Written Statement - The Professor Andrews Report on Care in Princess of Wales and Neath Port Talbot Hospitals

I am today publishing Professor June Andrews’ and Mark Butler’s report Trusted to Care. This follows the review of the quality of care for older people at the Princess of Wales and Neath Port Talbot hospitals. I will make an oral statement in the Chamber this afternoon but thought it important that I also write to you setting out my immediate response.

You will recall I commissioned this review towards the end of last year after significant concerns about patient care in the two hospitals were raised with me. The review took place over a four-month period from December 2013 to March 2014. The final report was received by Welsh Government on May 6, 2014 and I am today publishing it in full.

This report does not make easy reading; it will be particularly difficult for all concerned with the care of older people in these hospitals. The review team’s findings and observations will make difficult reading for everyone working in the NHS who do their very best for patients in providing the highest standards of compassionate care. This is what all patients have a right to expect.

The report will be difficult for patients and their families too. As the Minister for Health and Social Services in Wales I want to offer my unreserved apology to those individuals and families whose care has fallen so far short of what they would expect while being looked after in these two hospitals.

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 Abertawe Bro Morgannwg University Health Board or indeed anywhere else in Wales in the future.

Despite the failings it  identifies, I am reassured that the report makes it absolutely and repeatedly clear that what has happened in these hospitals is not, and never has been, the same as that at the Mid Staffordshire NHS Trust in England.

Prof Andrews and Mr Butler say that, throughout the review, the key question posed by others was: “Is Abertawe Bro Morgannwg University Health Board another Mid-Staffs?” The report answers that question directly and unequivocally: “It is not”.

They have also given careful consideration to the ability of the current Abertawe Bro Morgannwg board and its senior executive team to make the urgent changes needed. Their unambiguous conclusion is that they are confident they can do so. Just as I accept the specific recommendations in the report, I accept the conclusion in this regard too. I have already met the chair and chief executive and made my expectations very clear. They in turn have given me strong assurances they will do all that is required to meet the responsibilities they have been set.

My senior officials and I will monitor progress closely and will expect to see immediate improvements, building on the actions and improvements that Abertawe Bro Morgannwg University Health Board has already started to put in place.

The report describes a wide range of issues in four key areas. Taken together they identify system-wide weaknesses and unacceptable practices at many levels.

The findings do not fall to one single healthcare profession or on the frontline of care. On wards, the lapses in standards were multidisciplinary in nature. While much of this was the responsibility of nurses, doctors failed to intervene or were not available when needed; pharmacists failed to act when they saw practices they knew were not right. At the same time, hospital managers either stood back from, or did not understand their responsibilities in ensuring good quality patient care.

All of this was too far removed from the board. It did not have robust processes in place to identify lapses in standards.

I take heart that the review team witnessed and documented exemplary practice in both hospitals. The poor care the team saw was not true of all the wards they visited – even on those wards where problems occurred – nor of all shifts. However, this level of variation in standards is not acceptable.

The report also makes it clear the responsibility of the board is to support, educate and develop its staff. This is essential to ensure that lapses in standards do not become systemic and rooted in practice as they have been allowed to become in parts of the Princess of Wales and Neath Port Talbot hospitals.

This is a report for all NHS organisations in Wales.

I have today written to the chair of every health board and NHS trust setting out my requirement that this report is read and discussed by their board; that they consider the standards of care for the elderly on their wards and put in place any actions that stem from the report for their organisation and their patients.

The report identifies some very specific areas where the care of older patients was compromised at Princess of Wales and Neath Port Talbot hospitals:

• In giving patients their medication
• In ensuring patients are kept hydrated
• In the overuse of night-time sedation; and
• In basic continence care

I require an immediate assurance that these failures are not happening in hospital wards across NHS Wales. I will set out further detail about how this assurance will be provided when I make my oral statement this afternoon. When I commissioned Prof Andrews to review care for older people at Princess of Wales and Neath Port Talbot hospitals, I specifically asked her team to look at how Abertawe Bro Morgannwg University Health Board handles complaints, including POVA investigations.

The report makes a series of important and serious observations about complaints handling across the health board. These will be passed on to Keith Evans, the former chief executive and managing director of Panasonic UK and Ireland, who is leading the Wales-wide review of concerns handling and which is due to report back to me in the coming months.

The report makes a total of 18 recommendations. They clearly describe the specific intentions which underpin each of these, and how, taken together, they believe the failures and deficiencies in care, culture and management practices can be rectified - and rectified quickly - over the coming weeks and months.

Fourteen of the recommendations are the responsibility of Abertawe Bro Morgannwg University Health Board, four fall to the Welsh Government. All the recommendations will be accepted.

For Abertawe Bro Morgannwg University Health Board, the recommendations include action to address deficits in skills, knowledge and education (recommendations four and five). Recommendation six deals with removing the fragmentation of responsibility through shared, multidisciplinary practice.

There are recommendations which cover the need to improve the physical environment of wards at the two hospitals (recommendation 10) and to simplify and strengthen management and clinical accountabilities to guarantee that the right clinical and support staff are in the right place to meet the needs of older people (recommendation 11).

The board is today publishing its response to the report, including a set of actions, to show how it will put all 14 recommendations into practice.

The recommendations for the Welsh Government, and what action we will take, are as follows:

• The Welsh Government should commission a strategic campaign to increase public and professional understanding that regular hydration and feeding are as important as hand-cleaning in promoting wellbeing for older people in hospital.

Planning will begin immediately, building on a range of actions already in hand, with a focus on increasing public as well as professional understanding.

• The Welsh Government should review the effectiveness of health scrutiny and quality reporting processes relating to the care of frail older people.

The deputy chief medical officer will lead work to ensure that our existing systems are strengthened and have a focus on the care of frail older people. This will dovetail with the recommendation below.

• The Welsh Government should commission Abertawe Bro Morgannwg University Health Board to develop a model dashboard and guidance for board assessment of frail and elderly care for adoption across NHS Wales by the end of 2014.

The Welsh Government will now discuss this recommendation with Abertawe Bro Morgannwg University Health Board in order to take it forward

• The Welsh Government should institute a further independent review of provision for older people within a year of the date of this report.

The Welsh Government is fully committed to doing this.

I again want to emphasise that the review team has said this report must be read and accepted as a whole. It states that a full public inquiry is not warranted and would serve no useful purpose. I am particularly encouraged that the report states the review team was struck by the fact the vast majority of the public and NHS staff they met wanted to be proud of health services in Bridgend and Neath Port Talbot. The majority also said they were interested in seeing more openness and making the system better for the future.

Abertawe Bro Morgannwg University Health Board must now meet this challenge and use the opportunity it presents to build public confidence and staff morale.

The review, with its deep dive into current practice and the look back exercise has taken less than six months to complete. It has given us a very clear picture of what needs to happen immediately, in the coming weeks and months, and how to put things right.

Public inquiries, in contrast, involve a long drawn out process and therefore cannot focus on what can be put immediately right. I believe strongly that this review has proved to be the right course of action.

Finally, I would like to thank Prof Andrews, Mark Butler and the review team for the work they have done and for the insightful and constructive report they have produced. I am determined all the recommendations will be delivered. The focus must now be on ensuring the necessary improvements are made.