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January 22, 2013

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HSE harsh in assessment of hospital’s failings, report concludes

An independent review of serious management failings concerning asbestos at a hospital in Wales has disputed the HSE’s earlier judgement that strategic management arrangements at the Trust were “wholly ineffective”.
 
The review was commissioned by NHS Wales following revelations that up to 30 maintenance workers at Bronglais Hospital, in Aberystwyth, may have been exposed to asbestos between 2004 and 2009, during which period the hospital’s controls in managing the hazardous substance were found to be inadequate.
 
The hospital, previously under the control of the former Ceredigion and Mid Wales Trust (CMWT), had failed to take suitable action after a survey in 2004 found asbestos in stairwells and lift shafts. However, the issue only came to light in 2009, when the hospital came under the control of the newly-formed Hywel Dda Health Board.
 
Once informed, the HSE carried out its own investigation and, in 2011, found that “the strategic management arrangements in operation at Bronglais Hospital, in respect of health and safety, were wholly inadequate”.
 
Despite its findings, the regulator was unable to prosecute the Health Board because a legislative error, relating to the restructure of NHS bodies, failed to ensure that matters of previous corporate criminal responsibility were transferred to the new Health Boards. All “senior accountable managers” who worked at the hospital between 2004 and 2009 had also left the organisation.
 
NHS Wales commissioned Dr Clive Grace, former director-general of the Audit Commission in Wales, to undertake a further review, with the aim of identifying the key events between 2004 and 2009, which led to the mismanagement of asbestos at the hospital.
 
Issued yesterday (21 January), Dr Grace’s report described the HSE’s judgement as “harsh and extreme, even if confined to health and safety matters”. Instead, he concludes “there were weaknesses in systems, behaviours, and judgements made, and significant failures to observe relevant guidance”.
 
The report also placed more weight on individual actions and non-actions, which were aggravated by thin managerial capacity at the Trust. Although he did not recommend action to be taken against any individual, he singled out the former head of estates, director of facilities and chief executive during the five-year period in question as directly responsible (in declining order) for the default.
 
In particular, the report criticises the head of estates for failing to request a summary report of the asbestos survey and provide feedback up the chain of command. The arrival of the full asbestos report coincided with pressures in this individual’s personal life – a fact that Dr Grace’s report notes – and an increased workload, following the departures of four other members of staff.
 
Dr Grace allowed each of the three individuals to respond to the criticisms, with the head of estates showing clear opposition to his findings. “I disagree with your support for the strategic mechanisms and think the HSE report a truer reflection of circumstances at the time,” wrote the individual. “Surely any strategic framework must be fit for purpose and should have picked up the absence of feedback from the report. It should also ensure the organisational framework and staffing structure can deliver the organisational objectives.”
 
A spokesman for the HSE reaffirmed to SHP that the failure to transfer criminal liabilities meant there was no prospect of a successful prosecution, adding: “Our investigation report makes clear our view of the situation at Bronglais and how it arose. This report is unaffected by Dr Grace’s findings.”
 
Dr Grace’s report makes a host of recommendations to improve the governance and management of health and safety in the NHS Wales, including:

  • the NHS Wales Shared Services Partnership completing a thematic audit and assurance of health and safety management in NHS organisations;
  • the Wales Audit Office including health and safety management in its  structured assessments of NHS organisations; and
  • the Health Inspectorate Wales including health and safety management as a theme in its next round of health-care summits.

All the recommendations have been accepted by the NHS Wales. Dr Grace’s report can be found at: http://wales.gov.uk/topics/health/publications/health/reports/asbestos/?lang=en

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