PFD report

Lilly Baxandall · Prevention of Future Deaths report

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Issued 17 May 2017•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.

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Concerns
4

Raised in this report

Recipients
8

Named on the report

Responses found
6

Of 8 recipients

Stated actions
40

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 raised4

  1. Delays in emergency department patient handover
    Part of recurring concern: Delays in ambulance-to-hospital patient handover
  2. Failure to maintain adequate emergency department staffing
    Part of recurring concern: Insufficient emergency-department capacity for timely patient carePart of recurring concern: Insufficient emergency-department staffing capacity for safe patient care
  3. Insufficient hospital bed capacity for admissions
    Part of recurring concern: Failure to provide timely hospital admission
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.23

  1. Action

    Invest in integrated generic health and social-care support staff to assist hospital discharges in Wrexham.

    Stated by Betsi Cadwaladr University LHB and Conwy County Borough Council and Denbighshire County Council and Flintshire County Council and Welsh Ambulance Services NHS Trust and Wrexham County Borough CouncilStated completedThe respondent said that this action was complete when they made their response on 17 August 2017.
  2. Action

    Create a Night Sister post to support patient flow and safety at Ysbyty Maelor Wrexham.

    Stated by Betsi Cadwaladr University LHB and Conwy County Borough Council and Denbighshire County Council and Flintshire County Council and Welsh Ambulance Services NHS Trust and Wrexham County Borough CouncilStated completedThe respondent said that this action was complete when they made their response on 17 August 2017.
  3. Action

    Develop the IV suite to provide emergency and elective IV therapy without overnight admission.

    Stated by Betsi Cadwaladr University LHB and Conwy County Borough Council and Denbighshire County Council and Flintshire County Council and Welsh Ambulance Services NHS Trust and Wrexham County Borough CouncilStated in progressThe respondent said that this action was in progress when they made their response on 17 August 2017.

Respondent positions A position is what a recipient says about a concern when it does not describe a specific action.1

  1. Position

    Establishing a North Wales Bed Bureau was not feasible because geography and local emergency admissions require access to the nearest appropriate hospital.

    Stated by Betsi Cadwaladr University LHB and Conwy County Borough Council and Denbighshire County Council and Flintshire County Council and Welsh Ambulance Services NHS Trust and Wrexham County Borough CouncilUnable to actThe respondent said that a constraint prevented them from taking the relevant action.

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

Delays in emergency department patient handover

Wider context from the report

“Following an inquest which concluded in January 2014 I issued a regulation 28 report in which I expressed concerns regarding the handover of patients at an emergency department which resulted in "unacceptable delays with patients being kept waiting for long periods in ambulances and ambulance resources consequently being unavailable for allocation to other calls". In September 2014 I issued a further regulation 28 report raising similar concerns regarding delays. In November 2015 I issued a regulation 28 report concerning delays in an emergency department which "were excessive and inadequate action was taken by the Health Board to overcome the problems of staff shortages leading to long waiting times and risks to patients". In December 2015 I issued a regulation 28 report expressing concerns regarding the throughput of patients in hospital and Delayed Transfer of Care. In August 2016 I issued a regulation 28 report regarding a delay in admission to hospital via the emergency department which formed part of a cumulative delay in diagnosis and treatment which prevented a patient having the best prospect of a successful outcome. In January 2017 I issued a regulation 28 report expressing a concern “that there are invariably delays in admissions to hospital as there are insufficient beds available to accommodate all admissions”. In March 2017 I issued a regulation 28 report expressing concern that there “continue to be substantial delays in the handover of patients particularly as a result of problems in patient flow resulting in an inability to admit patients who require treatment” Despite the above reports issued to the Health Board and Ambulance Service the problems of ambulance delays/handover delays/bed blocking/patient flow and delayed transfer of care continue to the present day and patients’ lives are being placed at risk as a result. It is very well recognised that the issues are multifactorial and will require multi agency cooperation for improvements or change to be made, however unless services and resources are made available or working practices altered to facilitate such change then it is inevitable that future deaths will occur which might have otherwise been preventable. ”

Is this part of a recurring concern?

Yes — Delays in ambulance-to-hospital patient handover.

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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 maintain adequate emergency department staffing

Wider context from the report

“Following an inquest which concluded in January 2014 I issued a regulation 28 report in which I expressed concerns regarding the handover of patients at an emergency department which resulted in "unacceptable delays with patients being kept waiting for long periods in ambulances and ambulance resources consequently being unavailable for allocation to other calls". In September 2014 I issued a further regulation 28 report raising similar concerns regarding delays. In November 2015 I issued a regulation 28 report concerning delays in an emergency department which "were excessive and inadequate action was taken by the Health Board to overcome the problems of staff shortages leading to long waiting times and risks to patients". In December 2015 I issued a regulation 28 report expressing concerns regarding the throughput of patients in hospital and Delayed Transfer of Care. In August 2016 I issued a regulation 28 report regarding a delay in admission to hospital via the emergency department which formed part of a cumulative delay in diagnosis and treatment which prevented a patient having the best prospect of a successful outcome. In January 2017 I issued a regulation 28 report expressing a concern “that there are invariably delays in admissions to hospital as there are insufficient beds available to accommodate all admissions”. In March 2017 I issued a regulation 28 report expressing concern that there “continue to be substantial delays in the handover of patients particularly as a result of problems in patient flow resulting in an inability to admit patients who require treatment” Despite the above reports issued to the Health Board and Ambulance Service the problems of ambulance delays/handover delays/bed blocking/patient flow and delayed transfer of care continue to the present day and patients’ lives are being placed at risk as a result. It is very well recognised that the issues are multifactorial and will require multi agency cooperation for improvements or change to be made, however unless services and resources are made available or working practices altered to facilitate such change then it is inevitable that future deaths will occur which might have otherwise been preventable. ”

Is this part of a recurring concern?

Yes — Insufficient emergency-department capacity for timely patient care; Insufficient emergency-department staffing capacity for safe patient care.

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

Insufficient hospital bed capacity for admissions

Wider context from the report

“Following an inquest which concluded in January 2014 I issued a regulation 28 report in which I expressed concerns regarding the handover of patients at an emergency department which resulted in "unacceptable delays with patients being kept waiting for long periods in ambulances and ambulance resources consequently being unavailable for allocation to other calls". In September 2014 I issued a further regulation 28 report raising similar concerns regarding delays. In November 2015 I issued a regulation 28 report concerning delays in an emergency department which "were excessive and inadequate action was taken by the Health Board to overcome the problems of staff shortages leading to long waiting times and risks to patients". In December 2015 I issued a regulation 28 report expressing concerns regarding the throughput of patients in hospital and Delayed Transfer of Care. In August 2016 I issued a regulation 28 report regarding a delay in admission to hospital via the emergency department which formed part of a cumulative delay in diagnosis and treatment which prevented a patient having the best prospect of a successful outcome. In January 2017 I issued a regulation 28 report expressing a concern “that there are invariably delays in admissions to hospital as there are insufficient beds available to accommodate all admissions”. In March 2017 I issued a regulation 28 report expressing concern that there “continue to be substantial delays in the handover of patients particularly as a result of problems in patient flow resulting in an inability to admit patients who require treatment” Despite the above reports issued to the Health Board and Ambulance Service the problems of ambulance delays/handover delays/bed blocking/patient flow and delayed transfer of care continue to the present day and patients’ lives are being placed at risk as a result. It is very well recognised that the issues are multifactorial and will require multi agency cooperation for improvements or change to be made, however unless services and resources are made available or working practices altered to facilitate such change then it is inevitable that future deaths will occur which might have otherwise been preventable. ”

Is this part of a recurring concern?

Yes — Failure to provide timely hospital admission.

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 of hospital patient flow and delayed transfer of care processes

Wider context from the report

“Following an inquest which concluded in January 2014 I issued a regulation 28 report in which I expressed concerns regarding the handover of patients at an emergency department which resulted in "unacceptable delays with patients being kept waiting for long periods in ambulances and ambulance resources consequently being unavailable for allocation to other calls". In September 2014 I issued a further regulation 28 report raising similar concerns regarding delays. In November 2015 I issued a regulation 28 report concerning delays in an emergency department which "were excessive and inadequate action was taken by the Health Board to overcome the problems of staff shortages leading to long waiting times and risks to patients". In December 2015 I issued a regulation 28 report expressing concerns regarding the throughput of patients in hospital and Delayed Transfer of Care. In August 2016 I issued a regulation 28 report regarding a delay in admission to hospital via the emergency department which formed part of a cumulative delay in diagnosis and treatment which prevented a patient having the best prospect of a successful outcome. In January 2017 I issued a regulation 28 report expressing a concern “that there are invariably delays in admissions to hospital as there are insufficient beds available to accommodate all admissions”. In March 2017 I issued a regulation 28 report expressing concern that there “continue to be substantial delays in the handover of patients particularly as a result of problems in patient flow resulting in an inability to admit patients who require treatment” Despite the above reports issued to the Health Board and Ambulance Service the problems of ambulance delays/handover delays/bed blocking/patient flow and delayed transfer of care continue to the present day and patients’ lives are being placed at risk as a result. It is very well recognised that the issues are multifactorial and will require multi agency cooperation for improvements or change to be made, however unless services and resources are made available or working practices altered to facilitate such change then it is inevitable that future deaths will occur which might have otherwise been preventable. ”

Is this part of a recurring concern?

Yes — Failure to ensure timely transfer to an appropriate hospital care environment; Failure to maintain safe hospital patient flow; Failure to provide timely hospital admission.

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

Invest in integrated generic health and social-care support staff to assist hospital discharges in Wrexham.

Verbatim wording from the response

“Provision of dedicated hospital social workers and Assistant Team Manager to facilitate discharge as soon as an individual is medically fit to leave the acute hospital. The social workers are based at the Maelor Hospital and Chirk community hospital and are integrated with the Discharge Liaison team.”

Source location

2017-0160-Response-by-University-Health-Board
Page 12 · response
Published 17 August 2017

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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

Create a Night Sister post to support patient flow and safety at Ysbyty Maelor Wrexham.

Verbatim wording from the response

“• A Night Sister post has been put in place to assist the Clinical Site Manager with patient flow and associated quality and safety issues”

Source location

2017-0160-Response-by-University-Health-Board
Page 8 · response
Published 17 August 2017

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

Develop the IV suite to provide emergency and elective IV therapy without overnight admission.

Verbatim wording from the response

“• The provision of an IV suite continues to develop as an important service to enable individuals to receive IV therapy as a day attender (both emergency and elective) without the need for an overnight hospital stay.”

Source location

2017-0160-Response-by-University-Health-Board
Page 9 · response
Published 17 August 2017

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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

Implement escalation protocols and joint action plans for delayed ambulance handovers.

Verbatim wording from the response

“BCUHB has developed an escalation protocol to ensure a consistent approach to the safe management of patients whose handover is delayed. This is to support the procedure to enable the immediate release of delayed ambulances to enable WAST to respond to life threatening or clinically urgent 999 calls in the community (the immediate release system).”

Source location

2017-0160-Response-by-University-Health-Board
Page 6 · response
Published 17 August 2017

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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

Recruit and increase funded nursing and medical staffing at Ysbyty Glan Clwyd ED.

Verbatim wording from the response

“• On-going recruitment of nursing and medical staff is a key focus. This has resulted in an increase in the funded nursing establishment in ED from 56 WTE to 94 WTE, and an increase in funded medical staff posts to double the posts from 4 to 8 full time Consultants and from 5 to 8 middle grade senior doctors. It will take time to attract and recruit substantive staff to all posts although recent recruitment campaigns for senior medical staff have met with success. It is anticipated that the Consultant and senior middle grade doctor posts will all be filled with substantive appointments by the end of 2017. Until this time, the service is employing locum medical staff to provide as much service cover and continuity of care as possible.”

Source location

2017-0160-Response-by-University-Health-Board
Page 7 · response
Published 17 August 2017

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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

Develop patient-transfer, discharge, routine and repatriation guidance for ambulance-resource requests.

Verbatim wording from the response

“Healthcare Inspectorate Wales is soon due to commence a patient discharge thematic review within BCUHB which may identify new actions for the Health Board and possibly its partners to complete to realise improvements to the discharge planning process. WAST is currently developing ‘Patient Transfer, Discharge, Routine and Repatriation Guidance’ to ensure that WAST and the wider NHS community fully understand the process of requesting an ambulance resource for particular groups of patients who need transport to enable their discharge/transfer to another facility. This will help ensure timely discharge using the most appropriate resource whilst also maintaining the availability of WAST resources to respond to 999 calls.”

Source location

2017-0160-Response-by-University-Health-Board
Page 10 · response
Published 17 August 2017

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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

Expand Ysbyty Glan Clwyd ED assessment capacity through additional spaces, observation beds and daytime GP facilities.

Verbatim wording from the response

“• A review of the use of the physical space within ED has created an open ambulatory chair centric area with 4 additional assessment/treatment spaces; the commissioning of 2 additional beds in the observation bedded area of the ED; the use of the co-located GP Out of Hours area during the day (Monday to Friday, 9am - 5pm) to provide 4 rooms for assessment / treatment; and the adoption of a flexible approach, in extenuating circumstances, to the use of all space within the ED during times of peak pressure.”

Source location

2017-0160-Response-by-University-Health-Board
Page 7 · response
Published 17 August 2017

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

Provide hospital liaison officers or duty operational managers when ambulance handovers are delayed.

Verbatim wording from the response

“With WAST, BCUHB has also developed a Local Escalation Action Plan (LEAP) which clearly outlines the escalation processes for WAST and BCUHB staff to apply to enable ambulance crews to hand over patients to ED with minimum delay. As part of the ‘LEAP’ protocol, WAST provides a Hospital Ambulance Liaison Officer (HALO) or a Duty Operational Manager (DOM) at hospitals when ambulances are delayed. These are usually WAST Clinical Team Leaders whose role is to supervise crews experiencing handover delays and liaise directly with ED.”

Source location

2017-0160-Response-by-University-Health-Board
Page 6 · response
Published 17 August 2017

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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

Trial Frailty Assessment Units to support front-door assessment and admission avoidance.

Verbatim wording from the response

“• In early autumn, a Frailty Assessment Unit will be trialled, providing a more comprehensive assessment of frail patients at the ‘front door’ with the aim of avoiding admission for some of these by providing additional community support to enable patients to be safely managed in their own homes. This needs further discussion with the local authorities.”

Source location

2017-0160-Response-by-University-Health-Board
Page 8 · response
Published 17 August 2017

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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

Establish five short-term extra-care apartments to support admission avoidance and timely discharge in Conwy.

Verbatim wording from the response

“Conwy have established 5 successful short term apartments at our Extra Care Housing Schemes. These apartments provide individuals with their own flat and an on-site support teams focused on Reablement and retaining independence. This supports individuals to either avoid a hospital admission or facilitate discharge to an intermediate facility before (primarily) returning home. These beds have further strengthened our ability to offer appropriate and timely discharge for people who are medically fit to leave inpatient beds but are not yet ready to go home.”

Source location

2017-0160-Response-by-University-Health-Board
Page 13 · response
Published 17 August 2017

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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

Provide dedicated hospital social-work staffing and rapid reablement support for discharge in Flintshire.

Verbatim wording from the response

“Flintshire has community based, responsive Community Care services which work effectively to prevent people being admitted to hospital when it is feasible and safe for these people to be supported at home. We have a leading Reablement Service which intervenes effectively, often on the same day and certainly with due urgency to ensure people maintain their independence, do not deteriorate and are supported at home. We also have a fully functioning Single Point of Access with involvement of the Voluntary Sector and co-located with Health. Finally, Flintshire leads on behalf of Wrexham, BCUHB and our County with a Community Equipment Service which provides rapid and responsive equipment again if needed, on the same day. There are 10 dedicated hospital social workers to facilitate discharge as soon as an individual is medically fit to leave the acute hospital.”

Source location

2017-0160-Response-by-University-Health-Board
Page 11 · response
Published 17 August 2017

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

Recruit medical staff and revise staffing rotas at Ysbyty Maelor Wrexham ED.

Verbatim wording from the response

“• The recruitment of medical staff is ongoing to improve cover of the medical rota from August 2017 at middle grade and SHO level. There are 2 wte Consultant vacancies currently covered with locum Consultants. There is a focused campaign of work ongoing to recruit to these key posts on a permanent basis.”

Source location

2017-0160-Response-by-University-Health-Board
Page 7 · response
Published 17 August 2017

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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

Increase specialty medical and surgical in-reach into ED to support earlier assessment and discharge.

Verbatim wording from the response

“• Work is also on-going to increase speciality ‘in reach’ into ED by medical and surgical specialties who attend ED to review patients rather than wait for them to be admitted to an inpatient ward. This does result in some patients being discharged home from ED.”

Source location

2017-0160-Response-by-University-Health-Board
Page 7 · response
Published 17 August 2017

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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

Create a Step Down Manager post to coordinate movement of complex-care patients through discharge pathways.

Verbatim wording from the response

“• A ‘Step Down’ Manager post has been created who works collaboratively with community health and social care colleagues to ensure that patients with complex care needs are moved to the next stage of their care pathway without undue delay”

Source location

2017-0160-Response-by-University-Health-Board
Page 8 · response
Published 17 August 2017

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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

Align senior medical staffing hours with peak ED demand.

Verbatim wording from the response

“• The service is also working towards better matching senior medical staff working hours with times of peak patient demand. The aim is to have the Consultant late day shift extended from 18.00hrs to 22.00hrs and have a second Consultant working until 9pm Monday to Friday”

Source location

2017-0160-Response-by-University-Health-Board
Page 7 · response
Published 17 August 2017

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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

Operate a rapid assessment unit at Ysbyty Maelor Wrexham to assess and admit patients from ED and primary care without undue delay.

Verbatim wording from the response

“• From the 1st August 2017, a rapid assessment unit will be operational to assess and admit patients from ED (and GPs) without undue delay. From the autumn, this will be complimented with a Frailty Assessment Unit with a focus on admission avoidance to return individuals to their own homes with the support of community staff, including therapists. The unit will provide rapid assessment and treatment of patients who have the potential to return home the same day or within a maximum of 72 hours. Patients will be treated as ambulatory until proven otherwise and within the unit, individuals will receive rapid diagnosis and stabilisation before they are supported home.”

Source location

2017-0160-Response-by-University-Health-Board
Page 9 · response
Published 17 August 2017

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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

Develop enhanced multidisciplinary community resource teams to provide care at home.

Verbatim wording from the response

“• Developing enhanced multi-disciplinary community resource teams (CRT) to provide more care for individuals in their own homes. The CRTs are in varying degrees of development across North Wales and whilst have the potential to better manage care closer at home need to build on the range of successful intermediate care provision already delivered in the 6 local authorities.”

Source location

2017-0160-Response-by-University-Health-Board
Page 5 · response
Published 17 August 2017

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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

Explore a Rapid Assessment and Treatment area at Ysbyty Glan Clwyd for rapid handover and assessment.

Verbatim wording from the response

“At Ysbyty Maelor Wrexham, a holding area in ED is created whenever possible during the day to enable patients of low risk to be handed over without delay by WAST and brought into ED. At Ysbyty Glan Clwyd, options are being explored to establish a physical ‘RATS’ (Rapid Assessment & Treatment Service) area in ED to enable the rapid handover and assessment of patients.”

Source location

2017-0160-Response-by-University-Health-Board
Page 6 · response
Published 17 August 2017

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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

Use paramedic guidance to identify suitable patients for transfer to ED waiting rooms rather than remaining in ambulances.

Verbatim wording from the response

“The WAST Clinical Contact Centre (CCC) uses a demand management plan to ensure good communications with hospital sites about WAST community activity and demand, particularly during times of handover delays. Delays are escalated to a WAST senior manager who liaises with senior BCUHB officers to agree how resources can be safely released to respond to WAST community activity. WAST and BCUHB have together developed guidance for paramedics to identify patients well enough to be placed in the ED waiting room, rather than wait on an emergency ambulance.”

Source location

2017-0160-Response-by-University-Health-Board
Page 6 · response
Published 17 August 2017

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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

Implement the SAFER patient-flow bundle across all three acute hospital sites.

Verbatim wording from the response

“4.3. SAFER BCUHB has committed to implement the SAFER bundle in all 3 acute hospital sites over the next 6 months. This is an evidence based bundle of actions shown to reduce length of stay and support safe patient discharge. The key elements of this are:”

Source location

2017-0160-Response-by-University-Health-Board
Page 9 · response
Published 17 August 2017

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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

Establish a joint Single Point of Access and step-down cluster to support hospital discharge in Denbighshire.

Verbatim wording from the response

“This has resulted in a number of changes to how services have been provided in the past and include a joint Single Point of Access with agreed pathways for discharge from hospital and a co-located Community Team of health and social care professionals able to work together more effectively. The latter will be rolled out across the County when its effectiveness has been reviewed.”

Source location

2017-0160-Response-by-University-Health-Board
Page 14 · response
Published 17 August 2017

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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

Provide overnight district nursing in Wrexham to support safe care at home.

Verbatim wording from the response

“• During times of peak demand, additional ‘surge’ inpatient bed capacity is opened in line with available staffing. This includes the escalation of additional beds on some wards where staffing levels enable this to be done safely. The District Nursing Service in Wrexham is now available overnight, enabling more patients to be safely cared for at home rather than remain in hospital.”

Source location

2017-0160-Response-by-University-Health-Board
Page 9 · response
Published 17 August 2017

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

Open additional surge inpatient capacity during peak demand where staffing permits safe operation.

Verbatim wording from the response

“• During times of peak demand, additional ‘surge’ inpatient bed capacity is opened in line with available staffing. This includes the use of medical and surgical assessment spaces as overnight inpatient beds and the escalation of additional beds on some wards where staffing levels enable this to be done safely.”

Source location

2017-0160-Response-by-University-Health-Board
Page 8 · response
Published 17 August 2017

Open published response

Source evidence

How this respondent position was interpreted

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

PFD Monitor interpretation

Establishing a North Wales Bed Bureau was not feasible because geography and local emergency admissions require access to the nearest appropriate hospital.

Verbatim wording from the response

“In reviewing the action plans already submitted in response to the 7 previous Regulation 28 reports that are referenced in the Regulation 28 for Lilly Baxandall, BCUHB notes that all previous actions have been implemented or are work in progress, with the exception of the establishment of a North Wales Bed Bureau. After consideration of this, it was not deemed a feasible way of improving access for acute hospital admissions across North Wales due to geography and enabling the admission of emergency patients to as local a hospital as possible, as often as possible.”

Source location

2017-0160-Response-by-University-Health-Board
Page 1 · response
Published 17 August 2017

Open published response

Other statements in published responses

These actions and other statements could not be clearly connected to one concern in this report.

Recipient-stated actions An action is something a recipient says it has done, is doing, or plans to do in response to a concern raised.17

  1. 1

    Provide a daytime GP in ED to treat primary-care self-presenters.

    Stated by Betsi Cadwaladr University LHB and Conwy County Borough Council and Denbighshire County Council and Flintshire County Council and Welsh Ambulance Services NHS Trust and Wrexham County Borough CouncilStated completedThe respondent said that this action was complete when they made their response on 17 August 2017.
  2. 2

    Develop WAST’s paramedic clinical leadership structure and appoint an Assistant Director of Paramedicine.

    Stated by Betsi Cadwaladr University LHB and Conwy County Borough Council and Denbighshire County Council and Flintshire County Council and Welsh Ambulance Services NHS Trust and Wrexham County Borough CouncilStated in progressThe respondent said that this action was in progress when they made their response on 17 August 2017.
  3. 3

    Implement a North Wales mental-health crisis alternative care pathway to avoid inappropriate ED conveyance.

    Stated by Betsi Cadwaladr University LHB and Conwy County Borough Council and Denbighshire County Council and Flintshire County Council and Welsh Ambulance Services NHS Trust and Wrexham County Borough CouncilStated in progressThe respondent said that this action was in progress when they made their response on 17 August 2017.
  4. 4

    Establish a falls strategic improvement group to improve assessment and response across the falls pathway.

    Stated by Betsi Cadwaladr University LHB and Conwy County Borough Council and Denbighshire County Council and Flintshire County Council and Welsh Ambulance Services NHS Trust and Wrexham County Borough CouncilStated completedThe respondent said that this action was complete when they made their response on 17 August 2017.
  5. 5

    Operate and expand the Clinical Support Desk telephone-triage service with additional clinicians.

    Stated by Betsi Cadwaladr University LHB and Conwy County Borough Council and Denbighshire County Council and Flintshire County Council and Welsh Ambulance Services NHS Trust and Wrexham County Borough CouncilStated completedThe respondent said that this action was complete when they made their response on 17 August 2017.
  6. 6

    Introduce a North Wales service providing alternative community care for frequent ambulance callers.

    Stated by Betsi Cadwaladr University LHB and Conwy County Borough Council and Denbighshire County Council and Flintshire County Council and Welsh Ambulance Services NHS Trust and Wrexham County Borough CouncilStated plannedThe respondent said that this action was planned when they made their response on 17 August 2017.
  7. 7

    Develop alternative pathways for catheter management, palliative care and falls.

    Stated by Betsi Cadwaladr University LHB and Conwy County Borough Council and Denbighshire County Council and Flintshire County Council and Welsh Ambulance Services NHS Trust and Wrexham County Borough CouncilStated in progressThe respondent said that this action was in progress when they made their response on 17 August 2017.
  8. 8

    Introduce Treatment Escalation Plans for nursing and residential homes to support safe treatment without ambulance conveyance.

    Stated by Betsi Cadwaladr University LHB and Conwy County Borough Council and Denbighshire County Council and Flintshire County Council and Welsh Ambulance Services NHS Trust and Wrexham County Borough CouncilStated in progressThe respondent said that this action was in progress when they made their response on 17 August 2017.
  9. 9

    Protect ENP staffing and clinical space and open three additional ED rooms for minor injuries and related services.

    Stated by Betsi Cadwaladr University LHB and Conwy County Borough Council and Denbighshire County Council and Flintshire County Council and Welsh Ambulance Services NHS Trust and Wrexham County Borough CouncilStated completedThe respondent said that this action was complete when they made their response on 17 August 2017.
  10. 10

    Implement a North Wales-wide falls pathway for patients who fall at home.

    Stated by Betsi Cadwaladr University LHB and Conwy County Borough Council and Denbighshire County Council and Flintshire County Council and Welsh Ambulance Services NHS Trust and Wrexham County Borough CouncilStated plannedThe respondent said that this action was planned when they made their response on 17 August 2017.
  11. 11

    Increase Minor Injury Unit access, including reviewing criteria, extending opening times and publicising availability.

    Stated by Betsi Cadwaladr University LHB and Conwy County Borough Council and Denbighshire County Council and Flintshire County Council and Welsh Ambulance Services NHS Trust and Wrexham County Borough CouncilStated in progressThe respondent said that this action was in progress when they made their response on 17 August 2017.
  12. 12

    Triage suitable self-presenting ED patients into co-located GP out-of-hours services.

    Stated by Betsi Cadwaladr University LHB and Conwy County Borough Council and Denbighshire County Council and Flintshire County Council and Welsh Ambulance Services NHS Trust and Wrexham County Borough CouncilStated in progressThe respondent said that this action was in progress when they made their response on 17 August 2017.
  13. 13

    Develop alternative emergency care pathways through joint clinical workshops and prioritised workstreams.

    Stated by Betsi Cadwaladr University LHB and Conwy County Borough Council and Denbighshire County Council and Flintshire County Council and Welsh Ambulance Services NHS Trust and Wrexham County Borough CouncilStated in progressThe respondent said that this action was in progress when they made their response on 17 August 2017.
  14. 14

    Evaluate the Manchester Triage System trial to inform potential alternative-pathway rollout.

    Stated by Betsi Cadwaladr University LHB and Conwy County Borough Council and Denbighshire County Council and Flintshire County Council and Welsh Ambulance Services NHS Trust and Wrexham County Borough CouncilStated in progressThe respondent said that this action was in progress when they made their response on 17 August 2017.
  15. 15

    Develop mental-health assessment training and risk-assessment tools for frontline clinicians.

    Stated by Betsi Cadwaladr University LHB and Conwy County Borough Council and Denbighshire County Council and Flintshire County Council and Welsh Ambulance Services NHS Trust and Wrexham County Borough CouncilStated in progressThe respondent said that this action was in progress when they made their response on 17 August 2017.
  16. 16

    Maintain the clinical response model that clinically assesses 999 callers and prioritises life-saving responses.

    Stated by Betsi Cadwaladr University LHB and Conwy County Borough Council and Denbighshire County Council and Flintshire County Council and Welsh Ambulance Services NHS Trust and Wrexham County Borough CouncilStated completedThe respondent said that this action was complete when they made their response on 17 August 2017.
  17. 17

    Fully introduce unified assessment documentation for patients awaiting admission at Ysbyty Glan Clwyd.

    Stated by Betsi Cadwaladr University LHB and Conwy County Borough Council and Denbighshire County Council and Flintshire County Council and Welsh Ambulance Services NHS Trust and Wrexham County Borough CouncilStated plannedThe respondent said that this action was planned when they made their response on 17 August 2017.

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

Provide a daytime GP in ED to treat primary-care self-presenters.

Verbatim wording from the response

“• A day time GP, Monday to Friday, is also in place in ED to treat primary care self-presenters to ED.”

Source location

2017-0160-Response-by-University-Health-Board
Page 7 · response
Published 17 August 2017

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

Develop WAST’s paramedic clinical leadership structure and appoint an Assistant Director of Paramedicine.

Verbatim wording from the response

“1.5. Enhancement of WAST Clinical Leadership”

Source location

2017-0160-Response-by-University-Health-Board
Page 5 · response
Published 17 August 2017

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

Implement a North Wales mental-health crisis alternative care pathway to avoid inappropriate ED conveyance.

Verbatim wording from the response

“• Mental Health: As a result of both service user and staff feedback, WAST has developed a Mental Health Improvement Plan outlining 6 priority areas for those with mental health needs. This includes supporting WAST staff through the use of an assessment of the patient’s mental health illness or mental distress. This will be based on using up to date evidence based education and training and developing risk assessment tools for frontline clinicians to support their decision making.”

Source location

2017-0160-Response-by-University-Health-Board
Page 4 · response
Published 17 August 2017

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

Establish a falls strategic improvement group to improve assessment and response across the falls pathway.

Verbatim wording from the response

“WAST has established a falls strategic improvement group to focus on improving the assessment and response to patients who have fallen across the 5 step model to inform a ‘once for wales’ approach to falls.”

Source location

2017-0160-Response-by-University-Health-Board
Page 4 · response
Published 17 August 2017

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

Operate and expand the Clinical Support Desk telephone-triage service with additional clinicians.

Verbatim wording from the response

“1.2. Increased effectiveness of the Clinical Support Desk As the result of a service improvement initiative, WAST has invested in a Clinical Support Desk within the Clinical Contact Centre (CCC). This means that a clinician (nurse / paramedic) is available to clinically assess, through telephone triage, the needs of patients and advise on appropriate alternative care pathways or conveyance. This initiative has proved highly successful, resulting in an average of 2,500 calls per month having a non-ambulance outcome, thereby substantially reducing ambulance conveyances to hospital. Following the success of this initiative, WAST has successfully presented a business case to the Ambulance Services Commissioner and Welsh”

Source location

2017-0160-Response-by-University-Health-Board
Page 3 · response
Published 17 August 2017

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 North Wales service providing alternative community care for frequent ambulance callers.

Verbatim wording from the response

“1.3. Frequent Caller Initiative A number of patients repeatedly access the 999 emergency ambulance service where alternative care may be more appropriate for them. These individuals often have complex health and / or social needs and may have disengaged from appropriate care services.”

Source location

2017-0160-Response-by-University-Health-Board
Page 4 · response
Published 17 August 2017

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

Develop alternative pathways for catheter management, palliative care and falls.

Verbatim wording from the response

“• Developing a range of alternative care pathways including for catheter management, palliative/end of life care at home or in a nursing/residential home and work with WAST to develop a number of alternative care pathways including one for falls (see below). One authority already provides a successful palliative care service on behalf”

Source location

2017-0160-Response-by-University-Health-Board
Page 5 · response
Published 17 August 2017

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 Treatment Escalation Plans for nursing and residential homes to support safe treatment without ambulance conveyance.

Verbatim wording from the response

“Complimenting this work by WAST are a range of BCUHB initiatives to reduce ambulance conveyance/ED attendance. These include:”

Source location

2017-0160-Response-by-University-Health-Board
Page 5 · response
Published 17 August 2017

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

Protect ENP staffing and clinical space and open three additional ED rooms for minor injuries and related services.

Verbatim wording from the response

“• The ENP service has protected staffing and clinical space to ensure patients with minor injuries are treated in a timely manner.”

Source location

2017-0160-Response-by-University-Health-Board
Page 8 · response
Published 17 August 2017

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

Implement a North Wales-wide falls pathway for patients who fall at home.

Verbatim wording from the response

“• Falls: The Clinical Support Desk is working collaboratively with Wrexham Fire Service and North Wales Police to provide care and assistance to non-injury fallers within the community setting. The fire service will respond and assist the patient and while doing so, undertake preventative work including surveying the house for any immediate fall hazard risks, security and fire prevention.”

Source location

2017-0160-Response-by-University-Health-Board
Page 4 · response
Published 17 August 2017

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

Increase Minor Injury Unit access, including reviewing criteria, extending opening times and publicising availability.

Verbatim wording from the response

“1.1 Minor Injury Units (MIU) The Head of Operations for WAST has been leading work with BCUHB to increase the access to and use of MIUs by WAST, supported by a joint steering group which aims to:”

Source location

2017-0160-Response-by-University-Health-Board
Page 3 · response
Published 17 August 2017

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

Triage suitable self-presenting ED patients into co-located GP out-of-hours services.

Verbatim wording from the response

“• Work is also underway with the co-located GP Out of Hours service in the ED department to identify more suitable patients through the triage of self-presenting patients to ED for ‘pull’ into the GP Out of Hours service.”

Source location

2017-0160-Response-by-University-Health-Board
Page 7 · response
Published 17 August 2017

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

Develop alternative emergency care pathways through joint clinical workshops and prioritised workstreams.

Verbatim wording from the response

“All other patients receive a bespoke clinical response based on their condition, rather than a response based solely on a time standard. These changes sought to improve the patient’s care, outcome and experience, as well as improve patient flow into hospitals. WAST has been working with BCUHB to develop new services and alternative care pathways. Latterly, this has included holding a series of joint, clinically focused workshops across North Wales to review, identify and implement new emergency care pathways that WAST can access, some of which have been agreed in other parts of Wales. The final workshop took place on 7th July following which a number of key innovations, work streams and care pathways have been prioritised.”

Source location

2017-0160-Response-by-University-Health-Board
Page 3 · response
Published 17 August 2017

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

Evaluate the Manchester Triage System trial to inform potential alternative-pathway rollout.

Verbatim wording from the response

“• Paramedic Pathfinder The demand for emergency ambulance attendance is increasing year on year. Many patients can be treated through safe alternatives to transportation to an ED. Paramedic Pathfinder has been designed to support ambulance clinicians in assessing patients in the pre-hospital environment. It does this by enabling the exclusion of serious discriminators before any consideration is given to an alternative pathway of care other than conveyance to an ED. WAST is currently undertaking a trial of the Manchester Triage System (decision support tool) in the Abertawe Bro Morgannwg University Health Board area. This will be evaluated for potential future roll out across Wales to inform alternative pathway development.”

Source location

2017-0160-Response-by-University-Health-Board
Page 5 · response
Published 17 August 2017

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

Develop mental-health assessment training and risk-assessment tools for frontline clinicians.

Verbatim wording from the response

“• Mental Health: As a result of both service user and staff feedback, WAST has developed a Mental Health Improvement Plan outlining 6 priority areas for those with mental health needs. This includes supporting WAST staff through the use of an assessment of the patient’s mental health illness or mental distress. This will be based on using up to date evidence based education and training and developing risk assessment tools for frontline clinicians to support their decision making.”

Source location

2017-0160-Response-by-University-Health-Board
Page 4 · response
Published 17 August 2017

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

Maintain the clinical response model that clinically assesses 999 callers and prioritises life-saving responses.

Verbatim wording from the response

“In October 2015 WAST introduced a new clinical response model to implement new ways in which callers to 999 are assessed. This sought to ensure that patients and users of the service received the most appropriate care and a response to suit their individual needs. The changes made clearly identify those patients who require an immediate life-saving response and these patients receive the highest priority response in the fastest possible time.”

Source location

2017-0160-Response-by-University-Health-Board
Page 2 · response
Published 17 August 2017

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

Fully introduce unified assessment documentation for patients awaiting admission at Ysbyty Glan Clwyd.

Verbatim wording from the response

“• A modified form of unified assessment documentation for patients awaiting admission from ED has been under development. This supports the provision of inpatient level type care to ED patients, ensuring their clinical outcomes and treatment is not compromised. It is intended to fully introduce this process in early August, following a period of trial to ensure all documentation and processes are fully fit for purpose.”

Source location

2017-0160-Response-by-University-Health-Board
Page 8 · response
Published 17 August 2017

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