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Health board statement on ’20-year journey’ in full

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THIS is the full statement from Chief Executive Steve Moore of  Hywel Dda University Health Board following the extraordinary meeting on Wednesday (Sept 26) at County Hall, Carmarthen:

 

HEALTH BOARD STATEMENT

Hywel Dda University Health Board will embark on an ambitious 20-year journey to transform the way we receive health care and support in Carmarthenshire, Ceredigion, Pembrokeshire and borders, it was decided at a public board meeting.

Twelve recommendations from clinicians (doctors, nurses and a range of healthcare professionals such as health scientists and therapists) were approved and can be read in full here https://bit.ly/2NJxft5.

Headline decisions included:

  • more investment will be made in the integration of social care with health and well-being across the seven localities (north and south Ceredigion, north and south Pembrokeshire, Taf/Tywi, Amman/Gwendraeth and Llanelli)
  • a hospital model, will be adopted and includes:
    • a business case to be made for a new hospital in the south of Hywel Dda (somewhere between Narberth and St Clears) to provide specialist urgent and emergency care services and planned care
    • hospital services to be retained and developed at Bronglais Hospital, Aberystwyth, in-line with the Mid Wales Joint Health & Social Care Committee recognising importance of hospital in delivery of services to populations of Ceredigion, Powys and South Gwynedd
    • acute medicine (hospital services that need medical input) to be retained at Prince Philip Hospital, Llanelli, following recent modernisation of services developed with the local community and serving a densely populated area
    • re-purposing Glangwili (Carmarthen) and Withybush (Haverfordwest) hospitals to support community health needs including overnight beds, day case procedures, out-patient and walk-in services such as minor injuries and much more

This follows one of the largest local NHS consultations in the UK (Hywel Dda Our Big NHS Change), which was held between April and July, and which saw a huge and passionate response from the local population. Responses included more than 5,400 questionnaires, 4,000 attendees at events and workshops, hundreds of written submissions, five petitions and extensive social media debate.

Board members considered all they heard from patients, staff, the general public and interested organisations, not just during the consultation, but also in the pre-consultation engagement and option development period.

They also considered recommendations made by Hywel Dda Community Health Council, the clinical viewpoint following consultation, and other matters including safety standards the NHS has to meet and the ability to provide services in the future.

Whilst some key decisions were made, the health board received really insightful feedback from people during the consultation and wants to investigate further, and demonstrate, some developments, including:

  • commitment to work with people and organisations to develop integrated networks (as opposed to hubs) which are unique to the needs of their community and to consider the geographical areas highlighted in the consultation as gaps in current provision
  • work with the community on an early model of the above in Pembrokeshire, focusing on the ability to provide more community based care 24/7 and to demonstrate how it could work and the impact it could have
  • work with local people to explore potential for a range of different types of beds within the local community – whether in existing community hospitals, at home or another setting review, test and challenge the model for acute medicine to be responsive to demand and changes in patient flows associated with the whole system change
  • work closely with Abertawe Bro Morgannwg University Health Board on services where patients could benefit from a regional approach
  • examine the opportunities a new hospital and community model could offer maternity and child health services to ensure doctor and midwifery led care, and care for children (paediatrics) and sick babies (neonatal) are maintained within the boundaries of the Hywel Dda area
  • align with the transformation work in mental health services to ensure mental health and learning disability assessment and treatment units are provided at the new urgent and planned care hospital
  • investigate the practicalities and impacts (through a feasibility study and options appraisal) of locations between Narberth and St Clears for the new hospital
  • work with people living and working in the areas furthest from a new hospital to provide additional support for emergency and urgent care (potential to look at things like placing paramedics within in a community as opposed to within a vehicle)
  • respond to public anxiety over the ability to manage emergency conditions that are time sensitive (e.g. ST Elevation Myocardial Infarction STEMI, stroke and sepsis) consider the opportunities a new hospital in the south would provide Bronglais Hospital
  • work closely with other organisations, including county councils and the third sector, to develop Glangwili and Withybush hospitals
  • develop a detailed plan to address concern heard in consultation regarding access, travel, transport and infrastructure, working with the Regional Transport Group, communities (including those with protected characteristics in response to the difficulties we heard about from people and the equality impact assessment) and Welsh Ambulance Services NHS Trust
  • formally state the Health Board’s support for building a case for provision of a 24/7 service to bring medics to the scene of an accident (e.g. the Emergency Medical Retrieval Transport Service, which operates 12 hours a day and CHANTS (Neonatal Retrieval Service))
  • develop a plan to maximise use of technology in health and care, backed up by secure IT so patient data is safe and joined up between services in the hospital and community
  • put in place a staff plan to deliver future models and provide opportunities for staff
  • work with education and university partners to train a workforce with the skills and expertise to work in the new service model, and drive research, innovation and evaluation into our service development
  • continue to talk the public, staff and interested organisation about all that we do, especially focusing on people with protected characteristics

Chief Executive Steve Moore said: “Today is a hugely momentous day as we confirm we will take a new direction to providing much more preventative and community based healthcare to our population. We’ve heard the concern people have with current healthcare provision and our ability to deliver this sea-change in the years to come but our clinicians have led this work and we believe what has been put before us today offers us the best chance to deal with the fragility our NHS faces and to provide the population with safe, effective care that meets their needs.”

Chair Bernardine Rees added: “We are really grateful to everyone who got involved in our consultation as it has given us really rich feedback. Our ambition is to continue that conversation and input so that we can grow services in our seven localities, using schemes we have already delivered, such as the front of house project at Prince Philip Hospital and Tenby walk-in, as the basis of what can be achieved.”

The next step will be for clinicians and staff to work with the public and other organisations to bring the additional detail together into a draft Health Strategy to put before public Health Board at the end of November.

Medical Director and Director of Clinical Strategy Dr Philip Kloer said: “We’re aware that some people, particularly those who live furthest from the new hospital zone between Narberth and St Clears may be anxious about these changes. They will not happen overnight and we are committed to working with those communities and our partners to demonstrate and test what additional provision can be made, particularly for time-sensitive emergency conditions.

“For example we are working with partners to build the case for the Emergency Medical Retrieval Team (doctors who are brought to the scene to treat and then transfer) and CHANTS (the Neonatal Retrieval Team) to be a 24-hour service, and also investigating the potential to place advanced paramedics in communities so they are available solely to that community.

“Another important factor in providing life-saving treatment is getting people quickly to the definitive hospital which will provide their care. At the moment, people in our coastal areas of Pembrokeshire have to travel to Glangwili for some treatment, which in the future, we will be able to offer at a more equitable location, for the south of Hywel Dda, in the new hospital zone.”

The new hospital will be dependent also on a full business case, which will be made to the Welsh Government.

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Tenby pedestrianisation starts Monday

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THE TENBY pedestrianisation scheme starts on Monday, July 1. The scheme – which operates within the town walls – will operate until Friday, September 13 between the hours of 11am and 5.30pm. The scheme will be suspended for the Long Course Weekend on July 6/7.

This permanent time-frame has been chosen following a questionnaire and consultation exercise Pembrokeshire County Council carried out after last year’s scheme which trialled the new dates.

The town pedestrianisation scheme is a popular one with visitors as it allows a vibrant ‘cafe culture’ feel to be embraced in the town with many of the pubs and restaurants within the exclusion zone opting an alfresco-style seating and dining experience, and on sunny summer days, it allows guests and visitors to sit outside and enjoy lunch or drinks in the sunshine.

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Substitution in psychoactive substances a growing concern for experts

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THERE is evidence of a growing market in the manufacture and distribution of new benzodiazepine susbstances, with 71% of samples of what users think is diazepam testing positive for other chemicals.

Street valium is bought and sold on the streets of Wales for as little as 50p per tablet.

Josie Smith, Head of Substance Misuse for Public Health Wales and Programme Lead for WEDINOS said: “Although there are always concerns and potential for adverse effects from the consumption of psychoactive substances, the risk is increased by the rising prevalence of substance substitution within the unregulated illicit benzodiazepine market.

“As substitute substances have varying therapeutic doses and duration of effects, there is a concern in relation to the increased potential for an individual to experience adverse and acute effects; including accidental overdose, hospitalisation and death.”

Public Health Wales’s WEDINOS service has seen an increase in the number of samples submitted for testing in the last year, with the substitution of substances within drug groups a key emerging trend.

The WEDINOS Annual Report for 2018-19 also identifies a substantial increase in non-prescribed ‘prescription’ medications being submitted to its drug testing facility.

As in 2017/18, benzodiazepines were the most commonly identified class of psychoactive substances.

Benzodiazepines such as Diazepam, Etizolam and Alprazolam (Xanax) are common sedative drugs often prescribed for anxiety and insomnia.

In addition to prescribed medical use, benzodiazepines are used recreationally and there is evidence of a growing market in the manufacture and distribution of new benzodiazepine substances.

This year, WEDINOS found a higher frequency of substitution amongst samples submitted as benzodiazepines, in particular, diazepam; with nearly three quarters of all samples submitted as diazepam in the first quarter of 2019 were found to contain other substances.

For the first time this year, WEDINOS tested samples of benzodiazepines submitted in blister pack form that contained a substance different to that named on the pack.

Josie Smith continues: “The evidence of substitution indicates that even if a person has purchased tablets looking like a medication, they may not contain the stated contents. This represents a public health challenge and a need for greater awareness and pragmatic harm reduction advice and education.”

The report shows a 58 per cent increase in the number of samples submitted to WEDINOS for testing in 2018-19 compared to the previous year. In total, 2,145 samples were tested between April 2018 and March 2019.

Public Health Wales produces reports and information to influence national and international policy to ensure it is based on the best evidence to protect and improve health.

Those seeking to receive support for drug or alcohol related concerns can contact the Wales Drug and Alcohol Helpline on freephone 0808 808 2234, by texting DAN to: 81066 or by visiting dan247.org.uk

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£700,000 flood scheme that protects people in 41 Pembrokeshire homes completed

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Natural Resources Wales (NRW) has completed a £700,000 improvement to a flood scheme that protects people in 41 properties in west Wales.

The flood storage area at Pont y Cerbyd, Pembrokeshire holds back flood waters which threaten the nearby villages of Middle Mill and Solva.

The improvements include a new 50 metre-long spillway, a new overflow structure which controls the amount of water the reservoir can hold, reinforcement to the embankment to protect against erosion, and additional drainage.

Originally built in 1990 the work on the storage area was needed after several major floods eroded part of the old spillway, making it less effective.

Now the work is complete the structure can maintain the original level of flood protection to people in the downstream villages.

To further protect and warn the local communities, NRW has installed new equipment to monitor river levels as well as a small wind turbine to power a CCTV camera that can be used to view the reservoir’s water levels in real time.

As part of the scheme, NRW also organised exercises to practice using emergency pumping equipment to manage water levels in the reservoir should the need arise.

Andy Irving, team leader flood incident management for NRW, said:

“Protecting Wales’ communities is a vital part of our work which is why we monitor river levels all over the country 24/7 and invest millions of pounds into projects to reduce people’s flood risk.

“The Pont y Cerbyd flood storage area helps manage the flood risk to 41 properties downstream of the Solva river where levels can increase quickly in harsh weather.

“Investing in improvement projects adds another level of protection for at-risk homes and businesses.

“Combining this with our training exercises means we can continue to react to incidents quickly and efficiently.”

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