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‘Once in a lifetime’ reorganisation planned by Health Board

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THE LOCAL Health Board is embarking on a ‘once in a lifetime’ reorganisational plan which is looking at all potential options to ‘change the status quo and focus on improving health’ of locals.

This will involve, a press release has revealed, transferring more hospital services into the community where appropriate.

This is part of a strategy that the Health Board is looking into, to help solve an acute recruitment problem which is putting a great deal of pressure on the way that the Heath Board operates – and is leading to an untenable level of use of costly temporary staff to plug gaps and services.

In the summer of 2017, the Health Board embarked in an engagement with the public called ‘The Big Conversation’ which involved public workshops and drop-ins being held across the three counties of Pembrokeshire, Carmarthenshire and Ceredigion.

The Health Board now says the it has independently analysed opinions of the general public and has been using that data to explore, challenge and test different scenarios.

It is yet to be seen what these changes will mean for end service users.

The Herald understands it is likely to mean hospital services being reduced or cut, and replaced with community alternatives.

The Health Board has said it will not make any changes, unless it can guarantee the safety of the people which it serves.

The Health Board has insisted that no preferred option for change has yet been determined, and nothing has been signed off or agreed at this stage.

Medical Director Dr Philip Kloer said: “This is a once in a lifetime opportunity for our health service and community to work together to design an NHS which is fit for our generation and beyond. It has been acknowledged for some time across the UK that healthcare services are challenged like never before and we need significant change. Indeed this has been recognised in the recently published ‘Parliamentary Review of Health & Social Care’ here in Wales.

“We need to develop more proactive, resilient and better resourced local community services to support and improve people’s health and wellbeing, and avoid deterioration where possible. This will involve closer working with our partners, particularly colleagues in social care. We are also looking at ways of providing the most modern clinical practice, using the latest digital, technological, and new scientific developments, in fit for purpose facilities to provide better patient outcomes and experience.

“A number of our services are fragile and dependent on significant numbers of temporary staff, which can lead to poorer quality care. For us specifically in Hywel Dda, the geography we cover is large, with many scattered communities that are getting older, needing more holistic health and social care treatment and support. Because of this, we need to better resource our community based care, which is where most of our patient contact is, and help people manage their health conditions. We also need to evolve traditional ways of working and provide a more proactive approach. This should give patients – young, older and frail and everyone in between – the services they need when the need it, so people do not have to wait too long.

“This will mean changing hospital-based care, as well as community care, and we appreciate the attachment local people and our own staff have for their local hospitals. They have been cared for in them, or work in them, and they also play an important role in our wider communities. The options may propose change to a local hospital; however this is about more than the buildings. This is about investing in our communities, attracting doctors, nurses and therapists by operating a modern healthcare system and keeping hospitals for those who really need hospital care.

“We will not put in place any change that isn’t safe for our patients and population. And we will look at all the impacts from ensuring services are safer with better patient outcomes, to considering the wider impact on people, including the most vulnerable.”

Dr Kloer added: “The potential options are evolving, with changes to them on almost a daily basis. Many will never even reach public consultation, for a variety of reasons including safety, accessibility and affordability, or will change significantly as they are tested against population needs and healthcare standards.

“We will be coming back to the public in the spring with fewer options that have been more rigorously tested and we will open and honest about what we think our preferred option is and why. We would not, and cannot, propose something that would not be safe for our population.

“We live in this community, use our NHS and work for our NHS and we want to work with our patients, staff, partners and public to ensure it is the best it can be.”

Meanwhile, Elin Jones, Ceredigion’s Assembly Member, has called for urgency in the implementation of electronic records for NHS patients in Wales, following the publication of a report by the Wales Audit Office, ‘Informatics systems in NHS Wales’.

The report outlines several of the opportunities that electronic patient records can bring to patients and health boards, as well as the current obstacles to achieving this goal.

Elin Jones, who has long-called for a paperless NHS has welcomed the report, saying: “This is an important step in the development of health services in Wales, which is long-overdue. It would make our NHS more sustainable and more flexible to every patient’s needs.

“I have heard of many instances where patients have turned up to appointments in Llanelli, Swansea or Cardiff, only to find that their medical records have not arrived. These are people who have, in some cases, had to wait a long time for a specialist appointment, and have had to travel long distances, sometimes leaving very early in the morning or have arranged overnight accommodation in order to get to a 9 am appointment.

“Being turned away because their paper record has not arrived is a failure in the current system, and would be addressed directly by electronic records.

“The technology is available, it’s just a case of putting the funding in place.

“With the proper investment into the Welsh NHS by the Welsh Government, electronic patient records can help the NHS to deliver better outcomes for patients and to make more efficient and effective use of scarce financial and human resources.”

Community

County Hall to offer space for community banking

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A CALL for Pembrokeshire County Council to potentially change its banking arrangement with Barclays, after it closed its Haverfordwest branch has been turned down, but County Hall is to offer space for community banking.

Barclays Bank, on the town’s High Street, is to close on May 10.

The council has had a banking services contract with Barclays since 2013.

Councillor Huw Murphy, in a notice of motion heard by Pembrokeshire County Council’s Cabinet meeting of April 22, asked the council to review its banking arrangements with Barclays following the announced closure.

e said the loss of a branch “not only impacts upon town centres and businesses but also disproportionately impacts the elderly who are less likely to embrace on-line banking options”.

A report for Cabinet members said, in terms of the impact on Pembrokeshire residents, Barclays has said that it is “not leaving Haverfordwest and [will] continue to provide face-to-face support for those who need it” via community locations.

Two options were presented to Cabinet: to retender the banking services contract, and, the favoured, to work with Barclays to ensure a community location is set up in Haverfordwest.

Members heard the costs associated with moving to a new banking service provider could be in excess of £50,000.

For the second, favoured option, members heard Barclays was in discussions with the council about a location for potential community banking.

Cabinet Member for Corporate Finance Cllr Alec Cormack, after outlining the risks in the report for members, and moving the notice be not adopted, said he had “considerable sympathy” with Cllr Murphy’s notice.

He told councillors there was a glimmer of light for banking arrangements in the county, with an agreement now signed for two ground floor rooms at County Hall, Haverfordwest, to be used for community banking.

From April 25, the rooms will be available on Wednesdays, Thursdays, and Fridays, members heard.

Cabinet Member for Planning & Housing Delivery Cllr Jon Harvey also said he had “a lot of sympathy” for the motion, adding: “It’s excellent news a deal has been struck to occupy the ground floor rooms three days a week; hopefully this will mitigate, to a certain amount, the closure.

“If we can work with the respective banks to get a community-type approach let’s move forward.”

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Haverfordwest interchange: Next stage of £19m project backed

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The second stage of building Haverfordwest’s near-£19m transport interchange has been backed, with senior councillors hearing it could cost the council more to not support it.

The transport interchange, which includes an integrated bus station and construction of a new multi-storey car park, is part of a wider series of regeneration projects in the county town.

The total cost of the scheme in the approved budget is £18.881m, £1.987m from Pembrokeshire County Council; the remainder, £16.894m, from an already-awarded Welsh Government grant.

To date, £3.425m has been spent on advanced works, including the demolition of the old multi-storey car park and a temporary bus station.

Members of Pembrokeshire County Council’s Cabinet, meeting on April 22, were recommended to approve the award of the Stage 2 construction contract for the Haverfordwest Transport Interchange.

The report for members listed two simple options for Cabinet, to authorise the award of a contract, recommended, or to not.

For the latter it warned: “It is envisaged Welsh Government will withdraw the funding awarded and the council would need to repay grants received to date; £10.322m has been received to date of which £3.376m has been offset against expenditure.”

It added: “Cost to cease this project could cost PCC more in terms of grant repayment and any capital work required to make good. PCC match contribution for the project is forecast as £1.987m of the £18.881m.”

Planning permission for the interchange was granted in 2022, with a temporary bus station constructed that year and the old multi-storey building demolished in 2023.

That year, members of the county council’s Cabinet agreed a temporary car park will be sited on the demolished remains of the old multi-storey car park until the Haverfordwest Public Transport Interchange – delayed as no compliant tender had been found at the time – is built.

Speaking at the meeting, Deputy Leader Cllr Paul Miller said: “The interchange is an important part of the regeneration of Haverfordwest, it will not regenerate Haverfordwest on its own, it is part of a wider process. The alternative to us being engaged is we simply allow it to decline and fail.”

He said the interchange was about “making it easier to visit Haverfordwest,” making parking provision “really straightforward, making it easy and convenient as possible”.

Cllr Miller said not progressing with the scheme would risk the grants already obtained, meaning the council could potentially foot the bill for costs to date, at a greater level than progressing.

He said the cost options were a near-£2m subsidised council involvement for the whole scheme or the £3m-plus spent to date if the scheme was ended, which would leave the car park as it is now.

“It’s pretty reasonable that if they give us the money and we don’t build a transport interchange they’ll be looking for that money back,” Cllr Miller said.

He said previous figures from parking revenue – back in 2019 – amounted to £100,000 a year; and could be expected to at least double on a “like-for-like” basis following the increase in parking charges.

Members, after a private and confidential session over the actual contract details, agreed to proceed with the scheme, awarding the contract to Kier Construction Western and Wales.

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RNLI prepare for summer with medical training exercise in Pembrokeshire

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RNLI lifeguards from the north Pembrokeshire team, volunteers from St Davids RNLI and St Davids Coastguard Rescue Team came together at Whitesands beach on Thursday (18 April), for a multi-agency medical training exercise. Pembrokeshire RNLI lifeguards and St Davids volunteer lifeboat crew took part in a multi-agency medical training exercise alongside St Davids Coastguard Rescue Team in preparation for the upcoming summer season.

The Coastal Medicine programme was set up six years ago at the suggestion of clinicians from Hywel Dda University Health Board. The aim of the programme is train lifeguards, lifeboat crews and HM Coastguard teams in working collaboratively when responding to medical incidents on the coast.

Clinicians from Hywel Dda work with RNLI staff to design exercises simulating mass-casualty incidents on land and afloat. The exercises allow lifeguards, lifeboat crews and Coastguard teams to practise and test their rescue response and casualty care.

The simulated incident at Whitesands involved a medical incident at sea leading to a boat going out of control and ploughing through a group of swimmers causing multiple injuries. RNLI lifeguards responded to casualties on the beach while St Davids inshore and all-weather lifeboat crews dealt with the situation at sea. St Davids Coastguard Rescue supported RNLI colleagues as they would in a real-life scenario.

In total there were six casualties to treat, all of whom were given the immediate medical care by the teams on scene. As in a real-life scenario, they were then prepared to be handed over to the care of the Ambulance Service.

Roger Smith, RNLI Area Lifesaving Manager said: ‘The scenario was based on a real-life incident, it’s so important that we train in dealing with challenging situations.

‘The RNLI lifeguards, lifeboat crew, and the Coastguard rescue team worked really well together collaborating together to achieve the best possible result.

‘The feedback from all the participants was really positive, and our medical colleagues were very complimentary about the competence shown and the inter-agency co-operation.

‘This scenario training gives confidence to our lifeguards and lifeboat crews, and ensures the teamwork and communication is already in place ready for real-life incidents.’

Martin Charlton, an RNLI lifeguard in north Pembrokeshire said:

‘Last night’s exercise was a great opportunity for me and my colleagues on the lifeguard team to upskill ahead of the summer season.

‘We regularly attend incidents in the season that require a multi-agency response. These scenarios are a brilliant opportunity to prepare for the the most challenging situations.

‘The team and I thoroughly enjoyed the exercise and feel better prepared for the season as a result.

‘It’s always a pleasure working alongside the Coastguard rescue team and the lifeboat as one crew.’

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