“Sea-change needed to provide best care for emergency patients,” says Withybush A&E Consultant

A Senior A&E Consultant at Withybush General Hospital has thrown her support behind ambitious proposals by Hywel Dda to develop a new major hospital with state of the art facilities between Pembrokeshire and Carmarthenshire.

With just two weeks to go until Hywel Dda’s Big NHS Change consultation ends, Dr Nicola Drake said she was “very positive” about the proposals, which would mark a “sea-change” shift in the way Emergency Care could be provided in the future and prevent patients with urgent care needs from having to wait to be seen at busy A&E departments.

Hywel Dda’s Medical Director, Dr Phil Kloer, also said that around 40 per cent of patients who were currently occupying beds in the health board’s four hospitals wouldn’t need to be there if community and primary care services were also radically overhauled under the consultation proposals.

Dr Drake added: “As an A&E consultant I’m quite biased towards whatever system is in place that best helps us to see and treat patients with emergency care needs, which is why I’m very supportive of the proposals that the health board is putting forward.

“We’ve got to change, it’s as simple as that.  Under the current system, within Accident and Emergency, we are doing everything humanly possible to see and treat patients who come to us with life-threatening emergencies, but far too often they’re turning up in an ambulance and there just isn’t a space for them.

So we can treat them and stabilise them and then they have to wait, basically, somewhere in the A&E department or in the back of an ambulance until an inpatient bed becomes available elsewhere in the hospital.  The problem is that those hospital beds have often already been taken up by people who have been admitted, and in many cases are actually well enough to be discharged, but who don’t have a nursing home place or care plan in place to help them when they’re discharged because of the way the existing health and social care system works.

“I know the plans [for a new hospital] are causing a lot of concern locally and l completely understand why some residents would feel worried or angry about their local A&E department moving further away from them, but I can’t emphasise enough that what we’re talking about here is a whole-system change – a complete transformation not just of emergency care, but also the way that people access it. It’s not just about Hywel Dda changing – the Welsh Ambulance Service Trust (WAST) and the Wales Air Ambulance, as well as neighbouring health boards, would also have a big part to play.

“So that’s the challenge we all face – we’ve got to change and I think the plans that the health board have put forward represent the best, safest and most accessible way of doing that.”

As well as the benefit to patients of having more senior clinical decision-makers at the front door of a single A&E department in west Wales, the health board’s ambition is to be able to provide more specialist services in a new major hospital – these currently have to be commissioned elsewhere – which, together with a cutting edge research and learning environment, would significantly help in attracting more doctors, nurses and support service staff to come and work in the area.

Hywel Dda’s Executive Medical Director & Director of Clinical Strategy, Dr Phil Kloer, added: “In terms of new roles it’s not just the doctors we’re trying to attract to Hywel Dda; this is about our whole multi- agency workforce too, so we would expect new roles for nurses, therapists, physician associates and others, including paramedics, to take on leadership roles – leading care where the doctor isn’t really needed there on a daily basis.”

“Angen newid radical i ddarparu’r gofal gorau ar gyfer cleifion brys,” meddai Ymgynghorydd Damweiniau ac Achosion Brys yn Llwynhelyg

Mae Uwch Ymgynghorydd Damweiniau ac Achosion Brys yn Ysbyty Cyffredinol Llwynhelyg wedi rhoi ei chefnogaeth y tu ôl i gynigion uchelgeision gan Hywel Dda i ddatblygu prif ysbyty newydd gyda’r cyfleusterau gorau rhwng Sir Benfro a Sir Gaerfyrddin.

Gyda dim ond pythefnos i fynd tan ddiwedd ymgynghoriad Trawsnewid ein Gwasanaeth Iechyd Hywel Dda, meddai Dr Nicola Drake ei bod hi’n bositif iawn am y cynigion, a alla’i nodi newid radical i’r ffordd o ddarparu Gofal Brys yn y dyfodol, a fyddai’n atal cleifion sydd ag anghenion gofal brys rhag gorfod aros i gael eu gweld mewn adrannau prysur.

Dywedodd Dr Phil Kloer, Cyfarwyddwr Meddygol Hywel Dda, na fyddai o leiaf 40 y cant o’r cleifion sydd yng ngwelyau pedwar ysbyty’r bwrdd iechyd ar hyn o bryd yno petai gwasanaethau cymunedol a gofal sylfaenol yn cael eu trawsnewid yn radical hefyd – fel sydd i’w weld yng nghynigion yr ymgynghoriad.

Ychwanegodd Dr Drake: “Fel Ymgynghorydd yn yr Adran Damweiniau ac Achosion Brys, dw’i o blaid pa system bynnag fydda’i orau yn ein helpu ni i weld a thrin cleifion sydd ag anghenion gofal brys, a dyna pam yr ydw i’n gefnogol iawn o gynigion y bwrdd iechyd.

“Mae’n rhaid i ni newid, mae mor syml â hynny. O dan y system bresennol, o fewn Damweiniau ac Achosion Brys, rydym yn gwneud popeth posibl i weld a thrin cleifion sy’n dod atom gydag argyfwng sy’n bygwth bywyd, ond yn rhy aml o lawer maen nhw’n dod mewn ambiwlans a does dim gwely iddynt. Felly, rydym ni’n eu trin a’u sefydlogi nhw, ac yna mae’n rhaid iddynt aros, rhywle yn yr adran neu yng nghefn ambiwlans, tan fod gwely claf mewnol ar gael rhywle arall yn yr ysbyty. Y broblem yw bod y gwelyau hynny wedi’u llenwi gan bobl sydd eisoes wedi’u derbyn i ysbyty. Mewn nifer o achosion mae’r cleifion hynny’n ddigon da i gael eu rhyddhau, ond naill ai nid oes ganddynt le mewn cartref nyrsio neu does dim cynllun gofal ar eu cyfer oherwydd y ffordd y mae’r system iechyd a gofal cymdeithasol bresennol yn gweithredu.

“Dwi’n gwybod bod y cynlluniau [ar gyfer ysbyty newydd] yn achosi llawer o bryder yn lleol a dwi’n deall pam bod rhai trigolion yn poeni neu’n ddig am weld eu hadran Damweiniau ac Achosion Brys yn symud ymhellach oddi wrthynt, ond alla’i ddim pwysleisio digon mai’r hyn yr ydym yn sôn am yma yw newid system-gyfan – trawsnewidiad llwyr nid yn unig o ofal brys, ond hefyd y ffordd mae pobl yn cael mynediad iddo. Nid newid yn Hywel Dda yn unig – ond bydd gan Ymddiriedolaeth Gwasanaeth Ambiwlans Cymru (WAST) ac Ambiwlans Awyr Cymru yn ogystal â byrddau iechyd cyfagos ran fawr i’w chwarae hefyd.

“Felly, dyna’r her sy’n wynebu pob un ohonom – mae’n rhaid i ni newid a chredaf bod y cynlluniau mae’r bwrdd iechyd wedi’u cyflwyno yn cynrychioli’r ffordd orau, mwyaf diogel a mwyaf hygyrch o wneud hynny.”

Yn ogystal â’r budd i gleifion o gael mwy o uwch swyddogion gwneud penderfyniadau clinigol wrth ddrws blaen un adran Damweiniau ac Achosion Brys yn y Gorllewin. Uchelgais y bwrdd iechyd yw gallu darparu mwy o wasanaethau arbenigol mewn prif ysbyty newydd – ar hyn o bryd, mae’n rhaid comisiynu’r rhain i fyrddau iechyd eraill – a fyddai, ar y cyd ag amgylchedd ymchwil a dysgu blaengar, yn helpu’n sylweddol i ddenu mwy o feddygon i ddod i weithio yn yr ardal.

Ychwanegodd Dr Phil Kloer, Cyfarwyddwr Clinigol a Chyfarwyddwr Strategaeth Glinigol: “O ran rolau newydd, nid dim ond meddygon yr ydym yn ceisio eu denu i Hywel Dda; mae hyn yn ymwneud â’n gweithlu aml-asiantaeth hefyd, felly byddem yn disgwyl rolau newydd ar gyfer nyrsys, therapyddion, cymdeithion meddygol ac eraill, yn cynnwys parafeddygon, i wneud rolau arweiniol – gan arwain gofal lle nad oes wir angen meddyg yno yn ddyddiol.”