Full report into women and children’s services received by Hywel Dda Board

The Royal College of Paediatrics and Child Health has provided Hywel Dda University Health Board with its full report into women and children’s services, which will be discussed at the next Board meeting to be held in Withybush Hospital Conference Centre on Thursday 26 November.
The report provides more in-depth information and specific themed recommendations for each service area, over and above the headline recommendations that were contained in the interim report released in September.
Medical Director Dr Philip Kloer will introduce the report at full Health Board and will describe some of the activity that has already taken place in recent months, including:
• development of the Phase 2 Business Case for improvements to accommodation at Glangwili Hospital underway, including putting a project structure in place, and ongoing writing of the business case and staff engagement on the schedule of accommodation
• improvements to transport services for patients, with good use being made of voluntary transport services
• continued work with staff in the women and children’s directorate on organisational development include improving and better integrating midwifery teams, and supporting and developing clinical leadership within the service
• continued delivery of the Dedicated Ambulance Vehicle with work to extend the contract being pursued
The report says that the review group “found no evidence that clinical outcomes had worsened since the changes and there is better compliance with professional standards’ and “no clinical sense in reversing the major decisions of reconfiguration made one year ago”.
It calls out 54 specific recommendations, which the review team considers necessary for improved future delivery of services for the local population, as well as high principle recommendations as follows:
• Patient Safety: The provision of maternity and children's services must continue to build on the current momentum with the major emphasis on provision of services that provide maximum safety for patients, but are sustainable in the long term, being cognisant of the geographical challenges of the area. We found no evidence that clinical outcomes had worsened since the changes and there is better compliance with professional standards. There is no clinical sense in reversing the major decisions of reconfiguration made one year ago.
• Clinical Accommodation: The further development of clinical excellence can only occur if the accommodation to deliver such care is appropriate and adequate for patient safety. Further delay with ‘Phase Two’ is unacceptable and a potential risk to patient safety.
• Community Needs and Access to Services: Inevitably some decisions around reconfiguration will make access to safe services more difficult for some people. Alongside such changes, there therefore must be improvements in access to more routine care and the review recommends improved out-patient services at Withybush to demonstrate commitment to patients and the public. The continued provision of a dedicated staffed ambulance for women and children must be supported, but the current consultant on-call arrangements for paediatric and obstetric/gynaecology out of hours are an inefficient use of resources which are hampering development of unified medical teams and these should be phased out.
• Recognition of Staff Commitment: The planning of care must involve all members of the clinical community and build on their professionalism, enthusiasm and commitment to patient welfare.
• Organisational Leadership: There needs to be more active and visible clinical leadership of women and children’s services from the Board, and also at divisional and specialty level.
• Communication; The Health Board needs to prioritise an active and evidence-based dialogue with patients, advisory groups and clinical staff to mitigate the misunderstandings and anxieties that have arisen in the past.
Chief Executive Steve Moore said: “I am grateful to the review team for this robust report which gives us a great deal of information and direction to further improve our women and children’s services for the local population. I know some people in our communities have been disappointed that the report has not recommended a return of services to Withybush Hospital and I acknowledge and understand that this change has been difficult and emotive and that there is significant anxiety still. I hope that the evidence that has been shared through this report, and the external and expert clinical view from the team, has provided some reassurance as to the safety of our services and improved outcomes for patients.
He continued: “We are fully committed to delivering Phase Two of improvements to the accommodation at Glangwili Hospital and I am personally overseeing that project as the senior accountable officer. As a Board, and with our clinicians and other staff, we will work through all the recommendations to produce an action plan and alongside this deliver clearer communication and engagement with staff, patients and the community.”
The full report is available here:http://www.wales.nhs.uk/sitesplus/862/opendoc/278578