South Wales Programme: Decision Time

Moves towards a “final” recommendation of the controversial South Wales Programme of hospital reorganisations were announced yesterday, following a meeting of the relevant local health boards and Wales Ambulance Trust.

Except….there wasn’t any decision, just another round of uncertainty.

The plans are to centralise some key services on fewer sites. I’ve gone into the reasoning for changes, and arguments against, in previous posts and I’m sure you’re all familiar with them now. Those services are: accident and emergency services for the most critically ill, consultant-led maternity services and children’s services.

Just to recap, there were four options on the table.

In each case, services would be retained at University Hospital, Cardiff (“The Heath”), Morriston Hospital in Swansea and a new specialist critical care centre to be built near Cwmbran circa 2018-19.

However, only one or two of the other acute general hospitals in south Wales would retain these services.

  • Option 1 – Merthyr
  • Option 2 – Llantrisant
  • Option 3 – Bridgend and Merthyr
  • Option 4 – Llantrisant and Merthyr

Most of the health boards have – as expected, and as strongly hinted in the evidence – backed Option 3, meaning the Royal Glamorgan Hospital in Llantrisant will be downgraded, and the specialist services will be maintained at the Princess of Wales Hospital, Bridgend and Prince Charles Hospital, Merthyr Tydfil.
Cwm Taf LHB – which covers the Royal Glamorgan – rejected proposals to remove services there, instead putting forward their own alternative which would see services shared between Bridgend and Llantrisant as an interim measure towards full-blown centralisation. If I’m honest that’s unlikely to happen, but it’s caused the uncertainty as reported by BBC Wales.

This still has to be formally approved by the health boards, which are meeting again next week to discuss the options further. Then it will need approval from the respective Community Health Councils. There’s also the outside chance the decision could be referred to the Health Minister, Mark Drakeford (Lab, Cardiff West).

What will this mean?

This is a snippet of the evidence presented at the time:

  • Prince Charles Hospital could see an extra 5,000 A&E attendances, Bridgend 6,000, Cardiff 4,000. Royal Glamorgan A&E attendances would fall by 11,000 and Neville Hall Hospital by 10,000.
  • The average journey time to A&E will increase by 8.3%.
  • Prince Charles Hospital could see a 75% increase in paediatrics admissions, Bridgend 57%, Cardiff 16%. Average paediatrics journey time would increase by just over 8%.
  • Births will be redirected mainly to Prince Charles Hospital from the Royal Glamorgan, with a few hundred per year redirected to Cardiff and Bridgend respectively. This could increase average maternity journey times by 7%.

Since then, however, there’s been significant changes. Leighton Andrews AM (Lab, Rhondda) blogged that in updated evidence presented just before Christmas, it’s now widely-expected the bulk of patients from the Rhondda area won’t head to Merthyr or Bridgend (as hinted in the original patient flow evidence outlined above) but The Heath in Cardiff, which is under enough pressure as it is when it comes to specialist services.
I would’ve thought that was obvious. Common sense and gut instinct can sometimes trump statistics. Although I doubt it undermines the case for Option 3 to any great extent, you have to question whether the wider consultation has been based on faulty evidence.

The final report (pdf) says implementing Option 3 would save around £3million per year in running costs but with a £75million in (presumed new build) capital costs. I’m not sure if that includes the cost of the new Cwmbran centre, though the report says the costs will be shared between the five local health boards.The Royal Glamorgan Hospital could become a centre of excellence for some pre-planned medical services. It’s been suggested this will include management of long-term chronic illnesses, day services for the elderly and diagnostics.

The report also says some services that weren’t covered by this set of proposals might need to be addressed in future including: arterial surgery, stroke care and some diagnostic services. I wouldn’t at all be surprised if there were another round of centralisations in the medium-term as a result.

There’s no set timetable for when services will be moved. The final report says services could move at different times, though it’s said there’ll be a 12 month transition period. So I’d guess that everything will be in place by 2016 should this decision be ratified.

Owen