Royal College of Physicians Cymru Wales: ABUHB report
In response to today’s BBC Wales story about the RCP report about Aneurin Bevan University Health Board, Dr Olwen Williams, RCP vice president for Wales said:
‘Patient safety is our driving motivator here. The Grange was opened during the COVID-19 pandemic and we appreciate the work that went into opening the hospital early. However, the issues raised by RCP members in our report are not new to the health board. The BMA wrote to the health board in July 2020 setting out concerns on the four-take clinical model of care, general medicine provision at the Grange, staffing, transport, consultant wellbeing and a lack of consultation with NHS staff. Not enough has been done in the past 16 months to address these concerns, and there is a huge amount of work to be done by ABUHB to rebuild trust among clinicians.
‘The health board has produced an action plan against our recommendations and we will be monitoring progress closely. We have welcomed the commitment from ABUHB to rapidly develop robust pathways of care for non-medical patients at Nevill Hall, the Royal Gwent and Ysbyty Ystrad Fawr, and to reconsider the lack of general internal medicine at the Grange. As winter begins, the challenges that face the medical workforce are immense – there are simply not enough doctors and nurses in the system. The health board action plan is encouraging, but a great deal of work will be needed to repair damaged relationships.
‘The RCP visit team met with junior and specialty doctors, consultants and physician associates on 21 June. We also held a closed meeting with trainees on 16 June, several one-to-one meetings with consultant physicians, and issued a call for written evidence. We published our report on 17 August and shared it with national, regulatory and statutory bodies (including the Welsh Government and Healthcare Inspectorate Wales) at the time. We have not released the report to the media or published it on our website.
'This may be a tough set of findings, but the report should not reflect badly on the many senior clinicians at the health board who are doing their very best during an unprecedented global health crisis to keep patients and trainees safe. Our intention is to support and listen to our colleagues. We want to work with senior management and our frontline clinicians across the health board to improve patient care and reduce the workload on NHS staff.'
Key messages
1 The model of care at the Grange
The health board must urgently review its provision of general medicine and care of the elderly/frailty medicine at the Grange, as part of a wider review of the Clinical Futures model of care, with emphasis placed on improving patient outcomes for frail, older people, and expanding the medical training opportunities available to junior doctors at the Grange.
2 The model of care at the Gwent, Nevill Hall and YYF
No physician (specialist in the care of adults) should ever be involved in the treatment of a paediatric patient at any time, under any circumstance. This includes Child and Adolescent Mental Health Services (CAMHS) patients, who should not be managed in an adult medical assessment unit.
3 Genuine clinical engagement with consultants and trainees
Trainees should have representation at a senior management level. Health board executives must meet with trainees, listen to their concerns, and take genuine action to find solutions. The health board must involve all clinicians in future service change in a genuine, constructive and open way, and communicate more openly and more often with clinicians. Where concerns are raised, there should be transparent communication. Comprehensive feedback should be shared with the doctor on the outcome of escalation.
