Thursday, 30 July 2015

Community Health Councils set to be stripped of their right to inspect health care settings.

On the 6th July 2015, the Minister for Health Mark Drakeford published a Green Paper, "Our Health, Our Health Service, " with the purpose of stopping the rot or in the Green Paper's words:
"... is to promote discussion and gather views to help inform the potential for further legislation in the Fifth Assembly with regards to improving quality and governance in the NHS in Wales"
The Green Paper whilst not promoting quality as it claims to do will in fact reduce the regulatory regime and remove powers of inspection of health care settings from Community Health Councils. 

Paragraph 92 of the Green Paper states:
"... The role of CHCs may need to be refocused towards some key functions, such as collectively representing the patient voice and providing advocacy for people wishing to raise concerns about care, while stepping back from activities which may be better carried out by others, such as inspections and service change proposals. In addition, the current model of one CHC for each health board area may no longer be the best fit for a service which works increasingly across boundaries and in partnership with other services. CHCs may need to change reflect a more integrated service model. Whether and how CHCs should change to fit the new integrated structure needs careful
consideration "
The regulation regime for visits will if the above is agreed fall to the Health Inspectorate Wales, who are not slow in ensuring their rehabilitation (after Tawelfan) and are busily undermining and briefing against the Community Health Councils to strengthen their own position.

There is however a vast difference in the capacity of Community Health Council's to carry out inspections of health care settings compared to the capacity of the poorly resourced and bureaucratic Health Inspectorate Wales. 

The difference between the two organisation is best exemplified by an email that the Chief Executive of the North Wales CHC, Geoff Ryall - Harvey sent to his members:
You will be aware that the NHS Green Paper proposes that CHCs should be stripped of their rights to enter and inspect NHS premises – a right we have held since 1974. I understand that this proposal is strongly supported by HIW who have been promoting their own “professionalism”, criticising the CHC’s lay focus and citing the Minister’s desire to do away with duplication in the inspection of the NHS.
Before accepting these arguments at face value, it would be useful to look at how things work in the real world. Let’s take, for example, Bryn Beryl Community Hospital;
When the CHC first visited Bryn Beryl using its BugWatch regime in the Summer of 2014, CHC members were appalled by the findings. I contacted the Director of Nursing and the Director of Infection Control & Preventionthat day. The hospital was closed and a range of measures including deep cleaning, staff training and support and extensive repairs to the fabric of the building were undertaken very rapidly.
CHC members visited Bryn Beryl again in November 2014 and also in February 2015 using our CareWatch methodology. We found the hospital much improved but still relatively poorly performing. We notified BCUHB accordingly and they undertook to address the issues raised.
When we visited in June of this year we found that the problems we identified in Summer 2014 were back again. CHC Officers contacted the Director of Nursing and the Director of Infection Control & Prevention and we went through a similar process of rapid rectification. The worrying thing is, of course, that matters in this isolated community hospital had deteriorated once again without BCUHB being aware of it.
Where were HIW in all of this?? The last time they visited Bryn Beryl was 2008. Seven years ago – 3 years before the creation of BCUHB. Let me say that again;
However professional and detailed that inspection was, it was seven years ago. Bryn Beryl is an isolated community hospital dealing with many vulnerable dementia patients. This is a known set of risk factors and although their own inspection showed many serious problems - HIW appeared to be content with a period between visits of at least seven years.
The 2008 HIW Report identified the same issues that the CHC identified in the Summer of 2014 – yet SEVEN YEARS LATER they have still not undertaken a follow up visit. HIW relied on an exchange of letters rather than an actual inspection to check that improvement to patient care had been carried out. By contrast, the CHC lay members did a follow up within weeks and then kept following up using BugWatch and CareWatch. We will also do our FoodWatch survey in the near future. Rest assured that we will visit Bryn Beryl very frequently until we see permanent improvements.
The BCUHB Annual Quality Statement for 2014/5 that says;
“During 2014 -2015 Healthcare Inspectorate Wales undertook a total of 8 Dignity and Essential Care Inspections across the range of ours services including our main hospitals, community settings and Mental Health Services.”
Over the past 3 years there have been many concerns about the quality of care provided by BCUHB and at least five major critical reports. This is the Local Health Board that has caused Welsh Government the most concern and it is the only Welsh Health Board to be placed in Special Measures. Despite this, HIW felt that Betsi Cadwaladr University Health Board warranted only 8 Dignity and Essential Care Inspections in 2014/15. NW CHC felt very differently and CHC Members have given freely of their time in order to monitor the quality of services from a patient perspective.
Page 32 of the same report records that:
“CHC members undertook over 500 assessments during 2014-15”.
There has been criticism that this is “too many”. However, we do not hear that from Ward Managers and Nurses. They welcome our members as it is often the only way they can get problems sorted out. With regard to the idea that 500+ visits is too many, this works out at somewhere around 4 visits per ward per year – certain wards may receive more than this but it will still be in single figures. HIW visiting frequency could be 4 or 5 years or even as long as a decade apart.
The Minister is right to be concerned about spending NHS money on a duplication of inspections but is aware that, in reality, HIW inspections are few and far between?
There are several other proposals in the Green Paper that substantially reduce the powers of CHCs including reducing our role in consultations and removing the power to refer Local Health Boards to the Minister. I will brief you on those changes over the next month. The closing date for comments on the Green Paper is 20th November 2015 and I believe it is essential that everyone responds, including individual members and any local organizations with an interest in maintaining an effective Patient Voice in the NHS.
Let's be in no doubt that if powerful vested health interests in Wales succeed in removing the regulatory and inspection powers of Community Health Council's there will be more care and cleanliness issues but much much less openness and transparency. 500 inspections compared to 8 will be a massive reduction in quality monitoring.

Please lobby your AM's to prevent this detrimental change from going ahead and to maintain an effective Patient Voice in the Welsh NHS.


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