Posted: Tue 2nd Aug 2022

“Highly concerning report” into North Wales vascular services shows frontline staff and patients are being let down, says Plaid MS for people living in or visiting the wrexham area
This article is old - Published: Tuesday, Aug 2nd, 2022

Frontline staff and patients are being let down by the “double blow of mismanagement and the Welsh Government’s inability to get a grip” on Vascular Services within the Betsi Cadwaladr Health Board, Plaid Cymru Health spokesperson Rhun ap Iorwerth has said. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

Mr ap Iorwerth’s comments follow the latest critical reports into Vascular Services in North Wales which highlighted “concerns in relation to the management of aortic patients following the completion of a review of 11 patients’ notes.” ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

In March 2022 it was announced that complex cases requiring vascular services were being moved to Liverpool after two concerning safety incidents were identified. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

At the start of June Targeted Intervention Measures were introduced at Ysbyty Glan Clwyd. This decision was made amid ongoing concerns relating to the health board in a number of areas – with a particular focus on the vascular service and the emergency department. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

Ahead of a public meeting of the health board in August 4, a series of public reports and minutes have been released – which provides an update on vascular services in North Wales. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

The report states that Betsi Cadwaladr has “significantly supported investment in the vascular workforce through the IMTP process to address issues within the vascular consultant workforce, the staffing of diabetic foot teams in both hub and spoke sites and the recruitment of nursing staff to Ward 3 (the vascular ward in YGC).” ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

However it adds that the health board’s “Vascular Improvement plan continues and is currently being updated to ensure that there is a consistent approach to improvement methodology with other work in the Health Board.” ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

It reads: “The Health Board implemented a hub and spoke model for delivery of vascular services in north Wales in April 2019 thereby implementing a model for service delivery that was endorsed by external review. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

“An Invited Service Review by the Royal College of Surgeons (RCS) was commissioned by the Board in 2020 to review the quality of the new service, the first report from this review being received by the Health Board in March 2021 and the second report being received in February 2022. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

“In response to the first report a group was established to develop and oversee an improvement plan. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

“This group has participation from the Community Health Council (CHC) and lay representation. In November 2021 the Terms of Reference for the group were revised and the group became the Vascular Steering Group which now meets monthly and is chaired by the Executive Medical Director (EMD). Quality, Safety and Patient Experience (QSE) Committee receive regular updates on progress with the Vascular Improvement Plan and the Board retains close oversight. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

“The second report from the RCS related to a case note review of 50 sets of notes. The College was able to review 47 sets of notes and raised concerns about the care received by patients and the quality of documentation. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

“The Board therefore convened a Vascular Quality Panel (VQP) with an external chair and an external medical lead to review those notes and to make recommendations about the care of individual patients and any service improvements that could be made. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

“That panel first met in April 2022 and reports to QSE, with weekly escalation reports to the EMD, which then inform the Vascular
Improvement Plan. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

“Two Never Events in the service and other concerns relating to safety and sustainability resulted in Health Inspectorate Wales (HIW) designating the vascular network a Service requiring Significant Improvement in March 2022. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

“On 8 July 2022 the Chair of the VQP raised safety concerns in relation to the management of aortic patients following the completion of a review of 11 patients’ notes. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

“The EMD received 3 recommendations for immediate implementation. These were: ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

  • Reintroduction of dual consultant operating (for aortic patients only)
  • Involvement of a specialist centre in the Multidisciplinary Team (MDT) meetings for all aortic cases
  • The recruitment of a vascular surgeon with aortic experience.

“The first and second recommendations were implemented that day and remain in force. The MDT is supported by Liverpool University Hospital Foundation Trust (LUHFT). ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

“The fragility of the consultant rota led to the Health Board to consider contingency plans should the service not be able to be delivered as currently configured and these plans remain under close review. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

“LUHFT have supported these plans to date and have supported out of hours provision for emergency surgery for one on-call period (due to consultant sickness and leave pressures) although no patients required treatment during this period. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

“These arrangements have resulted in cancellation of some outpatient activity and non-urgent elective surgery.” ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

Responding to the latest report Rhun ap Iorwerth MS said: “This is another highly concerning report into a health board which was taken out of special measures too early, and which has a litany of failures to its name. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

“Plaid Cymru has consistently raised its concerns about Vascular services at Betsi since it was centralised in 2019, echoing the calls of medical professionals for the facilities at Ysbyty Gwynedd to be preserved. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

“The Ysbyty Gwynedd service was excellent, with world class results. Poor decisions, that we and staff argued vigorously against, have ruined the service patients used to have. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

“Frontline staff and patients are being let down by the double blow of mismanagement and the Welsh Government’s inability to get a grip on the situation.” ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

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