Protecting Our Local District Hospitals

We all seek to be well and we all believe that the National Health Service is part of our birthright; we want great services delivered near our homes by lovely people who will hold our hands through what can be some of the worst moments in our lives.


But the birthright costs and in the field of medicine the costs have risen exponentially. Whether it’s the cost of a bed, 21 days of antibiotics or some amazing drug that enables a sick person to hang on to their precious life for longer and in a better way.


Therefore we need to have a mature debate about how Wales can afford a health service fit for the 21st Century and of course part of that debate needs to focus on our hospitals.


I believe many people recognise there are services that only a hospital can provide in the future, and until the delivery of targeted outpatient care is delivered in homes or local surgeries and that delivery is embedded throughout Wales there will also remain many services that only hospitals can deliver at present.


I believe that many people understand that surgical procedures have become more specialised and specialised within disciplines. For example; an orthopaedic consultant may actually specialise in knee joints and if your knee is crocked then you will want to go and see that super specialist rather than the general surgeon. You want the person who does 10 a week not 10 a month or 10 a year.


However I also believe that many people look to their local district general hospital and expect that there are will be key specialisms that affect all such as birth and death, obstetrics & histopathology or are important for other reasons such as A&E because people need immediate care or oncology because cancer is a disease that affects many people either directly or in providing ongoing care and support to friends and families.


There will also be other services such as Paediatrics where we understand that children are a vulnerable group that need urgent attention and ongoing support or Rheumatology to support many of our predominately elderly community.


Given the above I am deeply concerned that the debate that each health board should be having with the people living in their areas is going to be sidelined by the National Clinical Forum. That this super quango will simply not engage in discussions with the general population and that the setting up of this super quango allows the Government off the hook. That politically difficult decisions can be offed to the National Clinical Forum and that the Government can cry “ it wasn’t us Guv, honest”


Why do I think this Minister? Because the consultation process engaged in by the local health board in my patch has been a farce. I am told by clinicians throughout Pembrokeshire and Carmarthenshire that the consultation in terms of clinical engagement has been about paying lip service rather than hearing what people want to say. I am told by consultants that the crucial decisions about the Criteria for Clinical Strategy were actually made by managers despite their assertions to the contrary.


The public consultations fare no better. The groups were selected by the Health Board and were presented with woolly 5 year information. No specific proposals and therefore nothing to really think about or challenge.


Minister are you able to tell me how many members of the National Clinical Forum have had significant experience of rural hospital practice at a consultant level? The view from Cardiff is very different to the view from Castlemartin and my deep concern is that this group will judge hospitals like Withybush and Bronglais on metro statistics.


Will we end up killing obstetric emergencies or people with ruptured spleens because they have to travel over an indifferent road network for some 50 miles before they can get the attention they need? And remember these are the types of emergencies that look under control but often deteriorate rapidly except these folk could deteriorate in an ambulance rather than in a hospital where everyone is on standby.


Once again Minister I find myself raising concerns about the plans for Withybush and by extension Bronglais. Are these hospitals being quietly allowed to suffer death from a 1000 cuts because of their rurality?


Withybush finds it difficult to get staff but of course people will be wary of joining an employer if they can’t see the shape of the future. The consultants list has the same names for Withybush & Glangwilli and yet Withybush has less face time so people have no alternative but to travel to Glangwilli for treatment.


In 09/10 9,481 patients who are registered in Pembrokeshire and Ceredigion attended A&E in Glangwilli Hospital in Carmarthen.


In the same year 14,769 people were admitted to Glangwilli hospital for a minimum of one nights stay, from Pembrokeshire and Ceredigion.


And 54,352 people attended Outpatients. I have tried to examine these statistics in detail Minister because I thought it could simply be geography that dictated that those people should attend Glangwilli but the centres of population do not bear this out so I had a look at the services the hospitals provide.


And it is interesting to see what has been added to Withybush and what has been taken away over the past year. Added, Community Support Unit, Transfer Team. Multi agency support team


Taken away, Histopathology, Orthodontics and patient pathways redesigned and resulting in reductions and changes in Urology, Vascular Services and Orthopaedic hip revisions.


The additions are welcome but they are services that don’t need the wrap around care of a DGH. Those losses are key services in a DGH and now there is speculation over whether Emergency Surgery is under threat at Withybush.  And that could affect General Surgery, thereby affecting Elective surgery and a consequence could be the loss of Colorectal surgery which is co-dependant on emergency surgery. Yet the Withybush Colorectal Unit is one of the best in Wales as determined by the National Audits.


Looking at the clinical services The A&E consultant at Withybush specialises in assessment & stabilisation whereas the 3 A&E consultants at Glangwilli specialise in, well in pretty much everything to do with trauma.


What’s the message. And what’s the message to the staff . They have suffered prolonged uncertainty over the past 3 and half years since the mergers of the boards. We have consultant resignations, consultant posts not being filled and a worsening recruitment problem.


Death of a 1000 cuts.


Minister will you ensure that consultations are fair and inclusive,


That the National Clinical Forum doesn’t ride roughshod over local people and understands the issues of delivering National Health Services in rural communities


And in regard to Withybush that we don’t lose more services and that the people who work in the health Service will not be subjected to more and more delays in knowing what is going on.


We need a mature debate but to undertake that we need information, we need to be treated responsibly and as responsible people and an atmosphere where we can truly take the correct decisions no matter how difficult they may be.