A north Wales health board has issued an apology after a review discovered that four historical patient deaths had not been fully declared to the coroner.

The review into Betsi Cadwaladr health board's vascular service revealed the issue.

Dr Nick Lyons, interim deputy CEO and executive medical director of Betsi Cadwaladr University Health Board, said: “Firstly, I would like to reiterate my sincere apologies to those patients who did not receive the first class service they deserve, some of whose cases were covered in this report.

“Following the Royal College of Surgeons’ report into our vascular service published in January 2022, which crucially spanned records from as early as 2015 up to July 2021, we were honest and said we needed to do better.

“I am satisfied the majority of the recommendations outlined in this review have already been completed and work continues on those outstanding.

“The hard work of our staff has resulted in a service which I believe is now serving the people of North Wales. We know we have more work to do and there has been a tremendous amount of training done on things like record keeping.

“Our partnerships with the Liverpool Vascular Network and the Royal Stoke University Hospital have given us vital cover for complex aortic cases and for those out of hours cases we infrequently require help with.

“Regular meetings of our hub and spoke operational management teams have also led to greater assurance we are prepared, not only for our routine clinics and inpatient activity, but any issues regarding staffing and cover across our sites.

“While I would be the first to acknowledge there is still much to do, I believe the vascular service across North Wales is in a far better place than it was prior to the invited RCS review and is providing good outcomes for our public.

“I also remain convinced the hub and spoke model is the best way of serving those patients in our communities who require vascular treatment, not least because it allows our clinicians to retain their skills and, therefore, keep the vast majority of vascular services within the area we serve.”

The health board's vascular service has come under fire before.

Eluned Morgan MS, Minister for Health and Social Services said: "On 3 February 2022, I issued a Written Statement highlighting the Royal College of Surgeons’ (RCS) report relating to vascular services at Betsi Cadwaladr University Health Board (BCUHB). I announced in in May 2022, the extension of targeted intervention arrangements to include vascular services and provided Members with a statement on progress in August 2022.

"When the RCS report was published, I expressed my disappointment and concern at its findings. I know local people and Senedd Members shared my concerns and wanted them addressed along with the future of this service.

"Today, a further report, commissioned by BCUHB, has been published by the independent Vascular Quality Review Panel. The Panel was constructed to ensure a mixed membership of individuals both internal and external to BCUHB; with an independent Chair, an external vascular surgical expert, and an external vascular specialist nurse who has no previous affiliation to BCUHB and is not working within NHS Wales.

"The Panel aimed to be objective in its approach to the reviews of patient notes, with an intention to reflect both identified concerns, and good practice. The Panel’s deliberation was solely in relation to the review of the forty-seven cases, and examining for each the following two questions:

"Whether the patient records contain the information expected for the patient episodes of care;

"Whether the necessary and appropriate follow up and aftercare plans were put in place.

"The findings of the Vascular Quality Review Panel are mainly consistent with the Royal College of Surgeons’ review findings, although in some instances, the Panel was privy to further identified information, and members’ local knowledge provided additional context.

"The report makes 27 recommendations, in relation to effectiveness of clinical pathways; clinical governance, including consent and decision-making, accountability and professional practice; person-centred care; team working, including the multi-disciplinary team; complex pain management; palliative care; education and learning; discharge, and necessary and appropriate follow up and aftercare plans.

"I do not underestimate how challenging it has been for the health board to address these issues, but they must provide assurance that they are addressing, or have already addressed, the recommendations within this report as a matter of urgency. The people in North Wales must be assured that BCUHB have rectified the issues identified, improved pathways and outcomes."

Welsh Conservative Shadow Minister for North Wales Darren Millar MS said: “Many people in North Wales will be concerned to read today’s report into vascular services in the region and to learn that the coroner was not fully informed of four patient deaths from the 47 cases which were reviewed.

“It begs the question as to how many other deaths, both in the vascular service and other clinical discipline, have not been appropriately referred to the coroner for consideration?

“The findings of chaotic patient record-keeping and a failure to fully implement recommendations from previous scathing reports is alarming, puts patients at risk and suggests that Betsi is not learning from its mistakes.

“The Labour Government must urgently explain what action it is taking to ensure that the Health Board makes the necessary changes and so that patients across the region can access the safe and effective care that they deserve.”