PFD report

John William Rogers · Prevention of Future Deaths report

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Issued 8 Mar 2016•North Wales (East and Central)

Report record

Published report and response evidence

This page connects the concerns raised in this report with statements found in recipients’ published responses. A link shows a clear evidence connection; it does not assign responsibility.

View original report
Concerns
2

Raised in this report

Recipients
1

Named on the report

Responses found
1

Of 1 recipient

Stated actions
2

Described in responses

Recipients and published responses

Source document

Full report text

This is the full text from the original published report.

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Concerns and recipient responses

Select any concern, action or position to view the source wording.

Concerns raised2

  1. Failure to ensure that staff training and qualifications remain up to date
  2. Failure to ensure that staff are appropriately qualified for their required work
Responses linked to these concerns

Each statement is shown once, even when linked to more than one concern.

Actions described in response An action is something a recipient says it has done, is doing, or plans to do in response to a concern raised.2

  1. Action

    Introduce a supportive and flexible approach to help staff complete mandatory training and keep their qualifications up to date.

    Stated by Betsi Cadwaladr University LHBStated completedThe respondent said that this action was complete when they made their response on 9 March 2016.
  2. Action

    Introduce a more rigorous system for monitoring mandatory training and qualification compliance, with monthly reporting and oversight through Clinical Accountability meetings.

    Stated by Betsi Cadwaladr University LHBStated completedThe respondent said that this action was complete when they made their response on 9 March 2016.

Source evidence

How this individual concern was interpreted

PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.

PFD Monitor interpretation

Failure to ensure that staff training and qualifications remain up to date

Wider context from the report

“That the current systems in place within BCUHB are not sufficiently robust to ensure that their staff are appropriately qualified to undertake the work required of them and that their training and qualifications remain up to date. ”

Is this part of a recurring concern?

No recurring-concern membership is currently published.

Open source report

Source evidence

How this individual concern was interpreted

PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.

PFD Monitor interpretation

Failure to ensure that staff are appropriately qualified for their required work

Wider context from the report

“That the current systems in place within BCUHB are not sufficiently robust to ensure that their staff are appropriately qualified to undertake the work required of them and that their training and qualifications remain up to date. ”

Is this part of a recurring concern?

No recurring-concern membership is currently published.

Open source report

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Introduce a supportive and flexible approach to help staff complete mandatory training and keep their qualifications up to date.

Verbatim wording from the response

“In reviewing the training framework and policies with colleagues, there are a range of actions which have been proposed and agreed within the Senior Managers and Executive Team, which will strengthen the current systems and processes to ensure training and qualifications status remain up to date (current) for the clinical area within which they work. To ensure that there are no lapses to training and qualifications, the Health Board has introduced a more rigorous approach to monitoring as well as a supportive and flexible approach for staff to complete their mandatory training.”

Source location

2016-0097-Response-by-University-Health-Board
Page 1 · response
Published 9 March 2016

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Introduce a more rigorous system for monitoring mandatory training and qualification compliance, with monthly reporting and oversight through Clinical Accountability meetings.

Verbatim wording from the response

“In reviewing the training framework and policies with colleagues, there are a range of actions which have been proposed and agreed within the Senior Managers and Executive Team, which will strengthen the current systems and processes to ensure training and qualifications status remain up to date (current) for the clinical area within which they work. To ensure that there are no lapses to training and qualifications, the Health Board has introduced a more rigorous approach to monitoring as well as a supportive and flexible approach for staff to complete their mandatory training.”

Source location

2016-0097-Response-by-University-Health-Board
Page 1 · response
Published 9 March 2016

Open published response
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Information checked against the published report and official responses · Data reviewed 7 Sep 2026 · About data quality and limitations

Data last updated 7 September 2026