Welsh Health Minister's statement on Hywel Dda area health changes
Hywel Dda Service Change Plans - Statement by Mark Drakeford AM, Minister for Health and Social Services
Change is unavoidable in the Welsh NHS, but proposals for change need to be concluded in a considered and timely fashion.
In a Written Statement of 17 July, I confirmed that agreement had been reached between Betsi Cadwaladr University Health Board and the local Community Health Council to implement the changes previously referred to me for determination in the North Wales area.
I am now pleased to be able to update Members on the position with the service change plan for Mid and West Wales – proposed by the Hywel Dda Health Board.
In January, the Health Board published its final proposals for changes to services. In accordance with our established guidance, the local Community Health Council were able to refer any elements of the proposals to Welsh Ministers for determination if local agreement could not be reached on the change proposals.
On 19 April, Hywel Dda Community Health Council made such a referral, relating to the Health Board’s proposals for Accident and Emergency Services at Prince Philip Hospital in Llanelli, and neonatal services specifically in relation to Withybush and Glangwili Hospitals.
An independent Scrutiny Panel has since been convened in the Hywel Dda area to provide me with advice and recommendations on these matters. The Panel visited on 14th and 15th August, meeting the Health Board and the CHC along with a number of key clinicians. The panel consisted of: Mr Jim Wardrope (Consultant in Emergency Medicine at Northern General Hospital Sheffield); Professor Neena Modi (Professor of Neonatal Medicine, Imperial College London and Honorary Consultant at Chelsea and Westminster Foundation Trust), and Dr David Salter (retired former Deputy Chief Medical for Wales with extensive knowledge of NHS Wales).
The Panel submitted its report on 12 September, and Members have received a copy from the Plenary Business Unit. Llywydd, I begin with the Panel’s conclusions in respect of Llanelli. The Panel strongly support the case for replacement of A&E services at Price Philip Hospital. It unanimously proposes that an Emergency Nurse Practitioner Unit supported by General Practitioners should form the future model of care at the Hospital.
I accept fully this expert advice and have therefore determined that this form of service will be implemented. I am pleased to report that the Health Board and CHC have already been working on the detail of this type of service model for Prince Philip Hospital.
At Prince Philip Hospital, in 2011-12 its Emergency Department saw 33,000 patients of which 6,500 were major cases. 422 of these needed to be transferred to another hospital. The remaining 80% of patients were treated at the Hospital and the decision I have made today means that this position will be no different in the future.
I turn now to the Panel’s conclusions in relation to neo-natal services. Here, while the thrust of the LHB’s original proposals is endorsed, the Panel was unable to reach a final conclusion until, it says, clear and definite plans for obstetric and midwifery services have been agreed for the Hywel Dda area.
I have therefore determined that the Health Board must carry out a further piece of work in respect of its obstetric, midwifery and gynaecology services, explicitly setting out the way in which these services are linked to its proposals for changes to neonatal services. I expect this work to be completed by the end of this year.
I must leave Members in no doubt, however, about the underlying model of neonatal services which the Panel endorses.
It says very clearly;
‘The provision of neo natal special care facilities across all Hywel Dda hospitals is neither safe nor sustainable’.
Rather; ‘There is consistent evidence from around the world that regionalisation of services for low risk deliveries and the centralisation of high risk deliveries are effective in reducing neo natal deaths’.
On that basis the panel supports the LHB’s proposals for a stratified service. At Bronglais, Withybush and Glangwili, services will provide care for the vast majority of babies born in those communities. The panels report puts this at the 90% level.
The Panel then specifically endorses the development of a Level Two neonatal unit at Glangwili for births in the wider Hywel Dda area which need a higher level of care. This will ensure that those babies who need more specialised care will receive it in a fully staffed, fully equipped Level 2 Unit operating to national clinical standards. Many of these births would have been identified in advance, with transfer to Carmarthen planned with the family concerned. Where the need for a Level Two service emerges on an unplanned basis, the Panel proposes the current neonatal transport service is extended to operate on a 24 hour basis. I have asked for the Board’s response to this proposal as part of the additional work to be completed by the end of 2013.
Finally, in this stratified approach, the Panel confirms that a very small number of complex births will continue to need Level Three care and that, for Hywel Dda residents, this should take place, as now, through services provided by the Abertawe Bro Morgannwg LHB.
I have outlined the model for neonatal services recommended to me by the expert Panel. Its final conclusion, however, awaits the additional work I have also set out. Once that has been completed, I will ask the Panel to reconvene and provide me with its final advice. I hope to be able to bring the whole process to an end through a further statement to the Assembly when we return after the Christmas recess.
The process of change is always challenging even when inevitable and necessary. The panels approach is consistent with that already adopted by the Welsh Government – retaining the bulk of services locally while ensuring that care for those with greater need is provided in accordance internationally accepted, evidence-based standards, leading to best outcomes for patients.
I would like to place on record my personal thanks to members of the Scrutiny Panel for all their hard work over the summer months in preparing their Report, despite other heavy commitments. I commend the expertise and professionalism they have brought collectively to this task.
I would also like to thank the Health Board and CHC who met with my officials here in Cardiff yesterday and who will continue to work together in the interests of the local communities to ensure the highest standards of care for the people of Mid & West Wales.
In a Written Statement of 17 July, I confirmed that agreement had been reached between Betsi Cadwaladr University Health Board and the local Community Health Council to implement the changes previously referred to me for determination in the North Wales area.
I am now pleased to be able to update Members on the position with the service change plan for Mid and West Wales – proposed by the Hywel Dda Health Board.
In January, the Health Board published its final proposals for changes to services. In accordance with our established guidance, the local Community Health Council were able to refer any elements of the proposals to Welsh Ministers for determination if local agreement could not be reached on the change proposals.
On 19 April, Hywel Dda Community Health Council made such a referral, relating to the Health Board’s proposals for Accident and Emergency Services at Prince Philip Hospital in Llanelli, and neonatal services specifically in relation to Withybush and Glangwili Hospitals.
An independent Scrutiny Panel has since been convened in the Hywel Dda area to provide me with advice and recommendations on these matters. The Panel visited on 14th and 15th August, meeting the Health Board and the CHC along with a number of key clinicians. The panel consisted of: Mr Jim Wardrope (Consultant in Emergency Medicine at Northern General Hospital Sheffield); Professor Neena Modi (Professor of Neonatal Medicine, Imperial College London and Honorary Consultant at Chelsea and Westminster Foundation Trust), and Dr David Salter (retired former Deputy Chief Medical for Wales with extensive knowledge of NHS Wales).
The Panel submitted its report on 12 September, and Members have received a copy from the Plenary Business Unit. Llywydd, I begin with the Panel’s conclusions in respect of Llanelli. The Panel strongly support the case for replacement of A&E services at Price Philip Hospital. It unanimously proposes that an Emergency Nurse Practitioner Unit supported by General Practitioners should form the future model of care at the Hospital.
I accept fully this expert advice and have therefore determined that this form of service will be implemented. I am pleased to report that the Health Board and CHC have already been working on the detail of this type of service model for Prince Philip Hospital.
At Prince Philip Hospital, in 2011-12 its Emergency Department saw 33,000 patients of which 6,500 were major cases. 422 of these needed to be transferred to another hospital. The remaining 80% of patients were treated at the Hospital and the decision I have made today means that this position will be no different in the future.
I turn now to the Panel’s conclusions in relation to neo-natal services. Here, while the thrust of the LHB’s original proposals is endorsed, the Panel was unable to reach a final conclusion until, it says, clear and definite plans for obstetric and midwifery services have been agreed for the Hywel Dda area.
I have therefore determined that the Health Board must carry out a further piece of work in respect of its obstetric, midwifery and gynaecology services, explicitly setting out the way in which these services are linked to its proposals for changes to neonatal services. I expect this work to be completed by the end of this year.
I must leave Members in no doubt, however, about the underlying model of neonatal services which the Panel endorses.
It says very clearly;
‘The provision of neo natal special care facilities across all Hywel Dda hospitals is neither safe nor sustainable’.
Rather; ‘There is consistent evidence from around the world that regionalisation of services for low risk deliveries and the centralisation of high risk deliveries are effective in reducing neo natal deaths’.
On that basis the panel supports the LHB’s proposals for a stratified service. At Bronglais, Withybush and Glangwili, services will provide care for the vast majority of babies born in those communities. The panels report puts this at the 90% level.
The Panel then specifically endorses the development of a Level Two neonatal unit at Glangwili for births in the wider Hywel Dda area which need a higher level of care. This will ensure that those babies who need more specialised care will receive it in a fully staffed, fully equipped Level 2 Unit operating to national clinical standards. Many of these births would have been identified in advance, with transfer to Carmarthen planned with the family concerned. Where the need for a Level Two service emerges on an unplanned basis, the Panel proposes the current neonatal transport service is extended to operate on a 24 hour basis. I have asked for the Board’s response to this proposal as part of the additional work to be completed by the end of 2013.
Finally, in this stratified approach, the Panel confirms that a very small number of complex births will continue to need Level Three care and that, for Hywel Dda residents, this should take place, as now, through services provided by the Abertawe Bro Morgannwg LHB.
I have outlined the model for neonatal services recommended to me by the expert Panel. Its final conclusion, however, awaits the additional work I have also set out. Once that has been completed, I will ask the Panel to reconvene and provide me with its final advice. I hope to be able to bring the whole process to an end through a further statement to the Assembly when we return after the Christmas recess.
The process of change is always challenging even when inevitable and necessary. The panels approach is consistent with that already adopted by the Welsh Government – retaining the bulk of services locally while ensuring that care for those with greater need is provided in accordance internationally accepted, evidence-based standards, leading to best outcomes for patients.
I would like to place on record my personal thanks to members of the Scrutiny Panel for all their hard work over the summer months in preparing their Report, despite other heavy commitments. I commend the expertise and professionalism they have brought collectively to this task.
I would also like to thank the Health Board and CHC who met with my officials here in Cardiff yesterday and who will continue to work together in the interests of the local communities to ensure the highest standards of care for the people of Mid & West Wales.
Comments