Review of Progress Against Healthcare Standards for Wales

DRIVING IMPROVEMENT THROUGH INDEPENDENT AND OBJECTIVE REVIEW RThrevieeweof-Pyroeargress against Healthcare Sptarogndarrammeds for Wales 2009 - 2012 North Wales NHS Trust 1JAulpyri2l0200908 - 31 March 2009 Contents Page Executive Summary iii 1. Introduction and Background 1 2. Findings 3 3. Conclusion and Next Steps 25 Annex 1: North Wales NHS Trust Internal 27 Audit Report Annex 2: Summary of Healthcare Standards 41 for Wales Annex 3: Maturity Level Definitions 49 Annex 4: Areas for Improvement 51 i ii Executive Summary In May 2005 the Welsh Assembly Government published Healthcare Standards for Wales, setting out a common framework to support the NHS and partner organisations in providing effective, timely and quality services across all healthcare settings. The standards are focused on improving the experience of patients and service users and placing them at the centre of the way in which services are planned and delivered, providing a basis for continuous improvement. North Wales NHS Trust is a new organisation, formed from the former North East Wales NHS Trust and the Conwy and Denbighshire NHS Trust. This is the first year in which the Trust has self-assessed its performance against each of the 32 standards and submitted its assessment to Healthcare Inspectorate Wales (HIW) for testing and validation. The reports for the two former organisations for the years 2006-07 and 2007-08 can be accessed from our website. As noted at paragraph 3.3, the North Wales NHS Trust will be dissolved as part of the current reorganisation of the NHS in Wales, its functions being assumed by the new Betsi Cadwaladr University Local Health Board. Section 1 of this report provides full details of the assessment process adopted and the methodology used to test and validate Trusts’ self-assessment. Between 9 and 12 March 2009, HIW undertook unannounced visits to North Wales NHS Trust. The purpose of these was to validate and test compliance and performance against Healthcare Standards by looking at how care is delivered to patients and service users. We conducted unannounced visits to Ysbyty Glan Clwyd and Ysbyty Maelor (Wrexham). We also visited Glan Traeth (Rhyl), Holywell Hospital, Flint Hospital, Mold Hospital, Denbighshire Infirmary and Ruthin Community Hospital. These visits focused on 10 of the 32 standards that relate to dignity and respect, child protection and vulnerable adults. iii Overall, North Wales NHS Trust performed reasonably well against these 10 standards. It was assessed as providing a standard of care that is a maturity of Developing or above at the User Experience1 levels. The Trust demonstrated particular strengths in relation to Standard 9 (Nutrition) which is assessed as Practising across the User Experience level. It is clear that the Trust is committed to providing high quality care and respecting individuals’ privacy and dignity. We are satisfied that, in general, a good standard of care is delivered to patients and service users attending the Trust’s hospitals and we identified a number of areas of notable practice that should be shared across the Trust to support the Trust’s approach to improving the experience of its patients. It was evident that there was good teamwork amongst staff and that they were committed to ensuring high standards of care for patients and service users. The patients and service users we spoke to were extremely positive about their experiences of the Trust’s services. Staff morale was generally high in the acute hospitals, although there were concerns in the community hospitals in Mold and Flint because of the uncertainty about their future. Overall, while there are a number of issues for the Trust to address, there are many aspects of its activities which work well and the adaptability and willingness of staff means that generally the Trust presents a welcoming and effective face to its patients and service users. 1 User Experience is the term used throughout this report to represent the experience of patients, service users and carers. iv 1. Introduction and Background 1.1 Each year since 2007 NHS healthcare organisations across Wales have been required to self-assess against the Healthcare Standards for Wales published by the Welsh Assembly Government in 2005 the way in which they provide and commission services. Our reports from 2007 and 2008 can be accessed from our website www.hiw.org.uk or by writing to: Healthcare Inspectorate Wales Bevan House Caerphilly Business Park Van Road Caerphilly CF83 3ED 1.2 The 32 Healthcare Standards set out a common framework to support healthcare organisations to provide effective, timely and quality services. They are designed to deliver improved levels of care and treatment to the citizens of Wales. 1.3 As the leading health inspectorate in Wales, Healthcare Inspectorate Wales tests and validates the self-assessments submitted by each organisation. To do this we adopt each year an approach that is relevant to the issues that we believe or people tell us matter most to the public of Wales. 1.4 This year we have validated and tested healthcare organisations’ compliance and performance against the Healthcare Standards by undertaking unannounced visits to every Welsh NHS Trust and a sample of GP practices across Wales. As part of these visits we focused on: 1 Child protection – as the Baby Peter case has highlighted concerns in England. Protection of Vulnerable Adults - as our previous reviews have highlighted this as an area where more work is needed. Dignity and respect issues – as these are important to patients’ and service users’ experience and should matter to us all. 1.5 As part of our visit to North Wales NHS Trust we undertook observational visits to: The Accident and Emergency (A&E) Departments at Wrexham Maelor and Ysbyty Glan Clwyd The Medical Assessment Units at Wrexham Maelor and Ysbyty Glan Clwyd The Paediatric/Children’s Wards at Wrexham Maelor and Ysbyty Glan Clwyd The Acute Medical Wards at Wrexham Maelor and Ysbyty Glan Clwyd The Elderly Mental Health Wards at Wrexham Maelor, Ysbyty Glan Clwyd, Glan Traeth (Rhyl), The Holywell Hospital, Flint Hospital, Denbighshire Infirmary and Ruthin Community Hospital The Minor Injuries Unit at Holywell Hospital, Flint Hospital, Mold Hospital, Denbighshire Infirmary and Ruthin Community Hospital. 1.6 We have also worked closely with the Mersey Internal Audit Agency, the Internal Auditors of North Wales NHS Trust and have where possible used their findings in our validation work. Their report can be found at Annex 1. 2 2. Findings 2.1 To enable us to assess how well North Wales NHS Trust is delivering against requirements relating to child protection, protection of vulnerable adults and dignity and respect we looked in detail at the following 10 Standards: Standard 4: Environment of Care. Standard 5: Maintenance and Cleanliness. Standard 6: Information and Communication. Standard 7: Patients and Service Users contribution to Care Planning. Standard 8: Dignity, Respect, Consent and Confidentiality. Standard 9: Nutrition. Standard 10: Access to Healthcare. Standard 12: Care and treatment meets the patients and service users needs. Standard 15: Feedback, Compliments and Complaints. Standard 17: POVA (Protection of Vulnerable Adults) and POCA (Protection of Children Act) 2.2 The full set of 32 Standards are at Annex 2 and the Maturity Level Definitions in Annex 3. 2.3 Our evaluation of the 10 Standards above has enabled us to provide an assessment of: How appropriate are the Trust’s healthcare environments: i.e. are the structures and layout of wards and departments fit for purpose? How clean are the Trust’s healthcare environments? The usefulness and suitability of information provided by the Trust to patients and service users. 3 Whether patients and service users are appropriately involved in their care planning. Whether consent is appropriately sought from patients and properly documented. Whether patients and service users are treated with dignity and respect. Whether patient information is treated confidentially. Whether the Trust provides food that is of good quality and whether patients’ and service users’ are provided with the support they need to eat. Whether the care provided by the Trust takes account of patients’ and service users’ physical, cultural and psychological needs and preferences. Whether the Trust has appropriate systems and procedures in place to ensure that children and vulnerable adults are appropriately safeguarded and protected. The details of our findings are set out below. Standard 4: Environment of Care 2.4 North Wales Trust has taken adequate measures to ensure privacy, dignity and respect for all patients and service users, such as through the use of curtains or single rooms, if available. However the availability and access to single rooms, segregated toileting and shower facilities vary throughout the Trust and in the medical admission unit mixed sex bays were identified. 2.5 The layout of some departments in the organisation, such as the accident and emergency at Glan Clwyd hospital, presents challenges in ensuring privacy for patients and service users. The departments design is outmoded which results in all patients and visitors, including Blue Light emergencies, accessing 4 the department through the same single entrance. The waiting areas for patients and their companions are close to the entrance and it is often necessary for the staff to use makeshift curtains to shield people in the waiting room from viewing potentially distressing scenes. The Trust has identified the issues and has instigated an acute service redevelopment project to address the issues. 2.6 The Accident and Emergency Department in Wrexham Maelor hospital was very busy on the day of the visit and suffered from delays in moving patients to inpatient beds. On the morning of the visit, 12 March 2009, the department was very busy, staff confirmed that there were 25 ambulances waiting to move patients to the department and that they had been waiting up to a couple of hours; this was an exceptional and unusual event.

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