New pandemic report highlights staffing and building issues over hospital acquired Covid 19 cases

Over 18,000 cases of suspected hospital acquired Covid 19 infections have been investigated with a new report published on the ‘learnings’ from the pandemic, which highlights staffing issues, old hospital buildings possibly contributed to the spread of Covid 19.

The tricky balance over visiting restrictions is also covered, noting it is a method to tackle infectious outbreaks however has “many adverse effects on the physical and mental health of patients – especially those in the vulnerable groups that the restrictions were intended to safeguard, many of whom were not able to fully understand the decisions made”.

Mark Drakeford MS, the new Cabinet Secretary for Health and Social Care – and First Minister during the pandemic – issued a statement publishing the report to members of the Senedd and has said he will be open to taking questions on the topic when it returns from recess.

The statement refers to this 24 page report now out that covers March 2020 to April 2022 on ‘nosocomial’ or hospital acquired Covid 19 infections, as well as taking it as an opportunity to “…consider how NHS Wales manages and undertakes patient safety investigations; particularly how service users, families and carers are supported and engaged in the process.”

On releasing the report Mr Drakeford said, “Throughout the Covid-19 pandemic, the NHS in Wales worked incredibly hard to keep the virus out of our hospitals and protect people who were being cared for in difficult conditions. However, despite strict infection control procedures, due to the high transmissibility of the virus, nosocomial (hospital-acquired) Covid-19 infections occurred and, sadly, in some cases people suffered harm or died.

“When such incidents occur, it is important NHS Wales is open with those affected and their families and that clinical teams carry out investigations to find out what happened, what lessons can be learned and what needs to happen next to reduce the likelihood of it happening again. It is important the NHS shares the results and findings from these investigations so care can be improved.

“In January 2021, the former Cabinet Secretary for Health and Social Care agreed to provide £4.54m pa year, over two years, to support health boards, NHS trusts and the NHS Wales Executive to carry out a major and complex programme of investigation work into cases of hospital-acquired Covid-19. I would like to acknowledge the part played by the Bereaved Families for Justice Cymru in the setting up of this programme.

“I am pleased to report that this work has been completed and the NHS Wales Executive has today published its National Nosocomial Covid-19 Programme End of Programme Learning.

“More than 18,360 cases have been investigated, providing reports to individuals, loved ones and families, as well as capturing valuable learning for the NHS. By acknowledging and recognising the impact of Covid-19 on individuals, families, carers and NHS Wales staff, the programme has taken a learning approach that aims not to place blame but maximise the opportunity for learning and improvement.

“Expanding on the themes identified in the Interim Learning Report, which was published in March 2023, the End of Programme Learning Report highlights further national learning in relation to communication with families and carers, clinical record keeping, staffing and resource, discharge planning and the impact of hospital environments.

“In addition to the learning that has been captured through investigation processes, the report also acknowledges areas of good practice from across NHS Wales. Recognising and sharing good practice is essential to drive improvements in quality, safety, and experience. Examples of good practice have been identified in a number of areas such as the compassion demonstrated by staff, the way organisations rapidly responded to the pandemic, collaborative working, and the implementation of a number of patient safety initiatives.

“Learning and good practice from the programme has been shared at a range of local and national forums and will continue to be used to inform improvements in quality, safety, and experience.

“Learning from the investigations is of paramount importance and I welcome this final report. I am committed to ensuring these findings will lead to meaningful change and improvements in the quality and safety of patient care.

“I would like to thank all the individuals and organisations across the NHS in Wales for their commitment and dedication to this challenging work. I also pay tribute to, and thank, all the families who lost loved ones for their patience as we have worked to find answers for them.”

There has been no statement by Public Health Wales.

Current data from the active PHW dashboard here.

Extracts from the report:

Visting

Visiting restrictions are a method used in response to infectious outbreaks in healthcare settings. Restrictions during COVID-19 were introduced to help reduce transmission from community settings into hospital environments, and particularly to minimise the risk for vulnerable patient groups.
The programme identified, through service user, family and carer feedback, that visiting restrictions had many adverse effects on the physical and mental health of patients – especially those in the vulnerable groups that the restrictions were intended to safeguard, many of whom were not able to fully understand the decisions made. The limited alternative arrangements for making contact and communicating with loved ones, also negatively impacted the experience for many other service users, families and carers.
Investigations highlighted that families often relied on clinical teams and ward staff to connect with their loved ones. Whilst this communication in the main has been highlighted as positive, there are instances where communication was below the expected standards, especially the inability to make contact during busy periods.

Staffing

During the onset of the COVID-19 pandemic, typical ways of working were suspended or altered to ensure health boards and trusts could respond to the risks the pandemic presented.
Many NHS staff were redeployed to areas experiencing increased demand or depleted staffing levels. Many staff were also utilised to support with the vaccination programme and testing. Additionally, a number of hospital wards were repurposed to establish additional capacity based on patient need. The flexibility of staff going to work in different areas should not be underestimated.
Investigations have demonstrated how in periods of huge uncertainty and distress, staff left their familiar working environments in the interest of caring for patients. Despite variations in skill mix, competency and experience, staff rose to the challenge. Findings also highlight how the contributions of new graduates and Health Care Support Workers was instrumental in the delivery of patient care in such intense periods of pressure.
Prior to the pandemic, the NHS in Wales, and the wider UK, has faced challenges with staff recruitment and retention. Investigations reinforce how existing vacancy rates intensified workforce pressures during the pandemic. Health boards and trusts were extremely agile in reviewing capacity and demand and identifying where resource is best placed based on patient need.
Health boards and trusts utilised agency staff where possible to cover absence and/or enhance resource. Findings suggest agency staff made an extremely valuable contribution as part of the NHS Wales workforce, however, working in unfamiliar environments with different systems and processes sometimes put additional pressure on both NHS employed and agency staff, subsequently impacting quality of care.
Despite best efforts, staffing levels were under significant strain, and at some points, NHS Wales organisations were not able to maintain safe staffing levels.
The unintended consequences of this in conjunction with wider workforce challenges were increased risks to patient safety and sub-optimal care. It should be noted that during these circumstances, it was a distressing time for patients, families, carers and healthcare professionals who constantly strive to uphold the highest standards of care.

Testing and outbreak management

Due to the testing capacity challenges early in the pandemic, patients were discharged into other care settings or their own homes without the ability to rapidly test for COVID-19. This was in line with national guidance at the time, which did not advise that negative tests were required before transfer/admission into residential settings.
Further UK guidance, especially early in the pandemic, actively encouraged the discharge of patients from hospitals into care home settings, to free up hospital capacity in order to manage the anticipated demand for services.
Whilst a testing strategy produced by Welsh Government was launched on 15th July 2020, significant challenges in applying the policy existed due to limited access to the volume of consumable items required to undertake tests, and laboratory capacity to manage the extreme demand.

The physical environment of hospitals

Ageing estates across health boards and trusts in Wales present a number of challenges in relation to both IP&C and patient experience. Since many of the hospitals and other healthcare settings across Wales were designed and built, IP&C and patient experience best practice have developed considerably.
Many healthcare settings have limited access to single rooms which means there is less opportunity to isolate patients. As a result, many patients were cohorted to reduce the spread of infection, which often meant patients experienced multiple ward movements.
Bed-spacing and ventilation were also a challenge in some areas which limited the ability to manage the risk of infection. There is room for improvement in the design of future healthcare settings – the pandemic and subsequent learning has highlighted the impact modern estate design, such as the availability of single rooms, can have on strengthening IP&C.

The full report can be found here.