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Audit Wales finds healthcare services need improvement

24 September: Audit Wales has issued reports examining waiting lists, clinical coding and cost overruns incurred refurbishing a hospital in North Wales.

Audit Wales, the body established by the Welsh Parliament to audit public bodies in Wales, has recently issued three reports on operational and financial management in NHS Wales. 

COVID impact

One report looks at the negative impact COVID-19 has had on NHS Wales waiting lists and recommends several actions to build a better-planned healthcare system. At the end of May 2020, 148,000 patients had been waiting for more than six months – almost double the number who were waiting at the end of January 2020.

Audit Wales believes a wholesale change in the way NHS Wales operates is needed if the system is to be capable of meeting waiting time targets. Ten opportunities are suggested as a means of creating a sustainable process for treating patients promptly.

These include ensuring the system identifies and prioritises patients in most need of treatment, working with patients to explore alternative treatment options to avoid long waiting times and re-introducing services in a careful and planned way post the immediate COVID challenges. 

Clinicians and data scientists need to work together reviewing patient lists to determine whether surgery or treatment is the best option, while more and better public health messages are needed to encourage people to take more responsibility for their own and everyone else’s health by, for example, taking up flu jabs and maintaining social distance.

Longer-term suggestions include examining whether waiting list targets are helping services focus on what matters (or not). Strengthened leadership around change, learning lessons from the response to the pandemic, involving patients in reviewing service changes and being honest about what capacity and resources are needed would help over the long term to sustainably deliver planned care for NHS Wales. Measuring progress and success should be based on what matters to the patient.

Clinical coding

A second report examining the operation of clinical coding found NHS Wales was left wanting in giving clinical coding the profile it needs. 

Clinical coding is the process of translating medical information relating to a patient’s hospital admission into standardised codes which can be used for a range of statistical, clinical and management purposes. It is core to the information used by NHS organisations to govern the business and to ensure that resources are used efficiently and effectively.

It takes, on average, 18 months to train as a clinical coder and there is a target of 95% of clinical episodes being coded within a month of occurrence.

Adrian Crompton, Auditor General for Wales, said, “The importance of good quality information has come to the forefront during the coronavirus pandemic, now is the ideal opportunity to ensure that clinical coding has the attention that it needs as services start to be reinstated.”

Audit Wales recommends that senior leaders in NHS Wales provide sufficient profile to clinical coding, recognising its importance by having a named national lead for the expertise. Clinical coding should be included in the core training for junior doctors and that of independent board members. Further recommendations include identifying a way to measure and identify clinical workloads, making faster progress in digitising patient records and using IT systems to support code identification.

Major refurbishment costs

The third report was on the cost of the refurbishment of Ysbyty Glan Clwyd, a hospital in North Wales. Problems with asbestos prompted a major refurbishment, but the cost of £170.8m was almost 55% more than originally budgeted. More positively, the refurbishment was completed almost to time. Earlier reviews into the works concluded that there were weaknesses in the preparation of the business case and significant deficiencies in the governance and management of the project. These concerns have since been considered and actions taken to make improvements in how major projects are managed.

Commenting on the three reports Alison Ring, director for public sector at ICAEW, said: “Audit Wales is right to focus on how putting data to good use, be it to reduce waiting times for patients, provide accurate shielding information for GPs, or a better understanding of Covid-19 related demand on healthcare services, can help improve how healthcare services are provided to patients across Wales.

These reports highlight the importance of high-quality data, robust processes and strong financial controls in providing the best quality of healthcare and to being efficient in how that care is delivered.”

Read the three reports in full here: