National Assembly for Wales

Health and Social Care Committee

The work of the Healthcare Inspectorate Wales

Evidence from the Betsi Cadwaladr University Local Health Board – HIW 07

 

 

Dear Sirs

 

Re: Short inquiry into the work of Healthcare Inspectorate Wales (HIW)

 

Further to your letter dated 23rd July 2013 inviting the organisation to contribute to the inquiry on the above, please find below the response on behalf of Betsi Cadwaladr University Local Health Board.

 

  1. The effectiveness of HIW in undertaking its main functions and statutory responsibilities.

 

1.1Overall the health board is confident that HIW is broadly effective in undertaking its main statutory functions and responsibilities.

 

1.2 There are many examples where reviews such as those undertaken for IR(ME)R  have been well-structured  and provided a positive learning experience for staff and in turn improved outcomes for patients. The process has been undertaken with scrutiny and rigour and has been most effective when the reviewers are experienced and offer constructive challenge.

 

1.3The Health Board recognises the value of the Standards for Health Services, and the benefit to patients of using the self assessment tool in an honest and rigorous way. However, the Health Board feels that since the process of monitoring the standards is now on a self-assessment basis, we have lost the added benefit of having the opportunity to benchmark with other HBs

 

 

1.4On occasion, there has been a lack of clarity in relation to the unique role of HIW in some investigation process. This should routinely be agreed and formalised.

 

 

1.5 We should ensure that there are always clearly defined timescales for production of reports. Reports following inspections received from HIW have taken up to 12 months to be returned to the organisation.  During this time the organisation can have moved on considerably and the reports therefore do not provide a full or balanced picture of the service/ work that is now in place.

 

  1. The investigative and inspection functions of HIW, Specifically its responsibility for making sure patients have access to safe and effective services, and its responsiveness to incidences of serious concern and systematic failures.

 

 

2.1 HIW have responded promptly to request for additional investigations and inspections which are necessary when serious concerns are raised.

 

2.2Individual Serious concerns are routinely reported to the Quality and Safety Improvement Branch of the Welsh Government. The Health Board believe it would be helpful to clarify the relationship between HIW and WG in this area.  

 

  1. The overall development and accountability of HIW, including whether the organisation is fit for purpose.

 

3.1The Health Board believes it would be beneficial to clarify the role of HIW in relation to its various functions with a clear focus on patient outcomes; patient safety, and patient experience.

 

3.2It is more important than ever that we are in a position to give to the public an open and honest account of the quality and safety of the services we provide.  HIW provides a pivotal external source of assurance and therefore needs to resourced and organised appropriately to deliver a level of independent challenge and scrutiny.

 

 

  1. The effectiveness of working relationships, focusing on collaboration and information sharing between HIW, key stakeholders and other review bodies.

 

4.1Working relationships with the staff at HIW are reported as being positive, with staff being approachable and willing to help with any queries that are raised.

 

4.2As stated Serious Incidents are reported to Welsh Government. It is understood that they then share a number of these with HIW.  However the Health Board are not clear as to the criteria for determining which incidents WG might share and the role expected of HIW in relation to these. Clarity regarding the relationship between HIW and the Quality and Safety Improvement Branch would be welcomed

 

 

 

 

  1. Consideration of the role of HIW in strengthening the voice of patients and the public on the way health services are reviewed

 

Work to strengthen the way in which the voices and views of patients and the public are embedded in reviewing health services is vitally important Any such approach would need to ensure that due regard was given to ensuring that diversity and equality issues were attended to so that boards could take account of the experiences of different groups within the community.

.

  1. Safeguarding arrangement, specifically the handling of whistleblowing and complaints information.

 

These serious and sensitive issues could be better managed and coordinated within a clear and agreed process between health boards and HIW. This will ensure that there is provision of accurate, timely and balanced information which is integrated with any other relevant informal sources of intelligence for consideration, assessment and action as appropriate.

 

Yours sincerely

 

 

 

Dr Martin Duerden

Cyfarwyddwr Meddygol a Gwasanaethau Clinigol Dros Dro

Acting Medical Director and Director of Clinical Services

 

 

Angela Hopkins

Executive Director of Nursing,

Midwifery and Patient Services