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Written Statement - Publication of Ministerial Unannounced Spot Check Visit Reports

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An assessment of progress, 1 year on.
Mark Drakeford, Minister for Health and Social Services

The final report from the unannounced spot check visits to wards at district general hospitals across Wales is today being published.

The spot checks were a core element of the Welsh Government’s response to the publication of the Trusted to Care report, which was published in May and followed an independent inquiry into care at Princess of Wales and Neath Port Talbot hospitals by Professor June Andrews and Mark Butler.

The spot checks were designed to reassure the public that the failings highlighted in the Trusted to Care report were not evident in district general hospitals across Wales. They focused on four areas in the care of elderly patients:

  • Medicines management;
  • Hydration;
  • The use of night-time sedation
  • Continence care.

I would like to thank the three senior professional advisers – Professor Andrews; Sir Ian Carruthers and Professor Philip Routledge - who oversaw the process. Their engagement informed and strengthened the entire process, however, the insight Professor Andrews provided in helping to design the spot check process to ensure a focus on using clinical judgement, was fundamental to the success of this approach.  

The review team of senior health professionals, nurses and pharmacists visited 70 wards across 20 district general hospitals during a seven-week period between June 15 and July 30. The visits took place between 6am and midnight, on weekdays and at weekends. All the visits were unannounced.   

By observing nursing, medical and professional practice and by talking to patients, staff and relatives about the quality of care on that ward at that time, the spot check teams found no systemic concerns about patient hydration, continence care or the use of night-time sedation. They did highlight individual areas in some wards where improvements could, and have subsequently been made. 

While the visits did not identify any significant concerns about the use of sedation, there cannot be any room for complacency. They did identify some inconsistent practice across wards and it is important we do not lose this opportunity to address this and build on the good practice observed. 

The many ways staff approach and meet patients’ continence care was highlighted by the spot checks. In the majority of cases toileting needs were being met however we need to ensure this is the case at all times.

A theme that arose was how often water jugs were refreshed and refilled. Further work is needed to ensure hospitals provide patients with fresh water regularly, in accordance with expected standards. 

The spot checks highlighted where improvement is needed in medicines management on wards across health boards and NHS trusts in Wales. The main issues relate to the need for safe and secure storage of medicines as well as how medicines are administered to ensure compliance with professional standards. Health boards are taking action to address these areas, including replacing locks on medicine cabinets and changing the process for signing for medicines when they are given to patients.  

A national working group to look at the administration, recording, review and storage of medicines has been set up and the Royal Pharmaceutical Society in Wales’ fourth annual Wales Medicines Safety Conference today will focus on the safe and effective use of medicines in the ageing population. 

The Trusted to Care steering group, which is jointly chaired by the Chief Medical Officer and Chief Nursing Officer, will consider many of the themes to emerge from the spot checks as part of its work on the Trusted to Care report recommendations.  

The spot checks have found numerous areas of good practice in hospitals throughout Wales, which far outweigh those few, isolated examples of poor care. In the area of sedation, the spot checks highlighted how relatives had been invited to come onto the ward to sit with their loved ones to help promote calmness. They highlighted innovative schemes, including the Drink a Drop initiative at Prince Charles Hospital, in Merthyr Tydfil; recorded the use of measures to protect patients’ dignity and medicines reconciliation being consistently carried out by pharmacists.

All the examples of good practice, which are highlighted in the individual reports for each health board and Velindre NHS Trust will be shared throughout NHS Wales via a good practice directory. 

The findings from all 70 spot checks have been shared with Healthcare Inspectorate Wales (HIW) to ensure they inform its programme of unannounced dignity and essential care inspections. 

The spot checks have provided a valuable source of reassurance about the care of elderly patients and confidence-building for the public in the wake of the Trusted to Care report. They have also proved to be a valuable source of learning from which the NHS can make further improvements to the quality of patient care. The spot checks will now be extended to look at the standard of care elderly patients receive on mental health wards in hospital settings.