What the response said, with my comments

A Report on the Formal Investigation into Concerns Raised by CC


1. PURPOSE

1.1 The purpose of this report is to present the results of a recent investigation into the concerns formally raised in letters of complaint, emails and at a meeting with Trust Managers in October 2007.

1.2 The report will address three key themes:

· The findings from a re-investigation of the formal complaint made by letter dated 11th July 2007
· The issues raised in subsequent letters and emails regarding the application of the complaints process
· Miscellaneous issues outlined in emails and at meetings.


2. BACKGROUND

2.1 A formal complaint was raised by letter, dated 11th July 2007, which referred to the care and treatment provided by the xxx Community Mental Health Team, principally regarding the request for a care co-ordinator in the absence of SH, Community Mental Health Nurse. This was formally acknowledged by the Trust on 17th July 2007. Another issue regarding the contact details for the Trust Complaints Manager was also raised in this correspondence.

2.2 A formal response was provided to this complaint from PM (CEO) dated and posted on the 20th August 2007, and emailed on 21st August 2007. This was followed by an email from you outlining your dissatisfaction with the formal response, and indicating where you disagreed with the points raised in the letter. This email, and the comments made on the response letter were received by RB, Trust Complaints Manager on 21st August 2007.

2.3 These comments and queries were investigated and a further formal response was sent to you on 27th September 2007. This response also failed to address your concerns adequately, and indeed, caused you considerable distress and left you feeling vulnerable over the weekend, following receipt on a Friday.

2.4 Alongside the issues raised through the formal NHS Complaints process, there are a number of other issues that have been raised, under the Freedom of Information Act 2000, where you have requested copies of Trust Policies and information relating to the care arrangements provided for other service users whilst SH was absent from work due to ill health. A number of issues have also been raised regarding the application of the complaints policy and the service you have received from the complaints team whilst your concerns were being investigated.

2.5 A meeting was arranged for the 2nd October 2007, attended by SS, Director; CK, Associate Director; CB, Associate Director, yourself and DG advocate. The purpose of this meeting was to discuss the original complaint and other issues referred to above.

2.6 At this meeting it was agreed that your original complaint would be re-investigated, together with the issues discussed relating to the way your complaint had been managed by the complaints team at BLPT. CB would carry out this investigation and report back formally to you with the findings from this investigation. This investigation would supersede the previous formal responses and this would clearly be indicated in the file relating to the complaint. CB would also be the main point of contact with you on behalf of the Trust.


3. THE INVESTIGATION

3.1 Due to the need and desire to ensure the investigation was as impartial as possible, the decision was made to appoint an independent investigator to work on the investigation, directly under the supervision of CB. This investigator had no previous knowledge of the complaints made, and had no previous employment history with BLPT.

3.2 Several documents were reviewed as part of the investigation. These included the current complaint file, the file relating to a previous complaint made in 2005 and your clinical notes.

3.3 It was decided to conduct the investigation around 3 key themes. Firstly, the issues raised in the complaint letter dated 11th July 2007, secondly, issues regarding the way the complaint was handled by the complaints team and thirdly, to address any outstanding issues outlined in emails, letters and through meetings and telephone calls with Trust staff.

3.4 I will address each of these three themes individually in the remaining sections of this report.


4. THE ORIGINAL COMPLAINT

4.1 As already discussed, you made a formal complaint by letter dated 11th July 2007, which referred to the main issues as follows:

· Your requests for support from xxx CMHT following the ill health of your CPN SH;
· The communication you had from the CMHT manager, MG, when requesting this support;
· Your feeling that you are being discriminated against as a result of making a formal complaint 18 months ago;
· The contact details on the BLPT website for the complaints manager being incorrect, and therefore, making it difficult for you (and others) to raise formal issues of concern through the complaints process. (This was dealt with to my full satisfaction in the original response; I informed you of this. )

4.2 These issues have been re-investigated and the conclusions outlined in the following paragraphs.

4.3 Firstly, I would like to sincerely apologise for the way that your care and treatment has been disrupted over recent months. I recognise that this disruption coincided with a period where you found yourself having to deal with several stressful situations – the return to work, your GP being on annual leave, your sessions with DL (psychologist) coming to an end and your pastor being away on holiday. This must have been inordinately difficult for you to cope with, and I recognise that you needed, and should have received support from the Community Mental Health Team to help you navigate your way through this difficult period.

4.4 It was unfortunate therefore, that this coincided with a period of ill health for SH, who I’m sure, would have been very supportive of you as you dealt with the return to work and the stress and uncertainty this would have caused you. You did the right thing in contacting the CMHT for support, as suggested by the letter from MG when SH's period of illness began, and what was outlined in your care plan for monthly face to face visits and emotional support via email.

4.5 Again, due to factors outside your control, you found it impossible to secure this support. June and July were very challenging months for the xxx CMHT, with numbers of staff on annual leave and off work through ill health. Consequently, resources were stretched and had to be deployed to best effect (Was it, then “to best effect” to leave me without support at such a difficult time? Your response seems to suggest it was, and I find this very offensive.) by MG as the team manager. However, the result of this for you was that you were left without support in SH’s absence, reliant only on email support (There was no support in my emails from MG. This was the problem! ) from MG. This was not consistent with the details in your care plan.(Apology?)

4.6 I have reviewed the email correspondence between yourself and MG. What is clear is that you felt distressed by this communication, and I would conclude that there were misunderstandings and misinterpretations in these email exchanges by both parties. It is regrettable that a face to face meeting between yourself and MG could not have been arranged(Who is to blame for this? Not me – I tried as hard as I could to get a face to face meeting. Where is the apology?) to discuss this, rather than relying on email correspondence where there is more potential for miscommunication to occur as the subtleties of non-verbal communication cannot, by definition, be observed.

4.7 MG did the best she could to provide you with support (How can you say this when no support was provided and my Care Plan was ignored? The emails I received from MG can in no way be described as supportive.), and has acknowledged in her email dated July 10th 2007 that you did have the right to support from the CMHT, but that this was difficult to provide due to the capacity within the team at that moment. She maintained that if she could identify any capacity to cover for SH’s absence, she would do this. I could find no evidence that this was an attempt to punish you for having made earlier complaints (In conjunction with the previous problems I had obtaining support a very different picture emerges), but a reality due to the level of resources in the team at that time. (Then why did the response state that not providing me with support was an attempt to ensure I did not become over dependant on that support, and why did the second response state that I “have been provided with all the tools necessary to cope with any situation”? These statements do not back up the assertions in this report. Rather of concern, imo, is the fact that the phrase "a reality due to the level of resources int he team at that time) is taken verbatim from MG's response (in her role as investigator) to my complaint. Some bias there has already been agreed. ) However, what is clear is that you were left without a care co-ordinator during a period of significant personal stress. To that end, BLPT failed to provide you with the level of care and support indicated in your care plan and for which you had been encouraged to ask. (Apology?)

4.8 It was apparent from the email exchange between yourself and MG that the relationship was becoming increasingly strained by the 16th July 2007, and appeared to have broken down completely. In the circumstances, it was an entirely reasonable request that you made to be allocated to another CMHT for your care and treatment. I apologise profusely for this lack of consideration of your wishes and for the suggestion that MG or anyone else from the xxx CMHT should be your key worker following the breakdown in the relationship between you and the xxx team. I apologise that your request to MW (locality manager) for this to happen was not acted upon with greater speed and consideration for your feelings and wishes, despite the intervention of DL (psychologist) on your behalf. I understand that a new care co-ordinator was sourced within the aaa Team on 23rd July 2007 and that this is now a permanent arrangement. I am pleased to hear that you are finding this relationship helpful in addressing your care and treatment needs.

4.9 I am aware that there have been previous gaps in the support you have received from xxx CMHT, specifically in 2005, where you were receiving support from MM, but then that support was withdrawn without notification. Unfortunately, we could find no record in the clinical notes as to why this relationship ended. (What is the reason for this gap in records? What will be done to prevent this happening in future? ) However, the decision was made that you would be provided with a replacement care co-ordinator once a permanent member of staff had been recruited. (Not true. Email exchanges in my notes reveal the resistance of the Bedford East team to providing any support for me, despite the repeated insistence on this support by DL. To say that the decision was made to provide support is at best misleading and at worst inaccurate. Equally to imply that it was only possible after SH was appointed, 4 months later, can only be inaccurate. SH was well known to DL and I find it hard to believe that she was only recently appointed when she became my care coordinator. ) Unfortunately, it took over 4 months for SH to be appointed and begin her relationship with you. There was therefore, a definite break in the support service being supplied by the CMHT. During this period of non-support, and leading up to this point, there is no clear communication between the CMHT and yourself. MM does not contact you to inform you that the relationship is ending and there is no explanation from MM's Line Manager (MG!) indicating why the care support will be changing. This is poor communication and poor customer care. However, from the clinical notes, I could not find any link between this and the fact that you had made a complaint in 2005. (No, because the team failed to keep those clinical records! However, the circumstantial evidence points to the fact that I was not provided with support and my support was removed. There is no evidence of an explanation for this so how can you discount my explanation without an alternative explanation? Would you really expect such a link to be recorded in clinical notes?! Nobody is going to write “we are not providing support because of this user’s previous complaint” are they? So how can the lack of this be construed as evidence of there being no discrimination? )However, it is clearly indicative of poor communication (What steps are to be taken to improve communication? ) which must have caused you significant distress and I can understand why you wished to start afresh with a new CMHT providing your care and treatment. (Apology?)

4.10 Regarding the contact details for the complaints team on the BLPT website, I believe that this has been addressed in the letter from the Trust dated 20th August 2007. This was due to an administrative error and was in no way a conscious decision designed to prevent service users and carers from making a complaint. I apologise if this was the impression given.

4.11 We have reviewed your clinical notes as part of this investigation and have found one email from MM to MG on the 9th June 2006, where the comment ‘….However I think it will be for the rest of our lives…..M’. After considering the context of this comment, it is considered inappropriate and on the behalf of the Trust, I apologise for any distress caused by this comment.
(No attempt made to address the refusal to provide me with a copy of my Care Plan. No attempt made to address the fact that the annotated copy of my Care Plan was not included in my records. What actions are being taken to ensure this does not happen to other service users? There is nothing here to indicate any steps are being taken – though this was one of the things which was promised at the meeting I had. )

5. THE HANDLING OF THE COMPLAINT

5.1 In advance of the meeting help at Bedford Heights on 2nd October 2007, you provided an analysis of where the BLPT complaints policy had not been followed in your experience of making a formal complaint. I found this very helpful, both in evaluating how we managed your particular complaint, but also in ensuring that we made the requisite changes to policy to ensure that we provide a better service in the future.

5.2 Firstly, it is clear from reviewing the complaints file, that your complaint was not handled effectively. I have already acknowledged this and sent you a letter of apology for that following our meeting in October 2007. In this report, I will provide more detail in response to the questions you raise regarding complaints handling.

5.3 I acknowledge and apologise for the fact that you feel that you have not been kept fully informed of progress with your complaint. However, on examining the file, you did receive a formal letter acknowledging your complaint on 17th July 2007, and this indicated that you could expect a written response to your concerns within 25 working days from PM, the Chief Executive of the Trust. A copy of the Trust’s complaints leaflet explaining the processes was sent to you with this letter, together with contact details fro the Independent Complaints Advocacy Service (ICAS). This letter of acknowledgement was delayed by four days however, due to the incorrect contact details appearing on the Trust website regarding how to make a complaint, for which I apologise and this has issue has been addressed in previous correspondence. The Trust did respond to you formally within the 25 working days timeframe as per the NHS Complaints Regulations on 20th August 2007.

5.4 I also note from the complaints file that there is a significant volume of email correspondence. Whilst email is a quick and convenient method of communication, it is not always possible to respond to them by return, due to the volume of work that the complaints team deal with on a daily basis. I do feel however, from examining the responses to your emails, that the majority were addressed in a timely manner and updates provided when required by the Complaints team. (What about those that were not addressed – or where promises were made about issues being addressed which then failed to materialise? What about the way I was made to jump through hoops to get my complaint dealt with? )

5.5 You raised the issue of impartiality in the investigation of your complaint. I agree that the complaint should not have been investigated by MG. The role of the complaints manager is to manage the administrative process and to prepare the final response letter, based on the investigation report provided by the service managers. In your case, details of the complaint and a request for an investigation to be carried out were sent to MG and myself in a memo dated 17th July 2007, and copied to MW, LM and GK, who are the senior managers with responsibility for the operation of the CMHTs.

5.6 In my opinion, this request should not have been sent to MG, it should have been directly addressed to MW as the Service Manager with responsibility for the CMHTs. (So what was the cause of this being sent to the wrong person by the complaints office? )There was an attempt to remedy this, and there is an email on file dated 20th July 2007 from MW to RB indicating that LM, Acting Associate Director for Bedfordshire Working Age Mental Health Services, wished MW to investigate your complaint rather than MG.

5.7 However, during the course of the investigation, MW had a period of illness and was absent from work for a time. His Personal Assistant informed the Complaints Manager on 26th July 2007 of this, requesting that she be aware so that alternative arrangements could be made for the investigation. I can find no evidence in the file that any alternative arrangements were made to undertake the investigation at senior manager level.(Cause? ) A report was received from MG by the Complaints Manager on 25th July 2007, which addressed the issues you had raised. From this report, and from examining the formal letter of response to you, it is clear that the report from MG was used to formulate the final response letter. I would conclude therefore, that the investigation into your complaint was not as impartial as it could have been (I raised the impartiality issue in my response to the first complaint and it was not addressed then. Why did nobody pick up on this? ) , although the intention was for it to be so initially. (What steps will be taken to ensure this does not happen again? )
5.8 In terms of the issues you have raised regarding the sensitivity with which your complaint was handled, I uphold your assessment that the process has caused you distress. I have witnessed your distress personally and I am very sorry that the process of making a complaint was so difficult. A critical issue that you identified is the timing(Having highlighted this as an issue, how is it that you sent this report to me too late in the day for me to be able to contact my CPN? Also, how could you have sent the earlier email which indicated that there would be delays to the report but gave no indication of when I could expect to receive it. This caused me immense distress. )whereby the Trust issues response letters, and in conversation with me you have raised the distress caused by the second formal response letter to your complaint being received on a Friday, resulting in significant upset to you over the weekend, with no readily available means of support to help you to cope. (No attempt made to address how and why such inappropriate letters were signed off by senior Trust staff – this was promised at the meeting. )


6. ADDITIONAL ISSUES RAISED

6.1 In your email dated 23rd August 2007, you requested copies of the Trust’s Complaints Policy, Confidentiality of Patient Information – Code of Conduct for Trust staff and Security and Confidentiality of Patient Information. However, these documents were not sent to you, but an email dated August 30th 2007 was sent by RN, PALS manager indicating that these policies were for internal use only, and could not be sent to you.

6.2 RN sought advice from Trust colleagues (Which Trust colleagues did she seek advice from? Why did they not know? Why was RN herself not familiar with the key features of the FOIA – surely as a person dealing with enquiries from the public this was something she should have know about? What about the lack of communication while this “advice” was “being sought”? From whom was RN seeking advice at this second stage (after I made my request formal under the FOIA)? ) on whether your request could be complied with. The above advice was provided to RN by a member of Trust staff, and was obviously incorrect. I apologise profusely for this, you were entitled to this information and it should have been sent to you immediately.

6.3 However, what this has indicated is that there is a training need amongst the complaints team for Freedom of Information Act requests and Data Protection issues. I do not feel it was a deliberate attempt to prevent you from having the information (This statement is contradicted by the fact that RN was previously very happy to supply me with policies – if she did not need to seek advice about the CPA policy, why did she suddenly feel it necessary over the Complaints policy? ) , but rather a decision made by relatively inexperienced staff. However, it is clear that you had a right to this information under legislation and it should have been provided. Training has now been provided by the Trust leads on these matters, and the Complaints Manager and the PALS manager are aware of how to manage requests of this nature in future.

6.4 I know that the Trust lead for FOIA and DPA has now provided you with this information, and I understand that you have found it helpful. Also, as a result of your experiences, there are now much more effective links between the complaints team and the Information Governance teams on how to handle requests for information, with clear protocols being drafted to govern these links. I am only sorry that it took your poor experience to bring about this change in practice.

6.5 There have been instances where the information contained on the BLPT website has been erroneous or absent altogether. A particular example you gave was the details of the crisis help lines being inaccurate. The website is under development at the moment, and I can only assume that these issues were teething problems. I understand that they have since been rectified. The Communications Team are working closely with Information Management and Technology teams to develop the website.


7. CONCLUSION

7.1 In conclusion, the investigation has identified examples of poor communication and poor customer service in evidence throughout the process of your complaint. In particular, the investigation of the complaint should not have been carried out by MG, but instead by her senior manager.

7.2 We are working to make improvements to the BLPT Complaints Policy in order to ensure that we change the way that BLPT manages complaints in response to your experience. I have already indicated that there is now a process in place to address requests under Freedom of Information legislation and Data Protection. (If the previous Complaints Policy was not followed by Complaint Office Staff, how will you guarantee that a new one WILL be followed? )

7.3 We have examined your clinical notes and have identified one inappropriate comment within them. I would be happy to remove this if you wish, but if you decide to take this matter further, it may be in your interests for it to remain on file.

7.4 Once again, I would like to apologise for the obvious distress and inconvenience this has caused you, and I would like to thank you for the suggestions you have made on how we can improve our practice regarding complaints management.


CB
19th November 2007