Governance Leaflets

The leaflet is detailed below, or you can download the 'Being open and Duty of Candour' leaflet in PDF

This leaflet provides information to support you with our Trust’s “Being Open and Duty of Candour” policy at Liverpool’s Women’s Hospital.

You may have been given this leaflet because you or a patient you are supporting has been in involved in a Duty of Candour incident.

This leaflet explains what Duty of Candour incident is and what you can expect to happen next, when an incident affects you.

What is the Duty of Candour?

The definition of Candour is ‘being open and honest’.

Liverpool Women’s Hospital is committed to delivering safe, high quality care. However we also recognise that healthcare is complex and situations can change rapidly and unexpectedly.

On occasion things do not go to plan and despite our best intentions and safety checks being in place, a patient may be harmed whilst in our care. A legal Duty of Candour reinforces the ‘Being Open’ principles that we already deliver. The duty asks that healthcare providers ensure that patients, or their families (when the patient lacks capacity to make a decision regarding their own care or is deceased), are told openly, honestly and in a timely manner when mistakes happen, which are believed to have caused significant harm.

Being open involves:

• Swiftly providing a truthful account detailing clearly what we know about the incident.

• Apologising that harm was caused.

• Providing support to patients and/ or people involved or affected by the incident.

• Investigating why the incident happened and sharing the investigation findings with you.

• Communicating any learning for the Trust from your experience and explaining how we plan to prevent it happening again.

• Duty of Candour does not affect your right to complain. You can make a formal complaint if you are not happy with any aspect of your care.

Which Incidents are affected by Duty of Candour?

Duty of Candour applies where there has been a “notifiable safety incident” (an unintended or unexpected event which leads to harm of a patient receiving NHS care) which has resulted in one or more of the following categories of harm classified as moderate or above:

Harm may be defined as injury (physical or psychological) disease, suffering, disability or death.

 

Moderate harm

Means an incident has occurred resulting in a moderate increase in treatment and/or which caused significant, but not permanent harm.

A moderate increase in treatment includes:

• Unplanned return to surgery

• Unplanned re-admission

• Prolonged episode of care
(4-15 days extra care)

• Extra time in hospital or as an outpatient

• Cancelling of treatment because of harm caused

• Transfer to another area such as intensive care

Severe harm

Means a patient safety incident that appears to have resulted in permanent harm (permanent lessening of bodily functions, sensory, motor, physiological or intellectual, including removal of wrong limb or organ or brain damage).

Psychological harm

This means psychological harm which is experienced or is likely to be experienced for a continuous period of at least 28 days.

Death of a patient

The next of kin and/or family will be informed of the incident. The coroner’s report will provide a key source of information that will help to complete the detail of the event leading up to the incident.

What can I expect to happen?

Initial notification

A senior member of staff from your healthcare team will contact you and, where possible, meet with you to notify you of the incident. We hope to do this as soon as possible, but initial notification should happen within 10 working days from the point that we realise an incident has occurred.

This designated person will ensure that during the initial discussion you are informed of any details relating to the incident that we are aware of at that time. There will also be an opportunity for you to ask questions and make comments that will be part of our investigation, as your view of the incident is important to us. You can provide questions or comments when you meet with us via letter, email or over the phone. A review of the care received will then be carried out to agree the appropriate level of investigation to be undertaken.

 

Investigation

An investigation will then be completed within 60 working days, to fully review the incident and a report will be written. The final investigation findings will be shared with you in writing with an opportunity for a meeting to discuss the report, incident and any outcome or learning points for the Trust. The outcome of the report will be shared with you within 10 working days of the investigation being completed.

We would like to ensure that patients and their carers are fully supported during this process, so if you wish your family or other carer to also be present during any discussions, please let us know as soon as possible.

What treatment and care will I receive after the incident?

You can expect to continue to receive all future treatment with respect, compassion and dignity. Nevertheless, should you wish to receive treatment from another team or organisation, we would be happy to discuss this with you, although there maybe circumstances where this may not be clinically appropriate.

Questions or Support

If you have any questions relating to the Duty of Candour then you can contact:

The Patient Experience Team (based at Liverpool Women’s Hospital)

Tel: 0151 702 4353 (08:30am - 04:30pm Monday-Friday)

You can also contact the following independent organisations for support or advice:

The Care Quality Commission (CQC)

The CQC is the independent regulator of health and adult social care organisations in England and is responsible for monitoring compliance with standards such as the duty of candour.

Tel: 03000 61 61 61 www.cqc.org.uk/duty-candour

Action against Medical Accidents (AvMA)

AvMA is the charity for patient safety and justice which campaigned to bring about the duty of candour.

 

Tel: 0845 123 2352 (10am – 5pm Monday-Friday) www.avma.org.uk/help-advice

  

Patients who require this information in an alternative format:

For patients whose first language is not English we will arrange an interpreter to be available for any meetings or discussions and any written communication will be translated for you, including this leaflet. Any other requests for alternative formats of this leaflet can be made via the Patient Experience Team.

Can I Complain?

Duty of candour does not affect you right to complain. You can make a formal complaint if you are not happy with any aspect of your care

• To make a formal complaint you can contact the Patient Experience Team in one of the following ways
• By writing to the Chief Executive at Liverpool Women's NHS Foundation Trust, Crown Street, Liverpool L8 7SS
• By telephoning the Patient Experience Team on 0151 702 4353           
• 08:30am - 04:30pm Monday-Friday
•  By email via pals@lwh.nhs.uk

 

The leaflet is detailed below, or you can download the 'Comments, Suggestions and Complaints' leaflet in PDF.

At Liverpool Women’s we are continually working to ensure that our women, babies and their families have a positive experience. We aim to provide the highest standards of care and facilities to all our patients and visitors.

We accept that sometimes you may have some comments, suggestions or complaints about your experience that you wish to share with the Trust.

We welcome your feedback to help the Trust continually improve the services we provide.

We have a flexible process in place to assist our patients and visitors if they have any comments, suggestions or complaints they wish to bring to the attention of the Trust.

There are a number of ways you can do this:

Verbally

Often the best way of raising a concern is to speak to a member of staff in the ward or department, or if you wish you can ask to speak to a Manager or Matron. In many cases the matter can be promptly resolved to your satisfaction.

PALS

(Patient Advice Liaison Service):

Our dedicated PALS Team based at Liverpool Women’s NHS Foundation Trust, Crown Street, Liverpool, L8 7SS are here to help you with any comment, suggestions or complaints and would welcome your feedback. There are a number of ways you can contact the team:

Monday to Friday between 08:30 and 16:30

• You can telephone them on 0151 702 4353. If they are away from their desk when you call, please leave your name and contact details and we will get back to you as soon as possible. The PALS Team will return your call within three working days.
• The PALS Room is located opposite Main Reception. If the office is empty please ask Main Reception to call the PALS Team and one of the Team will come out and discuss your concerns with you.

Outside of these hours you can:

• Use the same number to leave your contact details or leave them with the receptionist. The Team will contact you on the next working day.
• Contact the duty manager via the main hospital switchboard on 0151 708 9988.

In writing

If you prefer to put your comments or suggestions in writing or make a formal complaint please send them by email: PALS@lwh.nhs.uk or post to:

PALS

Liverpool Women’s NHS Foundation Trust

Crown Street

L8 7SS

If you wish to make a formal complaint directly to the Chief Executive Officer (CEO) or if you are not satisfied with the process or outcome following your contact with the PALS Team please write to:

The Chief Executive

Liverpool Women’s NHS Foundation Trust

Crown Street

Liverpool

L8 7SS

It will help if you can tell us:

• Your full name, address and telephone number
• Your preferred method of contact – in writing, telephone or email
• Your patient hospital number (if known)
• The dates of your stay in hospital or outpatient appointment/s
• The ward or department concerned and the names of any relevant personnel
• Details of your complaint

Questions & Answers

Will details of my complaint be held on my hospital records?

No. All information and details of complaints are held by the PALS/Patient Experience Team. Your patient hospital notes will not contain any information to indicate that a complaint has been made.

Do complaints need to be made within a certain time limit?

The Trust will investigate complaints that are made within 12 months of an event. Every effort will be made to address and resolve the concerns received about care before this time but it may not be possible.

Are complaints treated in confidence?

Yes. The Trust respects patient confidentiality at all times.

What happens if I make a complaint to the Chief Executive and I am dissatisfied with the response?

The Trust will make every effort to make sure we investigate your concerns thoroughly and answer your questions. If you remain dissatisfied, you may wish to refer your complaint to the Parliamentary Health Service Ombudsman (PHSO). The Ombudsman is not obliged to investigate every complaint, with the decision on any action being entirely at his/her discretion. It should be noted that the Ombudsman would not usually review a case that has not been through the NHS Complaints Procedure, as detailed in this leaflet, or a case that is being handled by solicitors or the courts.

What do I do if I need help dealing with a concern or a complaint?

If you would like help when making a complaint, staff at n-compass - Liverpool Advocacy Hub would be happy to assist. The Hub is an independent and confidential single point of contact which will provide information, advice, and support to the public on issues relating to the Health Service. You can contact them at:

Liverpool Advocacy Hub

• Telephone: 0300 3030 629
• Email: referral@liverpooladvocacyhub.org.uk
• Website: liverpooladvocacyhub.org.uk

 

• Post: Head Office.

          Unit 1, Edward VII Quay

          Navigation Way

          Preston

          PR2 2YF

It is recognised that patients do, at times, wish to make a complaint but they may feel too unwell or unable to deal with the matter themselves. In such circumstances, we would be willing to accept a complaint from a close relative, (e.g. husband, wife, son, daughter), friend or advocate on the condition that a written consent, signed by you, is provided stating that you have nominated a named person to act on your behalf in respect of the complaint.

In cases where a patient is incapable of providing consent, a close relative or next of kin may be accepted as the complainant.

Parliamentary Health Service Ombudsman

11^th Floor

Millbank Tower

Millbank

London

SW1P 4QP

Tel: 0345 015 4033- Monday to Thursday 8.30am to 5.00pm | Friday 8.30am to 12pm

Web: www.ombudsman.org.uk

Liverpool Maternity and Neonatal Voices Partnership

Liverpool MNVP is a service user (patient)-led team, made up of service users and their families and those working in maternity and neonatal care. They work together to develop and improve local services. You can contact the team to pass on any additional feedback or suggestions for improvement, or to enquire about joining the team as a Volunteer Service User Representative.

Email: mvp.liverpool.voices@gmail.com

Facebook: facebook/com/LiverpoolMNVP

Twitter: @LiverpoolMNVP

Instagram: mnvp.liverpool.voices

The leaflet is detailed below, or you can download the 'Preventing pressure ulcers: A guide for patients and Carers' leaflet in PDF.

Definition

A pressure ulcer refers to localised damage to the skin and/or underlying tissue, usually over a bony prominence (or related to a medical or other device), resulting from sustained pressure (including pressure associated with shear). The damage can be present as intact skin or an open ulcer and may be painful

 

THREE main causes of pressure ulcers:

• Pressure: The weight of the body pressing down on the skin
• Shear: The layers of the skin are forced to slide over one another or over deeper tissues
• Friction: Rubbing the skin

 

Areas to look out for if:

Areas to look out for lying back:

• Head
• Shoulder
• Elbows
• Buttock
• Heel
• Toes

Lying side:

• Ear
• Shoulder
• Elbow (outer side)
• Hip
• Heel
• Ankle

Lying side:

• Head
• Shoulder
• Sacrum
• Buttock
• Heel

What should you be looking out for?

A pressure ulcer can develop very quickly in just one hour when the blood supply to that area of skin is cut off and pressure is not relieved.  It is therefore important to be aware of the signs and keep a close eye whilst in hospital. The first sign is typically a discolouration of the skin. On light-skinned people there may be red patches that do not go away, and on dark-skinned people there may be bluish/purplish patches that do not go away. Further signs include:

• Blisters or damage to the skin
• Patches of hot skin
• Swelling
• Patches of hard skin
• Patches of cool skin
• Localised pain or loss of feeling to an area

Am I likely to develop a pressure ulcer?

Your risk of developing a pressure ulcer is greatly increased if:

• You are spending long periods of time in bed or sitting in a chair
• You have difficulty moving around and cannot change position
• Poor oral fluid and nutritional intake
• Incontinence
• You are seriously ill or had surgery
• You have had a stroke and mobility is poor/reduced

• If you are overweight or underweight
• If you have a bad heart, poor circulation or diabetes
• You smoke
• If you have scar tissue from a previous pressure ulcer

N.B. Also keep an eye out for any external devices that may cause pressure damage including glasses, splints and footwear

How to avoid a pressure ulcer

• Regularly change position & check your skin for any signs of damage
• If able, have a short walk to increase blood flow and tone up the muscles
• If not able to move self, should have assistance with re-positioning every 2-4 hours (depending on skin integrity)
• Take care not to get crumbs in bed
• Eat a well-balanced diet and drink plenty of fluids
• Do not roll down anti-embolic stockings if wearing
• If incontinent, speak to nursing staff for advice
• If in an armchair or wheelchair, try relieve the weight off your bottom every 15 minutes
• Avoid rubbing or massaging your skin
• Avoid talcum powder as this can dry out your skin

What can you expect from us?

• Upon admission to the Liverpool Women’s hospital, you will have had an initial risk assessment completed. Patients will also undergo further risk assessments post-surgery and if their condition changes at all. Measures will be put in place for you if deemed at high risk of pressure damage:
• High specification foam mattresses to reduce the pressure on high risk areas of the body
• Encouragement to regularly change position or regular assistance to change position if required
• Skin assessment by a trained healthcare professional
• Nutritional assessment and monitoring of intake

• A discussion with your nurse/midwife who will involve you in the care planning and allow you time to make informed decisions about your own care and treatments
• If needed, a referral to the tissue viability nurse for the Trust

For further information please ask to speak with our Tissue Viability Nurse

External Websites:

www.nice.org.uk

www.your-turn.org.uk

The leaflet is detailed below, or you can download the 'Patient Transport' leaflet in PDF. 

Overview

In an emergency situation, transport to a hospital will be provided by ambulance. Where a patient requires transport to another hospital site from Liverpool Women’s in an emergency this will be provided by ambulance.

Outside of an emergency, it is the patient’s responsibility to make their own way to and from hospital for patient episodes of all types, including outpatients’ appointments, elective admissions, and discharge from hospital. This applies even for long distance travel or if the attendance is urgent.

Where there are patients on low income or in receipt of qualifying benefits or allowances, an application for reimbursement can be made for part or full costs incurred in travelling to receive certain NHS services. This is obtained through the Hospital Travel Costs Scheme (HTCS).

Where a patient’s medical condition means that they cannot make their own travel arrangements, transport will be provided by the Trust. This includes urgent transfer to another hospital where the patient is unable to make their own way and neonatal transport.

If a patient is referred to hospital or other NHS premises for specialist NHS treatment or diagnostic tests by a doctor or another primary care health professional, the patient may be able to claim a refund of reasonable travel costs under the Healthcare Travel Costs Scheme (HTCS). This refund will be given by the receiving hospital not the referring hospital.

The Trust will not reimburse travel costs for children or other dependants, carers and escorts. Applications for reimbursement should be made through the HTCS where appropriate to do so.

Hospital Travel Costs Scheme

To be eligible for full or partial reimbursement of travel costs, the patient must meet the following three conditions:

• At the time of your appointment, you or your partner (including civil partners) must receive one of the qualifying benefits or allowances (see 4.2 below), or meet the eligibility criteria of the NHS Low Income Scheme
• You must have a referral from a healthcare professional for a specialist or to a hospital for further NHS treatment or tests
• Your appointment must be on a separate visit to when the referral was made. This applies whether your treatment is provided at a different location (hospital or clinic) or on the same premises as where your GP or other health professional issued the referral

Further information is available on the NHS website

https://www.nhs.uk/using-the-nhs/help-with-health-costs/healthcare-travel-costs-scheme-htcs/

Form of Transport Allowed

Claims will based on the basis of what would have been the cheapest suitable mode of transport for their circumstances, which can include the patient’s age, medical condition or any other relevant factors.

This means the patient should use the cheapest, most appropriate means of transport, which in most cases will be public transport. If the patient travelled by car and the claim was approved, they will be reimbursed for the cost of fuel at the current mileage rate. Car parking charges (including those at the hospital) should be reimbursed where they are unavoidable, although not penalties incurred through illegal parking.

Mileage claim fuel rates to be used can be found at:

https://www.gov.uk/government/publications/advisory-fuel-rates

When using a taxi for transport, it is recommended that you agree this in advance with the Trust with evidence of necessity from a suitable medic. Otherwise reimbursement of taxi costs will be to the maximum of a “Daysaver” ticket on the bus.

Claiming a Refund

In most cases, the Patient is expected to pay for travel and claim back the costs.

However, HTCS does allow for advance payments to help you attend your healthcare appointments in certain situation – for example, if you do not have the money to get to your hospital appointment and you are on a low income or benefits.

The patient should take their travel receipts, appointment letter or card, and proof that they are receiving one of the qualifying benefits (listed above) to the Trust’s main reception who will liaise with the Finance team to claim their travel costs.

If the patient cannot demonstrate that they are in receipt of benefits, they must complete a Trust HC5 Claim form (see link below).

https://www.nhs.uk/nhsengland/healthcosts/documents/hc5(t).pdf

The Main Reception will contact the cashier/general office that are located within the Finance Department and are open 8am – 4pm Monday to Friday.

Where a patient has attended the hospital but has been unable to claim travelling expenses for which they are entitled, they will forward an HC5 form from the Department of Work and Pensions (DWP). This will subsequently be forwarded to the hospital if the DWP decide the claim is valid.

When a HC5 form is received at the hospital and the payment due to be made is in excess of £20.00 the finance department should request that a bank transfer is made to the patient.

If the payment is less than £20.00 the form should be kept until the patient’s next visit, when they should be reimbursed the outstanding amount from the Cashier/General Office. The HC5 form should be filed. If a patient has no further appointments payment should be sent by bank transfer as above.

In cases 2 and 3 if a letter needs to be sent out, then attach a copy of the HC5 form to the letter.

Exceptional Circumstances

On rare occasions, exceptional circumstances may mean that patients face difficulty in meeting travel costs. For example, in cases of bereavement or for urgent long distance travel.

In these exceptional circumstances, with the support of their healthcare professional, an application can be made to the Liverpool Women’s Charity for help. This will be considered on a case by case basis and in exceptional circumstances only. The Trust is unable to cover travel costs for patients other than as outlined above.