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Today a report from the Royal College of Surgeons of England (RCS) has been published in relation to vascular services at Betsi Cadwaladr University Health Board. A copy of the report can be found here. This report is the second part of an invited service review by the RCS, the first part of which reported in May of last year. A copy of that report can be found here.\[1]


I am disappointed and concerned by this most recent report, which reviewed 44 sets of case notes and found deficiencies in care, record keeping, consent\-taking and follow\-up in a number of the cases examined. The report covers a period from before the reorganisation up to July last year. I know local people and Senedd Members will share my concerns and want answers about these issues, as well as the future of this service.


The cases reviewed here involve real people and their families and there will be many others who may be worrying about the quality of the care they have received or are about to receive and whether this service is safe. I expect the health board to address these issues with immediate effect and put a plan and processes in place to contact and review patients appropriately and sensitively, to provide them with information and assurance as well as to address the other recommendations made by the RCS.


I know there has been a lot of anxiety about the changes made to vascular services in north Wales. No service change is easy and I understand the concerns. However, the model of care for vascular services, where the most complex procedures are carried out at a specialist centre, supported by local centres which carry out more straightforward treatments, is the right one. This ‘hub and spoke’ model is endorsed by the Vascular Society and Royal College of Surgeons and is the way to ensure sustainability of services going forward with 20 per cent of cases expected to be treated at the specialist centre and 80 per cent locally.  Out\-patient appointments, review of in\-patient vascular referrals and some less specialised procedures are still carried out right across north Wales.


I would therefore urge everyone not to get drawn into suggestions that the old service model should be re\-introduced because that cannot happen and would not be supported by the Royal College of Surgeons. In addition, a significant amount of investment has been made in this service, in particular into the hybrid theatre and interventional radiology facilities at Ysbyty Glan Clwyd.


However, as the health board’s own internal review and the two RCS reports have shown, the implementation of the new model has faced significant difficulties and in many respects has been poorly executed. I am also aware that the annual Vascular Registry Report \- which is an audit of care and outcomes \- has shown inconsistent results, which is also a matter of concern.


I do not underestimate how challenging it must be to alter long\-standing care pathways and to get everyone on board with a system\-wide change in particular in the middle of a pandemic; but there are many things which have not been done well and there should be no excuses for this. I am also sure the situation has not been helped by relentlessly negative public discourse which has overshadowed any positive impacts of the service reconfiguration and had the potential to impact on staff morale. This is something that was noted in the first RCS report.


For the sake of people in North Wales who need this service, and the staff working to provide this care, we must now do all we can to ensure the health board implements it properly, to make the pathway seamless and to improve outcomes. This is meant to be a flagship service and I am determined that it will become so.


Amongst other actions, the health board is now taking immediate steps to strengthen clinical leadership and to enter into an arrangement with a larger vascular service in England which will provide oversight and multi\-disciplinary support. My officials have received strong assurances from executives at the health board on all the recommendations and in addition I have written to the Chair of the health board today to set out my support for the work they are doing, but also my clear expectation that these matters must be given top priority and that the issues raised, including record\-keeping and consent are not endemic within the organisation. My officials will also be considering whether any further escalation measures or oversight will be required and I have asked that vascular services are discussed at the next tripartite meeting between Welsh Government, Healthcare Inspectorate Wales and Wales Audit Office.


Finally, to the staff working in this service at Betsi Cadwaladr University Health Board for whom this must be difficult, I would like to say that we value you, support you and want you to succeed. However this is going to require everyone to pull together to make this service a success for patients. I am counting on everyone concerned to help make this happen and look forward to receiving your continued support. 


\[1] Page 456 of the Betsi Cadwaladr University Health Board papers from the meeting held on 20 May 2021







Translation:


 
Heddiw, mae adroddiad gan Goleg Brenhinol Llawfeddygon Lloegr (RCS) wedi cael ei gyhoeddi, sy’n trafod gwasanaethau fasgwlaidd ym Mwrdd Iechyd Prifysgol Betsi Cadwaladr. Gallwch weld copi o’r adroddiad yma. Yr adroddiad hwn yw ail ran yr adolygiad o’r gwasanaeth y gwahoddwyd yr RCS i’w gynnal, ac adroddwyd ar y rhan gyntaf ym mis Mai y llynedd. Gallwch weld copi o’r adroddiad hwnnw yma.\[1]


Mae’r adroddiad diweddaraf hwn wedi achosi siom a phryder imi. Ynddo, adolygwyd 44 o setiau o nodiadau achos a darganfuwyd diffygion mewn gofal, y drefn cadw cofnodion, cael cydsyniad ac apwyntiadau dilynol mewn nifer o’r achosion a archwiliwyd. Mae’r adroddiad yn cwmpasu’r cyfnod o cyn yr ad\-drefnu hyd at fis Gorffennaf y llynedd. Gwn y bydd pobl leol ac Aelodau’r Senedd yn rhannu fy mhryderon, ac eisiau atebion am y materion hyn, yn ogystal â dyfodol y gwasanaeth hwn.


Mae’r achosion sy’n cael eu hadolygu yma yn ymdrin â phobl go iawn a’u teuluoedd, a bydd llawer o bobl eraill yn poeni am ansawdd y gofal maent wedi’i dderbyn neu ar fin ei dderbyn, a ph’un a yw’r gwasanaeth hwn yn ddiogel. Rwy’n disgwyl i’r bwrdd iechyd fynd i’r afael â’r materion hyn ar unwaith, a rhoi cynllun a phrosesau ar waith i gysylltu â chleifion a’u hadolygu mewn modd priodol a sensitif, er mwyn rhoi gwybodaeth a sicrwydd iddynt yn ogystal ag ymdrin â’r argymhellion eraill a wnaed gan yr RCS.


Gwn fod llawer wedi bod yn poeni am y newidiadau a wnaed i wasanaethau fasgwlaidd yn y Gogledd. Dydy newidiadau i wasanaethau byth yn hawdd, ac rwy’n deall y pryderon. Fodd bynnag, y model o ofal ar gyfer gwasanaethau fasgwlaidd, lle caiff y triniaethau mwyaf cymhleth eu cynnal mewn canolfan arbenigol, gyda chefnogaeth canolfannau lleol sy’n cynnal triniaethau symlach, yw’r model cywir. Mae’r Gymdeithas Fasgwlaidd a Choleg Brenhinol y Llawfeddygon yn cymeradwyo’r model "prif ganolfan a lloerennau" hwn, a dyma’r ffordd i sicrhau bod gwasanaethau’n gynaliadwy yn y dyfodol. Disgwylir y bydd 20 y cant o achosion yn cael eu trin yn y ganolfan arbenigol ac 80 y cant yn lleol. Mae apwyntiadau cleifion allanol, adolygiadau o atgyfeiriadau fasgwlaidd cleifion mewnol a rhai triniaethau llai arbenigol yn parhau i gael eu cynnal ar draws y Gogledd i gyd.


Hoffwn felly annog pawb i beidio â chael eu dylanwadu i dderbyn awgrymiadau y dylai’r hen fodel gwasanaeth gael ei ailgyflwyno, oherwydd ni all hynny ddigwydd, ac ni fyddai Coleg Brenhinol y Llawfeddygon yn cefnogi hynny. Yn ogystal, mae buddsoddiad sylweddol wedi’i wneud yn y gwasanaeth hwn, yn arbennig yn y theatr hybrid a’r cyfleusterau radioleg ymyriadau yn Ysbyty Glan Clwyd.


Fodd bynnag, fel y mae adolygiad mewnol y bwrdd iechyd ei hun a dau adroddiad yr RCS wedi dangos, rydym wedi wynebu anawsterau sylweddol wrth weithredu’r model newydd, ac ar sawl cyfrif, mae wedi cael ei weithredu’n wael. Rwyf hefyd yn ymwybodol bod Adroddiad blynyddol y Gofrestrfa Fasgwlaidd – sef archwiliad o ofal a chanlyniadau – wedi dangos canlyniadau anghyson, sydd hefyd yn peri pryder.


Rwy’n llawn sylweddoli pa mor heriol yw newid llwybr gofal hirsefydlog, a sicrhau bod pawb yn hapus gyda newid system gyfan, yn arbennig ynghanol pandemig; ond mae llawer o bethau sydd heb eu gwneud yn dda, ac nid oes esgus dros hyn. Rwyf hefyd yn sicr nad yw’r siarad negyddol cyhoeddus diddiwedd wedi helpu, ac mae hyn wedi taflu cysgod ar unrhyw effeithiau cadarnhaol sydd wedi codi yn sgil ad\-drefnu’r gwasanaeth, ac o bosibl wedi effeithio ar forâl staff. Cafodd hyn ei nodi yn adroddiad cyntaf yr RCS.


Er mwyn pobl y Gogledd sydd angen y gwasanaeth hwn, a’r staff sy’n gweithio i ddarparu’r gofal hwn, rhaid inni nawr wneud popeth o fewn ein gallu i sicrhau bod y bwrdd iechyd yn ei weithredu’n briodol, i wneud y llwybr yn un di\-dor a gwella canlyniadau. Mae’r gwasanaeth hwn wedi’i fwriadu i fod yn wasanaeth blaenllaw, ac rwy’n benderfynol mai dyna y bydd.


Yn ogystal â chamau eraill, mae’r bwrdd iechyd yn cymryd camau ar unwaith i gryfhau’r arweinyddiaeth glinigol ac ymrwymo i gytundeb gyda gwasanaeth fasgwlaidd mwy yn Lloegr, a fydd yn darparu trosolwg a chymorth traws\-ddisgyblaethol. Mae fy swyddogion wedi derbyn sicrwydd cryf gan swyddogion gweithredol yn y bwrdd iechyd ar yr holl argymhellion, ac rwyf hefyd wedi ysgrifennu at Gadeirydd y bwrdd iechyd heddiw i ddatgan fy nghefnogaeth i’r gwaith sy’n cael ei wneud. Ond rwyf hefyd yn nodi fy nisgwyliadau clir fod yn rhaid i’r materion hyn gael blaenoriaeth amlwg, ac nad yw’r materion a godwyd, gan gynnwys cadw cofnodion a chydsyniad yn endemig o fewn y sefydliad. Bydd fy swyddogion hefyd yn ystyried p’un a fydd mesurau uwchgyfeirio neu arolygu pellach yn ofynnol, ac rwyf wedi gofyn i wasanaethau fasgwlaidd gael eu trafod yn y cyfarfod nesaf rhwng Llywodraeth Cymru, Arolygiaeth Gofal Iechyd Cymru a Swyddfa Archwilio Cymru.


Yn olaf, i’r staff sy’n gweithio yn y gwasanaeth hwn ym Mwrdd Iechyd Prifysgol Betsi Cadwaladr sydd yn y sefyllfa anodd hon, hoffwn ddweud ein bod yn eich gwerthfawrogi chi, yn eich cefnogi chi ac rydym am eich gweld yn llwyddo. Fodd bynnag, bydd angen i bawb weithio gyda’i gilydd i sicrhau bod y gwasanaeth hwn yn llwyddo i gleifion. Rwy’n dibynnu ar bawb i helpu i sicrhau bod hyn yn digwydd, ac rwy’n edrych ymlaen at gael eich cefnogaeth barhaus.


\[1] Tudalen 456 o bapurau Bwrdd Iechyd Prifysgol Betsi Cadwaladr o’r cyfarfod a gynhaliwyd ar 20 Mai 2021