Health
Chair’s reflections and focus on recovery one year on
MARIA BATTLE, Chair of Hywel Dda University Health Board, which plans and delivers the majority of NHS care in Carmarthenshire, Ceredigion and Pembrokeshire, is reflecting on the last year as we reach the anniversary of the first UK stay-at-home instruction in response to the COVID-19 pandemic:
“The day of reflection planned across the UK on Tuesday March 23 2021 will be a poignant day.
Families who have suffered the loss of a loved one either directly from COVID-19, or during the pandemic, are living every day with their personal grief and loss. In Hywel Dda University Health Board alone, 474* people have died from COVID-19 since the start of the pandemic.
Loved ones lost before their time.
Our thoughts and sympathies are first and foremost with people who are grieving at this time. The hope is that this day of national reflection will demonstrate that their loved ones were seen and are remembered. Our thoughts are also with our staff who cared for those lost so lovingly at the end of their lives.
In Hywel Dda University Health Board, we will join others across the UK in a one minute’s silence at 12noon on Tuesday, to remember those lost. Care will continue to be provided, but what can be paused will be paused. We will take those moments privately, or collectively with our colleagues, to remember in peace and to pay tribute.
An online remembrance service has been organised for our staff on this day, so those who wish to come together have a place to do so, although not physically but in the spirit of togetherness.
As always, staff can attend our hospital chapels if they need a place for rest or recuperation, and are invited to light battery operated candles, funded by Hywel Dda Health Charites, and distributed across our sites and community services.
As we know, the simple act of lighting a candle can help the emotions we may experience from continued pain, suffering and anxiety become a tribute to hope and thankfulness for the heroic response by many people in our communities.
We are also invited to shine a beacon into the night sky at 8pm by using our phones, candles or torches; and we thank our partners in local authorities in Carmarthenshire, Ceredigion and Pembrokeshire who will light up landmark buildings in our area for this day of reflection.
But alongside remembrance and reflection, in Hywel Dda University Health Board, we have also turned our attentions to the recovery and learning that is necessary as we start to emerge out of the pandemic.
I am so very proud of the sacrifices made by our staff (frontline and support), their families, our partners and our communities during the past year.
I have been awed by how our communities have rolled up their sleeves. Whether that has been other key workers, people staying at home, those shielding, home schooling, or in support of neighbours by volunteering and carrying out heart- warming acts of human kindness.
The hope and the light that came when we received the first batch of vaccines on December 8 2020 grows daily and shines more brightly. Our staff, volunteers and partners have worked so hard together in recent months to deliver vaccines to those most at risk, to save lives and protect us all.
And people have come forward for their vaccinations in numbers we daren’t imagine were possible, to protect themselves and their loved ones and their communities.
As of March 17 2021, we have given 175,893 vaccinations in total, representing 39.5% of our population (more than 50% of eligible adult population) having received their first dose and 5.9% receiving the full course (2nd dose).
We are on target to offer vaccination to all adults in West Wales by the end of July, subject to supplies being received as planned.
This extraordinary achievement opens up hope for the future as we continue to work towards our vision for a healthier mid and west Wales. But we have a lot of work to do to re-build and a lot of learning to take stock of.
We are all acutely aware of the detrimental impact on people waiting for planned operations far longer than we would like. We have written to all patients who have waited more than 52 weeks to say how sorry we are, to explain why and to ensure our waiting lists are correct to help clinical decisions as we re-start non-urgent care. You can keep up-to-date on the re-starting and expansion of planned care services here: https://hduhb.nhs.wales/healthcare/covid-19-information/restarting-services/
We are about to offer a single point of contact and additional support to some patients. We are starting with a group of orthopaedic patients, so they are supported to look after themselves and be ready for surgery, and are able to recognise and report any significant changes to their clinical condition. We want to eventually roll this out to everyone on the waiting list.
General advice to people on how to remain well whilst awaiting surgery, which can improve outcomes after surgery, is available here: https://hduhb.nhs.wales/healthcare/covid-19-information/preparing-for-treatment-lifestyle-advice/
Without the pandemic however, we would unlikely have seen the speed of the digital roll out and community based care that we have been able to provide in people’s own homes, or closer to them.
For example, in March last year only 1% of outpatient appointments were carried out online, but as of January this year, 28% of outpatient appointments were carried out in this manner, with really good feedback from patients.
We are also continuing to support staff with their own health and wellbeing with a range of psychological and wellbeing services. Many are exhausted and they and their families have made great personal sacrifices. It has been humbling and inspirational to listen to their experiences and see how they have looked after each other as well as their patients. They need some time to rest and recover before the full resumption of all services.
I have recently set up a group of experts, including the Military, to advise on how we best support staff coming out of the pandemic. To rebuild stronger, we need a solid foundation and that is our staff who deliver or enable the care we provide
Following the Senedd elections, we will also ‘check in’ with our communities and open up a conversation about the pandemic and what it has meant for you and your experience and access to health and care. We want to consider any new information you have that we need to take into account when planning your health services for the future.
So next week is for reflection and remembrance. But it is a not a one day event for us in Hywel Dda UHB. We will use what we have learnt and all our experiences to inform what we do and how we do things moving forward to hopefully, make things better for our communities, our staff and our patients.
Health
‘We are on our own’: Unpaid carers forced to ‘beg’ for support
UNPAID carers are being left to “pick up the pieces” of a broken system due to a lack of respite, unsafe hospital discharges and carer’s assessments that result in “nothing at all”.
The warning came as the Senedd’s health scrutiny committee began taking evidence for an inquiry on access to support for more than 310,000 unpaid carers across Wales.
Chris Kemp-Philp, from Newport, who has been a carer for 33 years, gave up her career to become a full-time carer after her husband medically retired from the civil service in 1990.
Ms Kemp-Philp, whose husband died in April, told today’s (December 4) meeting: “I thought he’d been really badly treated… The last four months of his life were dreadful for both of us.”
She was only offered an updated carer’s needs assessment – a right under the 2014 Social Services and Wellbeing (Wales) Act – the day after her husband died.
Ms Kemp-Philp did not realise she had become a carer at first. “But, of course, having lost two incomes and to survive on a half civil service pension wasn’t great,” she said.
She told the committee how the couple “shielded” during the pandemic, saying: “For the past five years, basically, apart from going to a hospital or… a medical facility – I didn’t leave the house because if I’d have gone out, I could have brought something home.
“So, we spent five years literally avoiding people. The experience was unpleasant, I had two great-grandchildren born in that time and I only saw them on video.”
Ms Kemp-Philp said her husband was “pingponged” back and forth after unsafe discharges from hospitals in Gwent. He was put in a car by two nurses then she had to get him out on her own at the other end, with clinicians effectively telling her: it’s your problem now.
“Every time he was sent home, nobody came to help at all,” she said, explaining how she struggled to cope and her husband’s death brought a tragic sense of relief.
Judith Russell, who moved back to Wales to care for her mother 23 years ago, told Senedd Members the responsibility grew greater over the years.

Ms Russell, whose mother died last Saturday on the eve of her 102nd birthday, told the committee: “It’s been my privilege to care for her but I wish other people—I wish there had been more actual care for her. That’s it.”
Ms Russell also cares for her husband who has Alzheimer’s disease, acts as guardian for her disabled sister and cooks every week for her sister-in-law.
“It’s quite a responsibility,” she said. “My life is taken up with caring. I didn’t actually know I was a carer, I cared for my mother because she was my mother – I looked after her, of course I did – and it wasn’t until about three years ago that I identified as a carer.”
Ms Russell warned: “All through this last 23 years, I’ve had to fight and struggle to find things out… there’s very, very little help out there.”
She said she was given a carer’s assessment earlier this year but “there was nothing they could offer me, quite frankly – nothing at all”.
Ms Russell told Senedd Members: “We had a diagnosis [but] there’s no offer of help, there are no directions to find help, somebody to point you – you should be doing this, this is available, that’s available – nothing, you’re on your own completely.”
She joined the Bridgend carers’ group which opened a door to other people grappling with the same weight of responsibility and helped navigate the system. Ms Kemp-Philp added that joining a similar peer support group saved her life.
Ann Soley, who is originally from France and has been living in Wales for eight years, described how life was turned upside down when her British husband had a stroke.

She said: “We are stressed, we are lost. A lot of carers have lost their friends, that is just unbelievable for me because I realised society is not there – there is no compassion.”
Kaye Williams, who works at Bridgend carers’ centre and is herself a carer, warned the witnesses’ experiences are commonplace across the country.
Sue Rendell, from Caernarfon, has cared for her husband who has vascular parkinsonism for nearly 14 years and was waiting for a doctor to call as she gave evidence remotely.
She told the committee: “You go in in the morning to see if he’s still breathing to be honest. We’re at the later stages of his disease and it’s physically demanding, it’s mentally demanding and it’s administratively difficult as well… it’s just very wearing.”
Ms Rendell, who was shattered after a late night caring, said she has tried to get respite but has been told there’s nothing available in Gwynedd nor Anglesey for her loved one’s needs.
She told the committee unpaid carers in Wales are “expected to pick up the pieces” but “nothing much happens” after an assessment. “Fine words butter no parsnips,” she said.
Ms Russell added: “As carers, we save the government millions… and I asked for some help this week actually. I’m 258th on the list for a hip replacement… and I asked the doctor: as a carer, couldn’t I possibly go up the list a little bit? ‘No, we’re not allowed to do that.’
“It’s the only thing I’ve ever asked for.”
Education
‘Sink or swim’: Young carer sat exam hours after 3am hospital ordeal
A TEENAGE carer sat a GCSE exam only hours after getting home from a hospital at 3am following a family emergency, a Senedd committee has heard.
The warning came as witnesses highlighted a “sink-or-swim” reality where children as young as three are taking on caring roles while feeling invisible to schools and social services.
Elektra Thomas, 15, who cares for her autistic, non-verbal brother and her epileptic sister, was part of a remarkable and articulate trio of teenagers who gave evidence to a new health committee inquiry on access to support for unpaid carers today (December 4).
The teenager helps her brother Blake get ready for school in the morning and helps him communicate by acting as his voice, which she has done since about three years old.
Ms Thomas told Senedd Members her sister has two children, “so I’m either handling her having a seizure, running around with her medication… or I’m looking after her kids”.
She said: “I’ve been having school assessments at the same time she’s had a seizure. I’ve been in ambulances waiting for her to get into a hospital while also studying.”
Ms Thomas explained how she is unable to focus on her schoolwork if her brother has had an overwhelming day. “I can’t focus on myself and I don’t have time for myself,” she said.
The teenager, who is from Carmarthenshire, described how she was once in hospital until 3am then sat a test – which went towards her GCSE grades – that same day.
Ms Thomas warned young carers do not have time to manage their own mental health, saying: “I didn’t have time for myself, I had time for my brother and sister and that was it.”
She said: “As a young carer who wasn’t noticed for a decade, it was pure manic: I had no coping skills, I had no support – and this has been going on since I was about three or four.”
Ffiôn-Hâf Scott, 18, from Wrexham, who is working while studying in sixth form, has similarly been a carer since she was four years old.
“I used to care for my mum and my sister,” she told the committee. “My sister used to be in a psychiatric ward, she was there for seven years.
“And I care for my mum because she’s diabetic, classed as disabled, has a long list of mental health issues, she has in the past suffered a stroke and had cancer.
“I don’t know how she’s still standing.”

Ms Scott said: “The main challenge right now is looking after myself and learning that you actually have to keep yourself afloat… to keep looking after someone else.
“I think for a very long time I ran on nothing because of my caring role or I didn’t think about the things I needed to do for me, so respite and things like that.”
The Welsh Youth Parliament member warned a lack of support for young carers has been normalised, saying she has had to explain herself 70 different times while aged 12.
Ms Scott said: “I remember going to my teacher and saying – we had a piece of coursework – look I can’t do this right now… you’re going to have to fail me…
“Their response was just ‘well, you have too much on your plate and you need to take things off your plate’ and I was like: it’s very bold of you to stand where you’re stood and say that to me because it’s not a choice to take on the things that we do take on.”
She recalled receiving a phone call about her mum collapsing moments before a maths test and expressed concerns about the prospect of mobiles being banned in schools.
Albie Sutton, 16, a young carer from north Wales, looks after his disabled mother by doing things such as cleaning the house, budgeting and cooking for the family every day.

Mr Sutton said: “It’s a real struggle for her to move around the house, to even do stuff like getting dressed or moving to the toilet by herself… so I’ve got to help her.”
The teenager estimated his caring role takes up about 25 hours a week and makes it difficult for him to pursue some of his hobbies such as competing in powerlifting.
“My mind feels like a hive of bees,” he said. “There’s so many things going in and out… I get home at the end of the day and I’m like ‘oh my God, I’ve got to do this, I’ve got to do that’.”
Warning of the mental stress, he added: “It’s also really difficult for me to socialise… I feel very isolated in my caring role, especially at home. I’m always housebound, I never get the opportunity even just to go out in my local town.”
Mr Sutton told Senedd Members it plays on his mind that his younger brother may have to take on responsibility. “It’s got me debating whether I can go to university,” he said.
He called for a Wales-wide campaign to raise awareness among educators and employers of the issues young carers face and how to recognise the signs.
Ms Thomas agreed: “I’ve had multiple teachers look at me and go ‘what’s a young carer, sorry?’. I’ve had pharmacists go ‘are you sure you’re a young carer?’ and it baffles me.”
Health
Fresh alarm over life expectancy in Wales as CMO warns of ‘prevention revolution’
WALES is living sicker for longer, the Chief Medical Officer has warned, as new figures show a worrying drop in the number of years people can expect to live in good health – with women hit hardest.
The findings, published today in Dr Joanne Absolom’s first annual report since taking over from Sir Frank Atherton, have prompted immediate calls for the next Welsh Government to overhaul its approach to public health after the 2026 Senedd election.
Dr Absolom says Wales must now move decisively away from a system that largely treats illness towards one that prevents people becoming ill in the first place. Her report warns that healthy life expectancy is falling across the country and highlights widening inequalities between communities.
Responding to the findings, Darren Hughes, Director of the Welsh NHS Confederation, said the message could not be clearer.
“NHS leaders in Wales welcome the report’s call for a prevention-first approach,” he said. “We have to move from simply treating illness to actively promoting wellbeing, and that means a proper cross-government strategy that tackles inequality and gives people the support to take control of their own health.”
He added that every pound spent on proven public health programmes delivers an average return of £14 – evidence, he said, that prevention “makes moral and financial sense” at a time when NHS budgets are under extreme pressure.
“It is deeply concerning to see healthy life expectancy falling, particularly for women,” he said. “Investment in prevention is vital if we are to make our health and care services sustainable.”
While health boards, councils and community groups are already working on preventative programmes, the Welsh NHS Confederation says Wales needs far greater ambition – and the NHS must be given the tools and flexibility to scale up what works.
The Chief Medical Officer’s report also raises serious concerns about NHS workforce shortages and urges significant investment in digital technology to improve productivity and patient outcomes.
Mr Hughes said all political parties should “take heed” as they prepare their manifestos for next year’s Senedd election.
“Those seeking to form the next Welsh Government have a clear blueprint here. We cannot keep doing the same things and expect different results. Prevention, workforce and digital transformation have to be top priorities.”
The Welsh NHS Confederation — which represents all seven health boards, the three NHS trusts, HEIW and Digital Health and Care Wales — has already outlined its detailed priorities in its own election document, Building the health and wellbeing of the nation.
With the Senedd election just over a year away, today’s report adds fresh, authoritative evidence that Wales needs a radical shift in how it approaches health if it is to secure a healthier future for all.
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