Written Statement - Independent External Review of the Princess of Wales Hospital and Neath Port Talbot Hospital within Abertawe Bro Morgannwg University Health Board

Members will be aware of my intention to commission an external independent review into the care provided at the Princess of Wales Hospital, Bridgend and Neath Port Talbot Hospital. I would like to update Members on the arrangements for this review.

The Health Board is already taking a range of actions to ensure the delivery of safe and high quality care to patients at the Princess of Wales Hospital. Progress is being monitored by the Chief Medical Officer and the Chief Nursing Officer. As a part of these actions an external quality and safety review has been commissioned by the Health Board.

However, I felt there was also a need for an additional independent review focusing on the care of older patients at two hospitals, following a meeting with a family who described their experiences in relation to the care of their elderly relative. The independent external review will consider the care provided at the Princess of Wales Hospital and Neath Port Talbot Hospital and will be in addition to the review already commissioned by the Health Board.

Using an established ‘deep dive’ review methodology, the scope of the work will cover provision directly related to the care of older people focusing in more detail on the specific areas:

• how professional nursing standards are protected and delivered consistently, and determine how the Health Board responds to lapses in delivery of these standards;
• the culture of care, particularly focussing on the care of older patients in the medical wards;
• responding to complaints, particularly looking at how complaints are handled by the Health Board and how professionals are held to account for lapses in care identified through investigation of complaints (including POVA investigations); and,
• administration and recording of medicines, particularly looking at how medicines are administered to patients who are cognitively impaired or have other challenges in taking medicines orally.

I am pleased to confirm that Professor June Andrews, Director of the Dementia Services Development Centre (DSDC) in the School of Applied Social Science at the University of Stirling, Scotland has agreed to lead this review.

Professor Andrews is a world leading expert in the care of people with dementia and has broad experience in the NHS being a past nurse executive director, has worked as a Senior Civil Servant in the Scottish Government, she was Board Secretary of the Royal College of Nursing (Scotland) and in 2012 was given a lifetime achievement award by the four Chief Nursing Officers of the UK for her work in dementia care improvement. She is internationally recognised for her contribution to continuous improvement in health and social care systems.

The review will commence in December and continue into early next year. The review’s findings, together with recommendations, will be made publically available.

The full terms of reference for the review are set out in annex 1. 

Annex 1

“Deep Dive” review of practice in ABM University Health Board

1. Purpose and Scope
The review to be conducted by University of Stirling Dementia Services Development Centre (DSDC) will provide an independent assessment of the current strategies and provision related to the care of older people, including those with dementia, within Princess of Wales Hospital, Bridgend and Neath Port Talbot Hospital and to provide a report on fitness for purpose in relation to relevant evidence-based standards.

The focus will be on identifying key areas of strength, which can be built upon, and areas of potential risk, where further action might be recommended.  

The scope of the work will cover provision directly related to the care of older people at the Princess of Wales Hospital, Bridgend and Neath Port Talbot Hospital focusing in more detail on the specific areas below:

• how professional nursing standards are protected and delivered consistently, and how the Health Board responds to lapses in delivery of these standards; 
• the culture of care, particularly focussing on the care of older patients in the medical wards; 
• responding to complaints, particularly looking at how complaints are handled by the Health Board and how professionals are held to account for lapses in care identified through investigation of complaints (including POVA investigations); and, 
• administration and recording of medicines, particularly looking at how medicines are administered to patients who are cognitively impaired or have other challenges in taking medicines orally.

The focus is on two of the hospitals of the ABM University Health Board: Princess of Wales Hospital, Bridgend  and Neath Port Talbot Hospital.

2. Methodology and Timing
The “deep dive” uses an established methodology which has been developed over a period of years by DSDC. A Case Study on one of the “deep dives” can be found here http://www.dementia.stir.ac.uk/case-studies/04-change-deep-dive

The approach deliberately looks at strategic and practical issues together. The “deep dive” is normally conducted intensively over a short period of time.  In part it deliberately follows the direct experience of people using the service and their carers through services and pathways from admission onwards.  The methodology involves direct engagement with staff at all key points on this process, thus allowing important changes to be worked through with front-line staff at the time and unlocking immediate changes of demonstrable benefit in priority areas, based on evidence of what is known to work.

During the deep dive activity, specific areas of practice or policy will be identified to be part of the ‘look back’ exercise. The ‘look back’ will help identify how practices have evolved and where further change is advisable to improve standards of care.
The assessment will be undertaken from December 2013, through the early part of 2014  to include the following elements:

• review of key documents and data
• structured interviews with key stakeholders
• sample visits to service providers and partners

The assessment will be undertaken by two named individuals who have led other Deep Dives in the last two years:

• Professor June Andrews, Director of Dementia Services Development Centre, University of Stirling
• Mark Butler, Director of Development (DSDC) and Director, The People Organisation Ltd

Professor Andrews and Mark Butler will be assisted by the Director of Learning and Development of the DSDC, Shirley Law.  Expert contextual advice on the Welsh NHS will be obtained from an independent named associate from Wales to support the reviewers from outwith the Health Board.