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Health boards should not investigate serious concerns about themselves

Work still to be done to improve the governance processes of health boards throughout Wales

Louise Prime

Thursday, 31 January 2019

More work must be done to improve the governance processes of health boards throughout Wales, BMA Cymru Wales warned this morning, after a “deeply troubling report” identified weaknesses in the quality and safety governance arrangements at Abertawe Bro Morgannwg University Health Board and criticised its actions following several allegations of sexual abuse against the same member of staff. The BMA has called for urgent steps to ensure patient safeguarding, and said there is a “dire need for an individual within Health Boards with whom staff can raise concerns”.

Between 2011 and 2013, three female patients who received care from the learning disability service made allegations of sexual abuse against Kris Wade (Mr W). He was suspended from work in 2012 following the abuse allegations, but was still an employee of the health board in 2016 when he was arrested and convicted of murdering his neighbour Christine James. The health board carried out its own internal ‘desktop’ review – which considered only documentary evidence – to look at how it had handled the allegations and the subsequent disciplinary process. This identified some shortcomings in its processes, and established an action plan for improvement. But it also concluded that Mr W’s actions could not have been “predicted or prevented”.

The Welsh Government asked Healthcare Inspectorate Wales (HIW) last September to carry out an independent review of the health board’s actions, focusing on staff recruitment and employment, incident reporting, adult safeguarding, and governance and culture. HIW’s review considered whether: the health board’s internal review was sufficiently thorough; its conclusions were appropriate on the basis of the evidence considered; its actions in light of those conclusions were adequate to ensure patient safety; additional or different conclusions should be reached on the basis of additional evidence considered during this review; and there was any wider additional learning for the NHS in Wales.

HIW said in its report that the fact that the first allegation “was not initially recognised as a safeguarding incident despite being repeated to staff highlights the importance of listening to patients”, and it pointed out that there was a delay in removing Mr W from clinical duties.

It also found that the health board’s investigation of the allegations under its disciplinary process “took an excessively long time because it did not provide any additional resources to support the disciplinary investigation”.

HIW noted that Mr W did not have a Disclosure and Barring Service (DBS) check when he was employed, that there were a number of employees within the mental health and learning disability directorate who do not have a DBS check because their employment had predated the requirement for those checks, and that DBS checks are also not updated on a regular basis.

It commented: “The weaknesses identified in the health boards handling of this case strongly suggest that senior health board staff did not appreciate the seriousness or complexity of the allegations at the time.”

Dr David Bailey, chair of the BMA’s Welsh council said: “When we called for the independent report in 2017 we said that health boards should not investigate serious concerns about themselves. Today’s report confirms this and shows that there is still work to be done to improve the governance processes of health boards throughout Wales.

“Despite concerns being raised by us for a number of years, it is disappointing that the report found that the reporting structure for quality and safety remains unclear. The Health Board has had a significant amount of time to rectify this and has not done so. It is imperative that they now take urgent steps to put in a robust structure to ensure the safeguarding of patients.

“It is deeply troubling that the report found that ‘some executive Board’ members were individually aware of the details of the allegations against Kris Wade throughout the investigation and that these were not formally reported to the Board.

“I note that the Minister has accepted the recommendations for the Welsh Government in their entirety. This report highlights the dire need for an individual within Health Boards with whom staff can raise concerns. BMA Cymru Wales stands ready to work with the Welsh Government and Health Boards to implement these recommendations.”

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