Written Statement - Care and Compassion

I am sure you were as concerned as I was to read the recent report by the Health Service Ombudsman in England. Care and Compassion described 10 cases in NHS England where the older people concerned did not receive even the most basic levels of care. I am worried about the message this gives to the public about what they should expect from NHS Wales.

I wish to emphasis that quality, patient safety and ensuring all individuals are treated with dignity and respect are at the heart of everything we do in NHS Wales. There is no room for complacency when caring for the health and well being of individuals.

It is an unfortunate truth that we see good and bad practices in all areas of society.  Where levels of care are seen to fall short, I expect organisations to rigorously investigate and address the issues identified as failings. We have a number of robust structures and arrangements in place to drive up standards, and root out and deal with any failures in care in NHS Wales.

All NHS Wales organisations must comply with Doing Well, Doing Better – the Healthcare Standards for Wales. The focus of the standards is "doing the right thing, at the right time, for the right patient, in the right place and with the right staff".

Healthcare Inspectorate Wales (HIW) rigorously inspects and externally assures how well organisations meet these standards, including undertaking investigations into serious incidents and making unannounced cleanliness spot checks.

We have retained Community Health Councils in Wales and their programme of visiting, inspecting and monitoring services has continued to safeguard the public’s interests. I was pleased to note that the 2010 Hospital Patient Environment review, which is conducted annually by the CHC, showed a general trend of improvement sustained over the last 2-3 years. It also highlights areas that still need attention, and I expect all NHS organisations to use this valuable feedback in their drive to improve services.

In addition to these quality assurance arrangements, I have introduced a wide range of initiatives designed to help organisations deliver consistent high quality person-centred care:

• The Free to Lead, Free to Care initiative that enhances the powers for hospital ward sisters to manage their wards, which affects every aspect of the patient’s experience, such as protected mealtimes and ensuring cleanliness. There are now Fundamentals of Care audits of every ward in Wales.
• 1000 Lives Plus is making significant improvements in patient safety and reduction in harm across Wales. Some hospital wards have reduced and in some cases eliminated pressure ulcers, which is a remarkable achievement.
  The Transforming Care at the Bedside programme is seeing significant increases in the amount of time healthcare staff spend on direct patient care, and also reductions in adverse incidents.

In addition to programmes that focus on processes and behaviours, I have also looked at how we recruit and train staff and how we ensure all staff understand their responsibilities to patients:

• Uniquely in the UK, all applicants for nursing and midwifery education programmes in Wales must submit a Character Reference, which provides evidence about the individual’s attitudes to caring and ability to communicate with people.
• In January, I introduced a Code of Conduct for Healthcare Support Workers, who provide a large portion of hands-on patient care.  This sets out how they should behave and do the right thing at all times.

In addition to the programmes that improve services for all patients, I have also focused developments and funding for specific parts of the population, such as the National Dementia Vision for Wales, launched on 16 February 2011.

In the last 3 years, significant work has been driven through the Dignity in Care programme, set up to examine issues related to dignity and respect for older people in health and social care settings.

This extensive programme of work has involved engagement with staff at all levels, users and carers, to raise awareness of issues related to dignity and respect in caring for older people. It has seen the introduction of staff training programmes; ‘listening’ events with front line staff, users and carers; support for specific projects aimed at improving care; focused NHS inspections by HIW; and development of specific questions on dignity and respect in the Fundamentals of Care Audit Tool (now used on every ward in Wales).

Work is underway to consider creating a network of Dignity in Care Champions. Proposals include identifying individuals who are committed to taking action, however small, to create a care system that has compassion and respect for those using its services.

We have also been successful in restructuring overnight hospital accommodation to provide single rooms and/or single sex bay accommodation in ward areas. Moving to single accommodation is not without its detractors. Some patients have expressed a wish to be in shared accommodation, as this provides companionship and a feeling of safety from having other people around them.

To date, the gains in terms of privacy and improved dignity of patients, and the positive benefits in reducing Healthcare Associated Infection, have been the deciding factors when re-designing acute hospital environments to date. Perhaps now is the time to undertake some evaluation of the patient’s experience to explore these issues further.

When things do go wrong, people need to know that their concerns will be properly investigated and that the organisation will do everything it can to deal with them honestly and fairly. It is also important that people feel that the organisation has genuinely learnt from any mistakes that have been made.

I have only this week taken the NHS (Concerns, Complaints and Redress Arrangements) (Wales) Regulations 2011 through the Assembly and they will come into force on 1 April. These new arrangements will improve the way in which the NHS in Wales handles concerns. 

The new arrangements will provide a single, integrated process for dealing with concerns raised about treatment and care, whether through a complaint, claim or clinical incident. They will put the person raising the concern at the heart of the process, provide proportionate investigation and a thorough response. The new Regulations also introduce the concept of redress, which will allow lower value claims for clinical negligence to be settled without legal action. 

Despite all the things that have been put in place, there is still work to be done. There must be a zero tolerance to poor care. It is never acceptable for patients and users of our services to receive anything less than the best possible level of service - which must at all times be respectful, safe and compassionate.