For at least a year, the five local health boards (LHBs) that run the NHS in south Wales and Powys have been working on plans to reorganise key services – concentrating them on fewer sites – as part of the Welsh Government’s national hospital reorganisation strategy.
The South Wales Programme was formally unveiled earlier today. It’s proven contentious, as it was unclear which hospitals would be downgraded and which services would be moved. Closer to home, there were particular concerns about the future of some services at Bridgend’s Princess of Wales Hospital, leading to a protest march back in February.
The Welsh Government have long said that changes were needed for a variety of reasons, namely the lack of highly-qualified medical staff, in addition to budget constraints. Concentrating experts in fewer places could improve access to them – as long as people get to them quickly – instead of spreading them out thin.
Opposition politicians have claimed that some of the changes could put people at risk, as A&E departments have come under increasing strain – reducing them isn’t going to make things better, on paper – while ambulance services continue to under-perform.
What is the desired option?
The following services:
- Consultant-led maternity and neo-natal care
- Children’s inpatients
- Emergency medicine (full-time A&E departments)
Will be concentrated at the following hospitals:
- University Hospital of Wales, Cardiff
- Morriston Hospital, Swansea
- Princess of Wales Hospital, Bridgend
- A new Critical Care Centre to be built between Newport and Cwmbran (unclear when)
- Prince Charles Hospital, Merthyr Tydfil
The changes could also mean:
- The Royal Glamorgan Hospital, Llantrisant will have its full-time A&E department “downgraded” to a minor injuries unit (similar to Neath Port Talbot Hospital).
- Planned surgery, and acute (specialist) services, might move from the Princess of Wales Hospital, Bridgend & University Hospital, Cardiff to the Royal Glamorgan.
The formal public consultation on these proposals starts tomorrow (23rd May), and ends on July 19th 2013. A series of public meetings will also be held. In Bridgend County, these will be held on:
- June 3rd – 6:30pm, Court Coleman Manor, Pen-y-Fai
- June 10th – 6:30pm, Heronston Hotel, Bridgend
- June 20th – 6:30pm, Maesteg Town Hall
- June 25th – 2pm, Brewery Field, Bridgend
The possible impact of the choiceThe Princess of Wales Hospital should retain its A&E department, but could still lose services to the Royal Glamorgan, effectively “compensating” for the loss of their A&E. Most of those services are likely to be pre-planned and routine, so nothing that would put anyone at risk.
The headline will be/is the Royal Glamorgan potentially losing its A&E, children’s and maternity services. The LHBs can try and sugar coat that all they want by saying it’s not a “downgrade”, but I imagine
in most people’s eyes it’ll be considered a pretty significant downgrade. However, it’s said only 20% of A&E admissions are for “life-threatening emergencies”, and most people will still be treated for things like serious cuts, sprains, fractures, burns etc. as well as other hospital services.It won’t be too much of a problem somewhere like Pontypridd, as you can whip up or down the A470 to Cardiff or Merthyr in an ambulance relatively quickly.
If you’re suffering a serious life-threatening emergency – or an illness that could cause one – in the mid Rhondda valleys however, then you would have every right to be concerned. Even in good conditions, it’s likely to add at least 10 minutes, probably more, to an ambulance journey to an A&E department.
Let’s take a hypothetical heart attack in Penrhys.
First, the ambulance would need to get there – 8 minutes is the target for the Welsh Government, and only around half of ambulances currently reach that. In many cases that’ll be enough, but lets say it’s serious enough to require a consultant.
The shortest trip to the Royal Glamorgan is just under 10 miles – via Rhondda Fach, Porth and Tonyrefail – along reasonable quality A-roads. An experienced paramedic should be able to do that in 5-7 minutes. If the plans are approved, they won’t be able to do that anymore.
The journey to the Princess of Wales, via the “Bwlch”, Blackmill bends (a notorious accident black spot) and Brynmenyn would be 17 miles. Via Hendreforgan and the (bendy) Blackmill-Tonyrefail road its 16miles, and via the M4 (going past the Royal Glamorgan in the process, but along better quality roads) its 23 miles.
To Heath Hospital via Pontypridd (A470) its 17 miles, slightly longer than the journey to Bridgend but via faster roads. Via Llantrisant (again zipping past the Royal Glamorgan) and the M4 – 21miles. And remember that North Road is amongst the most congested parts of Cardiff at peak times.
Now, let’s say the Heath is overcrowded – and the Princess of Wales too – because of all these extra emergency cases being redirected there. Also, there’s a problem with people not paying attention to Welsh Government advice about going to A&E. Paramedics have to opt for Prince Chuckles instead.
Via Pontypridd and A470, that’s a 24 mile trip. If the paramedics were a bit dim, they could try the Maerdy-Aberdare road – that journey would be between 19-20 miles – but along poor quality roads and whilst driving through Ferndale and Aberdare town centre really, really fast. And the longer ambulances are on the road transporting people to hospital, or sitting in queues outside A&E departments, the longer they can’t respond to other emergencies.
That’s a worst case scenario, admittedly, but all that’s before throwing the emotive issue of children’s and maternity services into the mix.
I’ll leave you to decide if that’s “safe and sustainable” or not.