RUTH COLE 74, of Pembroke, died at Withybush Hospital on May 17, 2022, after waiting several hours for a critical scan. An inquest held at County Hall in Haverfordwest on October 18, raised questions about the timeliness and adequacy of her care, with testimony from medical experts and hospital staff indicating potential failings in procedure.

The inquest heard that Mrs Cole was admitted to Withybush Hospital with a high National Early Warning Score (NEWS) of 9—a marker indicating severe illness. Despite receiving initial treatment, her score climbed to 11 within ninety minutes, showing her condition was deteriorating. According to guidelines, a critical score like this should prompt a call to the hospital’s medical emergency team within two hours. However, the inquest revealed that this protocol was not followed, with significant delays in escalating her care.

Senior emergency department nurse, Nurse Dyer, who investigated Mrs Cole’s death on behalf of the health board, told the inquest: “Mrs Cole’s condition was worsening, and she should have received more urgent attention.” She added, “The body can only endure so much when faced with persistently high NEWS scores.”

After several hours, Mrs Cole finally underwent a scan, which was subsequently sent to an external company for assessment. The scan showed she had an ascending aortic aneurysm—a life-threatening condition requiring immediate surgery. Plans were made to transfer her to Morriston Hospital for emergency treatment. Tragically, before she could be moved, Mrs Cole suffered a fatal cardiac arrest at 3:50am on May 17.

The inquest presented findings from independent experts who testified about the impact of delays in her care. Dr John Heyworth, an emergency medicine expert, explained that several of Mrs Cole’s symptoms were consistent with an ascending aortic aneurysm and that the time it took for her scan and diagnosis raised serious concerns. He stated that, had Mrs Cole reached theatre at Morriston by 3:00am, her survival rate for surgery would have been between 75-90%, with an estimated 50% chance of surviving for five years.

Another expert, Mr Lall, noted that the failure to diagnose her condition earlier and arrange a prompt transfer to a specialist facility deprived her of a potential recovery. “Had she been moved sooner, there was a realistic chance of a successful outcome,” he testified.

In his closing remarks, Pembrokeshire Coroner Paul Bennett concluded: “Ruth Susan Cole died from complications due to an untreated ascending aortic aneurysm. The delayed diagnosis and transfer likely affected her outcome. In light of expert evidence, it cannot be said that her death was an inevitable consequence of her condition.”

Since Mrs Cole’s death, Withybush Hospital has implemented procedural changes, including adjustments in staffing levels, to prevent similar incidents in future. Roy Pope, Mrs Cole’s husband, also spoke at the inquest, voicing his distress and disappointment: “She went into hospital. All the signs indicated her condition was worsening. There was no intervention. Something should have happened sooner. This day should never have happened.”

NHS performance data released on Thursday, October 23, contained more bad news for the Welsh Government.

The number of open patient pathways increased from 796,631 in July to 800,163 in August, the highest figure on record and equivalent to one in four of the Welsh population.

Two-year waits increased again for the fifth consecutive month to 24,193 in Wales.
By the end of August, the average (median) time patients waited for treatment was 23 weeks, an increase of 1.1 weeks from the previous month.

Only 49% of red calls (the most serious) received an emergency/ambulance response within eight minutes in September, a fall of 2.8 percentage points since August.

Performance against the 62-day target for patients starting cancer treatment was 56.5% in August.

As Eluned Morgan’s administration continues to struggle with the legacy of poor service delivery and failures to meet performance targets, her successor as Health Minister, Jeremy Miles, hunted for light amid the gloom.

On the same day that the Welsh Government released the performance data, Mr Miles announced £28m in extra funding to help health boards cut the longest waits.

The Cabinet Secretary for Health claimed, “This new funding will pay for more evening and weekend appointments, high-volume clinics, and regional work to target the longest waits in specialities such as orthopaedics, ophthalmology, general surgery and gynaecology.”

The money is certainly needed.

Speaking about the performance data, Mr Miles said: “Despite record levels of demand across the sector, today’s figures show some progress in both diagnostics and therapies, as well as an increase in performance against the 62-day cancer target to 56.5%.”

You know things are bad when being below two-thirds of the way to hitting a performance target is spun as good news.

Mr Miles highlighted that urgent and emergency care services were under pressure, with the second highest daily number of ‘red’ (immediately life-threatening) calls reported on record, and sustained pressure at emergency departments.

Mr Miles tried adding context to increases in ambulance response times by adding that the Ambulance Service responded to the second-highest number of people in the red category in eight minutes ever. However, there was no getting away from a decline against targets set by the Welsh Government.

Mr Miles concluded: “We recognise more work needs to be done to support people with urgent care needs in the community and to improve the timeliness of discharge home to help reduce long stays in ambulances and emergency departments.”

Meanwhile, speaking to BBC Wales, Mr Miles’s boss said she was asking for extra NHS funding in Rachel Reeves’s first budget as Chancellor of the Exchequer.

The First Minister told BBC Wales Live: “I’m really keen to see an injection of money for the NHS in England because we will then get a significant amount of money that will come to Wales as a consequence of that.”

Although that’s superficially good news, regardless of how much money is allocated to the NHS in England, the Welsh Government sets its own budget from the Treasury’s block grant.

That means increases in funding for the NHS in England will not necessarily mean an identical percentage increase in funding for the NHS in Wales.

That is down to Welsh ministers and their priorities.

Opposition parties in the Senedd are likely to press the Welsh Government to spend much more on health, bearing in mind its fragile state in Wales, while cutting spending on “nice to have” projects to bolster essential public services.

Sam Rowlands MS, Welsh Conservative Shadow Health Minister, was scathing about the performance data: “As NHS waiting lists continue to soar, Labour has proven itself as the party of broken promises.

“The additional cash that Baroness Morgan is pleading for will be too little too late and is a testament to Labour’s failure to prioritise the Welsh NHS. Crucially, any cash won’t be coupled with the vital reforms or long-term thinking we need to bear down on these excessive waits.

“Only the Welsh Conservatives have a plan to roll out surgical, diagnostic and care hubs to ease the pressure on hospitals and to recruit and retain healthcare workers with a tuition fee refund.”

PLANS to restrict profit making in the care of looked-after children cleared the first hurdle in the Senedd amid concerns about unintended consequences.

Senedd members voted to agree to the principles of the health and social care bill, which aims to restrict private profit, but warned of “huge risks” in practical terms.

Dawn Bowden, Wales’ social care minister, cautioned that the cost of caring for looked-after children has increased from £60m a decade ago to around £200m today.

“If we carry on that trajectory, we will be looking at a bill for local authorities of around £1bn in the next ten years,” she said, stressing that doing nothing is not an option.

Ms Bowden added: “We don’t want to see children treated as commodities in the care sector; we want to see investment in the care of our looked-after children.”

Russell George, who chairs the Senedd’s health committee, called for investment beyond the £68m the Welsh Government has already committed to the policy.

The Conservative said a majority of members supported the principles but the committee raised “very real concerns” about how the bill will work.

Mr George told the Senedd: “There are huge risks for the sufficiency and sustainability of residential and foster places … as an unknown number of providers leave the market.”

He said the cost of caring for looked-after children has risen dramatically in the past decade, which seems unsustainable with councils already facing enormous pressures.

Plaid Cymru’s Peredur Owen Griffiths raised the finance committee’s concerns about the “disappointing, below par” quality of information provided alongside the bill.

He said the minister wrote to the committee in October to confirm the total cost of the bill at £429m to £455m, a full three months after giving evidence.

“Although we are grateful for the clarification, this approach is simply not good enough,” said the committee chair who raised concerns about “fundamental ambiguities”.

Buffy Williams warned the bill makes it easier for councils to place children out of county.

The Labour chair of the children’s committee explained councils would be required to find accommodation “within or near to” the area rather than the current “must be within”.

She said: “We have significant concerns about this proposal…. Given the critical shortage of quality placements, we fear these provisions will mean that children are inevitably placed further away from their homes.”

Altaf Hussain, the Conservatives’ shadow social care minister, said the bill has admirable intentions but he warned of unintended consequences.

“This bill could lead to a huge decline in the care of looked-after children,” he said.

Dr Hussain told the Senedd seven councils in Wales provide no care at all, “so the private sector is the only game in town”, as he criticised ministers for “demonising” providers.

Mabon ap Gwynfor, Plaid Cymru’s shadow health secretary, backed the aims of the bill which was part of his party’s now-collapsed cooperation deal with the Welsh Government.

He said £3 for every £10 spent on foster care in Wales is going into the pockets of shareholders rather than being reinvested in improving the quality of services.

Mike Hedges, who chairs the legislation committee, was concerned that details of the bill’s impact on key issues such as human rights were not published in time for scrutiny.

“The lack of timely information from the government was a theme of our findings,” he said.

Mr Hedges criticised potentially misleading Welsh Government statements about the “elimination” of private profit from the care of looked-after children.

He clarified that the bill would restrict, rather than eliminate, profit.

Mr Hedges also raised concerns about the lack of an end date for transitional arrangements.

His Labour colleague Joyce Watson called for a national register of foster carers.

Jane Dodds, a former social care worker who is the Liberal Democrats’ leader in Wales, described the current system as dysfunctional.

She said: “If we think about it, we are paying our council tax; that goes straight into the shareholders’ pockets and it doesn’t meet the needs of those really vulnerable children.”

Ms Dodds urged ministers to avoid pitfalls from the experience in Scotland, where a study showed councils spent £218m on for-profit care despite a similar commitment in 2020.

Following the debate on October 22, Senedd members backed the bill, 37-14, with Labour, Plaid Cymru and Ms Dodds in favour while the Conservatives voted against.

The bill now moves on to the second of four stages in the Senedd law-making process, which will see the health committee consider detailed amendments.