Welsh Government 'reappraise' Whitehall meetings after an email checking facts for the Prime Minister's attacks on the Welsh health service
The concerns of the Medical Director of the NHS in England about the Welsh NHS have been released under the Freedom of Information Act.
A group of doctors have written to the new Health Minister warning that emergency units in Wales are 'at the point of meltdown'
The Health Minister, Mark Drakeford, has told AMs that "sustained extreme weather conditions" explain why only 52.8% of ambulances responding to category A emergencies last month got to the patient within the eight minute target. He was answering an urgent question in the Senedd.
– Health Minister Mark Drakeford AM
It ill-behoves us, sitting here in the comfort of the National Assembly, to take no account of the conditions which people delivering those services faced during February.
Kirsty Williams, for the Liberal Democrats, said that the Welsh Government had not been able to deliver the ambulance service that Wales needs and deserves. The Conservatives and Plaid Cymru both argued that ambulance times should not have got worse since January, when there was also bad weather.
The Minister said there had been a cumulative effect and he had come close to suspending response time targets altogether on police advice. Earlier today he announced new targets, for how soon a patient receives effective treatment, which he said were more relevant than ambulance response times.
– Health Minister Mark Drakeford AM
The eight minute target does nothing to help outcomes for the patients... [but] ...as we have moved out of February and into March the performance has improved.
The Health Minister, Mark Drakeford, has said that the new targets in the NHS will measure the real difference that effective treatment makes to patients and will be more meaningful than simple time-based targets, such as the maximum eight minute wait for an emergency ambulance.
I want us to judge the success of our services by measuring things which make a difference to patients and the effectiveness of the treatment they receive. This development work will make sure that what we measure is more meaningful in terms of clinical benefit and outcomes for patients, rather than on the basis of time alone.
– Health Minister Mark Drakeford AM
The eight minute ambulance target is in many ways an arbitrary figure rather than being based on patient or clinical evidence. We will be sharing the results of the development work widely and will be holding public discussions on the findings before any decisions about future measures.
Between April 2014 and March 2015, the new targets will run alongside existing ones. They will cover emergency treatment, with new measures for cancer treatment and planned care to be introduced later this year.
– Dr Grant Robinson
We will be working with clinicians to develop measures of urgent and emergency care which make sense to people using these services and which give a clearer sense of quality of care. Like other measures of safety and quality in Wales, we will make these transparently available to allow people to see easily how their local health service is doing.
Dr Robinson is the Welsh Government's clinical lead for improvement in unscheduled care.
The Welsh NHS is to look at new ways of measuring whether patients get timely and effective treatment, which it's claimed can be more important than simple targets such as an ambulance responding within eight minutes or the wait in A&E lasting no more than four hours.
During a year long trial, starting next month, the new targets will be set in addition to the existing ones before a review decides which are needed in future. Officials in charge of the trial have highlighted three key measures.
- The time before a patient who's suffered a heart attack caused by blood clots receives clot-busting drugs. The target will be one hour after the 999 call.
- The time before a stroke patient has undergone the "stroke care bundle" series of tests and been given a scan. The trial will help to refine what the target should be. Research in London suggests that a scan within four hours is needed.
- How soon a patient with a broken hip is given effective pain relief. Again the trial will be used to decide what the target should be.
Diagnosis and initial treatment is frequently done by paramedics. If the patient then needs to go to hospital, it's hoped to by-pass A&E more often in future and go straight to the appropriate specialist medical team. One benefit would be fewer ambulances queuing outside casualty departments.
The Welsh Government says it's taking steps to speed up treatment for heart patients. It follows criticism of cardiac surgery waiting times from the Royal College of Surgeons and from the Prime Minister.
A Welsh Government spokesperson said,
– Welsh Government spokesperson
The quality of cardiac surgery in South Wales is very good as are the outcomes for patients.
However, we also know there is not enough capacity to meet current demand which is why we have already put in place a number of immediate steps to speed up treatment, including offering patients treatment at other cardiac centres and undertaking surgery at weekend. In the longer term we are further investing in increase capacity to Wales.
The medical director of the NHS in England has called for mortality rates and waiting times in Welsh hospitals to be investigated.
Sir Bruce Keogh wrote to Chris Jones, who runs the Welsh NHS, with his concerns.
His e-mail mentions six Welsh hospitals that he describes as having a 'persistently high mortality rate.'
The Welsh Government says the NHS in Wales is "open, transparent and has a higher level of scrutiny than any other part of the UK", adding that comparisons on A&E waiting times and mortality rates cannot be made between England and Wales as both sets of data are calculated differently.
The Welsh Government has issued a strongly-worded statement following concerns over mortality rates in Wales' hospitals.
A Welsh Government spokesperson said: “The NHS in Wales is open, transparent and has a higher level of scrutiny than any other part of the UK.
"Mortality rates in Wales are published on a quarterly basis and latest figures demonstrate clear improvement. If issues are identified, we work quickly to put them right and we do not hesitate to investigate as needed.
“To suggest that the Welsh NHS is covering up high death rates is therefore utterly ridiculous and completely without foundation.
"This allegation appears to be based entirely on an email from the National Medical Director for NHS England, Sir Bruce Keogh, to the Deputy Chief Medical Officer for Wales, Dr Chris Jones.
“In his email, Sir Bruce admits that there is insufficient data to conclude that an investigation should be carried out into any Welsh hospital.
"Moreover, Sir Bruce acknowledges that even where data did exist, he cannot vouch for its accuracy. The points raised by Sir Bruce were discussed with him at a meeting with Dr Chris Jones on December10th.
“The UK Government Statistical Service has also made it clear that comparisons on A & E waiting times and mortality rates cannot be made between England and Wales. Both sets of data are calculated differently."
The Conservatives are calling for an urgent response from the Welsh Government to the concerns about Welsh hospital death rates raised by English NHS medical director Sir Bruce Keogh.
– Leader of the Opposition Andrew RT Davies AM
The concerns raised in this email confirm our serious worries over standards of care in the NHS.Professor Keogh’s recommendation of ‘investigation’ into mortality rates should be immediately undertaken and no longer ignored. It is a matter of great regret that Carwyn Jones and Welsh Labour appear to have dismissed the advice provided by this leading expert.For the sake of future generations - Welsh Conservatives have long called for a Keogh-style inquiry into NHS standards of care.I sincerely hope that this will now take place.
Professor Keogh’s comments are further proof of extremely serious problems within the Welsh NHS.If this leading expert has offered assistance and raised concerns over a potential cover-up – he should not be ignored.I am staggered at reports that his correspondence has gone unanswered and I urge Labour’s First Minister to clarify these reports as soon as possible.
– Shadow Health Minister Darren Millar AM
Mortality rates in Wales are of huge concern and I have long raised questions over recent misleading statistics. NHS Wales has suffered catastrophically from Labour’s record-breaking budget cuts. Queuing ambulances, bed blocking, rocketing waiting lists and missed response times continue to throw the service into crisis.A Keogh-style inquiry would address serious concerns and see structures put in place to protect communities.
The Welsh Government has responded to the release of Sir Bruce Keogh's concerns about death rates in Welsh Hospitals, saying the medical director of the NHS in England doesn't have the information to support his suspicions.
As Sir Bruce makes clear, he does not have adequate data to form a view of whether there should be an investigation into the hospitals named in the email. Moreover, even when he does have data, he cannot vouch for its veracity. The National Statistics Authority has also recently concluded that it is not possible to compare mortality rates between England and Wales as they are measured differently.
– Welsh Government Spokesperson
Despite the frequent attempts to criticise the Welsh NHS, well over 90 per cent of people in Wales who actually use the NHS are happy with the care they receive. If legitimate concerns are raised about particular aspects of care at specific hospitals, we have acted quickly and ordered independent reviews to identify and resolve any issues.
Welsh Conservatives have called for a clampdown on spending on temporary workers in the NHS. The party's obtained figures under the Freedom of Information Act which show that health boards have spent more than £150m on locum and agency staff over the last three years.
Opposition leader Andrew RT Davies says it's a result of the repeated failure by the Welsh Government to recruit permanent staff.
– Andrew RT Davies, leader of the Opposition
While temporary staff may be a fact of life for most health boards - many of these figures will be rightly questioned by taxpayers.
It is more than clear that Carwyn Jones is failing to see through his promise to attract more permanent staff to Wales - and health boards and patients are suffering as a result.
The figures show wide variations in the amount spent on locum and agency staff from board to board with Betsi Cadwaladr the highest-spender and Powys the lowest. The totals from the last financial year (2012/13) are listed below:
- Abertawe Bro Morgannwg - £9.858m
- Aneurin Bevan - £4.058m
- Betsi Cadwaladr - £14.766m
- Cardiff & Vale - £8.274m (2013)
- Cwm Taf - £7.045m
- Hywel Dda - £5.872m
- Powys - £100,016