Position Statement 19/20

Shane Mills
Director of Quality and Patient Experience

I write this in July 2020 with Covid-19 still disrupting our services, as well as our way of life. During this time we have adjusted our quality monitoring processes and are working closely with providers to ensure their services can meet the needs of patients/residents within the restrictions and challenges of this pandemic.

Reflecting on last years business this report demonstrates we remain successful in providing vigorous assurance to commissioners, although we are not a service that rests on its (award winning!) laurels and we continue to learn and move forward and there is still much to do.

In terms of matters which concern me there was a reduction in achievement across a number of quality standards last year, especially restrictive practices, training and staffing numbers. We also saw a rise in patients being verbally abusive to staff and other patients and incidents of self-harm. We will be looking closely at all these issues in 2020/21.

In terms of successes I am pleased that we have the highest number of patients being cared for in Wales since we were established as a team 9 years ago. I am also pleased that more commissioners than ever now use the National Frameworks, with several Local Authorities making placements last year. 

We continue to increase the choice available to commissioners to better meet individual needs and we now have over 3,700 hospital beds and 2,300 care home beds available for placements.

We want to ensure that the National Frameworks, wherever possible and with due regard for quality, provide placements that are as close as possible to the patients/residents community of choice and it is positive to see that over six in ten of our adult placements are now made within fifty miles and over half our care home placements are within ten miles. The distance for placements of children remain a
concern but this will change this year with a provider in Wales being reinstated and with an overall significant reduction in children requiring a National Frameworks placement.

Last year we saw a decrease in incidents and complaints across the three National Frameworks although we will continue to work with providers to ensure that safe care is delivered.

I am proud of all members of the Quality Assurance Improvement Service, who last year, against a significant increase in depth and breadth of audits, managed to undertake over 240 reviews and we
audited every placement caring for a Welsh patient/resident. These reviews generated over 1,400 remedial actions and, with robust monitoring and oversight, the majority of these issues were rectified.

We continue to be intolerant of substandard quality and we suspended 14 units last year until we could be satisfied they were fit to care for Welsh patients. It is good to see commissioners recognising the value of the bespoke ‘Q’ quality mark and we now have the highest number of placements with ‘3Q’ providers.

We also know that, after quality, value is important to commissioners, and we have the highest number of patients/residents placed with a top five ranked provider. The value of placements made across the three National Frameworks has now reached nearly £70 million and with particular pressure on NHS finance, I am pleased that our value and cost pressure processes have managed to stabilise and in some cases reduce costs.

In 2019, we started to deploy some new audits focussing on an improvement pathway for providers. We also implemented new methods of recognising acuity, individual goal-based measures and
ways of keeping providers on track to meet patient/residents outcomes.

I am confident that these new measures have improved the quality assurance systems we have in place to ensure that Welsh patients/ residents receive high quality, safe, individual and outcome focussed services whilst moving in a timely manner through the care system.

I am delighted to publish the 8th Annual Position Statement which confirms that we can improve the quality, experience and value of care for Welsh patients/residents by working in collaboration with Health Boards, Local Authorities, regulators and providers.