NHS staff in Hywel Dda University Health Board were thanked by Board members today for their efforts, whether frontline or support, to maintain services where there are significant workforce challenges.

Board members received a report at their latest Health Board meeting, held in Carmarthen on Thursday 31 May, detailing the difficulties in maintaining services in some areas, including accident and emergency services, medical and surgical rotas, paediatric services, mental health and learning disability out-of-hours services and GP out-of-hours services.

The problem is caused by not having the sufficient number of staff to cover all rotas across the health board’s four main hospitals and three counties, with particular pressure at certain times like overnight and weekends.

This results in the health board having to seek additional hours from internal staff and agency, as well as more expensive external agency staff for hard to fill posts.

On occasions these shifts are filled at the last hour and it is an increasing risk that contingency measurers and alternatives will need to be put in place for temporary periods if sufficient staffing cannot be found and would compromise patient safety. This has already been the case in some areas.

For example GP Out-of-Hours services in Carmarthenshire, which has necessitated support from neighbouring county GPs, or directing people to minor injury and accident and emergency departments.

Also there have been occasions where staffing problems in paediatric services in Pembrokeshire has meant diverts to Glangwili Hospital have needed to be made early than usual in-hours.

Medical Director and Director of Clinical Services Dr Philip Kloer said: “Despite our best efforts and some positive impact from our ongoing recruitment drive, the fragility in some of our rotas remain. We have particular problems because we run rotas across four main hospital sites, which is a struggle when we are trying to attract doctors from the same pool as other health boards in Wales who have more attractive rotas.

“We are also not attracting the number of medical trainees from the Wales Deanery that we need and due to issues with Visas affecting the NHS across the country, the solution of using overseas doctors that we have used in previous years, may not be so successful this year if we cannot get them in place in time.”

Several Board members noted the hard work of staff is assisting to fill the gaps. Chairman Bernardine Rees said: “Our staff are working really hard, right up to the last moment and we are really grateful.”

Director of Workforce and Organisational Development Lisa Gostling added: “The well-being of our staff is really important and we rely on individuals and managers to ensure safe working hours and to monitor this.”

Contingency measures for areas of concern are in place and include continuation of recruitment efforts, the formation of clinical advisory groups to tackle specific issues in relation to take up of shifts and flexibility, and the use of advanced nurse practitioners where appropriate.

In the longer term, the health board’s strategy is to re-organise its service models to provide more care in the community and to re-organise hospital services. It is currently consulting with the public on proposals which include provide a new emergency care hospital in the south of Hywel Dda, which the health board believes would provide more attractive rotas for clinicians, improve facilities for staff and patients and improve the attractiveness of training opportunities.

Chief Executive Steve Moore said: “We do not want the fragility of services to be normalised and we want to create hope for the future. I see it as a signal of strength that our clinicians are at the forefront of our current consultation on the future of our local health services – they do not believe that what we have now is the best for our patients and they want to see change to improve things in the future.”

If you want to read more about the proposals out for public consultation on future health and care provision in the Hywel Dda area, please visit www.hywelddahb.wales.nhs.uk/hddchange or call 01554 899056.

The full report on the continuity of services is available here: 

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