BEHIND THE HEADLINES: We’re in good shape, says NHS Wales chief
6:02pm Tuesday 8th October 2013 in News
UNPRECEDENTED demand on emergency departments and the cancellation of more than 2,500 operations across Wales mainly as a consequence; warnings from frontline staff that A&E units were close to meltdown; warnings too that health boards face difficult decisions on service provision due to a squeeze on budgets.
It has been a tough year for the NHS in Wales, indeed the service across the UK, especially when the damning findings of the Francis Report into failings at Mid-Staffordshire Hospital are also taken into account.
David Sissling, the man at the helm of the NHS in Wales, acknowledges the service has challenges to overcome, improvements to make.
But he is bullish about what he sees as its achievements, and the progress it is making in areas where improvement is needed.
His newly published annual report highlights three issues – quality and safety; changing models of service; and dealing with pressures on services – that he believes defined 2012/13 and will continue to be key factors against which the NHS in Wales is measured, in the short and long term.
“We have an enhanced focus on quality and safety, and the Francis Report has highlighted these across the UK, but a lot of this stuff we have been doing anyway,” he said.
“A lot of it is based on building on strengths, because much of our care is of a very high standard.
“We are making good progress on issues like infection rates, and reducing pressure ulcers. Health boards are being held much more to account, and we need to be transparent about these things.”
Through a new website – mylocalhealthservice.wales.gov.uk – people can find details of hospitals’ mortality and infection rates, and other information “at the push of a button,” said Mr Sissling.
“NHS Wales must be transparent, share information, and be accountable to the public.”
Another high profile development in Wales is the South Wales Programme, which sets out the case for regional change in four key specialities – A&E, paediatrics, obstetrics, and neonatal services. Changes to hospital services are also proposed in other parts of Wales.
In South Wales, the idea of reducing the number of hospitals at which the aforementioned services are provided, to safeguard their futures, patient safety, and quality of care in the face of staffing and other difficulties, has been the subject of two public consultations, the second attracting 60,000 responses.
Mr Sissling said the argument for change has been “very well made” and with the outcome of analysis of those responses received this week, he anticipates health boards, including Aneurin Bevan, will be able to decide on the way forward in November.
Delivery plans for major conditions, such as stroke and diabetes, have also been developed, with the focus on innovation.
Health boards are also planning for increased demand during the coming winter, drawing on the experiences of last winter, which was characterised by a much longer than expected cold spell.
More than 2,500 cancelled non-urgent operations across Wales in the first three months of 2013 were a consequence, causing a backlog that has proved difficult to clear.
“It is right to acknowledge that last winter was difficult. There was unprecedented demand, increased demand on unscheduled care, particularly from the elderly,” said Mr Sissling.
“Health boards are working on plans for this winter coming winter, and they must be strong and resilient.”
So too must three-year service and spending plans, being introduced to give health boards more flexibility over how they spend their money, rather than focusing on an annual break-even target.
Mr Sissling said health boards are being challenged to make sure these longer term plans are robust and based as much on quality assurance as financial prudence.
“They will enable financial planning over a three-year period, but the key thing is that it is driven by good planning,” he said.
Mr Sissling’s report also highlights a £10m investment in nursing numbers, investment too in primary care, and revision of complaints arrangements to make the process quicker.
“There is a particular emphasis on quality and safety, and patients’ experience, and I am very much heartened by the information we are receiving,” he said.
“More than 99 per cent of reports on health boards’ approach to privacy and dignity are good, and patient satisfaction surveys are consistently high, above 90 per cent.”
lAgainst many of the measures highlighted in Mr Sissling’s annual report, Aneurin Bevan University Health Board is making progress – but there remains plenty of scope to improve:
Big strides have been made recently in reducing cases of the potentially fatal superbugs Clostridium Difficile and MRSA (methycillin resistant staphylococcus aureus) in Gwent hospitals.
The number of C Difficile cases more than halved, to 212, during 2012/13, compared to two years’ previously.
An increase in cases since April – there have been more than 20 every month during April-August – is being tackled by a range of measures including deep cleaning of wards.
Different methods among health boards of measuring pressure ulcers makes comparison difficult but in Gwent, the proportion that develop in hospitals against the numbers identified on admission is low.
All Grade Three and Four hospital-acquired ulcers are subject to investigation and action plans, and a specialist nurse is being appointed to manage the issue among nursing home patients.
Gwent hospitals’ death rate is roughly on a par with the all-Wales rate, but slightly above that predicted and expected. The health board has a mortality and harm group which reviews the figures and carries out specific reviews as part of ongoing work to reduce the rate.
Complaints to Aneurin Bevan University Health Board have risen since the harsh winter of 2011/12 and so far in 2013 have averaged more than 80 a month. A Welsh Risk Pool report has indicated that the health board has improved its management of complaints and concerns in the past year.
During January-August this year, 715 routine operations were cancelled in Gwent due to a lack of beds, caused by increased demand through medical admissions.
This winter, up to 125 extra beds will be made available in the area’s hospitals to try to manage that demand.
Infection figures for Gwent hospitals are available by following the link at aneurinbevanhb.wales.nhs.uk
Other Gwent health figures are available at mylocalhealthservice.wales.gov.uk
Mr Sissling’s annual report for 2012/13 is available at wales.gov.uk/topics/health/publications/health/reports
lOne of the service changes and improvements highlighted in Mr Sissling’s report concerns the Royal Gwent Hospital’s new stroke unit.
A move closer to A&E has allowed for more timely application of thrombolysis – treatment with a drug that breaks down blood clots – while installation of a Telestroke system means stroke physicians can link to other hospitals through a TV monitor to study scans and view patients’ responses and appearance, to judge whether thrombolysis is required.
The treatment is not appropriate for all stroke patients, but if it is, it must be given inside a tight timescale to be effective, so ruling it in or out as quickly as possible is vital.
Dr Yaqoob Bhat, lead stroke physician at the Royal Gwent Hospital, said the development is among several that have helped improve stroke care in Gwent and the rest of Wales “significantly” in the past couple of years.
Also highlighted in Mr Sissling’s report is stroke patient Raymond Charles, from Talywain, among those to benefit from the Royal Gwent’s new unit.
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