IMMEDIATE improvements in standards of care must be made at Neath Port Talbot Hospital and Princess of Wales Hospital in Bridgend, the Health Minister has ordered.
It follows an independent report which found serious concerns about the quality of care and patient safety in the two hospitals, both of which are run by Abertawe Bro Morgannwg University Health Board.
ABMU has apologised unreservedly to those affected, and said that it accepts all the findings of the report and that action is being taken to address issues raised.
The report – Trusted to Care – by Professor June Andrews and Mark Butler, was commissioned by Health Minister Mark Drakeford after concerns were raised about patient care at the hospitals.
The report makes 18 recommendations, including four for the Welsh Government, which have been accepted in full.
As a result of the report, the Health Minister has ordered:
• Immediate improvements to standards of care at Princess of Wales and Neath Port Talbot hospitals.
• A series of unannounced spot checks by a ministerial team of experts to check standards of care for elderly patients at district general hospitals in Wales. The spot checks will focus on the delivery of medication, hydration, night time sedation and continence care. This work will be overseen by Prof June Andrews and Sir Ian Carruthers, who has held a number of senior roles in the NHS, including chief executive of NHS South of England.
• A new task group, including the Chief Medical Officer and Chief Nursing Officer, will lead the operation of the spot checks and report back to the Health Minister.
Prof Drakeford said: “This review does not make easy reading; it will be particularly difficult for all concerned with the care of older people in these hospitals.
“As the Health Minister, I give my unreserved apology to those individuals and their families whose care has fallen short of what they might expect from the Welsh NHS. I have been shocked by some of what I have read in this report.
“I am determined that nothing of this sort will be tolerated in these two hospitals, in this health board or indeed anywhere else in Wales in the future. I am not going to pick and choose parts of this report. The actions we need to make have been made clear and must be taken as a whole.
“That is why I have ordered a series of actions to ensure that the standards that we demand of our health service are being delivered and to reassure patients.
“I have met the chair and chief executive of Abertawe Bro Morgannwg University Health Board and made it clear I expect immediate improvements to patient care at both hospitals.”
All health boards in Wales will have four weeks to consider the report and its recommendations.
Prof Drakeford added: “I do not believe the failings outlined in this report are widespread in hospitals throughout Wales. But I am instigating a series of special spot checks in hospitals across the country to test standards of care and reassure patients.
“Let me be clear, while finding many areas of concern, the report also highlights what it describes as exemplary areas of care at both hospitals.
“It also makes it absolutely clear that what has happened in these hospitals is not and never has been the same as what happened at Mid Staffordshire NHS Trust. We have heard that accusation far too many times - this report puts that matter to rest.”
The Mid Staffordshire Trust was criticised in February 2013 in a public inquiry headed by Robert Francis QC for causing the "suffering of hundreds of people" in its care between 2005 and 2008.
A statement from ABMU said: “ABM University Health Board again wishes to apologise unreservedly to patients, and their families or carers, who have been let down by the poor care described in the Andrews Report. While we believe most of our care is of a high standard, we openly acknowledge some care has been very poor; this is clearly unacceptable.
“We accept all the findings and recommendations of the Andrews Report without reservation.
“The report makes very uncomfortable reading, and contains tough messages. The sort of poor care it describes cannot and will not be tolerated. High quality care must be consistently provided across all our wards and departments, in all our hospitals, and we will settle for nothing less. We are determined to put things right.”
The health board said that when issues were identified at the Princess of Wales Hospital in March last year it took immediate action.
“Some of these actions are already showing progress including an improvement in mortality rates, a reduction in hospital acquired infections and pressure ulcer (bed sores) rates plus 95% positive feedback via the Friends and Family Test (ward-based feedback system).
“However, the improvements to date are still not enough and the Health Board is committed to urgently replacing any remaining pockets of poor care with consistently excellent care.
“We took immediate action when concerns were first raised, and we are taking immediate further action now on the issues raised in this report, particularly in relation to:
• Night-time Sedation
• Continence care
“The report specifically asks us to develop clear standards for the care of frail older people to address some poor practice highlighted in the report. We will do this as a matter of urgency over the coming weeks with the help of external experts, patients, carers, relatives and frontline teams.
“However, there are some issues in the report which we want to be clear are completely unacceptable and should never happen in any of our hospitals:
• Patients being given prescribed medication but then not being observed taking it;
• Staff signing the medicines chart to say that a patient has taken medication when they have not seen this;
• Inappropriate use of sedation for “aggression”;
• Patients being told to go to the toilet in bed;
• In addition we must ensure that patients are appropriately hydrated.
“We are taking immediate action, including:
• Additional staff training on each of the specific issues listed above. This training will be guided by external experts.
• An urgent review of the use of sedation
• Using a checklist specifically developed to check medication, continence and hydration, both regular and unannounced spot-check inspections will be carried out by senior personnel and Board members
• A review will begin of the environment of wards for dementia care
“In addition, we have already:
• Commissioned a nationally recognised team of clinical leaders in the field of frail elderly care to help us develop more rigorous ways of ensuring high standards are consistently maintained.
• Engaged a firm of external experts who have supported other NHS organisations in major change programmes to work with us from June. This will enable us to ensure the board works in partnership with staff and our citizens to develop shared expectations of standards of care, as has now been recommended in the report.
• Put in place a taskforce of experienced staff from various disciplines and professions to supplement the ongoing improvements and push ahead with the report’s recommendations.
• Reinforced standards through strengthened inspections and monitoring by senior clinical staff and directors.”
The board said a detailed action plan setting out the actions over the next 12 months would be going to its next meeting on May 22.
“Over the next 48 hours the chairman, chief executive, director of nursing and medical director are meeting with staff to ensure everybody, no matter what their role, is clear about the high standards of care we must provide for our frail older patients.
“This is our opportunity to work together to achieve what we all want to deliver – excellent patient care – and this report enables us to make the Princess of Wales, Neath Port Talbot and all our other hospitals the best examples of excellent patient care.
“All staff share the responsibility for the safety of our patients – nurses, doctors, pharmacists, managers, support staff and others. We must all take action to ensure that poor or unacceptable practice is eradicated. Where any of us see instances of poor care we must raise these immediately so action can be taken.”
Chairman, Professor Andrew Davies, said: “As a Health Board we expect the highest professional standards and behaviours and will not tolerate poor care. This report was very uncomfortable to read but we are determined to emerge as a Health Board where all our hospitals provide excellent, patient-centred, care.”
ABM University Health Board Chief Executive, Paul Roberts, said: “This was a painful report to read. We know we have let down some of our patients and their families, and we apologise unreservedly for the distress this has undoubtedly caused.
“I believe the report is, however, a springboard to help us progress even faster in improving care. It has set us some tough challenges in a tight timescale. We will do our utmost to meet them.
“I appreciate that Professor Andrews has also acknowledged examples of exemplary care taking place in both hospitals. I hope this and the determination of the Board goes some way to reassuring patients of our commitment and intention to provide consistently excellent care.”