Hywel Dda Health Board – Transforming health and care in Mid and West Wales

Twelve recommendations from clinicians (doctors, nurses and a range of healthcare professionals such as health scientists and therapists) were approved and can be read in full here https://bit.ly/2NJxft5.

Headline decisions included:

• More investment will be made in the integration of social care with health and well-being across the seven localities (North and South Ceredigion, North and South Pembrokeshire, Taf/Tywi, Amman/Gwendraeth and Llanelli)
• A hospital model, will be adopted and includes:
  • A business case to be made for a new hospital in the South of Hywel Dda (somewhere between Narberth and St Clears) to provide specialist urgent and emergency care services and planned care.
  • Hospital services to be retained and developed at Bronglais Hospital, Aberystwyth, in-line with the Mid Wales Joint Health & Social Care Committee recognising importance of hospital in delivery of services to populations of Ceredigion, Powys and South Gwynedd.
  • Acute medicine (hospital services that need medical input) to be retained at Prince Philip Hospital, Llanelli, following recent modernisation of services developed with the local community and serving a densely populated area.
  • Re-purposing Glangwili (Carmarthen) and Withybush (Haverfordwest) hospitals to support community health needs including overnight beds, day case procedures, out-patient and walk-in services such as minor injuries and much more.

This follows one of the largest local NHS consultations in the UK (Hywel Dda Our Big NHS Change), which was held between April and July, and which saw a huge and passionate response from the local population. Responses included more than 5,400 questionnaires, 4,000 attendees at events and workshops, hundreds of written submissions, five petitions and extensive social media debate.

Board members considered all they heard from patients, staff, the general public and interested organisations, not just during the consultation, but also in the pre-consultation engagement and option development period.

They also considered recommendations made by Hywel Dda Community Health Council, the clinical viewpoint following consultation, and other matters including safety standards the NHS has to meet and the ability to provide services in the future.

Whilst some key decisions were made, the health board received really insightful feedback from people during the consultation and wants to investigate further, and demonstrate, some developments, including:

• Commitment to work with people and organisations to develop integrated networks (as opposed to hubs) which are unique to the needs of their community and to consider the geographical areas highlighted in the consultation as gaps in current provision.

• Work with the community on an early model of the above in Pembrokeshire, focusing on the ability to provide more community based care 24/7 and to demonstrate how it could work and the impact it could have.
• Work with local people to explore potential for a range of different types of beds within the local community – whether in existing community hospitals, at home or another setting review, test and challenge the model for acute medicine to be responsive to demand and changes in patient flows associated with the whole system change.
• Work closely with Abertawe Bro Morgannwg University Health Board on services where patients could benefit from a regional approach.
• Examine the opportunities a new hospital and community model could offer maternity and child health services to ensure doctor and midwifery led care, and care for children (paediatrics) and sick babies (neonatal) are maintained within the boundaries of the Hywel Dda area.
• Align with the transformation, work in mental health services to ensure mental health and learning disability assessment and treatment units are provided at the new urgent and planned care hospital.
• Investigate the practicalities and impacts (through a feasibility study and options appraisal) of locations between Narberth and St Clears for the new hospital.
• Work with people living and working in the areas furthest from a new hospital to provide additional support for emergency and urgent care (potential to look at things like placing paramedics within a community as opposed to within a vehicle).
• Respond to public anxiety over the ability to manage emergency conditions that are time sensitive (e.g. ST Elevation Myocardial Infarction STEMI, stroke and sepsis) consider the opportunities a new hospital in the south would provide Bronglais Hospital.
• Work closely with other organisations, including county councils and the third sector, to develop Glangwili and Withybush hospitals.
• Develop a detailed plan to address concern heard in consultation regarding access, travel, transport and infrastructure, working with the Regional Transport Group, communities (including those with protected characteristics in response to the difficulties we heard about from people and the equality impact assessment) and Welsh Ambulance Services NHS Trust.
• Formally state the Health Board’s support for building a case for provision of a 24/7 service to bring medics to the scene of an accident (e.g. the Emergency Medical Retrieval Transport Service, which operates 12 hours a day and CHANTS (Neonatal Retrieval Service)).
• Develop a plan to maximise use of technology in health and care, backed up by secure IT so patient data is safe and joined up between services in the hospital and community.
• Put in place a staff plan to deliver future models and provide opportunities for staff.
• Work with education and university partners to train a workforce with the skills and expertise to work in the new service model, and drive research, innovation and evaluation into our service development.
• Continue to talk the public, staff and interested organisation about all that we do, especially focusing on people with protected characteristics.

Chief Executive Steve Moore said:

“Today is a hugely momentous day as we confirm we will take a new direction to providing much more preventative and community based healthcare to our population. We’ve heard the concern people have with current healthcare provision and our ability to deliver this see-change in the years to come but our clinicians have led this work and we believe what has been put before us today, offers us the best chance to deal with the fragility our NHS faces and to provide the population with safe, effective care that meets their needs.”

Chair Bernardine Rees added:

“We are really grateful to everyone who got involved in our consultation as it has given us really rich feedback. Our ambition is to continue that conversation and input so that we can grow services in our seven localities, using schemes we have already delivered, such as the front of house project at Prince Philip Hospital and Tenby walk-in, as the basis of what can be achieved.”

The next step will be for clinicians and staff to work with the public and other organisations to bring the additional detail together into a draft Health Strategy to be put before the public Health Board at the end of November.

Medical Director and Director of Clinical Strategy Dr Philip Kloer said:

“We’re aware that some people, particularly those who live furthest from the new hospital zone between Narberth and St Clears may be anxious about these changes. They will not happen overnight and we are committed to working with those communities and our partners to demonstrate and test what additional provision can be made, particularly for time-sensitive emergency conditions.

“For example we are working with partners to build the case for the Emergency Medical Retrieval Team (doctors who are brought to the scene to treat and then transfer) and CHANTS (the Neonatal Retrieval Team) to be a 24-hour service, and also investigating the potential to place advanced paramedics in communities so that they are available solely to that community.

“Another important factor in providing life-saving treatment is getting people quickly to the definitive hospital which will provide their care. At the moment, people in our coastal areas of Pembrokeshire have to travel to Glangwili for some treatment, which in the future, we will be able to offer at a more equitable location, for the south of Hywel Dda, in the new hospital zone.”

The new hospital will be dependent also on a full business case, which will be made to the Welsh Government.