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'Welsh approach' needed for hospital deaths data

A new 'Welsh approach' to the publication of death rates in hospitals is needed, an expert group has recommended.

The Health Minister, Mark Drakeford, asked a team of senior clinicians, information specialists and patient representatives to examine whether the continued use of current mortality indicators covering Wales and England was clinically meaningful.

The team, led by Dr Chris Jones, the Deputy Chief Medical Officer, has concluded that risk adjusted hospital mortality rates (RAMI) cannot be used to compare the quality of care between different healthcare systems.

The Transparency Taskforce findings, published today, also call for more clinical data to be made easily available to patients in Wales at hospital and even specialty level.

The report recommends that mortality measures are treated with caution, and should always be published and considered alongside more direct measures of service quality, such as patient feedback and untoward incidents.

Poor ratings for Welsh Government's performance

The latest Wales Barometer poll asked people if they thought the Welsh Government is doing a good or bad job in three of the main policy areas for which it has responsibility. The figures show that there is widespread disappointment with its performance.

  • Is the Welsh Government doing a good or bad job with the NHS?
  • Good 25%
  • Bad 43%
  • Neither/Don't know 32%
  • Is the Welsh Government doing a good or bad job with schools?
  • Good 24%
  • Bad 39%
  • Neither/DK 37%
  • Is the Welsh Government doing a good or bad job with the economy?
  • Good 25%
  • Bad 31%
  • Neither/DK 44%

The performance of the Welsh Government has been heavily criticised by Labour’s opponents. To see whether such criticisms have had much resonance with the public we asked respondents to evaluate the Welsh Government’s record since the last Assembly election in 2011 in three key policy areas. The results will not make pleasant reading for Carwyn Jones and his team.

– Professor Roger Scully, Wales Governance Centre

Since the 2011 Assembly election, Labour has governed alone after winning exactly half the seats in the Senedd. Labour supporters were somewhat more positive about government performance.

  • Is the Welsh Government doing a good or bad job with the NHS?
  • Good 37%
  • Bad 31%
  • Neither/Don't know 31%
  • Is the Welsh Government doing a good or bad job with schools?
  • Good 36%
  • Bad 26%
  • Neither/DK 39%
  • Is the Welsh Government doing a good or bad job with the economy?
  • Good 41%
  • Bad 20%
  • Neither/DK 39%

What will surely frustrate Labour’s opponents in Wales is the apparent lack of connection between voters’ assessments of Labour’s record in government in Wales and their current voting intentions. Not many people seem to think that Labour have done a good job in government in Wales, yet many Welsh people still intend to vote Labour.

– Professor Roger Scully, Wales Governance Centre


Fred Pring's widow hopes inquest will lead to changes

Standing outside the inquest, Joyce Pring said she was glad her husband's death had received such media attention because the feels it is "such an important issue".

She said she had been "shocked" at some of the revelations during this inquest, and says to this day she has "no idea" what she could have said to the ambulance call handlers to elevate it from a category 2 emergency to category 1, the highest emergency.

She said she hoped changes made following this inquest would stop others going through her ordeal.

  1. Lorna Prichard

Ambulance service and health board express regret to Fred Pring's family and say working hard to reduce delays

The inquest heard a number of ambulances were delayed on night Fred Pring died Credit: Family picture

In a joint statement the Welsh Ambulance Trust and Betsi Cadwaladr UHB said:"We extend our condolences to the Pring family at what is a very sad and difficult time. It is with deep regret that on this occasion there was no ambulance available to send to Mr Pring in a more timely manner.

"It is our responsibility to ensure we have a safe, effective and high-quality urgent care system and together we are working hard to reduce any delays in transferring patients to hospital. We have already made a number of improvements since March 2013."

They said they were strengthening the training for on-call managers and ensuring handover procedures were clear for staff across the organisations.

They are also currently revising working practices to make sure they have "appropriate staffing" during periods of high demand.

"The urgent healthcare system across Wales is facing unparalleled pressure with high demands on both the ambulance services and on hospital emergency departments."

"We are taking a range of actions to ensure that our busy ambulances and emergency departments are available to those who need them most urgently", they added.

  1. Lorna Prichard

Coroner warns other lives at risk unless action taken

The coroner said:

The categorisation of [ambulance] calls and the prioritising of resources does not currently appear to take into account the issue of delay and the potentially catastrophic impact of delay on both the patient and those seeking care for him.

– John Gittins, Coroner

He also criticised the current system of giving ambulance crews rest breaks that mean them returning back to their base because it "may result in an unacceptable diminution in available resources".

He also said the current practices in place for the handover of patients at A&E departments "far too often results in wholly unacceptable delayed with patients being kept waiting for long periods in ambulances and ambulance resources consequently being unavailable for allocation to other calls".

The loss of even a single life to a potentially avoidable delay is unacceptable and so I intend to make reports to both the Ambulance Trust and the Health Board advising them of my concerns that unless action is taken, circumstances creating a risk of other deaths will continue to exist.

  1. Lorna Prichard

Coroner returns narrative conclusion in Fred Pring inquest

Fred Pring died after a 50 minute delay in an ambulance arriving at his home after he experienced chest pains Credit: Family picture

Ending the inquest with a narrative conclusion, the coroner said if an ambulance had been sent sooner - after Mrs Pring's first call - it was "probable" that Fred Pring would have survived long enough to receive medical attention at hospital.

He said it was "unacceptable" for ambulance delays to cause the potential loss of one life, and warned that other lives would also be at risk if action was not taken to improve matters.


  1. Lorna Prichard

Pring inquest: 'Measures in place' to minimise delays

The coroner asked the medical director to provide an explanation of the handover process between ambulance crew and hospital staff, in order to free up the ambulance to be deployed to another emergency.

Professor Makin said the hospitals and the ambulance service had a joint target time of 15 minutes when it comes to handing over a patient.

He said on March 20th last year, the health board only achieved this handover target time with 57% of its 197 admissions.

He said, however, that on that day, North Wales had done better than the average for Wales, which was 53%.

The all-Wales target is to achieve a 15 minute handover time with 95% of admissions.

Professor Makin said: "All too often in the health service we trot this thing out about lessons being learned. I want to see changes that significantly improve performance."

He said a number of measures were already in place to improve the health board's process of managing patients and minimising delays in admissions.

Coroner John Gittins told the medical director: "The reality is, the crux of how this problem arose was due to this triaging process, where a patient is cared for in an ambulance whilst waiting for admission... in this instance it's hugely important that improvements happen rapidly."

  1. Lorna Prichard

Pring inquest: Over-capacity 'Wales-wide issue' at time

Betsi Cadwaladr University Health Board conducted a serious incident review following Fred Pring's death and found the hospitals had been under considerable strain that week.

The coroner asked: "Does it fundamentally come down to an issue of staffing and bed numbers?"

Professor Makin, medical director, said it "doesn't characterise it appropriately to say it was just about not enough beds being available."

He then provided the inquest with a snapshot of what the health board was dealing with that day. He said all three major hospitals in North Wales were reporting a problem with over-capacity and anticipating having more admissions than beds available.

"Twenty-two ambulances were waiting outside hospitals to transfer patients; there were major patients being held in minor [units]; there were long waits for medical beds," Professor Makin said.

He added it was important to say that the problem was a Wales-wide problem at the time - not just specific to North Wales.

  1. Lorna Prichard

Pring inquest: 'Considerable stress on A&E' at time

The Fred Pring inquest has resumed, with evidence from Professor Matthew Makin - medical director of Betsi Cadwaladr University Health Board.

He said it was clear that there was "considerable stress" on the system within A&E last March, when Mr Pring needed an ambulance. There was an increased demand for in-patient beds, which was a fairly typical pattern for March and April.

"In the last 20 years, the populations of patients who attend A&E department has changed considerably," he said.

"Now they are very elderly and frail, and when they are admitted they are in for a longer stay.

"The question is, how do we keep up with that demand?"

  1. Lorna Prichard

Ambulance delays 'impacted by non-disturbable breaks'

A Welsh Ambulance Service manager has told an inquest she held an investigation after Fred Pring's death, which concluded that there were no ambulances available to go to his aid.

Jill Plemming said: "Between 0109 hours and 0142 hours there were no resources available to this patient. The reason for this was the significant delays in transferring patients both to Wrexham Maelor and Glan Clwyd hospitals."

She added the delays were further impacted by the urgent requirement to give crews 'non-disturbable' breaks after five hours of duty.

An accumulation of these breaks also had a knock-on effect on resources available at that time, Ms Plemming said.

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