Vascular services at Betsi Cadwaladr University Health Board: A review of progress (HIW, 29 June 2023)

Summary

This report by Healthcare Inspectorate Wales (HIW) relates to vascular services provided by Betsi Cadwaladr University Health Board following the de-escalation of these services as a Service Requiring Significant Improvement (SRSI). The review outlines that while progress has been made against all nine recommendations made by the Royal College of Surgeons, the health board still has improvements to make.

Content

Review recommendations

1. The health board must consider its responsibilities in line with the NHS Wales Putting Things Right process. This is to establish whether timelier responses could have been given following the two formal complaints it received, and whether it is assured that updates were given appropriately throughout the course of the complaint investigation. The health board should set out what action will be taken to ensure that in future, people are communicated with in a timely manner when raising concerns.
2. The health board must maintain the record keeping audit process, to assure itself that the standards expected for record keeping, are consistent and are being maintained in the immediate and long term. Particularly within its vascular services, but also across the health board. This includes record keeping for all members of the MDT.
3. The health board must explore the reasons for reported inconsistencies in the implementation of the Diabetic Foot Pathway across its three acute sites.
4. The health board must consider and address the issues reported to us regarding the lack of clinical areas at YG, to review patients pre and post operatively.
5. The health board must consider the comments and findings in this report regarding staff culture and the perceptions of different teams. This is to establish whether there is learning, or development required to improve the working relationships across all teams, to support a positive working culture.
6. The health board must consider the comments made by staff regarding the ongoing issues following the implementation of new pathways. This is to establish whether the pathways need to be revised, or further action is required for compliance with the pathways as appropriately.
7. The health board must ensure that all staff are completing all aspects of the consent process as applicable and are documenting this within the relevant clinical records. In addition, further consent process audits must be undertaken and continue on a regular basis, with feedback provided to all staff and actions implemented as applicable.
8. The health board must ensure that: a) All clinical record entries are filed in chronological order; b) Surgical operation records are filled promptly after the surgical procedure.
9. The health board must address the issue where we found examples of misfiling an incorrect patient clinical record, in a different person’s record.
10. The health board must ensure that clinical documentation entries are signed with the clinician’s name legibly printed for identification of the author.
11. The health board must ensure a process is in place to evaluate the sustainability of its vascular service support from UHNM to determine what arrangements will be in place once current agreements end in 2024.