As a result of the Andrews report into standards of care at Abertawe Bro Morgannwg Local Health Board (Abertawe Bro Morgannwg: Trusted to Care?), Health Minister, Mark Drakeford (Lab, Cardiff West), ordered a series of unannounced “spot checks” at all Welsh general hospitals, which took place over June and July this year.
Last week, the team tasked with the checks – part overseen by Prof. Andrews herself – reported back (pdf), and it’s been widely covered by some major news outlets in Wales – BBC Wales, South Wales Evening Post, Western Mail.
I thought it was worth looking at the national report in a bit more detail, though individual hospitals were also issued with their own reports.
Individual reports for Abertawe Bro Morgannwg LHB:
- Princess of Wales Hospital, Bridgend (pdf)
- Morriston Hospital, Swansea (pdf)
- Neath Port Talbot Hospital (pdf)
- Singleton Hospital, Swansea (pdf)
The Good News
- There were no significant concerns about the use of sedation, and the report says there were “many examples of good practice”.
- Whenever anti-psychotics were issued, they were usually in low doses and used “appropriately”.
- Relatives have been invited onto wards to calm confused patients, and in some cases nurses were providing one-to-one care for those patients with high levels of need. The report suggested possible alternatives to calm confused patients, like hot drinks before bedtime.
- Fundamental toilet needs were being met, with patients often walked to a toilet to promote privacy and dignity instead of using bedpans.
- Hydration was actively promoted by staff at all grades, who made use of fluid balance charts and the Bristol Stool Scale (for those unfamiliar with it or with weak stomachs, I’ll leave the latter to your imagination).
- Drinks were often provided within easy reach, and clear instructions were provided to patients.
The Bad News
- There was a “lack of adherence to professional standards” on medicines management, including failing to watch patients take medicines, failing to check ID or in a few cases medicines simply being left for the patient to take themselves.
- Medicines charts were poorly managed and in some cases allergy notices weren’t completed.
- There was poor management of patient’s own medicines, with inadequate storage being a major problem.
- There were loads of minor problems relating to medicines storage elsewhere (i.e poor temperature controls, no locks, lack of training on automated dispensing systems, failure to monitor temperatures).
- Urinal bottles were often left on bedside tables and windowsills.
- The “All Wales Continence Bundle” (eh!?) isn’t used by staff due to the amount of paperwork required and duplication.
- Staffing levels often meant it was difficult for them to respond to toilet needs in a timely manner on wards with large numbers of highly-dependent patients.
- There were examples of poor oral hygiene in patients.
The Verdict on the Princess of Wales Hospital (pdf) This was one of the main hospitals under the spotlight, so it’s worth taking a closer look at what the spot checks found in Bridgend. The team visited four wards at different times of the day: Ward 5 (Respiratory), Ward 6 (Gastroenterology), Ward 19 (Elderly Care) and the Acute Medical Unit.
- No major concerns about sedation, toilet needs or hydration on Wards 5, 6, 19
- Toilet facilities on Ward 5 were described as “extremely clean”.
- Ward 19 used reminders about proper hydration, toilet needs and medicines administration as computer screen savers.
- No concerns at all about sedation, toilet needs, hydration or medicines administration in the Acute Medical Unit. The team didn’t propose any improvements as a result, and highlighted a number of examples of good practice here that other wards could learn from.
- Ward 5 used what’s described as an unlocked “DIY Box” to carry and store medicines. Other drug cupboards were unlocked.
- On Ward 6 there was evidence of drugs being given out but not signed for (which was immediately corrected). There were also problems with security of medicines and the ward was too hot (29C – though it was during the summer).
- Ward 6 documentation was described as “untidy” and“incomplete”.
- ID checks when administering medication on Ward 19 were poor. There was also incomplete documentation and the locks on drug lockers were broken.
Spot Checking the Spot Checks Although today’s Daily Mail headline (above) will have put the cat amongst the pigeons, all of us who’ve followed Welsh politics and our domestic press closely will realise it’s a recycling of old stories, neatly re-packaged for an English audience with next May in mind.The Welsh Government have issued a rebuttal which flagged up a number of inaccuracies, but this is the Daily Mail we’re talking about. The damage has been done. It’s not as if they’ll roll over like the Western Mail or BBC Wales would.I don’t think the results of the spot checks paint as rosy a picture as the (Welsh) headlines are suggesting or the Welsh Government will inevitably claim. I still get comments on old posts, and occasional emails, flagging up concerns at the Princess of Wales Hospital – but the situation clearly isn’t as bad as it was.
The Welsh Conservatives and AMBU Support Group are again calling for a full public inquiry – recently joined by the British Medical Association (BMA) – and I don’t expect those calls to go away just because of this one review. The First Minister has, unsurprisingly, dismissed those calls.
Carwyn won’t be able to do that forever. Although I still believe a full inquiry is unnecessary at present, as I said in my post on the original report , we’re only one big tragedy or scandal away from it.
If the contents of the report are correct, then we’re halfway towards a full resolution of the problems highlighted in Trusted to Care, which means there’s still a lot of work to do, especially on medicines management and the NHS complaints system. Considering the former’s one of the main functions of a health service, it’s disappointing lessons there haven’t been learnt quickly enough. The evidence presented in the spot check report hints that medicines management is too bureaucratic.
The spot checks should be a continuing process. We’ll only know what the situation’s really like through winter when demands and pressures on staff will peak.