Changing for the Better response

Carwyn Jones AM
Response to “Changing for the Better” engagement document

This document is the formal response of Carwyn Jones, Assembly Member for Bridgend, to the ABMU engagement document “Changing for the Better”. This response is set to the wider context laid out in “The South Wales Programme” which made a series of proposals for meeting the challenges of the Health Service across South Wales.

1. Introduction

A number of issues are clear to me. Changing demographics and a growing population will change and increase the demands on the NHS. The ambition to deliver world class services can only be met by careful planning and efficient use of resources.

People tell me that they want high quality, safe and reliable services, as close as possible to their home. The status quo will not serve us in the future. I have received a great deal of correspondence regarding the Princess of Wales, raising concerns in particular about the potential for a decline in Accident and Emergency waiting times, ambulance response times and cover for obstetrics and maternity wards. This demonstrates recognition that services will not remain sustainable as they are.

Our Health Board has a number of constraints to factor into the planning of service delivery, most notably centred on difficulties in recruiting enough specialist clinicians. It is not possible to create fully staffed specialist centres across a range of disciplines at all hospital sites across South Wales. The changes to the way services should be delivered are focussed on a small proportion of people who have complex needs when they are taken into hospital. This covers high risk births and emergency admissions where patients have severe trauma such as from road accidents. The majority of admissions to hospital do not require such highly specialised services.

By locating specialist centres strategically and ensuring that people are taken to the most appropriate place for treatment, all departments will be better placed to run more efficiently and safely. With appropriate staffing levels better quality of care and improved outcomes will be delivered for all patients, most importantly, for those who are extremely unwell, requiring highly specialised care.
To inform my response I have taken on board the views of constituents who have written and spoken to me about the engagement process. I have also spoken to clinicians who approached me for discussions and with representatives of the ABMU Health Board and Ambulance Service.

Based on this, I am arguing for the Princess of Wales hospital, Bridgend to be one of the additional Regional Centres for South Wales.

2. Accident and Emergency Provision

The majority of feedback I have received from constituents raises the concern of potential journey times in emergencies. This includes people making their own way to hospital during an emergency, during labour or when a birth becomes unexpectedly high risk and also for incidents where an ambulance is needed to take a patient to hospital.

There is recognition from people that the current delivery of services will not be able to achieve the highest standards expected unless the delivery of services changes to cope with increasing demand. People have been unnecessarily concerned that A&E at the Princess of Wales could close altogether. A&E should not close, neither will the Princess of Wales hospital and this is clear in the “South Wales Programme” and in “Changing for the Better”.

There are two solutions; one being for the most complex needs to be taken to another hospital with fully staffed specialist facilities and by developing a Minor Injuries Unit at the Princess of Wales. This could improve the service delivered, in a similar way to the Port Talbot Minor Injuries Unit.
The second option, which I strongly argue for, is for the Princess of Wales to become one of the Regional Centres, enabling people from Bridgend and surrounding areas to access specialist provision on a 24/7 basis on this site.

The Princess of Wales is equidistant between Cardiff and Swansea which already serve as Specialist Centres. It is already accepted that patients with brain injuries are taken to Cardiff, and those with severe burns go to Swansea. It is important that the services provided by the Princess of Wales are able to strategically complement the highly specialised services already developed elsewhere.
By utilising the Princess of Wales as a Regional Centre, people across Bridgend will retain quick access to A&E. The catchment area can be opened up further afield due to ease of access via the M4. A more efficient A&E service will reduce delays and release paramedics once patients have been transferred to a bed, improving waiting times.

Both scenarios need to be underpinned by efficient and appropriate staffing for on-scene emergency treatment, avoiding unnecessary trips to hospital and also improving ambulance response times in an emergency. The Ambulance Service across the ABMU region has trained a number of Specialist Paramedics with a wider range of skills who are able to assess and treat patients based on clinical need. This is part of a new “Pathway” initiative, which ensures that patients are treated on the scene if appropriate, or referred or taken to the most appropriate place for care. This reduces unnecessary ambulance trips and hospital journeys, creating a more efficient service.

There is clear good work creating improvements to the Ambulance Service across the region which will continue whatever the outcome of the South Wales health reorganisation. The Welsh Ambulance Service and ABMU have worked well together throughout the engagement process and it is crucial for the success of health reorganisation that they continue to work closely throughout the future consultation period.

3. Maternity and Obstetrics provision

People feel passionately that there should be no reduction in services within paediatric, obstetric and neonatal care.

The aim of reorganisation of services is to ensure that there is only improvement in the services delivered. Where consultants are currently spread too thinly, all healthcare sites risk running a service that is below standard. People want services to be delivered as close to their home as possible but there are not enough staff to provide 24/7 specialist provision at all hospitals.

I have received correspondence from constituents praising the hard work and dedication of NHS staff. Staff are under immense pressure due to staffing shortages and it is clear that the services currently being delivered cannot be sustained and this could put lives at risk.

As with A&E provision, there are two options here. The first is for specialist provision to be sited elsewhere with a midwife-led unit at the Princess of Wales. However, people are rightly concerned that during an unexpected emergency in labour or with a very young child, travelling further could reduce the chances of a good outcome.

I argue for specialist paediatric, obstetric and neonatal care to be delivered from the Princess of Wales, so that complex births and at least level 2 and 1 tier patients be treated on site. This would complement specialist A&E provision at the Princess of Wales.

4. Staffing

Improvement to the NHS in South Wales relies on attracting staff at all levels and specifically, doctors in training within a particular specialism, and specialist consultants.

To attract more doctors-in-training, specialist centres are needed. Since doctors’ hours are capped by the European Working Time Directive, specialist centres provide a higher number of patients allowing doctors to gain experience in their specialism. Specialist centres also ensure enough Specialist Consultants to support training and to provide sufficient cover on a 24/7 basis, to deliver consistently high quality services no matter what day of the week or time of day that a person needs this level of medical help.

It is crucial to ensure the Princess of Wales remains attractive for doctors-in-training and Specialists in order to fill vacancies. Higher patient numbers and a concentration of other specialists to provide training will encourage more doctors in.
Discussions with clinicians highlight that the Princess of Wales has the best undergraduate facilities in Wales, which is an achievement we can all be proud of. The Princess of Wales needs to become a Regional Centre in order to secure the high quality facilities and attractiveness of the Princess of Wales for training undergraduates for the future.

Geographically, Bridgend can also be promoted as a good place to live and work. There is easy access to the M4 and nearby cities, as well as our stunning coastline and countryside.

Current patterns of service delivery will not provide enough specialists enough of the time in the future, creating inconsistency for patients.
By concentrating specialists on a smaller number of sites, it is much easier to attract staff to fill the vacancies, further improving outcomes for patients. The Princess of Wales should be a Regional Centre, developing specialisms to complement those already in existence at other regional centres.

5. Conclusion

I argue for the Princess of Wales to become one of the additional Regional Centres in South Wales. Being equidistant between Cardiff and Swansea and situated just off the M4, the Princess of Wales Hospital is accessible to people living in a large geographical area.

Accessibility of health services is important to people. Bridgend County Borough has a population of over 139,000 residents with a reasonably symmetrical population spread to the East and West of Bridgend within the ABMU catchment area. The hospital also attracts significant numbers of people from Neath Port Talbot. There is a strong logistical case for the Princess of Wales to become a Regional Centre.

The hospital is well situated to develop specialist services that complement those offered by Swansea and Cardiff, providing a more attractive prospect for both training and experienced specialists.
However, all potential scenarios for the siting of Regional Centres must be underpinned by close working with the Ambulance Service in order to realign ambulance provision to complement reorganisation of services. Quick response times, appropriate on-site assessment and treatment and quick journey times to the appropriate hospital are absolutely crucial in improving outcomes for patients.

In drawing up proposals for the realignment of health services across South Wales, it is essential for the role of the Ambulance Service and paramedics to be integral to any steps taken towards improving service delivery.