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Case Studies

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Kay's Story (not clients real name)

The client wished to complain about the poor treatment she received whilst undertaking an inpatient alcohol detox programme, the environment of the hospital, and about the poor treatment she observed of other patients on the ward.

Melchor's Story (not clients real name)

A young Filipino man, with limited English, was held under section in a Psychiatric Intensive Care Unit (PICU) in Oxford for nearly two years.

John's Story

John is an ex-army veteran who was detained  in a prison in Oxfordshire. He was very unhappy with the service he was receiving from the prison health care service and wanted advocacy support to help him challenge his treatment.

An Innocent Prisoner

Mr Barrass complained about the treatment his mother received in a care home and he wants his mother’s story to influence the way complaints are investigated and the way care homes are regulated.

Service used:

Simon's Story

The support of an Independent Mental Health Advocate helped Simon gain the confidence to self-advocate and secure his discharge from a medium secure unit.

Nicole's story

Nicole needed support with an Exceptional Funding Appeal to try and overturn her PCT's decision not to fund an out-of-county treatment package recommended by her consultant.

Kay's Story (not clients real name)

Service used: Independent Health Complaints Advocacy (IHCA)

The client wished to complain about the poor treatment she received whilst undertaking an inpatient alcohol detox programme, the environment of the hospital, and about the poor treatment she observed of other patients on the ward.

She approached seAp for help as she was finding it difficult and protracted dealing with the Trust and her complaint was taking months to resolve.

The client had been upset and shocked by the negative experience she had been through, and felt strongly that she had a responsibility to have her concerns addressed in order to improve services in the future.

CLIENT ISSUES & DESIRED OUTCOMES

The client had a very poor experience of the nursing staff on the ward, and felt they had acted both unprofessionally and uncaringly towards her and other patients.

The administration of medication was problematic, whereby prescribed drugs were withdrawn upon admittance, causing unnecessary withdrawal symptoms and distress. Also, medication prescribed for alcohol withdrawal was sometimes administered up to 5 hours late, causing severe side effects and further anxiety.

Patient care seemed poor and where the client reported to staff that she had observed others becoming distressed or being left in vulnerable positions by staff, she was told to not interfere.

The nursing staff were hard to approach because the nurses’ station was small and overcrowded, with no opportunity to talk privately. Meetings to discuss her care or any concerns she had were not offered. Staff acted aggressively and dismissively towards her, and did not respond well to any concerns she reported to them.
Once she had made a complaint, she had not heard back within a reasonable time, and had not been satisfied to date with the complaints procedure within the Trust.

For all the above issues, the client required explanation, apology and review of relevant policies and procedures resulting in a change in services to ensure that others would not experience anything similar.

CHALLENGES

The client had been extremely distressed by her experience, and had lost faith in the services provided by the Trust, so needed a lot of support to pursue resolution. This included:

• providing an opportunity for the client to be heard, and to voice her experience with confidence
• helping the client to understand the Trust’s response to her complaint and to clarify in an objective manner how and if the outcomes she sought had been met
• liaising with the Trust to challenge them when they did not keep to expected timescales and encouraging/supporting them to do so

The complaint was complex, and contained multiple issues, so the Trust investigation took a long time and involved several different areas. This made it difficult to monitor and keep them to timescales.

The client stated from the outset that she worked very long hours, and that as she was often unavailable communication with the advocate might be difficult.

WHAT DID THE ADVOCATE DO AND HOW?

It was agreed that communication between client and advocate would be by email wherever possible, so that the client could respond out of normal working hours. This took pressure off the client as she would have found it almost impossible to liaise regarding the complaint without this facility, and the arrangement enabled her to pursue the complaint and use the advocacy service to help her achieve her required outcomes.

At every stage of liaison with the Trust, the advocate acted with care to do so only under instruction from the client at all times, and kept her informed as to what she was doing. This helped build a sense of trust with the client that impacted favourably on the final outcomes, helping the client to begin to rebuild their trust in the services provided by the NHS.

The advocate responded sensitively to the distressing nature of the complaint, and empowered the client to feel confident in being represented by an advocacy service even though she was still vulnerable.

The advocate was tenacious and persistent in her liaison with the Trust and her encouragement to keep them to timescales and the agreed sharing of information.

WHAT WENT WELL

The final response from the Trust acknowledged the protracted amount of time it had taken to respond and the extra distress this had caused the client. The Trust apologised unreservedly for the fact that aspects of their service had fallen short of both the client’s expectations and the standard they themselves would expect. It included an assurance that they had learned from the concerns raised and would improve aspects of their practice as a result.

The openness and honesty of the response demonstrated excellent practice that was encouraged and supported by the consistent involvement of the advocate in communicating the expectations of the client, reminding the Trust of timescales, and ensuring that the Trust was aware that all outcomes needed to be addressed satisfactorily.

Communication was excellent between the advocate and client using the client’s preferred method of contact, email, ensuring that delays were minimised and discussions were clear, effective and recorded. The client believed she was well supported by the advocate because she felt listened to, and this was achieved through clear and sensitive negotiation, discussion and provision of the client’s needs and expectations.

WHAT WAS THE OUTCOME OF ADVOCACY SUPPORT?

The client was very satisfied with the outcomes that advocacy support helped them achieve. In particular these included the following:

1. The Trust implemented a series of compulsory medication training modules for registered and unregistered staff, to improve standards and safety.

2. The Trust changed the ward routine regarding medication and reviewed the practice of the Medication Management Team.

3. A review was undertaken of the ward’s reception area, nurses’ station and general physical aspects of the environment, as a direct result of the complaint.

4. Issues raised in relation to the care of other people were discussed within management supervision of the staff involved in order that they learn from the concerns raised and improve their practice, and the complaints in general were discussed at team meetings.

5. Comments on staff attitude were raised with staff involved within their management supervision and also within team meetings.

The client felt that the advocate’s attention to detail, sensitivity and care in her role had been exceptional, and had empowered her to feel supported and able to pursue the complaint. She stated that at every stage she felt she had someone to turn to and, although still vulnerable due to mental health issues, this gave her the confidence to continue with the complaint.