1) New concern
This is the total number of new concerns received by the organisation during the quarter, split by formal and informal.
A concern is any expression of dissatisfaction raised by a member of the public and can be verbal or written. Where a concern received has identified multiple issues, this should be counted as one concern i.e. it is the concern received that is counted and not the number of issues within the concern.
The concern is given an overall category as follows:
Formal - an expression of dissatisfaction that is graded as 3, 4 or 5 and a relevant and proportionate investigation must be undertaken. However, at the request of the complainant a grade 3 concern may be managed informally
Informal - an expression of dissatisfaction that could potentially be resolved immediately or within 2 working days through discussion explanation or the provision of information to the satisfaction of the person raising the concern/s. The informal process would usually be applied to correspondence graded 1 or 2 (see below – indicator 8 - for details regarding each grading classification).
Received during the quarter - this is the date of receipt when the organisation received the concern. In the case of a concern involving primary care providers, the date of receipt is still the date on which the concern was first received by that provider.
2) Welsh language
Of the new concerns received by the organisation during the quarter, this is the number which were made by, or on behalf of someone, who wished to communicate through the Welsh language.
3) Concerns by setting
This is the number of new concerns received by the organisation during the quarter, in relation to the following settings:
• acute / general hospital setting
• ambulance service (emergency and general transport)
• community setting
• general practice - out of hours
• general practice - in hours
• NHS dentist
• NHS optician
• NHS pharmacy
• other
Where a concern received identifies multiple issues, all settings relating to these issues should be included in the counts. Where information is not collected for each issue, the primary setting should be included. Therefore, the number of concerns by setting may not be the same as the number of concerns as identified in indicator 1.
Received during the quarter - this is the date of receipt when the organisation received the concern. In the case of a concern involving primary care providers, the date of receipt is still the date on which the concern was first received by that provider.
4) Concerns by profession
This is the number of new concerns received by the organisation during the quarter, in relation to the following professions:
• medical and dental staff
• nursing, midwifery and health visiting staff
• administration and estates staff
• scientific, therapeutic and technical staff
• healthcare assistants and support staff
• ambulance staff
• GP
• concern not related to a profession e.g. where a patient has a concern relating to a process
• other
• unknown
Where a concern received identifies multiple issues, all professions relating to these issues should be included in the counts. Where information is not collected for each issue, the primary profession should be included. Therefore, the number of concerns by profession may not be the same as the number of concerns as identified in indicator 1.
Received during the quarter - this is the date of receipt when the organisation received the concern. In the case of a concern involving primary care providers, the date of receipt is still the date on which the concern was first received by that provider.
Examples of staff categorised within each profession are provided below:
|
Profession |
Includes the following grades of staff: |
|
Medical and dental staff |
Consultants |
|
Specialty doctors | |
|
Staff grades | |
|
Associate specialists | |
|
Specialist registrars | |
|
Senior house officers | |
|
Foundation house officers | |
|
House officers | |
|
Others including clinical assistants and other medical/dental grades | |
|
Nursing, midwifery and health visiting staff |
Nurse manager |
|
Nurse consultant | |
|
Children’s nurse | |
|
Registered midwife | |
|
Health visitor | |
|
District nurse/Community psychiatric nurse/community learning disability nurse – 1st and 2nd level | |
|
Qualified school nurse | |
|
Other 1st and 2nd level nurses | |
|
Modern matron | |
|
Post-registration learners | |
|
Nursing assistant practitioners (unqualified) | |
|
Nursery nurse (unqualified) | |
|
Nursing assistants/auxiliaries (unqualified) | |
|
Pre-registration learners (unqualified) | |
|
Administration and estates staff |
Senior managers |
|
Managers | |
|
Clerical and administration staff | |
|
Maintenance and works staff | |
|
Scientific, therapeutic and technical staff |
Qualified allied health professionals |
|
Qualified healthcare scientists | |
|
Other qualified Scientific, Therapeutic and Technical staff | |
|
Support to Scientific, Therapeutic and Technical staff | |
|
Healthcare assistants and support staff |
Healthcare assistants |
|
Support workers (do not have a formal NVQ or healthcare assistant training) | |
|
Ambulance staff |
Manager |
|
|
Ambulance personnel |
|
|
Emergency care practitioner |
|
|
Ambulance paramedic |
|
|
Ambulance technician |
|
|
Trainee ambulance technician |
5) Concerns by subject
This is the number of new concerns received by the organisation during the quarter, in relation to the following subjects:
|
Access (bed availability)/referrals |
Equality/language |
|
Accident/falls |
Equipment |
|
Admissions |
Environment/facilities |
|
Appointments |
Infection control |
|
Attitude/behaviour/assault |
Medication |
|
Bereavement |
Monitoring/observation issues |
|
Catering |
Nutrition/hydration issues |
|
Cleanliness |
Patient care |
|
Clinical treatment/assessment |
Personal property/finance |
|
Communication issues |
Privacy/dignity |
|
Concerns handling |
Record keeping |
|
Confidentiality |
Resources |
|
Consent |
Test results |
|
Discharge issues |
Other |
Where a concern received identifies multiple issues, all subjects relating to these issues should be included in the counts if this information is collected. Where information is not collected for each issue, the primary subject should be included. Therefore, the number of concerns by subject may not be the same as the number of concerns as identified in indicator 1.
Received during the quarter - this is the date of receipt when the organisation received the concern. In the case of a concern involving primary care providers, the date of receipt is still the date on which the concern was first received by that provider.
6) Regulation 24
This is the total number of concerns settled during the quarter which had a final reply (under Regulation 24):
• up to and including 30 working days of the date the concern was first received by the organisation
• after 30 working days and up to and including 127 working days (6 months) of the date the concern was first received by the organisation
• after 127 working days (6 months) of the date the concern was first received by the organisation.
A final response under Regulation 24 should be issued within 30 working days of first receipt of the concern. If this is not possible the person raising the concern must be informed of the reason for the delay. The response must then be sent as soon as possible and within 6 months of the date the concern was received. If, in very exceptional circumstances, the response cannot be issued within 6 months, then the person raising the concern must be informed and given an expected date for a response.
A Regulation 24 will be issued if it is determined that there is no qualifying liability in tort to which Redress arrangement could apply. If there is or there may be a qualifying liability in tort worth less than £25,000 an interim response in accordance with Regulation 26 must be issued within 30 working days of first receipt of the concern. If this is not possible the person raising the concern must be informed of the reason for the delay. The response must then be sent as soon as possible and within 6 months of the date the concern was received. If, in very exceptional circumstances, the response cannot be issued within 6 months, then the person raising the concern must be informed and given an expected date for a response.
Qualifying liability - this is where there is proven personal injury or loss arising out of, or in connection with the care or treatment of a patient due to the service provided by the responsible body.
Tort - is a "wrong" that involves a breach of a civil duty owed to someone else, which is dealt with through civil proceedings.
The calculation of working days is as follows:
365 days in a typical calendar year
104 days are weekends in a typical calendar year (Saturday and Sunday) i.e. non-working days
8 days are bank holidays in a typical calendar year i.e. non-working days
Therefore, a typical year is 253 working days and a typical 6 month period is 127 working days (126.5 days rounded up).
7) Regulation 26
This is the total number of concerns investigated during the quarter which had an interim response (under Regulation 26):
• up to and including 30 working days of the date the concern was first received by the organisation
• after 30 working days and up to and including 127 working days (6 months) of the date the concern was first received by the organisation
• after 127 working days (6 months) and up to and including 253 working days (12 months) of the date the concern was first received by the organisation
• after 253 working days (12 months) of the date the concern was first received by the organisation.
A Regulation 24 will be issued if it is determined that there is no qualifying liability in tort to which Redress arrangement could apply. If there is or there may be a qualifying liability in tort worth less than £25,000 an interim response in accordance with Regulation 26 must be issued within 30 working days of first receipt of the concern. If this is not possible the person raising the concern must be informed of the reason for the delay. The response must then be sent as soon as possible and within 6 months of the date the concern was received. If, in very exceptional circumstances, the response cannot be issued within 6 months, then the person raising the concern must be informed and given an expected date for a response.
Qualifying liability - this is where there is proven personal injury or loss arising out of, or in connection with the care or treatment of a patient due to the service provided by the responsible body.
Tort - is a "wrong" that involves a breach of a civil duty owed to someone else, which is dealt with through civil proceedings.
The calculation of working days is as follows:
365 days in a typical calendar year
104 days are weekends in a typical calendar year (Saturday and Sunday) i.e. non-working days
8 days are bank holidays in a typical calendar year i.e. non-working days
Therefore, a typical year is 253 working days and a typical 6 month period is 127 working days (126.5 days rounded up).
8) Level of harm
This is the total number of formal concerns closed during the quarter, graded as follows:
• grade 5
• grade 4
• grade 3
• grade 2
• grade 1
at the end of the concerns procedure.
Grades are categorised as follows:
|
Grade |
Criteria |
Examples of seriousness |
|
Grade 5 - Catastrophic |
Death, multiple or permanent harm |
− Concern leading to avoidable death, multiple harm or irreversible health effects − Concern outlining gross failure to meet national standards − Normally clinical/process issues that have resulted in avoidable, irrecoverable injury or impairment of health, having a lifelong adverse effect on lifestyle, quality of life, physical and mental well-being − Clinical or process issues that have resulted in avoidable loss of life − RIDDOR Reportable Incident resulting in an avoidable death |
|
Grade 4 - Major |
Major harm |
•Clinical process issues that have resulted in avoidable, semi-permanent harm or impairment of health or damage leading to incapacity or disability •Increase in length of stay by >15 days •A concern, outlining non-compliance with national standards with significant risk to patient safety •Alleged misconduct issue of a serious nature resulting in disciplinary action •RIDDOR Reportable Incident resulting in permanent or irreversible health effect |
|
Grade 3 - Moderate |
Moderate or minor harm |
•Clinical/process issues that have resulted in avoidable, semi-permanent harm or impairment of health or damage that require intervention •Additional interventions required or treatment •Failure to provide follow up services •Readmission or return to surgery •Increase of length of stay by 3 – 15 days •RIDDOR Reportable Incident which has resulted in harm •Concerns that outline failure to meet internal standards •Alleged misconduct issues •Avoidable patient fall requiring treatment |
|
Grade 2 - Minor |
No harm or minor harm |
•Occasions where an apology would be appropriate when a patient’s experience of services has not been optimum •Alleged misconduct issues (not formal disciplinary issues) •Patient/staff fall requiring treatment •Increase of length of stay by 1- 2 days •Patient requiring treatment •Requiring time off work •Concern involve a single failure to meet internal standards but with minor implications for patient safety •Return for minor treatment e.g. local anaesthetic |
|
Grade 1 - Negligible |
No harm |
•Concerns which normally involve issues that can be easily/speedily addressed with no harm having arisen (e.g. outpatient appointment delayed but no consequences in terms of health, difficulty in parking etc) •Waiting list enquiries •Staff attitude |
9) Reopened concerns
This is the total number of concerns that were reopened during the quarter.
10) Claims received
This is the total number of claims received by the organisation during the quarter. This includes all compensation claims as governed by Section 8 of the Putting Things Right (PTR) Guidance i.e. all clinical negligence and personal injury claims.
Claim - this is the basis for demanding or getting something e.g. a patient who has been harmed makes a claim for compensation.
Received during the quarter - this is the date of receipt when the organisation received the claim.
11) Closed claims
This is the number of claims closed during the quarter and were investigated:
• as a concern and concluded as not having liability in tort - this relates to defended claims only and should not include those that were discontinued
• where a breach of duty and causation were agreed - closed as a claim (qualifying liability in tort damages)
Qualifying liability - this is where there is proven personal injury or loss arising out of, or in connection with the care or treatment of a patient due to the service provided by the responsible body.
Tort - is a "wrong" that involves a breach of a civil duty owed to someone else, which is dealt with through civil proceedings.
12) Claims initially considered under redress
This is the number of claims that were closed during the quarter that were initially considered under redress but the matter was closed as a claim.
As this indicator is a subset of the total number of claims closed during the quarter (indicator 11) then the value for this indicator can never be more than the total for indicator 11. The cell will turn red if an error is input.
13) Redress cases received
This is the number of redress cases that were received by the organisation during the quarter. This includes all cases where the Redress provisions under Part 6 of the Regulations have been engaged.
Redress - this relates to situations where a patient may have been harmed and that harm was caused by NHS Wales. It can only be considered if there is a proven qualifying liability in tort. It cannot be offered if the concern is or has been subject to civil proceedings (i.e. where court proceedings have been issued) or where it is considered at the investigation stage that the amount of financial compensation that would be awarded would exceed £25,000.
Redress can comprise of:
• a written apology;
• a report on the action which has or will be taken to prevent similar concerns arising;
• the giving of an explanation, and
• the offer of financial compensation and/or remedial treatment, on the proviso that the person will not seek to pursue the same through further civil proceedings.
Redress does not apply to primary care practitioners or to independent providers.
Received during the quarter - this is the date of receipt when the organisation received the redress case.
14) Closed redress cases
This is the number of redress cases that were closed during the quarter and were investigated:
• where there was a breach of duty, but no causation found (therefore a payment of compensation was not considered)
• where there was a breach of duty and causation agreed - compensation offered but not yet accepted
• where there was a breach of duty and causation agreed - compensation offered and accepted
• where there was a breach of duty and causation agreed - non financial compensation offered as redress (for example where cases have closed with an apology or alternative treatment etc.)
15) Written compliments
This is the total number of written compliments received by the organisations during the quarter.
Written compliments - this includes letters, e-mails, thank you cards and compliments made via social media such as Facebook and Twitter. It excludes any feedback which has been sought from surveys.
Received during the quarter - this is the date of receipt when the organisation received the compliment. In the case of compliments involving primary care providers, the date of receipt is still the date on which the compliment was first received by that provider.