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Patient deaths in Wales under scrutiny

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drakerfordA SENIOR doctor will lead work to make sure the way the NHS reviews the records of all patients who die in hospital is consistent throughout Wales, Health Minister Mark Drakeford announced on Tuesday (Sept 16) 

In July, the Welsh Government published an independent review into hospital mortality data. It concluded the current risk adjusted mortality index (RAMI) measure is not an effective “smoke alarm” to warn about potential failings in care at a hospital. The Palmer review said the twostage process of reviewing the medical notes of all patients who have died in hospital – a system pioneered in Wales – could provide a better, more robust way of assessing safety and quality of care.

The Health Minister has announced consultant pathologist Dr Jason Shannon will look at how variations in this process can be reduced so a consistent approach is taken across the country. Dr Shannon, assistant medical director at Cwm Taf University Health Board, will lead the further development of the Wales-wide approach to mortality reviews and extending them to deaths which occur in the community. He will also examine whether independent medical examiners, who will be introduced in Wales and England under changes brought in by the Coroners and Justice Act, could be responsible for the first stage of the case note mortality review process in Wales.

Professor Drakeford said: “The evidence from mortality case reviews demonstrates very clearly that deaths in Welsh hospitals are overwhelmingly not avoidable. Each one is a matter of intense sorrow and distress to those individuals most closely involved, including those who have provided care to the person who has died. “It is from these reviews that health boards learn how the overall quality of care can be improved. While mortality case note reviews already provide the most reliable and informative means of analysing deaths in hospitals there is more that can be done to improve the process further. “I am pleased to announce Dr Shannon will lead this work to develop the Wales-wide approach to mortality reviews and extending them to deaths which occur in the community.”

Consultant Pathologist and Assistant Medical Director at Cwm Taf University Health Board Dr Jason Shannon said: “In Cwm Taf, we do not rely solely on mortality indices to tell us about patient safety, we are pioneering the process of examining in detail the clinical record and circumstances in which a patient dies in hospital – the case note mortality review. “From April 2013, the hospital notes of every patient dying in either Prince Charles or Royal Glamorgan Hospital have been or are in the process of being reviewed by a team of senior clinical staff including GPs, hospital specialists and senior nursing staff.

As of April 2014 we extended this process to other hospital sites across Cwm Taf. “Our aim is not just to prevent avoidable death but to prevent any harm to patients, especially that which results in long-term suffering or disability. The process has already been valuable in highlighting areas where we think we could do better. For example, we have put in place more effective measures to reduce the risk of patients developing blood clots and significant infection during hospital admission. “I am delighted to be taking up the role on behalf of Welsh Government to work with other health boards to expand this work across the Welsh NHS.”

 

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Education

Sam Kurtz quizzed by primary school pupils about how was is governed

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PUPILS at St Oswald’s VA Primary School welcomed a visit from local Senedd member Samuel Kurtz on Monday (Feb 2), as children put questions to him about how Wales is governed.

Years five and six pupils took part in an interactive session where the Senedd Cymru member explained the role of the Welsh Parliament, how laws are made, and how elected representatives support local residents.

He outlined what a Member of the Senedd does day-to-day, how decisions affecting communities are taken, and why taking part in democracy is important.

The pupils were then given the chance to quiz him directly, raising questions about politics, local issues and how young people can make their voices heard. Staff said the children showed strong interest and came well prepared.

Speaking afterwards, Mr Kurtz said: “It was a real pleasure to visit St Oswald’s and see such enthusiasm and curiosity from the pupils.

“Understanding how democracy works and how decisions are made is important, and it is encouraging to see young people taking an interest in how their community and country are run.

“I was particularly impressed by the quality of the questions, which showed they had clearly done their research.”

Teachers described the visit as a valuable opportunity to bring lessons about citizenship and Welsh democracy to life.

The school visit forms part of Mr Kurtz’s ongoing programme of meeting with schools, community groups and residents across Carmarthen West and South Pembrokeshire.

 

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Crime

Police confirm teacher was stabbed at school as teenager appears in court

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15-year-old charged with Section 18 GBH with intent and possession of a bladed article on education premises

POLICE have confirmed that the teacher injured during Thursday’s lockdown at Milford Haven Comprehensive School suffered stab wounds, as a 15-year-old boy appears in court today (Saturday, Feb 7).

Dyfed-Powys Police said the teenager has been charged with Section 18 grievous bodily harm with intent and possession of a bladed article on education premises. He has been remanded in custody and is due before Swansea Magistrates’ Court this morning.

Emergency services were called to the school at around 3:20pm on Thursday (Feb 5) following reports that a member of staff had been assaulted by a pupil. The school was placed into immediate lockdown and police said all learners later returned home unharmed.

The injured teacher has since been discharged from hospital and is recovering with support.

Detective Chief Inspector Matthew Briggs said: “We are continuing to support the victim whilst they recover from this traumatic event. Following detailed enquiries by specialist officers, injuries initially assessed and described as non-stab injuries have now been confirmed as stab wounds.

“A statement at an early stage of the investigation was based on preliminary information available at the time.

“There will continue to be a higher than usual police presence in the area over the coming days to provide further reassurance. Officers will be working closely with local secondary schools to offer support over the coming week.”

In a joint update issued by the local authority and the school, deputy headteacher Daryl John thanked staff and the small number of pupils who remained on site, saying they acted “with professionalism” and were “calm throughout”. He added that the school community was grateful for the “rapid and effective response” of the emergency services and sent best wishes to the injured colleague for a “full and speedy recovery”.

Pembrokeshire County Council leader Cllr Jon Harvey confirmed the school will reopen on Monday, with additional support available for pupils and staff affected by the incident. He said lockdown procedures are routinely rehearsed so that, in rare cases where they are needed, everyone knows what to do.

The school was closed to pupils on Friday, with the town noticeably quieter than usual as children stayed home.

Police enquiries are continuing and further updates are expected following the court hearing.

 

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Local rugby talent Osian Williams selected for Wales Under-20 clash with England

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A FORMER Haverfordwest Blues junior has earned international honours after being selected to represent Wales Under-20 rugby union team in their fixture against England.

Osian Williams, who began his rugby journey at Haverfordwest Rugby Football Club, will pull on the red jersey this evening in what marks a proud milestone for both the player and the Pembrokeshire club that helped develop his talent.

Club members said the call-up reflects years of hard work, commitment and steady progress through the ranks, with Williams recognised locally for his determination and performances on the pitch from a young age.

A spokesperson for Haverfordwest RFC said the whole club is “incredibly proud” to see one of their own step onto the international stage.

They added that it is always special to watch former junior players progress to represent their country, describing Williams’ selection as “fully deserved” and an inspiration to the next generation coming through the Blues’ youth setup.

The match against England provides a stern test for the young Welsh side, but for Williams and his family it is also a moment to savour after years of dedication to the sport.

Friends, coaches and former teammates are expected to be cheering him on from Pembrokeshire as he makes his mark in Welsh colours.

Photo caption:

Osian Williams has been selected to play for Wales Under-20s against England (Pic: Supplied).

 

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