Hywel Dda University Health Board will present the public with preferred options to transform community and hospital services this spring.

The Health Board is proposing change so that it can make the most of every opportunity to improve population health and health services locally, as well as face its challenges and ensure services are the safest and highest value they can be for communities in mid and west Wales.

Following engagement with the public in summer 2017, potential options are currently being discussed, tested and narrowed down by the Health Board, in conjunction with doctors, nurses, wider staff groups, people who help provide care, patient representatives and partners.

All potential options, which are clinically-led, consider significant change to the status quo and focus on improving the health of the local population and transferring more hospital services into the community where appropriate. Some consider whether hospitals need to take on different roles, or even need to be replaced.

A fewer number of preferred options will be released publically in the spring, when the Health Board is confident they are viable, safe and an improvement on what is currently provided.

Medical Director Dr Philip Kloer said: “This is a once in a lifetime opportunity for our health service and community to work together to design an NHS which is fit for our generation and beyond. It has been acknowledged for some time across the UK that healthcare services are challenged like never before and we need significant change. Indeed this has been recognised in the recently published ‘Parliamentary Review of Health & Social Care’ here in Wales.

“We need to develop more proactive, resilient and better resourced local community services to support and improve people’s health and wellbeing, and avoid deterioration where possible. This will involve closer working with our partners, particularly colleagues in social care. We are also looking at ways of providing the most modern clinical practice, using the latest digital, technological, and new scientific developments, in fit for purpose facilities to provide better patient outcomes and experience.

“A number of our services are fragile and dependent on significant numbers of temporary staff, which can lead to poorer quality care. For us specifically in Hywel Dda, the geography we cover is large, with many scattered communities that are getting older, needing more holistic health and social care treatment and support. Because of this, we need to better resource our community based care, which is where most of our patient contact is, and help people manage their health conditions. We also need to evolve traditional ways of working and provide a more proactive approach. This should give patients – young, older and frail and everyone in between – the services they need when the need it, so people do not have to wait too long.

“This will mean changing hospital-based care, as well as community care, and we appreciate the attachment local people and our own staff have for their local hospitals. They have been cared for in them, or work in them, and they also play an important role in our wider communities. The options may propose change to a local hospital; however this is about more than the buildings. This is about investing in our communities, attracting doctors, nurses and therapists by operating a modern healthcare system and keeping hospitals for those who really need hospital care.

“We will not put in place any change that isn’t safe for our patients and population. And we will look at all the impacts from ensuring services are safer with better patient outcomes, to considering the wider impact on people, including the most vulnerable.”

Initial engagement with the public started with the Big Conversation in the summer of 2017, with public workshops and drop-ins held across the three counties of Carmarthenshire, Ceredigion and Pembrokeshire.

Those views have been independently analysed and used as a basis to explore, challenge and test different scenarios, which just since Christmas has resulted in 14 additional events attended by more than 350 people.

Dr Kloer said: “The potential options are evolving, with changes to them on almost a daily basis. Many will never even reach public consultation, for a variety of reasons including safety, accessibility and affordability, or will change significantly as they are tested against population needs and healthcare standards.

“We will be coming back to the public in the spring with fewer options that have been more rigorously tested and we will open and honest about what we think our preferred option is and why. We would not, and cannot, propose something that would not be safe for our population.”

No preferred option has yet been determined and the Health Board has not signed off or agreed to any change at this stage.

Dr Kloer said: “We live in this community, use our NHS and work for our NHS and we want to work with our patients, staff, partners and public to ensure it is the best it can be.”

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