Prince Philip Hospital in Llanelli

THE Hywel Dda University Health Board is to receive £27mil in further funding from the Welsh Assembly Government. Health Minister Vaughan Gething claims the money will put the health board on a fair funding basis with other health boards.

Hywel Dda is currently the health board with the biggest overspend in Wales.

Some working at the coal face within Hywel Dda have questioned the spending of the the health board and have called for a change in practices claiming that the health board is not efficient, specifically in the use of temporary/agency staff and what they claim is money being used for uncategorised spending.

In the six-page missive sent to Llanelli Online the contributors who did not wish to be identified claim that the HDUHB is a ‘failing organisation’ based on what the contributors claim is the result of consideration of more objective tests of ensuring our hospitals are optimally staffed and maintaining GP numbers and access during the day and otherwise.

The contributors maintain that disease rates per capita in Hywel Dda are very similar to those found in Cwm Taf whose residents are not being threatened with hospital closures. Further that Hywel Dda spends less on health per capita than Cwm Taf, which bears further testimony to the efficiency of the organisation. Hence the question of why is Hywel Dda over budget while Cwm Taf (a Labour stronghold) is not appears to be a valid one.

The contributors also want to know on what almost 40% of uncategorised Welsh NHS spending is being allocated to. They ask if more money could be allocated to front line GP and hospital services and claim that the people of Llanelli and surrounding areas deserve to know the answers to these questions.

The contributors argue that the claim that Hywel Dda is spending a fortune on locum doctors thus making the continued existence of Withybush and Bronglais economically untenable is also misleading and that according to Hywel Dda’s accounts ‘the real drain in staff budgets is agency nurses and other hospital staff and not consultants and junior doctors’.

The contributors make a claim that the public are also being ‘misled’ regarding the claims that the proposals are ‘the creation of local hospital consultants and GP’S who have our interests at heart and have nothing to do with politicians or bureaucrats running a health quango’.

The contributors suggest that the reality is very different and that ‘the proposals were created by Hywel Dda and or their agents in a process initiated by the Hywel Dda Board of Directors and led by a senior clinician’.

There are also questions over HDUHB documents, which claim that the process involved the use of stakeholder focus groups including one which contained ‘health care professionals’.

The contributors acknowledge that a small number of hospital consultants have been asked for an opinion on the proposals but claim that there is a world of difference between being asked to comment on a plethora of pre-existing proposals and creating such proposals themselves.

They go on to claim that use of the term ‘clinician led’ is also ‘misleading the people of Llanelli by accident or design’ and that the proposals are ‘clearly not the sole creation of local GPS and consultants in a process independent of Hywel Dda’.

The contributors also target the Welsh Labour government and claim that the assertion that the proposals are nothing to do with the Welsh Labour Government in Cardiff is ‘misleading’. They claim that Hywel Dda have been ‘under pressure from the Labour government to reduce their spending as they are constantly over budget’ and that HDUHB are being ‘controlled by politicians in Cardiff’.

The contributors claim that while Hywel Dda have to bear their share of the blame in this matter ‘the Welsh Labour government have been in charge of the NHS in Wales for over 13 years and have had ample opportunity to recruit and train the GPS and hospital doctors that we need’.

They argue that ‘the acute shortage of GP’S and Hospital doctors in West Wales is the result of ‘Welsh Labour government indolence, negligence and complacency and failure to control the medical establishment in Cardiff, which have fought the establishment of a medical school in Swansea tooth and nail’.

The contributors claim that there is an argument for a fully fledged medical school in Swansea and that the establishment of a Swansea and West Wales deanery would go some way to creating the training posts and supplying the junior doctors that our hospitals and our consultants need.

The contributors use the case of Scotland and their similar problems in recruiting GPS and claim that the Scottish deaneries have aggressively marketed Scotland in the English medical schools and the problem there is much less than it once was.

There is an argument the contributors claim that the unsurmountable, structural problems as a result of their geography and external medical perceptions of West Wales could be remedied by an increase in budget from the Welsh Labour government instead of what they claim is an imposition of ‘highly experimental and untried healthcare strategies on the people’ which could have ‘potentially devastating consequences for the people of West Wales in general and the Llanelli area in particular’.

The contributors also argue that the claim that the HDUHB has a higher population density of over 65’s than other health boards and is putting a disproportionate strain on secondary care is ‘simply not true’.

Addressing the issue of recruitment and staff retention the contributors argue that contracts could be constructed which could tempt nurses into full time roles and that current practices have to change or consultants are not going to accept posts in hospitals threatened with closure and suitably qualified doctors are not going to uproot their families if the posts advertised are temporary in nature.

The scenario used by the contributors is that if a company was faced with structural problems because of failure to attract crucial staff then they would headhunt appropriate candidates with irresistible renumeration and workload packages. They ask if that is too much to expect of the Hywel Dda/Labour government axis.

The contributors are critical of the language being used including one mantra they claim is being used to sell the proposed changes which is that ‘No change is not an option as the NHS is continually changing’. The contributors claim that this too is misleading as the NHS is not continually changing of its own volition but rather being continually changed by politicians and they claim very often for the worse.

The contributors sound a stark warning and a worst case scenario that the people of Llanelli and West Wales could be faced with the situation where the nearest A and E centre is Morriston which they claim is already at the point of collapse due to increased demand and reduced resources.

They end with a cautious view of whether any money will be available for the proposals claiming that the money has yet to be approved and that it might never be approved.

We contacted the Hywel Dda University Health Board to ask for a comment regarding the claims.

Sarah Jennings, Director of Partnerships at Hywel Dda University Health Board, said: “We would urge the contributors to this letter to meet with us so we can listen to their concerns and to offer our assurances over the issues they have raised.

“The process has been thorough and driven by the need to ensure that we can deliver services that are safe, sustainable, accessible and kind, not just for current generations but for our future population too.

“The clinical case for change is overwhelming.  We have got to address the challenges we face with an ageing population, difficulty for many people in accessing services close to home, significant recruitment challenges – particularly specialist medical staff – and ageing hospital buildings which require a lot of maintenance to keep running.

“We are urging everyone to get involved and share their views as our proposals are only a starting point and are open to influence and new ideas. This is a once-in-a-lifetime opportunity to fundamentally change the way that we provide services so it’s really important that everyone has their say.”

In response to the specific concerns raised by the contributors Hywel Dda responded:

Where is the money for a new hospital?

Building new hospitals and refurbishing buildings is expensive and we will need to carry on discussions with the Welsh Government about the investment needed to improve our facilities. We will work closely with the Welsh Government to apply for any funding that we might need to implement the proposals. Depending on the level of change needed, and the possibility we may need to apply to the Welsh Government for funding of any new buildings, it could take several years to fully put in place any changes agreed.

Isn’t this a downgrade of Prince Philip Hospital?

In all our proposals, Prince Philip would retain its Minor Injury Unit, and in two proposals it would remain a main hospital. It would continue to provide the majority of care for local people.

What about emergency access – won’t these proposals have an impact on patient safety?

We are proposing a new urgent care hospital to improve our ability to provide emergency care for our population.  Doing nothing is not an option as it would likely mean lower safety standards, worsening impact on health and reduced survival rates. Maintaining safety has been the most significant consideration, so the location for the proposed new hospital has been based on being within an hour’s reach for the majority of the population, where they are not able to access another hospital. The location identified would mean that 93% of the population would be within one hour of A&E by car. Whilst for some people, this would mean closer access to urgent care services, we acknowledge some people would need to travel further than they currently do. However, by bringing together A&E services we bring our senior, specialist doctors together at the front door of our hospitals so you have more timely access to them. Our paramedic colleagues also play a huge role as clinicians first on the scene providing emergency care and we will continue to work with WAST and EMRTS to ensure we get rapid support to people locally on the scene when necessary.

ABMU University Health Board is one of our closest partners and have been involved and informed during our initial engagement and option development work. All three hospital proposals are likely to increase the patient activity flowing towards Morriston Hospital from the east of our area. We will continue to work with ABM University Health Board to quantify the nature and impact of this increased activity and how this can be best addressed, so that patients across the region receive equitable access and excellent outcomes wherever their care is delivered. The existing, and any new, flows of patients in both directions across the boundary between our two Health Boards mean that it is essential we plan together on a regional basis. Therefore, we will collaborate closely on the business plans that will be required for both Health Boards, once the outcome of the consultation is known.

How can we trust the process?

We are following good practice guidelines set out by the Consultation Institute. The integrity with which we work through this process matters greatly as we want a solution that really works and the more people that are involved in that, the more likely it is to succeed.

Your feedback will be independently assessed and considered before any formal proposal is put before our Health Board for decision on how to proceed later in 2018. We will consider your feedback and test impacts and consequences, together with what our doctors and other healthcare professionals say and the standards we have to meet. We will detail all this in a consultation closing report, which will explain how feedback has influenced our thinking around the proposals.

The programme will put forward a recommendation to the Health Board’s Directors and Independent Members on the way forward so they can decide what they want us to do. We will continue to keep you updated.

You say a wide range of stakeholders have been involved – who and when?

We established the Transforming Clinical Services (TCS) Programme in June 2017 and held a 12 week ‘Big Conversation’ to describe the case for change and to gather people’s views. We held more than 80 meetings and events and received around 400 responses from a wide range of groups including our staff, patients, public and our partners.

There were dozens of events, attended by nearly 400 people including doctors and other clinicians, wider staff members, organisations we work with to deliver care and patient representatives, in the option development stage to test thinking and narrow down and refine proposals.

Can you explain how this is clinically led?

Our clinicians after hearing views from engagement last year and the option development work, have presented these three proposals to the Health Board, which agreed they could go out for public consultation. From the outset the work on our proposals has been led by the input of more than 600 doctors, nurses, therapists and other frontline healthcare workers and professional staff. We also sought the views of a wider range of organisations, groups and individuals including the community health councils, public service boards, county councillors, the Stakeholder Reference Group, collaborative, equality groups, People First, deaf clubs, sheltered accommodation, the veterans network, youth forums, gypsy traveller community, and 50+ forums to ensure we had a broad range of views to inform our work. More information can be found in our technical documents,
here:http://bit.ly/2GjOQDG and http://bit.ly/2DNUtoj

 Have you been in discussions with ABM University Health Board about the impact, particularly if patients in the East of Hywel Dda choose to present at Morriston Hospital in the future? How will Morriston Hospital cope with increased demand?

AMB University Health Board is one of our closest partners and have been involved and informed during our initial engagement and option development work. All three hospital proposals are likely to increase the patient activity flowing towards Morriston Hospital from the east of our area. We will continue to work with ABM University Health Board to quantify the nature and impact of this increased activity and how this can be best addressed, so that patients across the region receive equitable access and excellent outcomes wherever their care is delivered.

The existing, and any new, flows of patients in both directions across the boundary between our two Health Boards mean that it is essential we plan together on a regional basis. Therefore, we will collaborate closely on the business plans that will be required for both Health Boards, once the outcome of the consultation is known.

Depending on the level of change needed, and the possibility we may need to apply to the Welsh Government for funding of any new buildings, it could take several years to fully put in place any changes agreed.

Why can’t you pay staff more?

We are doing everything we can to recruit staff into our health board across all our geographic locations. We pay staff based on national terms and conditions (Agenda for Change), comparable with all health boards in Wales. If individuals move into the area to take up a post with ourselves, we also consider relocation support. We would appeal to the public and the media to help us celebrate what is great about living and working in West Wales to support our efforts to attract people into the area.

What is the impact of an ageing population?

The number of people over the age of 65 will rise by 60% between 2015 and 2035. People are living longer which is great news, but this means they will experience more years of illness and disability and so will require more support to stay well and independent. Many of the people living in Hywel Dda area have one of more long term medical conditions and this has an impact on services to support them. We also know that around 40% of out hospital bed days are occupied by people with conditions that could be better managed in the community.

We contacted Nia Griffith MP and Health Minister Vaughan Gething to ask for a comment regarding the claims.

Nia Griffith MP said: “Any extra money for health services in our area is welcome, but my priority is making sure we have a proper general hospital here in Llanelli. We must keep all our services at Prince Philip Hospital, so it is vital that Llanelli’s voice is heard loudly and clearly in Hywel Dda’s consultation. I would urge everyone to complete the questionnaire and join the campaign to save our hospital.”

We contacted the Shadow Cabinet Secretary for Health and Social Care, Rhun Ap Iorwerth and asked some questions regarding the claims of the contributors.

We were sent a response, which said that Plaid Cymru have sent a press release out locally with an alternative to Hywel Dda’s proposals. We have not been sent that press release.

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