Below is a copy of the full statement given to Tynwald's Social Affairs Policy Review Committee, by Minister for Health and Social Care Kate Beecroft MHK:
Mr Chairman, I have been clear during my time as a Member of the House of Keys that when it comes to the provision of care, the safety and wellbeing of patients and service users must always be the number one priority. This should be the guiding principle for everyone involved in delivering care, managing services and setting policy: from nurses, doctors and social workers, to administrators and senior managers, and of course political leaders.
Having said that, I want to say clearly that the decision to consolidate endoscopy services was done for that reason, and that reason alone.
It is a matter of profound regret to me personally as Minister, and for my colleagues in the Department, that the way events have unfolded over recent weeks has caused upset. I regret that the Committee has had reason to review this subject, given its already busy workload.
I return now to the matter of patient safety Mr Chairman. Further to my letter on 15 June, the Committee – and the wider public – is now aware of the circumstances that necessitated urgent action in relation to how the endoscopy service is delivered in the Isle of Man. Namely, the identification that a group of people have been waiting longer than the recommended time for a follow-up gastrointestinal endoscopy.
I am sure members of the Committee are as concerned and disappointed as I am that this situation has arisen.
What I can assure the Committee, Mr Chairman, is that when the information became known to me, the political Members, and the Chief Executive, immediate action was taken.
Had this not, in fact, been the case, I very much expect I would have found myself before this Committee on the same subject, but for a different reason: the failure to urgently address a serious matter of patient safety.
I am conscious that in other representations made to this Committee there has been talk of the need for consultation. This is understandable and the Department very much welcomes and embraces a collaborative approach. This method of working is a regular ‘business as usual’ occurrence across the Department and is, in fact, how many of our services have developed over time, not least in Ramsey.
But, Mr Chairman, the situation with endoscopies was not business as usual. Given the risk to patients involved, urgent action was required.
When the issue was raised, it appeared that as many as 500 patients could have been affected by late endoscopy surveillance. It was clear that additional capacity in the service would be required, whether from existing resources or through other means.
As Minister I was presented with a serious and alarming risk to patient safety but also presented with a proposal that would rectify what, from initial analysis, appeared to be a contributing factor: the unacceptable waiting times for endoscopies – an average of 33 weeks for a routine appointment – and the high number of individuals waiting for a first-time or follow-up endoscopy – over 1,650 people.
The proposal to consolidate the endoscopy service would enable the Department to dramatically increase capacity and, in turn, within 12 months, bring waiting times down to six weeks, in line with targets in England.
As well as helping to address the unacceptable waiting times, the additional capacity would provide clinicians with the ability to swiftly see the cohort of patients whose endoscopy surveillance time had been breached. Crucially this could be done with minimal disruption to the service – particularly in regard to urgent endoscopies, required where cancer is suspected, which the Department aims to undertake within two weeks of referral.
Again, Mr Chairman, representations have been made to this Committee expressing views that perhaps the Department should have devised different options, evaluated them and developed business plans before determining a course of action and proceeding. I state again that this was an urgent issue, requiring urgent action.
One way to increase capacity was recouping time spent by doctors travelling between Noble’s Hospital and Ramsey and District Cottage Hospital. This accounted for up to two hours each week. Over the course of a year this equates to approximately 100 hours of time that could – and should – be spent with patients. It is estimated that between 200 and 300 endoscopies a year could be carried out in this time, depending on their length and complexity.
Mr Chairman, the doctors in the general surgical and gastroenterology team who were carrying out endoscopies in Ramsey were not based at that facility. Running the endoscopy service is just one of their many duties and responsibilities, the remainder of which require their presence at Noble’s Hospital: from performing surgery in theatre to outpatient clinics and carrying out ward rounds.
I am concerned that public commentary and indeed evidence given by others to this Committee seems, at times, almost to pit Noble’s Hospital and Ramsey and District Cottage Hospital against each other, as though they are in competition. They are not. Any undertones of this nature are unwelcome and serve as an unnecessary distraction.
I need not remind the Committee that we have a National Health and Care Service, which is delivered or commissioned by the Department of Health and Social Care. One health and social care service – one team.
Returning then to the consolidation exercise, Mr Chairman, recouping the hours spent travelling by doctors alone would not be enough to transform the service, which was clearly required. By combining the endoscopy staff into a single team on a single site and redistributing existing clinicians and healthcare professionals, an additional 21 hours of endoscopies per week can now be provided – that’s capacity for 30 additional procedures per week on average.
This redistribution means there are now two rather than three endoscopic practitioners – registered nurses or healthcare assistants – supporting the doctor, as had been the practice in Ramsey. So we are using the same resources to deliver more, and this approach is in line with guidelines and best practice from the Joint Advisory Group on Gastrointestinal Endoscopy.
Overall, I think there is little doubt that it was sensible to consolidate the endoscopy service at the Island’s new, state of the art, purpose designed and built endoscopy unit in Noble’s Hospital. The consolidation meant that some specially trained members of staff were asked to do endoscopy sessions at Noble’s Hospital, and meant that the equipment would need to move with them.
After detailed review, 157 patients were found not to have been called for their endoscopy surveillance on time, which was better than the worst case scenario which we had estimated originally of around 500.
The Committee will understand that we were obliged to establish the number of patients affected by the delays and contact them first before any public announcement could be made.
To have done otherwise would have been wholly wrong. Had we written to everyone initially suspected as being affected, we would have undoubtedly caused unnecessary distress to hundreds of individuals in our community.
Moreover, to have haphazardly announced the situation whilst the Department had yet to establish the full facts, would potentially have caused undue worry to everybody waiting for a first-time or follow-up endoscopy – over 1,650 people.
Mr Chairman, I hope I have explained that when the public became aware of the decision to consolidate the service, why the Department was not in a position to make the full facts publicly available – just as I and the Chief Executive were not in possession of the final set of information from the clinical review at my last appearance before this Committee.
When the situation with delayed follow-ups became apparent and a way forward agreed, wheels did, however, need to be set in motion, to explore the operational implications of consolidating the service so that this serious issue could be addressed promptly. This involved initially making only key staff aware that there was a serious patient safety issue. At a time when the facts were still being established, senior managers weren’t in a position to provide more detail. Perhaps, understandably, word quickly spread – although without the full understanding of the reason for our action of course - and key stakeholders were alerted to the situation by third parties, and were not informed in the manner I would have liked.
The Welfare Trustees and the League of Friends became aware of the situation before the Department had the opportunity to raise the matter directly with them and with the courtesy and sensitivity one would expect. I apologise for that.
Understandably they feel aggrieved and feel that their interests have been disregarded in the process, which was not the Department’s intention.
I hope it is clear that the duty of the Department, not to cause undue alarm to patients, meant that the Department’s hands were tied and that the full reasons could not be announced until the final number of patients was identified and all had been contacted.
I make no apology for the fact that my, and the Department’s, primary concern was and remains those 157 patients whose follow-up endoscopies have not taken place when they should have. Likewise we are concerned about the high number of people waiting for an endoscopy, who deserve a faster service.
The Department’s responsibility, first and foremost, has been and must remain the safety of patients. Whilst I accept that there remains a sense of frustration at the way events unfolded, I hope, at least, the Committee can appreciate that the decision to relocate staff and equipment from Ramsey was done in the interest of patients, with the best of intentions, and to address an urgent situation.
We must and will work to rebuild valued and important relationships, not least with the Ramsey and District Cottage Hospital Welfare Fund and the League of Friends of Ramsey and District Hospitals.
-----------------
If the Committee will allow me a few more moments, Mr Chairman, I do also wish the set the record straight on a number of matters in light of evidence given on this subject last week. Some of these points may seem trivial to the layperson, but I believe it is important that the correct facts are placed on record.
• I want to make it clear that, unlike at Noble’s Hospital, which has a dedicated three room Endoscopy Suite, there is no Endoscopy Suite at Ramsey and District Cottage Hospital. Endoscopies undertaken there are accommodated in the theatre.
• On that topic, I also wish to say again that the theatre in Ramsey has not been closed. The only theatre activity that has transferred from Ramsey is endoscopies and the nursing staff who provided this service at Ramsey are ‘visiting’ Noble’s Hospital to deliver the service there. Their base remains Ramsey and District Cottage Hospital, and their oral surgery and dermatology surgery duties in Ramsey have not changed.
• At no stage have I or officers implied that endoscopies carried out at Ramsey or the hospital’s endoscopy facilities there are unsafe. I made this clear at the public requisition meeting on 23 May and again in my written follow-up to Ramsey Town Commissioners on 7 June.
• Urological endoscopies – called cystoscopies – have been and continue to be undertaken at Noble’s Hospital with two clinics a week.
• The possibility of a further waiting list initiative at Ramsey has been suggested as an alternative to the decision taken by the Department and one that would have been less disruptive.
We must, Mr Chairman, be realistic. Waiting list initiatives are only sustainable if a way to increase capacity or reduce demand in the long term has been identified. Otherwise as soon as a list is cleared and a service reverts to its business as usual capacity, the list once again begins to build up. In addition to this, waiting list initiatives are carried out by bringing in additional capacity - meaning paying staff additional hours, or bringing in locum and agency staff all of which are cost prohibitive. Whilst in this particular situation patient safety was the priority, I am sure I need not remind the Committee that the Department has a ?10 million savings target, must contribute to the SAVE scheme, and has required a supplementary vote in each of the last two financial years. A matter already before the Public Accounts Committee. The solution implemented delivers greater capacity, within existing resource at a time of significant financial pressures.
• Consultation and discussion did take place with the doctors responsible for delivering the gastroenterology endoscopy service and, I am advised, they fully supported the proposal given the urgency of the situation. Likewise consultation took place with operational managers at Noble’s Hospital.
• An alternative proposal put to us by theatre staff in Ramsey – which is to be commended – was considered, but it did not mitigate the doctors’ travelling time and therefore did not address the loss of up to 300 procedure slots a year.
• I am advised that the theatre team visiting Noble’s Hospital from Ramsey continue to work together and have not been split up. Bank staff are only used to backfill vacancies and staff absence.
• Mention was made last week by Mr Singer of 10 “capsule endoscopy” sets in stock at Ramsey now being out of date. This is odd, as there was an average of one capsule procedure a week in 2016/17. I have asked for further information and will report back to the Committee when I have it.
Thank you Mr Chairman.
