Written Statement: Vascular services at Betsi Cadwaladr University Health Board

Today a report from the Royal College of Surgeons of England (RCS) has been published in relation to vascular services at Betsi Cadwaladr University Health Board. A copy of the report can be found here. This report is the second part of an invited service review by the RCS, the first part of which reported in May of last year. A copy of that report can be found here.[1]

I am disappointed and concerned by this most recent report, which reviewed 44 sets of case notes and found deficiencies in care, record keeping, consent-taking and follow-up in a number of the cases examined. The report covers a period from before the reorganisation up to July last year. I know local people and Senedd Members will share my concerns and want answers about these issues, as well as the future of this service.

The cases reviewed here involve real people and their families and there will be many others who may be worrying about the quality of the care they have received or are about to receive and whether this service is safe. I expect the health board to address these issues with immediate effect and put a plan and processes in place to contact and review patients appropriately and sensitively, to provide them with information and assurance as well as to address the other recommendations made by the RCS.

I know there has been a lot of anxiety about the changes made to vascular services in north Wales. No service change is easy and I understand the concerns. However, the model of care for vascular services, where the most complex procedures are carried out at a specialist centre, supported by local centres which carry out more straightforward treatments, is the right one. This ‘hub and spoke’ model is endorsed by the Vascular Society and Royal College of Surgeons and is the way to ensure sustainability of services going forward with 20 per cent of cases expected to be treated at the specialist centre and 80 per cent locally.  Out-patient appointments, review of in-patient vascular referrals and some less specialised procedures are still carried out right across north Wales.

I would therefore urge everyone not to get drawn into suggestions that the old service model should be re-introduced because that cannot happen and would not be supported by the Royal College of Surgeons. In addition, a significant amount of investment has been made in this service, in particular into the hybrid theatre and interventional radiology facilities at Ysbyty Glan Clwyd.

However, as the health board’s own internal review and the two RCS reports have shown, the implementation of the new model has faced significant difficulties and in many respects has been poorly executed. I am also aware that the annual Vascular Registry Report - which is an audit of care and outcomes - has shown inconsistent results, which is also a matter of concern.

I do not underestimate how challenging it must be to alter long-standing care pathways and to get everyone on board with a system-wide change in particular in the middle of a pandemic; but there are many things which have not been done well and there should be no excuses for this. I am also sure the situation has not been helped by relentlessly negative public discourse which has overshadowed any positive impacts of the service reconfiguration and had the potential to impact on staff morale. This is something that was noted in the first RCS report.

For the sake of people in North Wales who need this service, and the staff working to provide this care, we must now do all we can to ensure the health board implements it properly, to make the pathway seamless and to improve outcomes. This is meant to be a flagship service and I am determined that it will become so.

Amongst other actions, the health board is now taking immediate steps to strengthen clinical leadership and to enter into an arrangement with a larger vascular service in England which will provide oversight and multi-disciplinary support. My officials have received strong assurances from executives at the health board on all the recommendations and in addition I have written to the Chair of the health board today to set out my support for the work they are doing, but also my clear expectation that these matters must be given top priority and that the issues raised, including record-keeping and consent are not endemic within the organisation. My officials will also be considering whether any further escalation measures or oversight will be required and I have asked that vascular services are discussed at the next tripartite meeting between Welsh Government, Healthcare Inspectorate Wales and Wales Audit Office.

Finally, to the staff working in this service at Betsi Cadwaladr University Health Board for whom this must be difficult, I would like to say that we value you, support you and want you to succeed. However this is going to require everyone to pull together to make this service a success for patients. I am counting on everyone concerned to help make this happen and look forward to receiving your continued support. 

[1] Page 456 of the Betsi Cadwaladr University Health Board papers from the meeting held on 20 May 2021