GENERAL HOSPITAL services will be lost from Pembrokeshire in each option being considered by the local health board.

The consultation document released this morning (Apr 19) reveals that the Board intends to downgrade Withybush, including removing A&E services and replacing them with a Minor Injuries Unit.

Hywel Dda are proposing the changes as the board are facing a number of issues, including:

• A deficit of £69m – the biggest in Wales
• High costs for paying members of staff to fill the gap of around 500 staff vacancies every month
• Ageing infrastructure, with most hospitals being older than 30 years old
• An ageing population with more health care needs than before

Hywel Dda are proposing that a new general hospital would be built between Narberth and St Clears, providing A&E services and urgent care.

This may mean that some people will have to travel further than they currently do to their current hospital, however the health board says that one centralised hospital will be easier to staff.

It would also benefit from being a modern building, operating 24/7.

Hywel Dda Chief Executive Steve Moore said: “Our proposals for change could affect everyone in our area, from bumps and babies to older people and everyone in between, so we are asking you all to tell us what you think. Whether you are a patient, a carer, a family member, or one of the thousands of people who work for the Health Board – we want to hear from you.

“Last year we started a conversation with our population, our staff and with people we work with to provide care to explore what is important to us and to jointly think about how to best run services. We did this because we think it is the right thing to do to design our services together. We explored the opportunities we think are offered to us through modern medicine and advancements in technology and the expectations you have for us to improve.

“We also set out the significant challenges faced by the NHS which we must deal with to ensure it thrives and delivers for you and your family now and in the future. This means that we will have to make decisions about where we can provide services and know that there are going to be compromises to make, so that we make best use of our resources.”

The proposals are:

Proposal A

• A new urgent care and planned care hospital between Narberth and St Clears
• Community hospitals in Glangwili, Prince Philip Hospital in Llanelli and Withybush
• A general hospital in Aberystwyth on the Bronglais Hospital site

Proposal B

• A new urgent care and planned care hospital between Narberth and St Clears
• Community hospitals in Glangwili and Withybush
• General hospitals at Prince Philip Hospital in Llanelli and Aberystwyth on the Bronglais Hospital site 

Proposal C

• A new urgent care hospital between Narberth and St Clears
• A planned care hospital on Glangwili site
• A community hospital in Withybush
• General hospitals at Prince Philip Hospital in Llanelli and Aberystwyth on the Bronglais Hospital site

Zoe Paul-Gugh, Head of Nutrition and Diabetic services for Pembrokeshire, said people need to ‘take more responsibility for their own health’.

She added: “Wait times are too long which is causing distress for patients and carers.

“Unreliability of planned services is not acceptable.”

The 12-week consultation, which is clinically-led, will involve a number of events for communities, both general and targeted, as well as an awareness raising campaign.

Hywel Dda manage four hospitals across west Wales – Withbyush (Haverfordwest), Glangwili (Carmarthen), Prince Philip (Llanelli) and Bronglais (Aberystwyth).

Dr Phil Kloer, Executive Medical Director and Director of Clinical Strategy thanked all of those who had contributed to bringing about the consultation for change.

He said: “We are seeing passion and urgency from everyone who has spoken, its nice to hear the authentic voices of everyone who has contributed. I couldn’t control what they were going to say today and I did not know what they were going to say.”

Dr Kloer pointed out the slogan written on the council chamber wall which translates to ‘out of unity comes strength’ and explained that is something that Hywel Dda could take on board.

He said: “Moving towards a much more social model of health. What matters to people in communities are simple things which don’t require a medical specialist.

“When we design the services, its about how we work with partners and not only the NHS.

“There is a real aspiration to meet and exceed expectations through clinical excellence.

“The family is very important to us. How we see our services through that lens. Everyone’s views are important in this consultation.”

In relation to the idea of a new super-hospital he said: “We’d have to acquire the funding for a new urgent build through a five stage business model.”

He promised that the consultation will be ‘a really robust and inclusive process’.

He concluded by saying: “We are ready to move from stage one to stage two of the consultation process which involves 12 weeks of consulting with all involved.”

Bernadine Rees OBE, Chair of the Health Board, said that for the first time ever her staff have given the board the opportunity to make changes which will really make a difference.

She warned that ‘there will be emotional attachment of individuals to where they have worked for a long time’ but highlighted that the point of the consultation was ‘clinical organisation of care going forwards to allow us to become a sustainable Health Board’.

Dr Owen Cox – Chair Local Medical Committee for Dyfed Powys, said that he thought that there was three very workable proposals in front of him.

He said that investment in primary care and community care had not been discussed and this was vital.

Dr Cox said: “Having been a clinician here for over 30 years, and having heard lots of previous commitments to invest in primary and community care, it has, ever since I have been here reduced. A challenge for the Health Board is to make this work; it needs the pre- investment in primary and community care – before new secondary care buildings are constructed.”

He added: “You have to do something you have never done before, put your money where your mouth is.”

Bernadine Rees OBE said that it was all about ‘pathways’, and that it was a ‘whole-system-change.’

“We do need investment rather than the sticking plaster approach we have to acute care,” she added.

Speaking to The Herald Conservative Shadow Health Secretary and Carmarthen West and South Pembrokeshire AM Angela Burns said: “I am sure that we all understand the pressure the NHS in Wales is under. It’s not just money, there are enormous problems in recruiting and training enough staff whether they are doctors, nurses, physiotherapists or pretty much every other discipline.

“Add to that the problems faced by Hywel Dda in particular such as a hospital in Carmarthen that is housed in buildings in desperate need of a radical overhaul and it is clear that something needs to be done. The problem is what?

“The proposals put out this week by the Health Board are challenging. There is some real innovation but they also pose some very difficult challenges. We would all like to see healthcare delivered closer to our homes and on the surface of it local hospitals and community services that deliver most of our day to day care is the way forward.

“But the devil is in the detail, there are too many words like “may” in the document which leave me feeling concerned about what we will end up with. A hospital may have renal services or may have a chemotherapy unit and so on.

“Another issue is that access to GPs is very difficult in many areas and doesn’t look set to improve. If there are major changes to Withybush then where does that leave my constituents in South Pembrokeshire? And can the Health Board really afford to build a new hospital and overhaul Glangwili to make it fit for today’s modern NHS?

“Public transport is poor in West Wales, the Health Board recognises our above average age population and our areas of deprivation. Can people really rely on public transport? Will access to Services become easier or more difficult?

“These are all significant questions and I will be going through these proposals in great detail and challenging the Health Board. I’d also like to know what you think about this important issue, so please email me on angela.burns@assembly.wales”

Paul Davies AM told The Herald: “The three proposals that Hywel Dda health board are consulting on signify a commitment by the health board to centralise services further again and will be disastrous for the people of Pembrokeshire.

“I’m extremely angry that the health board continues to ignore the views of the people living in my constituency and that as a result of all these proposals Withybush will be downgraded and patients will have to travel further for vital hospital care.

“The health board’s own impact assessment recognises the impact of travelling further on patients (and their families) in rural and isolated areas in west Pembrokeshire and yet these proposals have still been published.

“I will be raising this issue as a matter of urgency with the Welsh Government and I will be doing all that I can to oppose these catastrophic proposals.”

Local Authority member Councillor Simon Hancock asked questions about access to the new hospital and road infrastructure.

“An adverse effect could be felt by people living on the coast,” he explained

He said that improving the road network to improve access to the new super-hospital which would be located between Narberth and St Clears would be vital.

That is ‘something which we should be talking to the Welsh Government about’, he said.

Steve Moore, Chief Executive, countered that by warning that no decisions had yet to be taken as to the outcome of the consultation, and that the Board had been keeping the Welsh Ministers informed, and the question of roads would be something that would be part of discussions.

Stephen Crabb MP commented: “The consultation paper put forward by the Health Board casts another shadow over our local health services and creates yet more confusion and uncertainty for local people. All three options up for discussion see Withybush being downgraded which is bitterly disappointing. This has been the consistent aim of the Welsh Labour Government since it started chipping away at local services more than ten years ago.

“The proposal to move A&E out of Withybush will cause alarm in the local community. A new hospital between Glangwili and Withybush may see some services located closer to Pembrokeshire. However local people remember only too well the last time a new hospital was being talked about and what then happened: services were simply chopped at Withybush and crammed into Glangwili.”

The Herald asked Chief Executive Steve Moore about the plans for the new hospital and for a commitment that people will not lose services from the places they are currently provided.

Steve said: “Part of the very strong case for change is that our services are very fragile, I think our staff do a fantastic job despite that fragility in providing good quality care for our local population.

“What we’ve committed to do today is to have a conversation about how we can do that better in the future and in the meantime to invest in some of those primary and community services which will allow the current system to be more sustainable.

“It is against the backdrop of quite fragile services and some increasing challenges but that’s why we need to change.

“We’re at the very early stages of this so no decisions have been made about what we’re going to do or where particular services will sit and we genuinely want to hear people’s views.

“Clearly the point at which the board decides on the basis of clinical advice and what we’ve heard from the consultation will our strategy be clear.

“We can then get into detailed discussions about how we ensure some of the clearer messages from the public about the need for good infrastructure to get to our sites and we can plan that into whatever comes through from the consultation process.”

We went on to ask Executive Medical Director and Director of Clinical Strategy, Phil Kloer, about the Health Board’s plans and where the money would come from for a new hospital.

Phil added: “It’s a real challenge, community primary care services at the moment. One of the experiences from health systems across the world when they’ve transformed their primary and community care systems is that they’re able to attract staff in.

“I think when you have a traditional service you’re not able to attract the quality and quantity of staff that we require, and of course it won’t just be based on GPs, in fact the future needs of the population given that we’re going to have 65% more over 65 year olds in the next twenty years actually won’t just need to be a doctor and we need other professionals in our community and we think that with this consultation, with this transformed community and primary care model we’ll be able to attract those staff in, we’ll be in front of other systems in the UK.

“The other thing we’re looking at is attracting GPs into this area at a training stage, we’ve been successful with the enhanced payment to trainees and getting them into Pembrokeshire and that, down the line, will give us a stream of GPs who can work in practices in this area as well.”

Asked where the money will come from, Phil said: “The Welsh Government will only commit money when they have seen the completed business case and development process so we’ve had no absolute commitment to money, we do know that there are major capital developments across the rest of Wales so we know that it’s possible to go through with a successful business case for a new hospital and that’s the basis of discussions we’ve had with Welsh Government.”