A lack of rigour and candour
A damning report by the Public Services Ombudsman for Wales[1] (PSOW) into ‘a serious service failure’ by the Wrexham Maelor Hospital compounded by the lack of both rigour and candour in the investigation conducted by the Betsi Cadwaladr University Health Board. It is a report that deserves reading in full.
The complaint concerned a learning-disabled adult ‘Ms A’, with limited communication abilities and several medical conditions, including epilepsy and cerebral palsy. She required 24-hour care and support, and lived in a nursing home.
In June 2022 she was admitted to the Wrexham Maelor Hospital due to concerns over the increased frequency of her seizures and (among other things) the fact that she appeared to be experiencing significant pain (grimacing, teeth grinding, yelling out). Her hospital care (or more precisely the lack of it) was objectively dreadful: in large measure due to staffing difficulties, a lack of planning, a lack of understanding of her impairments and a failure to listen to, and act on, the concerns of her family.
At the end of her ordeal a complaint was made concerning her dreadful treatment. The complaint was investigated by the Betsi Cadwaladr University Health Board. It took the view that (apart from ‘occasional gaps within the documentation’) Ms A’s care had been satisfactory.
The PSOW disagreed, finding a serious service failure; a failure to monitor and manage her pain ‘which was not only distressing for her, but for her family as well’; and that in addition, the Health Board’s investigation ‘lacked both rigour and candour’ – revealing:
significant failings on the part of the Health Board … that [it] failed to objectively review the complaint and consider Ms A’s additional needs prior to issuing its complaint response.’
That the Health Board’s response:
fell well short of what [the subsequently implemented duty of candour] promotes and is intended to achieve. The Health Board needs to ensure that in future it responds openly and honestly to complaints, and that clinicians involved in formulating/feeding into the response also reflect on both the duty, and their own professional standards obligations when doing so. (paras 95).
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The Duty of Candour became a legal requirement for all NHS organisations in Wales in April 2023.[2] It commences with the statement ‘Openness and honesty should be at the heart of every relationship between those providing treatment and care and those experiencing it.’
Only time will tell whether such a duty makes any impact on the managerial culture of the NHS in Wales