Cardiff and Vale University Health Board has released details of a comprehensive service review into failing cardiology services at the University Hospital of Wales, after a six-month battle by WalesOnline to obtain the findings. Key details continue to be withheld.
The internal review was commissioned by the chief executive in July 2024. It followed concerns across a number of areas, including colleague feedback, quality and workforce indicators, and the General Medical Council (GMC) enhanced monitoring status of the service.
The investigation was carried out by a senior health board manager, a director of nursing, a consultant clinician and a member of the UHB People and Culture team. The team spoke to 70 members of staff of all professions and levels and conducted a document review.
What the review found
The review identified issues relating to infrastructure challenges, demand and capacity, behaviour and team culture, and a lack of unified vision or consistent management processes. The findings spanned behaviours, infrastructure, planning and leadership. Face-to-face briefings, chaired by members of the executive team, were held to allow colleagues to ask questions and provide feedback.
Actions and recommendations include the introduction of the Consultant of the Week model, reinstatement of Mortality and Morbidity meetings, and an Interventional Cardiology and Cardiac Surgery multi-disciplinary team. Appropriate management action has been taken over a small number of individuals whose behaviour fell outside organisational values, with some human resource processes still ongoing. The cardiology team is working with Shaping Change programme managers to implement the improvement plan, which will be reviewed by the executive team at monthly intervals.
Recommendations by theme
The review team has provided a response template for the clinical board. Recommendations are grouped into six themes: values and behaviours, checklists and processes, demand and capacity, governance, training, and workforce and structures.
For values and behaviours, recommended steps include training such as civility saves lives, organisational development focused on team dynamics, and the development of an engagement charter. Checklists and process recommendations include introducing the WHO checklist and structured debriefs in the catheter labs, further embedding the Consultant of the Week, adopting an EU whiteboard, and formalising bleep cover arrangements.
Demand, capacity and governance
The demand and capacity recommendations build on work by Cardiff University to complete the cardiology rightsizing exercise. The directorate is asked to review the conflict between tertiary and secondary care demand, examine catheter lab space requirements and whether moving to theatre 6 offers opportunities for pacing capacity, review equity of workloads, and consider benchmarking changes implemented in other health boards that support demand management.
On governance, the review recommends a shared vision and purpose co-produced with all professional groups before changes are introduced, and revised expectations for staff attendance at meetings. The directorate also needs to improve clinical audit completion, clinical incident reporting, the risk register, and responses to inspections and incidents through a quality management system.
Training and workforce
Training recommendations include management training, improvements to resident doctor training, broader multidisciplinary training, and a focus on improvements to mandatory training.
Workforce recommendations involve changes to the management structure in a number of areas within the directorate. Improvements are also needed to job planning, VBA completion rates and supervisory structures within the department.
