The Health and Social Care Board today received a performance report on aspects of services provided by the Western Trust. This had been triggered by under performance in reporting hospital x-ray at Altnagelvin Hospital, performance against breast care targets, and performance issues in respect of a number of high profile cases in child care and learning disability services.
The Board can report that the performance standards the Trust is required to meet in respect of these issues are now fully restored. As part of the work undertaken, the Trust processes were reviewed to ensure their compliance in handling such issues. Again the Board can report that it is satisfied with the outcome, subject to the implementation of recommendations made to the Trust. At forthcoming regular performance meetings, which occur monthly, the Trust will be required to continue the maintenance of performance standards and advise on progress on its recommendations.
Turning specifically to the matters examined, it is worth note that the majority had been fully in the public domain. The Board has always made it clear that this type of work will be appropriately made public and is doing so today.
The Board is aware that the issues reviewed may, by their very nature, cause concern or anxiety with individuals or local communities. The purpose of performance management is to systematically identify problems and ensure their resolution, and it is in this context that the work was undertaken.
This review demonstrates the importance of performance management within the HSC system, and reaffirms the ongoing commitment of the Board to ensure that the highest possible quality of care is available to the population.
The areas addressed under the review were as follows:
Following a report to the Board in July 2010, it became clear there was potential for a substantial number of reports on routine x-rays not to be completed within the agreed standard of a maximum of 28 days.
Immediate action rectified the position in regard to new patients and an exercise was undertaken to scale the extent of the problem. In August, this was sized at 18,500 of which around 3,400 were chest x-rays. Part of the
process was to risk assess the implications and be clear as to which patients were involved. From August to October, a detailed weekly report was required to ensure the backlog was addressed. Specifically, this required an analysis of any patient who might need recalled. Four patients were recalled and had their individual circumstances discussed with clinicians. As part of this review, Professor Gishen of Imperial College London, at the behest of the Board, reviewed the Trust’s radiology department and indicated that professional practice by those working there is fully acceptable.
2. Breast care
At the public Board meeting in September 2010, the underperformance against the 14-day target was reported. Immediate steps were required from the Trust to return to 100 per cent. This was substantially achieved by November (99 per cent) and involved, among other things, providing extra clinics, and is now at 100 per cent.
3. Children’s services
In December 2009, baby Milly Martin died. While the family confirmed publicly that baby Milly was not known to social services at that time, protocol requires a multi agency case management review (CMR) to be undertaken when a child dies and abuse or neglect is known or suspected. The CMR will look at all relevant issues but cannot report until criminal proceedings are completed.
A major review by Mr Henry Toner QC into social services involvement with Arthur McElhill, who murdered his family in Omagh in November 2007, found that no agency could have foreseen these tragic events. Mr Toner published his report in July, 2008. The Trust has taken forward the recommendations from Mr Toner’s report and in December 2009 the Minister for Health and Social Services asked him to assess the progress made. This report is awaited.
On 3rd September 2010, as a result of a judicial review, Mr Justice Treacy found that the Trust was required to review the timescales in which it assessed and then provided support to children in need and their carers. Outstanding assessments have subsequently been addressed.
4. Learning Disability
There was significant community, public, media and political interest and disquiet at the handling of the McDermott brothers’ cases and in September
2010, the Health and Social Services Minister, Michael McGimpsey MLA, asked RQIA (Regulation, Quality and Improvement Authority) to undertake an external review of them. RQIA subsequently found that the Trust had met the requirements of relevant legislation and policy in its supervision, care and treatment of the McDermott brothers.