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Ombudsman's report: Cwm Taf Health Board acknowledges 'failings'

We reiterate our sincerest sympathies to Mrs Y’s family following her death in May 2010, and apologise for the distress caused as a result of the failings identified within the report.

We accept the Public Services Ombudsman’s findings in respect of this case and work is ongoing within the health board to address the report’s recommendations.

– Allison Williams, Chief Executive, Cwm Taf Health Board

Ombudsman: Cwm Taf Health Board 'missed opportunity' to diagnose and treat woman who died

A woman who complained to Cwm Taf Health Board about her mother's treatment has had her complaint upheld by the Ombudsman for Wales.

The daughter complained that after taking her mother to Royal Glamorgan Hospital clinicians failed to take appropriate action after a blood test result indicated that she could have thrombosis.

Her mother died two days after she was discharged in May 2010.

Pulmonary thromboembolism was recorded as the main cause of death.

The Ombudsman said that the daughter believes if prompt action had been taken after the result came back as positive then her mother's death could have been prevented.

An investigation found that the test was seen by a nurse before the mother was discharged and that her blood result was positive.

It found that the test result did not seem to have been "appropriately considered, if at all" by the doctor who made the decision to discharge her, or by the consultant who had overall responsibility for her care.

The Ombudsman concluded:

"The failure to consider and act on the positive test result before making the decision to send the mother home fell below an acceptable standard of care. This failing gave rise to a missed opportunity to make the correct diagnosis and to treat her appropriately.

" The treatment that should have been given might have prevented her death.The investigation also identified a number of additional failings on the part of the health board."

The complaint was upheld by the Ombudsman and it was recommended that the health board should provide explanations and an apology to the patient's daughter.

The health board was told to pay £5,000 to Mrs Y's family.


"No matter how many concerns we raised... nothing seemed to be happening"

A grieving daughter has tonight talked of her heartache and anger after her father died following a series of delays in diagnosing and treating an infected abscess at one of North Wales' busiest hospitals.

It comes as the Public Services Ombudsman issues a critical report listing five different failures by staff working at Glan Clwyd Hospital in Bodelwyddan, in the days leading up to the death of Bob Seerey in 2009. Our Health Correspondent Mariclare Carey-Jones reports.

Health board responds to Ombudsman's report

Hywel Dda Health Board has responded to the findings set out in a report by the Public Services Ombudsman following a complaint from a woman regarding the treatment her late father received at Aberystwyth's Bronglais Hospital in December 2008.

The care offered to this patient fell below the standards expected and I would therefore like to apologise to the family again on behalf of the Health Board. We fully accept the findings of the report and have undertaken immediate action to avoid such a situation from happening again.

Since 2008, when this incident occurred, we have put in place numerous measures, including extra training for nurses in diabetes care and a review of the blood monitoring equipment.

We are committed to on-going improvements, specifically for the growing number of patients living with chronic conditions.

– Caroline Oakley, Director of Nursing and Midwifery


Ambulance Service: working to improve response to calls

The Ombudsman has recommended that the Welsh Ambulance Service should apologise to the families who complained, and pay them compensation. Both of the men who ambulances were called for later died in hospital, although no direct link to the ambulance response times has been made.

We acknowledge and accept the Ombudsman's report and extend our deepest and sincerest apologies to both families involved in these cases. The Trust has developed detailed plans to address the recommendations outlined. The Trust recognises the improvements it is required to make and is committed to deliver high quality and clinically safe services for patients across Wales in partnership with Health Boards. The way in which the Trust responds to incidents has and is being developed further to ensure every effort is made to respond to the most serious and life threatening cases first.

– Welsh Ambulance Service spokesperson

Nearby ambulances were available

The Ombudsman found that ambulances from nearby divisions weren't sent Credit: ITV News Wales

Complaints made by two families about the time it took for ambulances to attend 999 calls have been upheld by the Public Services Ombudman for Wales, Peter Tyndall. He found that that ambulances from outside the NHS boundaries were available to attend both incidents, but weren't deployed.

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