Two more vascular failings have been identified in North Wales in the weeks since a damming report found multiple issues with the service. The disclosure comes as Betsi Cadwaladr University Health Board revealed it is to farm out some emergency vascular operations to Liverpool, and is to delay other procedures and appointments.
The health board is not giving details of its latest “concerning safety incidents” in the vascular service – a move condemned by Plaid Cymru as lacking transparency. Just over a month ago, the Royal College of Surgeons published the final part of a critical report into the centralisation of Betsi’s vascular services to Ysbyty Glan Clwyd in 2019.
After examining the records of 44 patients dating from 2014, the RCS raised concerns over several cases, including an “unnecessary and futile” amputation. In another, an amputee’s wife had to “carry him to the toilet” after he was sent home from hospital without a care plan.
Betsi Cadwaladr said it is now investigating the latest cases to ensure lessons are learned and patient services are improved. Dr Nick Lyons, the health board’s executive medical director, said: “Our relentless focus is on doing the right thing for our patients and delivering the best possible outcomes across our North Wales network.
“We remain resolute that the Board decision to consolidate the vascular service in a hub and spoke model was the right one and is supported by the Royal College of Surgeons as the best arrangement for the North Wales population.”
Health Minister Eluned Morgan has given the health board an ultimatum on improving the service and, only last week, in the wake of the RCS report, Health Inspectorate Wales categorised of the service as “Requiring Significant Improvement”.
Mr ap Iorwerth, a long-time critic of the centralisation of vascular services, said the latest incidents were a cause for concern.
He said: “Whilst respecting patient confidentiality, we need total transparency from BCUHB about the circumstances. But we also need to see vascular services in the north being put in the highest possible level of special measures as work begins to restore patient confidence and to restore the quality of local services.”
Since the RCS report was published, Betsi has established new independent Vascular Quality Panel to improve services as centralisation continues at Ysbyty Glan Clwyd. New appointments are being made but the health board is still experiencing staffing capacity issues.
As a result, a “very small number” of complex vascular cases are to be redirected from Glan Clwyd to the Liverpool vascular network. Betsi expects that, each week, around four extra emergency procedures will take place at Liverpool University Hospitals NHS Trust. This arrangement will be in place for four weeks and then reviewed.
Most other vascular activities, such as routine surgery, diagnostic procedures and outpatient appointments, will continue in North Wales as usual. However, over the same four-week period, a further five patients per week are expected to have their surgery delayed.
In addition, some 12 outpatient appointments per week, totalling around 50 during the four-week period, will be postponed.
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Dr Lyons said: “I am sincerely sorry for the delay to the treatment of our vascular patients and recognise that it may cause inconvenience and distress. Patient safety and experience is the driver of this decision, which is a temporary solution while we put in place steps to assure ourselves that the service has the right workforce capacity and capability.”
He said closer collaboration with the Liverpool vascular network, on complex vascular cases, was recommended in the RCS report. He added: “During the next few weeks, we expect to be strengthening the capacity and capability of the existing vascular team further.
“We are also temporarily adding more consultants onto our on-call rota to ensure the safety of our patients. We are being open and transparent about the challenges in this service. It is the only way we can build trust and confidence with the public we serve.
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A helpline has been set up so that vascular patients to discuss their experiences, treatment and care. The number is 03000 851389 and it is open 9am to 5pm Monday to Friday, except Bank Holidays.