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Future for 24 hour A&E,but how good will it be?

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Dr Robertson-Steele: “24 hour services are no longer sustainable”

Tough questions at press conference

ON TUESDAY morning (Dec 2), at an emergency press briefing held at Withybush, Health Board executive members and Chair Bernadine Rees faced the press in attempt to play down the situation. Reporters were told that negative publicity in local newspapers, and blogging by pressure groups such as SWAT are to blame for the staffing shortages in Withybush hospital, Ms Rees claimed at the hastily arranged press conference.

Bernadine Rees called for everyone to work together to ensure that Pembrokeshire was a place medical specialists would like to come and work Speaking to The Herald on Tuesday Mr Rees referred to the adverse coverage the Board has had over Withybush Hospital: “Those who show an interest in working in Pembrokeshire, then go on to websites and with the plethora of jobs that are available they decide that perhaps Pembrokeshire is not the best place for them to go. You only have to look at the back pages of the British Medical Journal to see just how many vacancies there are across the UK. I cannot speak for the pressure groups but all I can say to them is to ask them to work with us to portray Pembrokeshire positively. We all want the same thing: to provide a sustainable future for health care in Pembrokeshire.”

The storm over the future of Withybush Hospital was rekindled when an internal document was leaked to the press. Re-assurances given to the media since the leak of the explosive letter have raised as many questions as they have provided answers. In particular, the Health Board appears to be contemplating a service model based around the Out of Hours GP Service while there is NO guarantee that 24/7 A&E services will be available after May 2015. The secret report reveals that since the downgrade in paediatric services overnight there has been increased burden on the out of hours service and that too is branded as ‘short staffed and at risk’. The leaked memo says that staffing issues led to the latest crisis in the service, and that a solution needs to be found.

It argues that Withybush should not provide services for patients where further or onward care is required, including those involving palliative care and oncology, to which the Board has made a very public and very recent public commitment, according to the document. Instead Dr Robertson-Steele, the hospital’s Clinical Director recommends: “Limiting provision at WGH to those services at WGH which are fully staffed and skilled.” SWAT chairman Dr Chris Overton told The Herald that the news was the ‘end game’ for Withybush Hospital. He added: “As predicted for many, many years, there will be nothing much will be left at the hospital.” The hospital action group has previously raised concerns that the knock on effect of services removal will result in changes having to be made at Withybush A&E.

LOCAL POLITICIANS REACT 

Stephen Crabb MP told The Herald: “This leaked document appears to confirm our worst fears about what the Board and Mark Drakeford have got planned for Withybush. A dark cloud is hanging over the future of our hospital. The removal of a 24 hour A&E service from Withybush is just unacceptable. The Welsh Health Minister should stop hiding away in Cardiff and come down to Pembrokeshire to either denounce these reckless plans or explain why he thinks they make our community safer. People in Pembrokeshire deserve more than behind-the-scenes plotting. Today the UK Government is giving Welsh Ministers an extra £70 million as a result of the increase in English NHS spending. I have asked that the Welsh Government confirm that it will use this money solely for Welsh health services. After all the recent cuts to services, Pembrokeshire should be first in the queue for this spending.”

Plaid Cymru Mid & West Assembly Member Simon Thomas said: “The people of Pembrokeshire deserve better A&E services. This development about emergency services at Withybush Hospital is very concerning indeed. Welsh Ministers rejected my concerns that losing 24/7 paediatrics would undermine the long term viability of A&E.” South Pembrokeshire MP Simon Hart told The Herald: “The Health Board has struggled with these staffing issues for years and has yet to solve the problem. If they are going to use “staff shortages” as an excuse to close any department where they can’t recruit then this will become self-fulfilling. We already know that one reason for the GP shortages in the county is the uncertainty over the future of the hospital. Mark Drakeford and the Welsh Government in Cardiff needs to get a grip of t h i s   situation and bring this uncertainty to an end.” Paul Davies AM told The Herald: “I’m appalled that A and E services at Withybush hospital could be at risk. Once again the people of Pembrokeshire are being treated like second class citizens and it’s quite clear that there is a drive to centralise services away from this area. I will be urging the Health Minister to come forward with a statement as a matter of urgency.”

William Powell, the Welsh Liberal Democrat AM for Mid and West Wales, added: “Having supported local campaigners in their efforts to protect these services since 2006, this is obviously a huge disappointment. Removing specialist services and a full A&E from Withybush will leave it as nothing more than a glorified cottage hospital, with no equivalent services for miles around. The people of Pembrokeshire deserve better.” Cllr Paul Miller, leader of the Labour Group on Pembrokeshire County Council told us: “Given the long history, I totally understand people’s concerns about this assurance and I’m going to keep working tirelessly to ensure pressure is kept up on this commitment. Acknowledging problems with communications and recruitment is one thing but now is the time to do something about it. I will not just sit on the side-lines and comment, I’m going to get stuck in and do whatever it takes. That said, if this commitment is not kept, then the Health Board should know that I will consider it my duty to do anything and everything in my power to force them to maintain this provision for the people I represent.”

THE BOARD’S RESPONSE  

The Health Board moved quickly in an attempt to quash rumours that it plans to further downgrade Withybush Hospital, but its initial response appeared to downplay the significance of the explosive memo’s origin. An initial press release sent out on Monday, December 1 said: “The document referred to is the viewpoint of a single consultant at one point in time and represents no decision by the University Health Board. Changes to paediatric services at the hospital have not resulted in this position, which is a reflection of the ongoing recruitment challenges discussed.”

However, Dr Robertson-Steele is both the Associate Medical Director for Quality and Safety for the Board AND Director of Clinical Care for Withybush Hospital. After Tuesday’s emergency press conference, the Board released a further and longer press statement which recapped its previous release and revealed that a meeting on the day of the leak had determined a plan to move forward. Medical Director Dr Sue Fish said: “Issues around recruitment, particularly into A&E posts, have been widely reported and continue to be a challenge faced by NHS organisations across the UK. At this meeting, alternative solutions for delivering a full, sustainable 24/7 service in the future have been identified to maintain this service in the weeks to come and to give us time to build in long term solutions. We would like to assure local people that we are fully committed to maintaining safe, high quality services at Withybush General Hospital.

As part of this planning process, University Health Board set up a Programme Board on October 1 which has been meeting on a regular basis to address these challenges in a planned way. They have been considering various contributions from a number of senior clinicians culminating in the -wide meeting. These contributions do not represent any decision taken by the University Health Board. We would like to assure people that this Programme Board, in partnership with our staff, will continue to plan the sustained future of this important service. Once these solutions have been agreed at Programme Board, we will be in a position to share this information more widely.” Dr Iain Robertson Steel added: “I would like to make it clear that this was a private and confidential paper that presents only one contribution from amongst a number being discussed and I am deeply distressed that this has been put into the public domain in this way.”

PRESSURE TO DELIVER 

The Board’s recruitment problems is part of a wider issue within the UK NHS. There is significant national shortage of qualified clinicians. In April of this year it was revealed that the NHS in England was actively recruiting overseas doctors to fill vacancies, including interviewing some prospective candidates via Skype. The Board have fought shy of giving an absolute unequivocal commitment to keeping A&E open 24/7 in the long term.

While it has long-trailed plans to reconfigure A&E services, the Board has not reached agreement with local GP practices to provide the service model it wishes to impose. May 2015 is not that far away and the Board will be under pressure to reach an acceptable long term solution which honours the commitment to retain a 24/7 service. One point raised in the leaked document appears to challenge the viability of the proposed scheme in any event. Dr Robertson-Steele, who should be well placed to know, states that the current Out of Hours GP Service one of those identified as suffering from staffing problems. It is difficult to see how the already stretched GP service will be able to cover up the cracks in the Board’s service provision at Withybush Hospital.  

Joyce questions strategy  

AT Assembly Question Time on Wednesday (Dec 3), Joyce Watson AM questioned deputy health minister, Vaughan Gething AM, about Withybush hospital A&E. 

Joyce Watson AM said:“First of all, I would like to thank Mark Drakeford for meeting with me yesterday at extremely short notice to discuss the situation at Withybush hospital. I, like everyone in Pembrokeshire, was hugely relieved by Hywel Dda Local Health Board’s categorical rebuttal of the claims that Withybush’s A&E department could be anything less than a 24/7 service. “You will know better than most, Deputy Minister, that the root cause of many of the pressures and pinch points in the service is recruitment.

Every time a leaked document creates a furore like this, Withybush, I suspect, becomes a less attractive prospect for an ambitious, newly qualified consultant, and it becomes a vicious circle. “Will you work to ensure that the health pressure groups work more closely with the health board to promote clear lines of communication? What can the Welsh Government do to further support recruitment in the west Wales NHS?” Vaughan Gething, Deputy Minister for Health:“I thank the Member for the question. I want to recognise at the outset and welcome the response of the clinical community across Hywel Dda to ensure that there is a future for 24-hour emergency-admission coverage. They have provided a solution for the next six months to allow them the space and time to deliver a longer term sustainable service. It is important to have that reassurance for the public.”

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Simon Hart MP says that First Minister is ‘reckless’ to say that the UK is ‘as it is, over’

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THE SECRETARY OF STATE FOR WALES, Carmarthen West and South Pembrokeshire MP Simon Hart, said that the First Minister for Wales, Mark Drakeford is wrong to suggest that the United Kingdom has had its day in its current form.

The First Minister’s exact words were “the UK as it is; is over”.

Mr Drakeford’s has said a new union should be created to reflect a “voluntary association of four nations”.

In his conference speech, the Welsh Labour leader called for “home rule for Wales in a successful United Kingdom”.

In a strong rebuke of Mark Drakeford’s comments Simon Hart MP said on the BBC’s politics Wales programme on Sunday (Mar 7) that his suggestions was “reckless” and “an overt act of flirtation with Plaid Cymru.”

Mr Hart added: “I think he realises if he wants to remain first minister he has to do a deal with Plaid, it’s the only option on the table. He hasn’t denied that, I’ve heard.

“In order to do that he has to start making noises about the union that has to appeal to his Plaid Cymru colleagues. I think it’s quite a reckless thing.”

Mr Hart explained that the UK “benefits” Wales and that the UK-wide procurement of Covid-19 vaccines proves this. He added: “It demonstrates just one example that the UK is a positive influence but it doesn’t mean that some of the other arguments are not valid”.

Plaid Cymru wants to hold a referendum on Welsh independence if it wins May’s Senedd election, but the power to do so lies at Westminster.

There has been a growing interest in more independence for Wales in the last few years, with a huge surge in membership of the non-political Yes Cymru group since the start of the pandemic.

Plaid leader Adam Price, speaking on the same programme, said: “We sincerely believe that independence is ultimately the only sustainable way whereby Wales can achieve its incredible potential as a nation that isn’t being delivered at the moment and whereby we can achieve social and economic justice for everyone that lives in Wales.”

Giving evidence to the Welsh Affairs Select Committee on Thursday, which The Herald was invited attended via a Zoom, Mr Drakeford explained said his idea of home-rule meant “the powers we have, and the devolution settlement we develop, would be guaranteed and would not be interfered with in the way we have seen so vividly in recent months”.

Mr Drakeford said: “I do think the effect of the pandemic and last 12 months has been to polarise opinion in Wales about how Wales should be governed.

“There are some people who take a lesson that we would be better off handing Wales back to Whitehall, there are some Conservative candidates standing in the Senedd elections who apparently take that view.

“It has undoubtedly strengthened interest in those people who believe Wales should be taken out of the United Kingdom altogether.”

The company which runs The Pembrokeshire Herald, Herald News UK, has recently launched a national news website for Wales which is sympathetic to Welsh independence.

This is something which could not have happened without a shift in feeling by many in Wales that as a nation it should have more autonomy.

Speaking on ITN’s News at Ten on Thursday (Mar 4), Herald.Wales South and West Wales Editor, Tom Sinclair said: “From our test marketing we can see that there certainly is a huge appetite for news that is about Wales, made in Wales, and owned by a company which is actually Welsh.”

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Education

Delight as foundation phase learners return to class

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PEMBROKESHIRE Headteachers have reported very positive returns to school for Foundation Phase Learners.

All Foundation Phase Learners returned to schools on Monday, March 1st and attendance has been reported at almost 90% since.

The Council’s Director for Education, Steven Richards-Downes, said: “A wide range of council services have worked together to ensure that Foundation Phase pupils have been able to return
safely to school.

“I am particularly grateful to all school staff and families for ensure that learning is now available for our youngest learners face to face.”

Headteachers remarked how schools have filled with smiles and laughter following the safe and phased return of Foundation Phase learners.

Cora O’Brien, Headteacher at Waldo Williams School in Haverfordwest emphasised how quickly learners have settled back in to a routine.

“It has been an absolute joy to hear their laughter in the playground and to observe their love of learning face to face once again. I thank everybody in the Waldo Williams School
community for working so hard to ensure that the transition went smoothly.”

Vicky Hart-Griffiths, Headteacher of Ysgol Hafan y Mor in Tenby, said: “It has been wonderful to welcome all our Foundation Phase learners back to school. They are thriving, being amongst
friends and back to a school routine.  

“All the pupils have spoken about how happy they are to have returned and it’s an absolute pleasure to welcome them back and we can’t wait until we have all our pupils back in school.

“The school feels alive again and there’s a positive buzz and laughter once again echoing throughout the school.”

Gareth Lewis, Headteacher at Broad Haven CP School said children had returned “with real enthusiasm, and have been very keen to meet up with their friends.”

Mr Lewis added: “Our parents have been very supportive and positive about the return, and those with older children are very much looking forward to a wider return to schooling.”

Mr Richards-Downes said plans were now turning to more learners returning to schools in the near future.

“We are looking to the next phases of the re-opening of schools on the 15th of March as long as the government guidelines allow.”

Further details will be released in due course.

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Pembrokeshire County Council: This week’s Leader’s coronavirus update

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PEMBROKESHIRE COUNTY COUNCIL Leader, Councillor David Simpson, has provided a further coronavirus update for Friday, 5th March as follows:

‘Welcome everyone to my weekly update.

“It is with rather a heavy heart that I tell you that it’s almost 12 months since my first statement on the coronavirus pandemic.

“On 9th March 2020, I addressed our Cabinet meeting with the following words:

“Further to the news yesterday that two people in Pembrokeshire had tested as positive for the Covid 19 virus, I am sure you will join me in wishing them both a speedy and full recovery.

“I can reassure you that our services will continue as usual, and all our employees can continue to attend to their work, appointments, schools and services as they normally would.

“We should all help protect ourselves and our communities by following Public Health Wales advice, particularly around washing hands and using a tissue for symptoms associated with cold and flu and then safely disposing of it.

“I am grateful to the co-operation and hard work of all of our staff and we will provide further updates and information when we have them.

“In the meantime I can confirm that detailed planning arrangements, both internally, with partner agencies and through the Dyfed Powys Local Resilience Forum, are well underway to ensure that the Council and Pembrokeshire are as well placed as possible for whatever challenges we may face. Thank you.”

“I am sure you will join me while I take a moment now to remember all those people in Pembrokeshire and further afield, who, very sadly, passed away since I made that announcement.

“I continue to be incredibly grateful, as I’m sure you are, to everyone who is helping to beat this pandemic, working so very hard now for over a year.

“We are fortunate now to be in a position where the vaccine programme is protecting older members of our community and starting to roll out among one of the biggest groups – the over 65s and those with underlying health conditions.

“This time next week (12th March) the Welsh Government will have notified us of their plans for the next three weeks.

“In the meantime, we remain in Alert Level 4 and the stay at home message continues to be more important than ever as we reach the threshold of better times.

“I wish you all a good weekend and thank you once again to the vast majority of wonderful Pembrokeshire residents who are doing the right thing and waiting patiently at home for restrictions to lift.

“We do really appreciate your efforts and determination to help bring this pandemic to an end.”

 

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