
Using postcards on vehicles
Operating two Pathfinder projects on behalf of NHS England and Commissioners to test out
methodologies for the FFT to inform future guidance on this important test
More about the FFT is outlined in the Future Focus section.
The introduction of Datix web has allowed for the development of more detailed reporting of
complaints, focussing on the Trust’s ability to understand the outcome of investigations in more
detail in order to identify lessons to be learned.
6
5.
Complaints and Compliments
The Trust has a well-established complaints policy and appropriate processes in place to both
answer complaints as well as identifying areas where lessons can be learnt. The responsibility for
managing all such enquires sits with the Making Experiences Count (MEC) Team who act as a point
of contact for patients, relatives, carers, other NHS providers and members of the general public to
share their opinions, thoughts and concerns on their experiences of the service.
All enquirers have an assigned point of contact in the MEC Team who is responsible for ensuring the
investigation is appropriately completed and maintaining contact. All complaints are risk assessed to
guide the level of investigation and management approval.
In light of one of the recommendations arising from the Public Inquiry into Mid Staffordshire NHS
Foundation Trust, NWAS amended how queries being received are categorised. The previous Patient
Advice and Liaison Service (PALS) function was removed with all enquiries being recorded as
complaints or general enquiries.
During the year, nine complaints were referred to the Parliamentary and Health Service Ombudsman
as the complainant remained dissatisfied with the explanation offered by the Trust. The
Ombudsman did not uphold any of the complaints against the Trust. Two minor learning points have
been identified which have been addressed.
During the year ending March 2014, the Trust received 2080 complaints. The table below details
where the complaints were received each month:
Apr
2013
May
2013
Jun
2013
Jul
2013
Aug
2013
Sep
2013
Oct
2013
Nov
2013
Dec
2013
Jan
2014
Feb
2014
Mar
2014
Total
72
47
49
68
47
69
74
62
51
60
86
79
764
90
65
60
63
62
62
62
68
51
66
107
97
853
30
33
21
31
25
29
43
27
31
35
32
37
374
Trust Wide
0
1
0
0
0
0
0
0
0
0
0
0
1
111 Service
Call Centres
0
0
0
0
0
0
0
9
21
26
19
13
88
Total
192
146
130
162
134
160
179
166
154
187
244
226
2080
Cumbria
and
Lancashire
(CAL)
Cheshire
and
Merseyside
(CAM)
Greater
Manchester
(GM)
As can be seen, with NWAS taking on the responsibility for the North West 111 provision from the
end of October 2013, those complaint numbers are also included.
7
By combining the previously reported separate number of complaints and PALS received, it is clear
that the overall number of queries decreased for the second year running though the overall trend
over six years has slightly increased.
In comparison to the combined data for year ending March 2013, there was a 24% decrease in
complaints reported for year ending March 2014. (NOTE: Some queries previously categorised as
PALS, are now classed as general enquires and therefore are not shown in these figures.)
3500
3000
2500
2000
Complaints /
PALS recevied
1500
1000
500
0
2008/09
2009/10
2010/11
2011/12
2012/13
2013/14
Upon receipt all complaints are risk scored using a 1-5 matrix. This is in line with the consequence
section of the Trust’s Risk Management Policy. The risk score can be amended as the investigation
processes. The chart below details the risk score of the complaints received in year by area.
The disparity between the overall total for Cumbria & Lancashire / Cheshire and Merseyside and
Greater Manchester is related to the provision of PTS Services as the Trust currently does not
provide this service for Greater Manchester.
Minimum
Minor
Moderate
Major
Serious
Total
CAL
220
406
102
36
0
764
CAM
225
492
121
15
0
853
GM
53
177
110
31
3
374
Trust Wide
1
0
0
0
0
1
111 Service Call
Centres
48
36
3
1
0
88
Total
547
1111
336
83
3
2080
Upon receipt, all complaints are categorised by a primary category, though there may be multiple
strands to one complaint. The figure below details the reason for complaints:
8
12
5
Emergency Response
221
Staff Conduct
493
Communication and
Information
Navigation
Driving Standards
End Of Life Care
PTS Transport
282
791
Care and Treatment
Damage or loss to property
120
135
Safeguarding
19
2
The Trust also closed 2818 complaints and PALS records in the year, of which 434 were upheld or
partly upheld. Details of reasons why complaints were upheld is detailed in Section 6.
Alongside complaints and queries, the Trust also receives compliments which are detailed below.
Staff have been commended for the care, kindness, being respectful, helpful, attentive, calm,
friendly and professional. There were thanks for attending to dying patients, saving lives, helping
with births (both over the phone and face to face), making scary situation better and for caring for
the families of patients during often traumatic situations.
Thanks have also been received for multiple occasions of care and very long journeys – particularly
on PTS.
Apr
2013
May
2013
Jun
2013
Jul
2013
Aug
2013
Sep
2013
Oct
2013
Nov
2013
Dec
2013
Jan
2014
Feb
2014
Mar
2014
Total
Cheshire
9
5
6
18
20
6
14
13
7
16
11
10
135
Cumbria
18
15
18
22
18
9
23
20
12
8
13
5
181
Greater
Manchester
18
14
19
20
13
14
15
13
16
21
25
17
205
Lancashire
32
23
27
30
26
20
31
26
27
35
36
29
342
Mersey
18
19
11
21
18
11
17
16
18
26
24
16
215
111 Service
Call Centres
0
0
0
0
0
0
0
0
0
3
1
0
4
Total
95
76
81
111
95
60
100
88
80
109
110
77
1082
This amount of feedback gives us a comprehensive assessment of the quality of care our
patients feel they are receiving.
6.
Feedback Results
9
6.1
Paramedic Emergency Service (PES) Survey Analysis and Complaints
Review 2013/2014
A survey is undertaken with members of the public following their need to contact our Paramedic
Emergency Service either through telephoning ‘999’, or their GP contacting our Service, or contact
made with the ‘111’ service and transferred to 999. Only patients who have received a response by
either a Rapid Response Vehicle or Ambulance are contacted for this particular survey.
Surveys have been previously undertaken by visiting a number of hospitals across the region and
surveying suitable patients face to face that have attended Emergency Departments by ambulance.
Whilst this method produces valuable feedback in terms of qualitative data, it is less representative
in terms of the number and type of patient accessing the 999 service. The Trust was keen to
increase the number of surveys undertaken in 2013/14 and two different methods have been
trialled to obtain feedback from over 1000 patients who have used the service. These included:
Ambulance Liaison Officers (ALOs)
The primary role of the ALO is predominantly to ensure the smooth handover of patients and to
work together with hospital colleagues to minimise any delays. They also had difficulties in
identifying suitable patients during the limited time that they spent in individual Emergency
Departments. The ALO’s were asked to hand out the surveys to patients within Emergency
Departments– the return rate for surveys handed out by the Officers was low, due to sufficient time
alongside their other commitments to identify suitable patients.
Postal Surveys
Patients were initially contacted by letter to obtain their consent to send a further postal survey
within the following two weeks, unless they opted out by either telephoning or returning a tear off
slip to a freepost address. We also offered patients the opportunity to participate in the survey over
the telephone. Both postal and telephone methods produced good results. This method remains the
most successful method to date in obtaining feedback from a more number of patients we treat and
care for throughout the North West.
10
A total of 1061 patients were surveyed by 31 March 2014.
The Friends and Family Test (FFT) Question is a national requirement that allows patients the
opportunity to provide feedback on the care that they have received in ‘real time’. Current
guidance for eligible patients is that the question is asked in real time or within 48 hours of receiving
the care. Since April 2013, it has been mandatory all inpatient hospital wards and Emergency
Departments to ask their patients this question and this is set to be extended across all NHS services
in England, including ambulance services, mental health services, community nursing and outpatient
appointments, by the end of March 2015.
(Number in title reflects survey question numbers)
In readiness for this NWAS, as part of the 2013/14 Patient Experience programme, this FFT Question
forms the opening for all of our Patient Experience Surveys.
These results are also supported with comments such as:
I would recommend them to anyone.
It took 2 hours for the ambulance to turn up.
They were first class.
In addition to the above question, patients were also asked a series of questions to obtain feedback
on their experience relating to dignity, care, compassion, reassurance, making the emergency call,
and communication. The themes are based on the Kings Fund What Matters to Patients research.
They were fantastic. They were brilliant, they made me laugh, they brought gas and air and
gave me morphine, and I think they even had the helicopter on standby as the crew member
in the back said to his mate to cancel it. I can't give them enough praise - it was like time did
not matter - I felt like I was the only person in the world that mattered to them.
11
12
Due to the serious nature of my mum’s condition, the crew treated my mum kind and caring in a
difficult situation as my mum was particularly uncomfortable, they transported her safely and
with care and compassion. It was such a life saver to know that I could telephone your service
and someone would come.
The Paramedic Emergency Service received a total of 1002 complaints in this reporting year. The
reasons for complaining are detailed below. Complaints are received through letters, telephone and
increasing via e-mail and through the Talk to Us section of the website. The overall number of
complaints received remains very low, in comparison to the level of activity as the Trust received
over 1.1m calls for assistance. This means that 0.09% of 999 calls received resulted in a complaint.
Despite this the Trust takes complaints very seriously and uses them as an opportunity to
understand what could be improved.
The charts below detail when the complaints were received by area and the reasons for complaints
against the Paramedic Emergency Service:
45
40
35
30
25
CAL
20
CAM
15
GM
10
5
0
Apr
2013
May
2013
Jun
2013
Jul
2013
Aug
2013
Sep
2013
Oct
2013
Nov
2013
Dec
2013
Jan
2014
Feb
2014
Mar
2014
13
7
4
145
Emergency Response
2
Staff Conduct
Communication and Information
104
491
17
Navigation
Driving Standards
End Of Life Care
53
Care and Treatment
Damage or loss to property
179
Safeguarding
Themes from Surveys and Complaints
Service users were asked what three factors were most important to them when telephoning for an
emergency ambulance. There are a number of themes highlighted in the feedback:
A fast response is one of the most important factors for our patients. Not only is it one of the most
common factors cited in the top three, to the individual making the emergency call it also impacts on
the satisfaction scores provided. However the feedback does show that there is a need to raise
awareness with the public as to what constitutes an emergency and what requires an immediate
response. For example, there are a number of comments about the time elderly patients who fall
sometimes have to wait for an ambulance and how age should be taken into account that although
the situation can be very distressing, it may not necessarily be an emergency situation. Where low
levels of satisfaction have been scored, this is predominantly followed by feedback that an
immediate response was not forthcoming.
The importance of a timely response was reflected in complaints made against the Trust, for year
ending March 2014. Complaints regarding emergency response time represent 49% (n=491) of all
PES complaints received in year and is the second most common reason for initiating a complaint
against the Trust. The chart below details when the complaints were received and historically, the
months of January and February receive more complaints due to the pressures in the winter months.
1. Prompt response
2. Whether you feel as though
everything possible was done?
3. CPR Advice
14
Emergency Response Complaints recevied by month
60
50
40
30
20
10
0
Apr
2013
May
2013
Jun Jul 2013 Aug
2013
2013
Sep
2013
Oct
2013
Nov
2013
Dec
2013
Jan
2014
Feb
2014
Mar
2014
Overall the Cheshire and Merseyside area received more emergency response complaints than the
other areas.
Why did it take over 2 hours to respond to my elderly father who was left lying outside
getting cold and wet?
There were 2 complaints risk assessed as Serious (consequence score 5). Both were in the Greater
Manchester area and both involved patients who subsequently died. Greater Manchester also had
the highest number of identified major (consequence score 4) complaints (n=11). These complaints
are defined as having significant delays resulting in non-permanent harm to the patient involved.
Minimum
Minor
Moderate
Major
Serious
Total
CAL
8
75
51
6
0
140
CAM
9
99
75
6
0
189
GM
5
76
69
11
2
163
111 Service Call Centres
0
1
0
0
0
1
Total
22
251
195
23
2
493
Emergency response complaints include concerns about the primary response, ambulance back up
following the attendance of a solo responder on a car, transfers between hospitals and Healthcare
15
Professional booking delays. As can be seen from table above, most complaints were defined as
minor i.e. causing distress rather than harm.
Of the 456 emergency response queries closed within the reporting year, 94 were either upheld or
partially upheld. The most common reason for upholding emergency response time complaints was
that the response did not meet the caller’s expectation. Errors is call handling, dispatch, call coding
as well as staff attitude were identified for a small number of complaints.
The call taker advised that because they were so busy there may be possible delays but said
that she would stay on the phone with me.
Good communication is vital – this can be in the first instance between the call taker and the person
making the emergency call but also between the ambulance staff and the patient/patient’s family.
Feedback showed that when the call taker provided the patient with information such as whether
the service was particularly busy at that time or where there may be delays then this helped to
manage patient expectations surrounding response times, this also related to feedback from
relatives or carers who were also present and received information and reassurance themselves.
Being treated with dignity, respect, kindness and compassion is an aspect of care that is very
important to our patients, 97.08 % of patients surveyed either agreed or strongly agreed that they
were treated in this way.
The two paramedics who cared for my father were wonderful. There kindness, professional
command of the situation, their genuine compassion was so reassuring and comforting to his
family and to my father.
Staff conduct queries were the second most common reason for PES complaints this reporting year
and represented 17.9% (n=179) of PES complaints received. The staff conduct category encompasses
complaints about attitude, behaviour and comments and relates to staff both in the Emergency
Operations Centre as well as on the road. The chart below when these complaints were received
detailing October and March as the highest reporting months.
Staff Conduct complaints recevied by month
30
25
20
15
10
5
0
Apr
2013
May
2013
Jun Jul 2013 Aug
2013
2013
Sep
2013
Oct
2013
Nov
2013
Dec
2013
Jan
2014
Feb
2014
Mar
2014
16
Complaints about staff attitude were fairly evenly
distributed across each of the three areas with
Greater Manchester having the most complaints and
the most serious complaint. Staff conduct complaints
assessed at being either major or serious are those
where staff have displayed behaviour that would
warrant either general or gross misconduct.
Minimum
Minor
Complainant felt that the attending crew
were dismissive of the patient’s family;
lacked empathy, respect and were rude.
This added to the stress of the situation.
Moderate
Major
Serious
Total
CAL
14
22
14
1
0
51
CAM
12
40
10
1
0
63
GM
13
40
9
2
1
65
Total
39
102
33
4
1
179
The Trust also closed 302 staff conduct or attitude queries in the year, 32 were upheld. These were
mainly where it was found that the staff’s attitude did not reach the standard expected by the Trust.
Other findings included inappropriate staff comments, inappropriate staff behaviour and one case of
intimidation.
Patients were also asked to provide feedback on
whether they were involved with decisions about their
care and treatment options. Although the overall
score for this is lower than other responses, 86.42%
agreeing or strongly agreeing, there are a number of
reasons for this. Patients seem unsure of what we are
asking. Patients have a lot of confidence in the
paramedic crews and put their trust in the decisions that they
make, they don’t always feel as though they need to be involved in the decision making process as
the paramedic has the knowledge to make the best choices for them. Also, the emergency situation
or the medical condition of the patient may mean that it is not appropriate for the patient to be
involved with decisions and choices have to be made on their behalf.
I didn't want to go to hospital and
once I was stabilised they spoke to
the A&E doctor and then respected
my wishes to let me stay at home.
Care and Treatment complaints represented
14.5% (n=145) of PES complaints received in year.
Receipt of these complaints varied throughout
the year with more being received in July and
November rather than other months. Given the
higher volumes in activity over the winter
months, there would be an expected rise in
complaints in February and March.
Why did the ambulance crew make the
patient walk to the ambulance when he
has poor eyesight and is so unsteady on
his feet? During the transfer, he fell
sustaining an injury to his knee. The
patient was later diagnosed as having had
a stroke
17
Care and Treatment complaints recevied by month
25
20
15
10
5
0
Apr
2013
May
2013
Jun Jul 2013 Aug
2013
2013
Sep
2013
Oct
2013
Nov
2013
Dec
2013
Jan
2014
Feb
2014
Mar
2014
Both Cumbria and Lancashire and Greater Manchester had more major level complaints than
Cheshire and Merseyside with slightly lower overall numbers. Some of the issues raised in the major
category have included patients falling in the crew’s care, patient sustaining injury in the crew’s care,
inadequate assessment of presenting injuries, poor dynamic risk assessment leading to poor manual
handling techniques undertaken and lack of immobilisation.
Minimum
Minor
Moderate
Major
Total
CAL
2
18
11
15
46
CAM
1
18
18
4
41
GM
2
22
19
15
58
Total
5
58
48
34
145
198 care and treatment complaints were also closed in the year, with 48 of them either upheld or
partly upheld. The reasons for upholding these complaints included inadequate assessment and
treatment, inappropriately leaving the patient at home, taking patients to an inappropriate
destination (e.g. Urgent Care Centre rather than Emergency Department), failure to employ
appropriate manual handling techniques and standard of completion of paperwork.
The Paramedic Emergency Service also received a further 187 complaints that were about the
following areas:
18
120
100
80
60
40
20
0
Communication
and Information
Navigation
Driving
Standards
Our neighbour is a frequent caller of the
ambulance service, however the
attending crews often park
inappropriately causing disturbance.
Can this please be addressed?
End Of Life Care Damage or loss Safeguarding
to property
As can be seen from the chart above, the most
common reason for other complaints is driving
standards (n=104). These complaints vary from
concerns about how vehicles are being driven, where
they are parked and the use of lights and sirens.
Communication and information complaints (n=55) included
concerns about information passed to and from the Emergency Operations Centre,
information being passed between healthcare providers, patients requesting attendance to a
particular hospital and not the nearest Emergency
Department, difficulties in locating patients and
Information for access to the key code
length of time it took to pass a call from one
was given to the 999 operator – why
ambulance service to another.
wasn’t this passed to the crew? The
There were 17 navigation complaints which included
crews attending incorrect addresses, difficulties in
finding specific addresses and addresses which can be
confused (i.e. different flats in communal living areas).
patient had to crawl to the front door
to let the crew in.
The 7 damage / loss of property complaints varied from personal items to damaged doorways, walls
and furniture in homes.
Both End of Life care complaints related to the transport provision and the one safeguarding
complaint concerned a previous safeguarding referral completed by ambulance staff.
Of the 163 other complaints closed in this year, 21 were upheld for a variety of reasons including
misuse of lights and sirens, poor driving standards, dispatcher error, delays with inter-hospital
transfer, sub-standard driving skills, inappropriate staff comments and attitude.
19
Key Findings









High levels of overall satisfaction are reported
Qualitative feedback suggests that some patients expect an immediate response
when calling 999 regardless of whether their condition is immediately life
threatening.
Low levels of understanding of the responsibilities and distance an ambulance can
cover within one shift.
Low levels of awareness of the role of Community First Responder.
Patients who have fallen and cannot mobilise have no alternative but to ring 999,
frequently they are uninjured and just need assistance. Some patients have
reported waiting a long time for an ambulance response and many are elderly.
The overall number of complaints received by the Trust has reduced this year in
comparison to last year (taking the combined figure of complaints and PALS for
2012/13).
Complaints arising from the work of the Paramedic Emergency Service remains very
low in comparison to the number of requests for assistance
Emergency Response time remains the most common reason for contacting the
Trust. In most cases, patients were attended to by the first available vehicle though
this did not meet the patient's expectation
The Trust upheld 10.4% of all the PES complaints and PALS enquires closed in the
year
They are very good. Sometimes when my
husband is on the floor we have to wait a
long time for the ambulance to arrive,
although we understand why.
6.2
A Community responder arrived first
and he didn't give me anything for the
pain, he didn't help me he just put
something on my finger. Crew came
from Cheadle to Macclesfield despite
an ambulance station being very near.
This took about 35 - 45 minutes (blues
and twos) - too long.
Patient Transport Service (PTS) Survey Analysis and Complaints Review
2013/2014
The North West Ambulance Service NHS Trust provides PTS in Cheshire, Mersey, Lancashire and
Cumbria areas. As part of the current contract we aim to obtain feedback from a minimum of 1% of
patients who have used the Service.
The Patient Transport Service (PTS) Survey is undertaken with patients who have used our PTS to
attend outpatient or hospital appointments throughout the North West area.
20
During previous patient experience programmes Surveys have been undertaken by visiting a number
of hospitals across the region and surveying suitable patients that have attended Outpatient
appointments by ambulance. Whilst this method produces valuable feedback in terms of qualitative
data, it is less representative in terms of the number of patients the Trust provides services to.
During the 2013/2014 Patient Experience programme, the team have trialled two new methods to
obtain feedback from patients who have used the service. These included:
Ambulance Liaison Assistants (ALAs)
ALAs are based in hospital out-patient departments. The ALA’s were asked to hand out the surveys
to patients within Outpatient Departments – the return rate for surveys handed out by the
Assistants was very positive, with a total of 470 surveys being returned completed by 31 March
2014.
Postal Surveys
At the point of booking transport patients were informed that they may be contacted by the Trust
to obtain there feedback on the service they had received. A random selection of patient names and
addresses was provided to the team by Health Informatics and these patients were sent a letter and
survey, along with a Freepost envelope to use to return the completed survey. A total of 1120
completed postal surveys have been returned.
At 31 March 2014, in total 1572 surveys were completed by patients using PTS.
21
The Friends and Family Test (FFT) Question is a national requirement that allows patients the
opportunity to provide feedback on the care that they have received in ‘real time’. Current
guidance for eligible patients is that the question is asked in real time or within 48 hours of receiving
the care. Since April 2013, it has been mandatory for all inpatient hospital wards and Emergency
Departments to ask their patients this question and this is set to be extended across all NHS services
in England, including ambulance services, mental health services, community nursing and outpatient
appointments, by the end of March 2015.
In readiness for this NWAS, as part of the 2013/14 Patient Experience programme, this FFT Question
forms the opening for all of our Patient Experience Surveys.
These results are also supported with comments such as:
First Appointment told to be ready 1 hour
before. Further apps. 1 3/4 Hours to 2 Hours
to pick up before appointment. Arrived for an
afternoon appointment 1 ½ hours early. All
times Volunteer Drivers.
Always been treated with care and
respect. Some mornings I need more care
than others and it's always there for me.
In addition to the above question, patients were also asked a series of questions to obtain
feedback on their experience relating to dignity, care, compassion, reassurance, booking
ambulances, the assessment process and communication.
All your staff treated me in a friendly and courteous manner and made the journey
interesting. I even had a chance to reacquaint with one of your civilian drivers who was an old
school mate last seen when we finished school in 1970.
22
The Trust received 982 complaints regarding the Patient Transport Service in this reporting year. The
number of complaints received remains very low in comparison to the level of activity undertaken as
0.09% of all journeys result in a complaint.
A small number of residual complaints were received regarding patients in the Greater Manchester
area although NWAS no longer provides this service. As can be seen, the start of the new PTS
contract in April 2013 did give rise to a significant number of complaints. Lancashire received most
complaints over the year (n=320) however this county has the highest level of activity. Complaints
represented 0.07% of all Lancashire journeys.
50
45
40
35
Greater Manchester
30
Lancashire
25
Mersey
20
Cheshire
15
Cumbria
10
5
0
Apr May Jun
Jul Aug Sep Oct Nov Dec Jan Feb Mar
2013 2013 2013 2013 2013 2013 2013 2013 2013 2014 2014 2014
Themes from Surveys and Complaints
As can be seen from the chart below, it is clear that the overwhelming number of complaints are
related to transport issues (n=790 or 81%). This chapter will therefore concentrate on those
complaints.
The table below details the complaints received by area and risk score. As can be seen there are 4
complaints that were deemed to be major; these included one major patient injury, a lack of
23
transport leading to a loss of appointment and therefore delayed treatment which the complainant
felt impacted on the long term care of the patient, and two complaints regarding sub-standard
driving for Voluntary Car Service (VCS). These reach the major threshold as the standard for VCS
would be lower than for others aspects of the service.
The 12 moderate complaints included long delays, repeated transport issues, transport refused or
wrong transport sent causing loss of appointment.
It is clear however that most of the complaints are of a minor nature with 97.9% being score as
minimum or minor.
Minimum
Minor
Moderate
Major
Total
Greater
Manchester
1
6
3
1
11
Lancashire
77
168
3
2
250
Mersey
62
118
2
0
182
Cheshire
101
139
2
0
242
Cumbria
46
57
2
1
106
Total
287
488
12
4
791
Service users were asked whether when making a booking were they taken through an assessment
process, 83.12% of patients agreed that they were taken through the assessment process, with
82.36% of patients confirming that they understood why they were asked these questions.
24
Patients were asked whether they were offered the option of the new booking reminder service, this
service was introduced as part of the new contact in 2013. Disappointingly only 20.95% of patients
were offered this service.
Despite patients not being offered the reminder service, reassuringly 91% of patients surveyed
confirmed that they are informed of a time to be ready when travelling with the PTS. However,
when analysing the qualitative feedback the actual information varies quite considerably. With
comments such as:
I’m always ready 1 ½ to 2 hours before &
Being ready to be picked up at 8.30am for
an appointment at 11:15 am is ridiculous,
or On several occasions the time to be
ready and the time picked up, there was
quite a gap in time.
Being given a time would have helped
instead of being ready by 8 am and just
sitting waiting.
91% of patients surveyed confirmed that their call into PTS control was handled politely and
respectfully.
25
Generally patients either strongly agree or agree that they are satisfied with the overall care
provided (96%), however there are still concerns that patients feel they are waiting too long prior to
the transport arriving and after their appointment waiting to go home. The Patient Transport Service
has quality standards to meet for collection times, however patients feel that these waiting times
are too long and most patients are not aware of what the quality standards are. Patients would
benefit from additional information prior to the journey.
On the homeward journey you are kept waiting a long time.
No information as to when to expect ambulance.
I gave a score of 10 - as I am well looked after from being picked up from my door till I returned home.
They are all a great bunch of people who work on the transport. They treat me with respect and have a
lot of patience. Well done to all of them!
26
A 10 would be appropriate but sometimes I
have to wait until the vehicle arrives almost at
my appointment time and the waiting to go
home and not knowing when the ambulance
will arrive, makes me anxious
Waiting for transport, either to or from appointments, is often cited in complaints to the Trust.
Complaints have varied though the most common reasons have been:






Vehicle not arriving at home destination to take the patient in
Vehicle arrive late at home destination to take the patient in
Transport not suitable for the patient’s condition
Vehicle did not arrive at the clinical destination to take the patient home
Vehicle arrived late at the clinical destination to take the patient home
Planning error in PTS control
One other significant issue, raised under the PTS Transport category, was issues relating to the
introduction of the eligibility criteria to decide whether patients could have transport or not. The
criteria was set by the Trust’s Commissioners and lead to transport being refused to more patients
where it was deemed that they were able to arrange their own transport.
There were 192 other complaints as detailed in the table below.
Staff
Conduct
Communica
tion and
Information
Navigation
Driving
Standards
Care and
Treatment
Damage or
loss to
property
Total
Greater
Manchester
0
0
0
1
3
1
5
Lancashire
39
5
2
12
10
2
70
Mersey
14
2
0
4
14
0
34
Cheshire
21
4
0
9
12
2
48
Cumbria
18
3
0
5
9
0
35
Total
92
14
2
31
48
5
192
27
Care and Treatment complaints have included patient injuries where patients have being involved in
minor traffic collisions, sustained skin tears, patients being walked to and from the vehicle when
they should be in a chair, not carrying patient up steps when required and patients not being
appropriately dressed for discharge.
The Trust also closed 932 complaints and queries within the year, of which 206 (22.1%) were either
upheld or partly upheld. Reasons for upholding complaints have included planning errors, poor staff
attitude, comments or behaviour, inappropriate manual handling techniques, sub-standard driving
skills, insufficient information passed to patients, late transport and incorrect eligibility criteria
outcome.
Patient reported that she asked the ambulance crew to help her but she states they were
extremely rude, unhelpful and made unnecessary comments which upset her.
Further transport had to be arranged. The patient reported this was totally different with a
helpful crew.
Key Findings










High levels of satisfaction with the Friends and Family Test question.
Low levels of patients received booking reminder service option
High levels of satisfaction when patients are liaising with PTS control
High levels of satisfaction and patients feeling reassured when travelling with operational
staff on ambulances
Low levels of awareness with standards and waiting times
Level levels of awareness of the PTS Charter and Information leaflets
Patients comments suggest that some taxi’s operating on behalf of NWAS do not provide a
good service.
The PTS Service continues to have a very low rate for complaints against the service.
The timeliness of attendance to patients both for journeys into and out of hospital is the
most common reason for complaining.
22.1% of complaints closed in year were upheld or partly upheld.
Am happy but it should
be less time waiting to
return home
I had a taxi last time but I was not happy about
it, with one person wheelchair.
28
Specialist Patients who use Patient Transport Services
This specialist group of patients include service users of our Patient Transport Service (PTS) who are
either receiving haemodialysis or treatment for cancer. These patients attend their hospital clinics
regularly and use the PTS around three to four times per week.
As well as the survey work, the Patient Experience team have visited five hospitals (see below)
within the North West area to engage with this specialist group of patients who regularly use the
Patient Transport Service. In addition to the hospitals, the Trust also held focus groups with patients
and spoken to clinical staff. We have also visited the Brain Tumour Support Group in Liverpool and
the Head & Neck Cancer CNS in Lancaster. We used a variety of methods to engage with this group
of patients and staff including our new Patient Experience board game and also asked specific
questions to gain feedback on their experience of using our PTS, and also to gauge their
understanding of the new Enhanced Priority Service element of the Patient Transport Service
contract which was introduced in April 2013.
During the 2013/2014 Patient Experience programme a total of 125 patients or their relatives/carers
provided feedback on the service they have received using the Patient Transport Service to travel to
and from appointments for haemodialysis or treatment for cancer.
The graph shows the breakdown of areas in which we spoke to patients throughout the North West
area. Greater Manchester area is not represented as we no longer transport patients to their
appointments in this area.
29
All patients were asked the Friends and Family test question and the graph below shows the results.
Of the 126 patients that provided feedback, 84.92% stated that they are either likely or extremely
likely to recommend the ambulance service to their friends and family should they need similar care
or treatment. High levels of satisfaction are recorded with comments as follows:
Ambulance staff are very considerate.
Ambulance men and women are
brilliant with you. People like to
have the same drivers.
You get to know them, they use your first
names - nice and friendly & very helpful.
30
Themes
The majority of PTS bookings for this specialist group of patients are made by the hospital clinics,
this minimises the information that can be provided prior to transportation. However, a marketing
campaign raising awareness of the introduction of the next collection service could be implemented
to inform our Healthcare professional colleagues of this recently introduced service. Feedback
suggests that this patient group would prefer a telephone call or text to advise them when transport
will be arriving. Afternoon patients would particularly benefit from this service on both the inward
and outward journey.
Patients were happy to be invited to provide feedback on the service they are receiving; their
comments indicate that this makes them feel valued. Patients expect a reliable Service that will turn
up on time, with friendly, professional staff, the results indicate that most patient are receiving this
level of service with 89.63% of feeling that they are cared for appropriately with dignity, compassion
and respect.
Patients still feel as though the waiting time to go home is too long, however when entering into
discussions this specialist patient group feel as though 30 minutes is an acceptable time to wait.
Most patients said they had not waited more than 90 minutes.
Patients state that since April 2013 their transport experience has either improved or remained the
same (neither agree or disagree), but on expanding on this question most stated that they were
happy and grateful with the service we provide. Despite the Patient Charter and Information leaflets
being displayed in the waiting areas of the hospitals visited, patients reported they were not aware
of either of these publications.
Everything's good - sometimes
you have to wait a while but
most of the time it is fine.
Waiting time to go home - always a bit of a
bind when you have to go to the discharge
lounge. It would be good to know that you
don't have to wait longer than 15 minutes.
31
Key Findings







High levels of satisfaction with the services the operational crews provide.
Low levels of awareness of the new quality standards within the Enhanced Priority
Service for both staff and patients.
Low levels of awareness of the new PTS Charter and information available to
enhance the patients experience.
Low levels of awareness with Hospital staff about the Patient Transport Service who
requested training and awareness raising of the eligibility criteria and booking
system.
Low levels of awareness of the ‘Next Collection Service’
Patients feel valued when asked for feedback on their experience.
Low levels of satisfaction around waiting times to go home.
32
6.3
Urgent Care
The Urgent Care Desk Service (UCD) Survey is aimed at members of the public who have called 999
and based on the nature of their call, have been referred to the urgent care desk for further
assessment by a specialist paramedic.
The UCD Service will undertake further assessment and clinical triage and based on the medical
needs of the patient, advice or refer the caller to the most appropriate pathway or service for their
needs.
This ranges from Hear and Treat, See and Treat or Refer, See and Transport. Clinicians manually tag
their incidents using codes which are then grouped into the one of the three outcomes:
Hear & Treat
ALTTRA
Alternative
Transport
Found
HATD
Hear &
Treat
Discharge
See & Treat
HATR
Hear &
Treat
Refer
SATR
See &
Treat
Refer
SATD
See &
Treat
Discharge
Conveyance (Transport)
PESI
PES Response
Inappropriate
PTLIFT
Patient
Lift Only
GRA
Green
Response
Appropriate
UPGR
Upgraded
due to
Clinician
Concern
Previously in the 2012/13 Patient Experience Programme, over a four week period, users of the
Urgent Care Desk service were asked by Urgent Care Desk (UCD) Paramedics if they would consent
to taking part in a postal survey. For this year’s programme, to increase the survey sample size (in
2012/13 120 derived via the 351surveys sent out, a 34.2% return rate), a different approach was
taken to capture records that were suitable for survey purposes.
Every caller was advised that they may be contacted and asked about their experience. Where the
caller indicated that they wanted to be excluded, this was added to the notes. This has been
included in the UCD Service Standard Operating Procedure (SOP). Once all the clinical requirements
had been met, at the end of the triage process/call, the following was added to the script: “You may
be contacted and asked about your experience today”.
From July to December 2013 a total of 3,698 postal surveys were sent out which saw a yield of 1,028
completed returned surveys, a success rate of 27.8%, with completed returns still coming in up to six
months after surveys were initially sent out. Reponses were received from across all five areas that
Based on your experience of our service, how likely are you to recommend our
Ambulance Service to friends and family if they needed similar care or
treatment?
1.6%
1.5%
2.4%
4.0%
1 - Extremely likely
4.7%
2 - Likely
15.9%
3 - Neither likely nor unlikely
70.0%
4 - Unlikely
5 - Extremely unlikely
6 - Don’t know
No response provided
33
make up the North West Ambulance Service (NWAS) geographical responsibility, with 0.5% of them
completed as telephone surveys.
The Friends and Family Test (FFT) Question is a national requirement that allows patients the
opportunity to provide feedback on the care that they have received in ‘real time’. Current
guidance for eligible patients is that the question is asked in real time or within 48 hours of receiving
the care. Since April 2013, it has been compulsory for all inpatient hospital wards and Emergency
Departments to ask their patients this question and this is set to be extended across all NHS services
in England, including ambulance services, mental health services, community nursing and outpatient
appointments, by the end of March 2015.
In readiness for this NWAS, as part of the 2013/14 Patient Experience programme, this FFT Question
forms the opening for all of our Patient Experience Surveys.
In addition to the above national question, patients were also asked a series of questions to obtain
feedback on their experience relating to dignity, care, compassion, reassurance, awareness and
understanding of our service and communication. The following pie charts show the results:
When you called 999, you understood why you were not immediately
provided with an ambulance and that you would be called within 60
minutes for further assessment.
5.1%
2.9%
8.9%
Strongly Agree
12.1%
Agree
Neither Agree or Disagree
29.4%
41.6%
Disagree
Strongly Disagree
No response provided
The results show that a total of 71.05% of service users agreed that they understood they would not
immediately receive an ambulance and would be called back within 60 minutes for further
assessment. Analysis of the qualitative data demonstrated that patients have a good understanding
of why they were not receiving an immediately response, but were provided with reassurance and
felt confident that they would receive the appropriate care to meet their needs. This question is
supported by the following comments:
The person who answered my
call was very helpful and clear in
his advice.
Care call made the 999 call. Ambulance
Service kept in touch all the time.
I received call back within 15
minutes – Great service.
34
“I fully understood the advice provided”
1.3%
0.4%
5.6%
“The member of staff was polite and
Strongly Agree
respectful.”
9.3%
0.8%
Agree
0.4%
3.5%
7.1%
40.7%
29.0%
42.8%
Strongly Agree
Neither Agree or Disagree
Agree
Disagree
Neither Agree or
Strongly Disagree
Disagree
59.2%
Disagree
No response
provided
Strongly Disagree
A small percentage (8%) of patients who
provided a negative response to the above question provided feedback which would suggest high
levels of pain and discomfort and delays in providing a call back impacted adversely on the patient’s
experience.
88.22% of patients surveyed agreed that staff were polite and respectful. Patients report that they
were provided with care by helpful and caring staff, in a courteous and polite manner with
reassurance and support.
Being told to phone back if
you get worse is pretty
depressing when you've
asked for help.
It was comforting
to have everything
explained.
I understood that my
case was not an
emergency and that is
why the wait was so
long.
High levels of satisfaction are reported from service users that they both fully understood the advice
provided and that the staff listened to their concerns. However, the results show that there is still
an expectation that when calling the emergency service an immediate response will be provided and
that a small number of patients experienced anxiety at the prospect of receiving a call back.
Feedback provided suggests that if a patient’s condition is suitable for an alternative pathway of care
and this care or advice is not followed up within the agreed timeframe this has a negative impact on
the patients experience if they are not kept informed of any unexpected delays or call backs.
I did not know how long I
would have to wait.
First call 1pm, 5 or 6 calls
made, ambulance came
about 8pm.
It took the Ambulance
longer to arrive than
advised on the Phone.
35
What did actually happen next?
0.6%
2.2%
0.2%
0.8%
Received Ambulance straight away
0.0%
8.4%
54.7%
2.4%
Referred to A & E by ambulance
8.0%
Referred to A & E by own transport
22.8%
Referred to Urgent Care / Walk in
Centre by ambulance
Referred to Urgent Care / Walk in
Centre by own transport
Ambulance attended but I was not
transported
Referred to GP
Received self–care over the telephone
Other
No response provided
This pie chart shows what pathway of care was provided for each patient who provided a completed
survey, based on their views. Just over 20% of patients surveyed were referred or advised to use
other services other than an emergency department. There were general high levels of satisfaction
with the advice and care provided by the urgent care desk.
Reassuring and prompt
telephone triage, careful
and considerate
assessment
I was directed by GP Practice on previous occasions
- I would like to find another way to save these
precious services for more serious cases
“The member of staff who called you back listened to my concerns”.
0.5%
1.8%
10.8%
5.9%
Strongly Agree
44.4%
Agree
Neither Agree or Disagree
36.7%
Disagree
Strongly Disagree
No response provided
36
To assist with ongoing public education and the management of expectation, we also asked groups
of patients what was important to them when calling 999.
What is important to you when you make an
emergency call for an ambulance.
Getting an emergency
ambulance
25.2%
21.9%
Professionalism - how your
call was handled
14.9%
20.2%
Reassurance - listened to
your concerns
Assessment - of medical
condition over the phone
17.8%
Response time - how
quickly you got to hospital
“I was satisfied with the help and care provided”
1.4%
1.4%
3.7%
Strongly Agree
8.7%
Agree
Neither Agree or Disagree
30.2%
54.6%
Disagree
Strongly Disagree
No response provided
As we were told someone would be with us and then we
received the call - it would have helped if we were initially
told it would be a return phone call.
37
I did have to wait over an hour for
my ambulance with a dislocated
shoulder but realised that they
were VERY busy.
Would have scored 10 for the guy on
the phone, but the Ambulance staff
were moody and very unhelpful, felt like
they just wanted to get rid of me.
Scored 4 out of 10
Scored 8 out of 10
It seemed a lot of time was wasted waiting for phone calls and waiting
for the Ambulance when my mother needed to be in Hospital.
Scored 4 out of 10
NHS 111
The Trust is currently operating the NHS 111 Service in
the North West. NWAS has been delivering the service
since October 2013. Patient surveys are also undertaken
with patients using the 111 service. These are sent to a
random sample of patients following consent provided
over the telephone.
I was just so glad that there was
someone I could talk to in my hour of
need
Totally satisfied. Nurse was
knowledgeable about the
problem I had and also gave
me advice on the adverse
effects of previous antibiotics
Recent patient
surveys have
revealed that 69 percent of patients were very satisfied
with the NHS 111 service in the North West, currently
being run by North West Ambulance Service.
36 percent of patients would have attended A&E or rang 999 for an ambulance if the NHS 111
service was not available and 85 percent of patients were either completely better or their
conditions had improved seven days after calling NHS 111
My condition was experienced during the night time and was initially quite alarming.
Although NHS111 were unable to diagnose the problem they gave me the comfort of
knowing it was not serious and the directions to see my GP as soon as I could the next
day, enabled me to cope with the situation. The service was very thorough and
understanding.
The 111 Service also received 88 complaints from the end of October 2013 until end March 2014. As
mirrored across other parts of NWAS, the complaint rate for the 111 is also very low at 0.03%. The
chart below details the primary category and risk score of the complaints received. Being a
telephone based service it is understandable that communication and information is the most
common reason for complaining.
38
One major complaint has been recorded during this time. The case involved the assessment and
advice given to a mother regarding her new born baby. The advice was to attend the GP however
the baby was rushed to hospital some hours later with a serious condition that been the subject of
the 111 call.
25
20
15
Minimum
Minor
10
Moderate
Major
5
0
Emergency
Response
Staff Conduct
Communication
and Information
Care and
Treatment
Safeguarding
The moderate complaints (n=3) included the ambulance sent as a result of the 111 call attending the
wrong house, inaccurate information on the call record passed to the Out of Hours service and the
lack of appropriate assessment by the Clinical Advisor leading to inappropriate advice.
Of the 85 complaints closed in the reporting year, 37 (43.5%) of the complaints were upheld.
Reasons for upholding complaints have included:






Talking over the caller or not listening fully to what is being said
Call handling not up to approved standard
Inappropriate attitude
Lack of appropriate assessment
Not following protocol in passing patient’s details to the Out of Hours Service
Inappropriate referrals to Social Services
Key Findings
1. High levels of satisfaction were reported across the core areas of experience in relation to making
the emergency call, communication, dignity, care, compassion, reassurance and advice provided
for both Urgent Care and the 111 Service.
2. Low levels of understanding that an ambulance may not be dispatched or delays may occur due
to the patient’s condition not being immediately life threatening.
3. Low levels of satisfaction that the elderly are not given priority.
4. Communication is vital to ensuring a positive patient experience – patients need to be listened to,
kept informed of any referral to another (such as GP or Out of Hours Service),
5. receiving a call back from a clinician or any potential delays in an ambulance attending
6. There is still reluctance for patients to consider using alternative healthcare providers. Patients
still believe that they will be seen in Emergency Departments quicker if they arrive by ambulance.
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7. The 111 Service upholds more complaints than other parts of NWAS. These decisions are more
easily decided as the evidence is the recorded conversation.
6.4
Feedback from Community Engagement
NWAS uses the NHS Equality Delivery System (EDS) to set out its strategic equality objectives
including its plans to engage with its diverse communities. The community engagement programme
of 2013/14 has included attendance at a number of large scale equality and diversity events as well
as targeted engagement with the ‘vulnerable’ protected characteristic groups of people including:






those with mental health conditions
people with physical disabilities,
children and young people
the elderly
people with sensory and learning disabilities
representatives of populations in social deprivation areas
The Trust uses a Patient Experience Board Game to facilitate the majority of this engagement as an
aid to collect qualitative feedback on our services. The Game creates an engaging, informal setting
to give a voice to groups which may be less likely to engage through other methods such as surveys
or public meetings. This is usually in the form of face to face sessions or setting up the board game
on a stand at a themed event. A second board game was recently commissioned and has been in
use since April 2013. Where appropriate, further support to our engagement is provided by
operational staff and an Ambulance vehicle.
In addition to us receiving feedback on access to services and employment opportunities from these
groups, we also try to:
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


Give reassurance that all feedback we receive from our community engagement is valued
and will be acted upon
Promote partnership working including volunteering opportunities and FT membership
Raise awareness of what to expect from the ambulance service and our commitment to
equality and diversity
Where applicable, raise awareness of the Trust support to health inequalities in the areas of
stroke, cardiac arrest, obesity and mental health.
Over 25 different community groups have been engaged with during 2013/14.
The patient experience board game has been played at focus group events with the following
seven community groups: Headway Brain Injuries Group, Preston; St Helen’s Carers Group,
Cheshire; Remind Mental Health, Merseyside; Manchester BME Network; Liverpool Arabic
Group; Bury Speak Easy Group; Rochdale Borough Wide Mental Health User Forum.
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
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‘Group discussed issues that may be considered an emergency. One lady has children
who have a nut allergy. If a child had accidentally eaten nuts or their derivatives, she
wanted to know if this would be considered an emergency.’ (Liverpool Arabic Women’s
Group)
‘My dad died on our way to hospital. When we wanted to go home we had to catch a
taxi’. (St Helens Carers)
You never get any feedback after completing a survey – waste of time (Headway Brain
Injury Group)
‘Husband called the ambulance service – they were brilliant with me. I did not feel
stereotyped at all, as a woman, and as a black woman, they were kind, so human, the
experience was very positive.’
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Eight themed events attended, have included: FT Monitor Focus Group held at NWAS Lancashire
Offices Broughton, Burnley College Health Fair (where we engaged predominantly with Black
and Minority Ethnic (BME) young persons to receive their perceptions on employment with the
Ambulance service); Blackpool Learning Disability Health Event; CODA (Children of Deaf
Adults) Emergency Services Open Day, Winsford, Cheshire; Asian Elders Association – Eid, Diwali,
Advent Event, Bolton; YAD - Year of Action on Dementia Event, Liverpool; Knowsley Health
watch; PENN National Workshop Event, Broughton, Preston.
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I’m not scared of Ambulances. I went to an open day and they let me take a look around
an Ambulance (Blackpool Learning Disability Health Event)
As a patient you would love to be treated with dignity, for your views and opinions to be
respected – it is really important for a medical professional to respect your views even if
you are a patient with dementia, not all your views or opinions stem from the condition.(
YAD - Year of Action on Dementia Event, Liverpool)
Very rare you hear the Ambulance service has made a blunder. (Asian Elders, Bolton)
Twelve of the large footfall Public Events attended include: Spirit of Bolton; Disability
Awareness Day; Cheadle Mosque; Blackpool, Chester, Liverpool and Manchester PRIDE
respectively; Preston, Leyland, Bolton and Fylde Coast Health Melas respectively; Chinese New
Year Event, Blackpool.
‘I am writing to thank you for participating at Blackpool Pride Festival and for your feedback.
Overall we were pleased with the event in the Winter Gardens, particularly on the Saturday.
Certainly the public seemed to have enjoyed themselves’. (Tim Allan Blackpool Pride organiser)
Matt Dunn, Advanced Practitioner and Red Ashcroft, EMT were both in attendance at the Bolton
Health Mela. A PES Ambulance vehicle was available to view and many commented on how this
‘stole the event’. Mat and Red were gently peppered throughout the day by over 60 young
people to be given the opportunity to see and receive practical Ambulance demonstrations.
Matt commented on the Trust attendance at the Health Mela as being ‘a great way of having
fun with our NWAS communities, whilst also being able to provide some very important
Ambulance health messages to a number of young people’. (NWAS Regional Bulletin March
2014)
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The charts below show the community engagement activities by NWAS areas and the differing
protected groups engaged respectively.
Protected Characteristics Engaged During 2013/14
2% 2%
Race
2%
All
15%
4%
Learning Disability
4%
Youth
6%
Mental Health
13%
6%
Religion
Sensory Disability
Physical Disability
Socio Economic
8%
11%
LGBT
Older
8%
Brain Injury
8%
11%
Dementia
Gender specific
During 2013/14 targeted engagement using the board game has produced over 100 feedback
comments: measured against the six best framework categories of: Communication (22), Access
(19), Responsive Service (15), Information (29), Treatment as an Individual (27) and Quality of Care
(20) ‘Picker’ NHS
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Feedback by Category 2013/14
Quality of Care,
15%
Communication ,
17%
Communication
Access
Treatment as an
Individual , 21%
Access , 14%
Responsive Service
Information
Treatment as an Individual
Responsive
Service, 10%
Quality of Care
Information , 23%
7. Learning from Experiences
It is essential that the Trust learns from all the feedback it receives.
7.1 Action Plans
This section outlines the proposed actions and improvements to be undertaken as a result:
PARAMEDIC EMERGENCY SERVICE
Feedback Theme
Proposed Improvement/Action
Patients expectation of appropriate and
timely response / clarity regarding the
alternative pathways available
Expectations management features in the Team 999
campaign.
Perception survey results show awareness is
increasing but continual education is required.
Patient experience of timely attendance
following 999 call
Review and redistribution of specific Emergency
Operations Centres (EOC) procedures in light of
complaint investigations
Individual feedback provided to EOC staff regarding
call handling to ensure calls coded appropriately,
correct codes followed, listening for potential reason
to upgrade the call and care provided to Trust
standard
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Individual feedback provided to EOC staff regarding
dispatch to ensure timely searches for vehicles
completed, nearest available vehicle dispatched,
importance of timely passing of information between
hospitals and crews and calls upgraded as necessary
More work regarding response categories required
Information provided to hospitals to ensure transfer
requests booked according to procedure
Reminder sent to staff regarding adherence to
second call procedure
Concerns raised about care and treatment
provided to patients
Staff to undertake more training on pain
management, care and dignity, manual handling,
safeguarding referrals and application of paramedic
pathfinder
Individual feedback provided to individual staff in
application of Cardiac Chest Pain policy including not
walking patient to the ambulance and managing pain
Individual feedback provided to staff in relation to
completing falls referral and requesting appropriate
back up befitting the presenting condition
Bulletin issued for care of patients who are over 20
weeks gestation
Reminder to individual staff about the application of
seat belts as required
Incident learning implemented to ensure treatment
given is indicated for presenting condition
Recognising the need for good
communication and information
Feedback to individual staff regarding the importance
of ensuring patients attend the correct hospital and
depending on clinical condition hospital of their
choice
Addresses flagged to provide more detailed
information for the attending staff including access,
medical and safety markers
Learning for individual clinical assessment
raised
Guidance distributed to staff regarding application of
the hyper acute stroke pathway
Reflective learning implemented to variety of staff to
ensure learning from individual incidents including
pain management, application of diagnosis of death,
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completion of Electro-Cardiograms and recognition
of hypostasis
Staff attitude
Feedback provided to ensure staff were aware how
they made patient feel, particularly for cases where
difficult to draw definitive conclusion
Customer care course identified
Issues with documentation
The importance of accurate Patient Report Form
(PRF) completion has been reiterated with a number
of staff and completion monitoring and audit was
implemented for a small number of staff
Requirement to provide more specialist
vehicles for some patients
Provision and introduction of specialist ambulances
for bariatric patients
Low levels of awareness of role of CFR
Team 999 has included a focus on community first
responders. Explore what further promotional
activities can be undertaken regarding the role.
PATIENT TRANSPORT SERVICE
Feedback Theme
Proposed Improvement/Action
Availability of booking reminder/next pickup
notification
NWAS Control staff to be reminded about the need
to offer this service and a guidance briefing provided
Low levels of awareness of the new PTS
Charter
Create a new poster for hospitals which have
information about the quality standards.
Introduce new personal information cards for
patients to help them understand what to expect
from the service
New marketing campaign to be launched in 2014 to
help patients and carers understand more about the
service.
Charter booklet provided to complainants to explain
service
Low levels of awareness of waiting times to
go home.
Raise awareness of quality standards with all
outpatient departments by introduction of new
leaflets and posters which can be displayed in
hospital areas
Explanation provided to individual patients during
complaints process
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Difficulties with incorrect transport provided
e.g. taxis/VCS
Memo sent to control staff to ensure patient’s
location for pick up is recorded on Cleric
Pictorial Mobility Guide to be produced
Working with bookers to ensure correct information
is given to provide correct transport
Completion of individual risk assessment for patients
Greater level of support identified and provided to
individual patients
Mobility status of patients changed to reflect
individual needs
Difficulties between staff / volunteers and
patients
Individual staff and volunteers no longer assigned to
particular patients
Small number of volunteers removed from service
and some reminded of expected standards
Individual notes added to patient records to avoid
some patients travelling with each other
Issues arising during the journey
Staff reminded of the importance of communication
to patients in the event of a breakdown, delays with
other patients or adverse conditions
Booking and allowing escorts
Advice provided to complainant (on behalf of new
patient) on when escorts are allowed and how they
can be booked
SPECIALIST PATIENTS – PATIENT TRANSPORT SERVICE
Feedback Theme
Proposed Improvement/Action
Low levels of understanding of both the PTS
Information leaflet and Patient Charter
Introduce new personal information cards for
patients to help them understand what to expect
from the service
New marketing campaign to be launched in 2014 to
help patients and carers understand more about the
service.
Hospital staff stated difficulties with booking
system.
NWAS to undertake further detailed work into usage
and understanding of the online booking system and
to develop improvements and materials to support
this feedback.
Individual feedback provided to staff further to
complaint investigations
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Low level invitation to use the advance
notification/reminder service
NWAS Control staff to be reminded about the need
to offer this service and a guidance briefing provided
Patients say that they are asked to be ready
to travel up to 2 hours before their
appointment time.
NWAS Control staff to be made more aware of new
quality standards for this specialist group and plan
journeys accordingly.
Patients feel as though the waiting time to
go home is still too long.
NWAS to continue to meet with this specialist group
of patients and raise awareness of the quality
standards.
PATIENT TRANSPORT SERVICE - OBSERVATIONS
Feedback Theme
Proposed Improvement/Action
Raise awareness of the needs of dementia
patients with staff.
Dementia Patient story should be shared at staff
forums and mandatory training days
Booking mobility concerns – the recently
produced PTS pictorial guide to be made
available to booking & hospital staff
Ensure that publication is available on the Trust
website and emailed to hospital patient experience
leads for distribution
Discharge Check list – Promote this checklist
to all hospital contacts
Ensure this checklist is available on the Trust PTS
microsite and available to hospital staff
URGENT CARE
Feedback Theme
Proposed Improvement/Action
Low levels of satisfaction when agreed
action is delayed e.g. no call back within 60
minutes.
UCD to monitor call back rates and where possible
keep patients informed of potential delays.
Lack of understanding of the Urgent Care
Desk processes and the Emergency Service.
Address as part of the Team 999 campaign
Incorrect information being provided by
EMD at the point of the initial emergency
call.
Review information provided by EMD if patients are
suitable for UCD intervention.
UCD call handling did not meet Trust
standard
Use of UCD audit to provide feedback to individual
staff
Ensure appropriate upgrade applied to provide
prompter response
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111 SERVICE
Feedback Theme
Proposed Improvement/Action
111 staff not handling calls according to
agreed procedure
Individual staff feedback, some increased audit
monitoring where identified
COMMUNITY ENGAGEMENT
Feedback Theme
Proposed Improvement/Action
Patients who have health passports and
personal health information
Raise awareness of NWAS staff of where these
schemes exist and to check with patients on
attendance
Feedback from their contributions
Ensure groups understand feedback is valued and
acted upon. Share examples of where this has
happened.
Lack of awareness of ED tools
Availability of ED communication tools e.g. language
line, pictorial handbook is promoted more widely.
Review any other tools or systems to improve
communication further
Awareness of mobility guide by hospital
staff
To be distributed more widely.
Awareness of what happens next when call
999
Explore the options for team 999 in terms of
targeted work with diversity groups as well as the
marketing materials being translated into other
languages
What to expect at handover in hospital
Individual patient information is available regarding
this. Review if this is being widely used.
Saying thank you
Ensure the public can easily let the Trust know they
would like to compliment the care received.
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7.1
How we learn
Action Plans
The service improvement proposals are translated into action plans in partnership with service
delivery leads and regular progress reports are requested.
Where required, individual action plans are drawn up for individual staff members to ensure learning
takes place. Staff may also be required to undertake a reflective piece of work, go through a retraining process or, in some cases, face disciplinary action.
Patient stories
The Trust has made extensive use of patient stories as an important learning tool. The Trust to date
has produced 24 stories. The stories are filmed using actors but all the stories are based on real life
situations.
The stories come from the patient survey feedback, interviews with patients,
complaints, compliments and experiences shared via community groups across the region.
The stories are available on DVD, with learning points and briefing materials. They are played
regularly at board meetings and generate discussions and action points. They are also shared with
commissioners at their quality meeting. Service delivery managers use them in staff forums and
meetings to highly both best practice examples as well as situations which didn’t go quite so well.
The stories are using on the Trust’s mandatory training programmes as well as other learning
opportunities. The stories are also used externally with community groups and for public education
purposes. A number are available on the Trust’s website.
All managers are asked to complete a feedback form when the stories are used so there is a record
of who has watched them and the discussion that took place.
Public Engagement
The Trust launched #Team999 in 2013 as a direct result of feedback from patients and staff on
improving education and engagement with the public about what to expect from the ambulance
service. The campaign has been very successful to date, demonstrating high levels of awareness,
and reach of the campaign as well as evidence of improving public perceptions of the service. The
Trust uses the #Team999 brand to help share messages with the public and other partners which are
a direct result from learning from patient experiences.
The campaign uses members of staff to
help explain to the public what happens when you call 999 and the alternative pathways available.
The campaign uses social media extensively to engage with the public as well as undertaking face to
face engagement with community roadshows and events. The campaign will continue to support
the Trust is engaging with patients and the public and this year is introducing a new campaign to
improve understanding of the Patient Transport Service.
The Trust will also explore how it integrates the NHS 111 role within its public education work in
conjunction with commissioners.
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Team 999 car sticker
Team 999 infographic
You Said We Did
This report and feedback received is published for patients and the public to view. In addition
feedback is shared through posters and leaflets in hospitals, on the website and with staff on
stations.
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Working in Partnership
Frontline staff involvement in how we improve the patient experience has always been an integral
part of the Trust’s patient experience programme:
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Each year, online ‘Talk to Us’ campaigns have been held to discuss with staff how we can improve
services for our patients. One example of feedback which has led to improvement is:
Top theme: More support for providing care for patients with mental health conditions.
Response: The Trust has introduced new training packages for frontline staff to support improved
awareness of mental health conditions. The Trust is also working with mental health partners to
identify alternative care pathways for mental health patients.
The staff working in the patient transport service have been coming together during 2013/14 to
discuss how the service can be improved and the results of these discussions will lead to a new
educational campaign for service users and health care professionals in 2014 to help them better
understand the service and how it works.
The Trust has worked closely with Health Watch organisations, other providers and commissioners
to elicit patient feedback and work together to improve service provision. This has included
reducing 999 call outs for fall in nursing homes, developing PTS patient information and a new
dedicated website, testing out the FFT in different settings, holding patient focus groups and
undertaking surveys.
Examples of learning in action
The Trust has undertake a number of service improvements as a result of learning and the following
are some examples:
Dignity posters
These have been produced based on patients’ views on dignity. The posters are being widely
distributed to staff across the Trust to highlight the importance of dignity and how patients want to
be treated.
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PTS personal information cards
New information cards in wallets have been produced to give to PTS patients to explain how the
service works, what the quality standards are and how they can contact us if they have any
questions.
8. Summary
The report demonstrates in the main high levels of satisfaction with the service but there is always
room for improvement and ensuring services meet the needs of our patients.
This report demonstrates that NWAS is committed to listening and learning from its service users
and most importantly is able to demonstrate how it is improving its services as a result.
We recognise there is always more work that can be done to gather more views and have more
engagement with the public and we continue to look at ways to do this effectively.
This report will be presented to the Board of Directors in July 2014 and subsequently published on
the Trust’s website. In addition a link to the report will be shared with our stakeholders in our
regular briefing document.
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9. Future Focus
A number of areas have been identified to improve our patient experience programme further:
1. Ensure the identified actions are shared with service delivery managers and there is
evidence of progress. This evidence is provided to the Quality Committee for assurance.
2. The Trust continues to foster a learning culture to ensure patients’ experience inform service
improvement.
3. The Trust will explore how it can ensure a sustainable programme of quantitative patient
feedback so the number of patients who give feedback is more representative of the
number of patients who use the service, but will always there are effective methods to
gather rich qualitative information also.
4. Family and Friends Test
The Family and Friends Test is being introduced in ambulance services by the end of March
2015. All NHS Trusts are expected to introduce the test to staff during 2014/15. By the end
of March 2015 all staff employed, front line and corporate, have to be offered the test.
The Trust has been piloting the FFT with patient groups for a couple of years and
particularly, recently, undertaken two Pathfinder projects funded by NHS England, for a
twelve week period, to test out the FFT in the ambulance sector to inform the national
guidance.
The Pathfinder projects will be completed and evaluated by 30 May and the results will be
shared with NHS England to influence the national guidance for ambulance patients.
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