Hywel Dda Health Board, our questions answered! Part 2

by Jonathan Williams

Here’s Part 2 of the questions that we have asked Hywel Dda and their replies, for Part 1 click here.

As always, please leave appropriate comments on the site or feel free to message us.

The first 2 questions relate to the meeting in Parc Y Scarlets on 4th September 2012.

1. There were allegedly two incidents tonight that required the attendance of two ambulances. One of which had to rush to PPH because urgent attention was required and one that was taken to Glangwili. Would this not prove the need for a full A&E department at PPH?

Hywel Dda Health Board has a strict protocol in place with the Welsh Ambulance service to ensure patients, depending upon their needs, are taken to the most appropriate place to get the right care that they need as quickly as possible.

2. How do you respond to comments made by some that the Board had ‘completely refused to be honest or to fully engage with the Llanelli people’?

Hywel Dda Health Board would like to thank the 200 Llanelli residents who turned up and contributed to this three hour public meeting. We can only reassure that we have listened very carefully to everything that they have said. For us, it was a very valuable engagement exercise – it is clear that those who attended are very passionate about their local health services and this message came across very strongly indeed.

We would like to reassure that all of the comments received at this formal consultation event, including the views on emergency services, demographics and socio-economic factors, will be fed back and independently analysed by Opinion Research Services. The final report will also be shared widely so everyone is aware of all the views expressed.

The following concern the consultation.

3. Since it was launched, do you still fully stand behind the Your Health Your Future consultation document or are you open to suggestions for change and would you carry out any changes? (if sensible obviously).

Before any final decisions are made, all feedback will be considered fully by the Health Board but we can only support alternatives that have compelling clinical evidence to support the case and are affordable and sustainable.

4. Would the Health Board carry out changes if a large percentage of its population called for more services within their area?

The final decision is for the health board to take and this will be informed by the feedback from staff, public and other stakeholders including partner agencies and our clinicians. Safety will always be the top priority. The Health Board can only support alternatives that have compelling clinical evidence to support the case and are affordable and sustainable.

5. How would you reply to argument that you are saving money by using nurses rather than doctors?

These proposals are not about saving money, but providing the most appropriate services to meet the healthcare needs of our population. Even if we had the money to provide every service in every hospital, there are not enough doctors available to safely deliver this.

The safety of patients is of paramount importance. None of the emergency departments in Hywel Dda Health Board fully comply with the College of Emergency Medicine guidelines. Royal College reports indicate the best emergency services are planned to serve a population of at least 400,000 people.

The Wales Deanery has also said fewer training posts will be available in Wales and Hywel Dda Health Board has a history of recruitment problems. We have tried to fill vacant posts but the way our emergency and urgent care departments are currently configured is not attractive to staff seeking high profile professional development opportunities.

These 2 questions were asked by Marcus Rose a local campaigner.

6. Why is there only one centre of excellence in the Board’s area covering 120 miles high and 90 miles wide when South Wales from Loughor bridge to the Severn is 90 miles and 90 miles across with about 5 centres of excellence and many high grade hospitals?

The centre of excellence that I am referring to is Glangwili Hospital in Carmarthen, to where the following services have been slowly removed from Prince Philip Llanelli. Surgical Emergencies, Acute Medicine, Cardiology, Trauma, Children, Head Injuries, Maternity, Gynaecology, Ears and Nose, Throat and Eye, Plus Post Mortem, 24/7 consultant led A&E, Orthodontic clinic, Microbiology and we lost our maternity hospital 33 years ago.

You don’t need a degree to understand that you have made Glangwili your Centre of Excellence. The breast clinic in Llanelli cost £6.5 million of which the public contributed £1 million. You have taken away a £30 -40 million 24/7 Consultant led A&E from Prince Philip in the largest catchment area.

The term ‘centre of excellence’ is not one used by the Health Board to commonly describe Glangwili Hospital over other hospitals and therefore we do not recognise this claim that there is only one centre of excellence within Hywel Dda Health Board. It is misleading to suggest all these services have been lost: many remain at Prince Philip Hospital, some have never been provided from the hospital and others are provided to the local population through community services or other healthcare locations nearby.

For example, acute medicine (including cardiology) is provided directly from Prince Philip Hospital. A full range of diagnostic, outpatient services and day and short stay surgery remain. Consultant led antenatal, paediatric, ophthalmology and ear, nose and throat (ENT) clinics are also available in Llanelli.

Investments and new services have also been brought into the hospital, for example the world-class breast care centre; thrombolysis and stroke rehabilitation, and the repatriation of a dedicated rheumatology unit. The health board also wants to provide new services including improved care for the frail elderly and those patients with dementia plus a short stay surgical unit, and develop it as a centre of excellence for orthopaedics and breast cancer care.

Some of the services listed have never been provided from Prince Philip Hospital (maternity) or have not been provided in excess of many years (trauma and inpatient paediatric services). In the last five years the only services to be removed or suspended from the hospital, for safety reasons, have been emergency general surgery, following full public consultation; major colorectal surgery; and a small number of complex vascular procedures.

7. Why is it that the one centre of excellence has the smallest catchment area (about 65,000 people within 12 miles) while the largest catchment area around Prince Philip Hospital all within 12 miles including Gorseinon (6 miles) Pontardulais (4 miles,) Gowerton (6 miles) Penclawdd (6 miles) Ammanford (11.5 miles) All of which used to come to PPH for 24/7 A&E without a fully functioning A&E?

Carmarthen has the smallest catchment area within 12 miles of the hospital. 65,000, Carmarthen town ranks 40th largest in population size in Wales. There are 79,000 people in the district of Llanelli alone.

That is 4,000 more than live in the County of Cardiganshire. Llanelli is the 6th largest town in Wales and that includes the cities. Bigger than Bridgend, Wrexham or Merthyr Tydfil. Carmarthen in the smallest catchment area in Carmarthenshire has the biggest hospital (390 beds), receiving the best services on their doorstep.

Why should I feel safe and satisfied with the loss of services close to my home? I live 24 miles away from Glangwili and 2.5 from Prince Philip Hospital. I do not have a car; I have to catch
6 buses on a round trip to Glangwili and back taking at least 5 – 6 hours. There is a very poor bus service between Llanelli and the remote area of Carmarthen. I am on pension credit and cannot afford a taxi. There are more people living within 2 miles of my home than the whole of Carmarthen town or Haverfordwest.

What the health board has heard very loudly during its listening and engagement exercise is that transport needs to be improved to allow people to access care appropriately. When developing its plans, the health board has been carefully considering transport and the need for patients and their families to move between their homes and health facilities – we know that getting from A to B can be challenging, especially for older people or those living in rural areas.

By introducing care closer to home (see section 5 of the consultation document) and transforming our Non-Emergency Patient Transport services, we will see a number of benefits and improved outcomes for our population. We will continue to work with those who currently provide the routes and timetables to ensure better public and community transport to access all our services on all our sites. For more information on how the health board plans to improve the issue of transport for patients please read the chapter ‘Addressing the issue of transport’ in our consultation document.

The following are just general questions.

8. Are there plans to improve the accessibility of Glangwili as at the moment it suffers from parking difficulties?

The Health Board is aware that the car park at Glangwili Hospital can become particularly busy at times, an issue experienced by many large hospitals. We have already reviewed car park provision at all our acute sites and plans are in place to deliver up to 24 additional car parking spaces by the end of September on the Glangwili site.

We are also working proactively with staff on a number of sustainable travel initiatives which will reduce the number of staff cars on the hospital site. It is hoped that this will also further improve the current situation.

9. What Hospitals are closest to the individual Board members?

Where any member of staff working for the health board lives is classed as personal and therefore private information.

Our comment: We did reply to the Board with the following:

“I understand that you wouldn’t give their addresses out and I’m not asking for them but one of the arguments that Sosppan have is that the board members do not live within the Llanelli area and they do not understand the locality and its problems.”

“Also that they favour one hospital over another etc.”

“You could dispel that argument by saying that e.g. 50% of the members live here, 25% there etc. By saying it is private, people will presume that none of them have PPH as their closest hospital.”

They replied with:

“That is an argument that has been addressed repeatedly directly to SOSPPAN and alluded to again in the meeting at the Llanelli event – the Vice Chair has lived in Llanelli all her life. We’re very confused as they know this that we’re still getting this query.”

So does that mean only 1 Board Member then?

10.  Who does the Health Board ultimately answer to?

Welsh Government.

Our comment: We did ask the Board if they were happy with this answer but they didn’t reply.

Personally, I would have been far happier with a ‘Welsh Government and ‘The People’ or ‘The Patients’ of Hywel Dda Health Board area wouldn’t you?