Health
High level of COVID-19 cases is impacting health service provision locally
HYWEL DDA Health Board has said that the high number of COVID-19 cases locally is a concern and is impacting on our public services across the Hywel Dda area. This is despite While the link between coronavirus infections and serious illness is weakening.
Public bodies have been making efforts this week to reassure that multi-agency partners are continually working together across the region to protect our communities, local public services and the NHS.
There have been 300 new coronavirus cases recorded in the Hywel Dda health board area according to the latest figures. Public Health Wales (PHW) data shows there were 199 new cases in Carmarthenshire, 63 in Pembrokeshire and 38 in Ceredigion since the last report.
The total number of cases across the three counties now stands at 26,930 – 16,620 in Carmarthenshire, 6,742 in Pembrokeshire and 3,568 in Ceredigion. One new COVID-19 related death has been recorded in the Hywel Dda area since the last report, with the total reaching 503 throughout the pandemic.
In total 2,618 new cases of coronavirus have been reported across Wales on Friday (Sept 17), bringing the national total to 320,099 cases.
Steve Moore, health board Chief Executive reported that there are 66 people in our hospitals with confirmed COVID, ten of these are in Intensive Care. He stated that about half of those in ICU have been vaccinated and added that the clinical view is that patients respond more quickly and favourably if they are vaccinated. All COVID deaths in the past few weeks have been of unvaccinated people.
Infection rates are coming down slightly but are still very high, with 506 cases per 100,000 people in Carmarthenshire (the 2nd highest level in Wales) and 293 cases per 100,000 in Pembrokeshire. There is a test positivity rate of 16% across the HB area. It is thought that cases peaked on 6th September, though the full impact of schools going back may not yet have been seen.
Hywel Dda University Health Board, Public Health Wales and Carmarthenshire, Ceredigion and Pembrokeshire local authorities together regularly monitor, review and agree actions needed to respond and manage the ongoing pandemic. This is co-ordinated through the Hywel Dda Regional Incident Management Team, established at the beginning of the pandemic, and continues to be further supported by county specific teams.
The Health Board put out a statement on Friday (Sept 17), saying: “Communicating regularly with our public across the region has been a key focus in our response to the pandemic. Currently, this has involved Community Development Outreach workers engaging with minority ethnic groups within the community”; and supporting youth services and groups in messaging to young people about how to keep safe and encourage vaccination.
“Local public sector leaders have come together to acknowledge the sacrifices people have made to keep our communities safe and to appeal to the public for support during the coming days and weeks.
Maria Battle, Chair of Hywel Dda UHB, continued: “The future does bring a degree of uncertainty, such as the roll out of the flu vaccine alongside COVID-19 booster jabs. What is certain however is the commitment of the health board and our partners to be as prepared as possible. The health board’s comprehensive recovery plan outlines, first and foremost, how we recover from the pandemic: how we support our staff to recover after what has been an exhausting year and a half, and how we lay the foundations to recover our services and support our communities.”
Temporary Chief Constable of Dyfed-Powys Police, Claire Parmenter, said: “With the uncertainties we face locally at the moment, we want everyone living, working and visiting this area to keep each other as safe as possible, so please remember the protective behaviours that will help ensure this for us all.
“We want it to be as easy as possible for people to get in touch when they need us. So save your time and report online – as you can now report non-emergency crimes and incidents online quickly and easily on our website
“This includes reports of domestic abuse, crimes, antisocial behaviour, road traffic incidents and collisions, and more. The online reporting isn’t replacing 101. But it’s important to promote the availability of our online services to those who would prefer to use this option, and it does mean we can answer calls from those who cannot contact us online quicker.
“We continue to work with our partners in a coordinated approach to serve in the best interests of our communities at this challenging time.”
Cllr Emlyn Dole, Leader of Carmarthenshire County Council, said: “Carmarthenshire currently has a very high number of COVID-19 cases and is one of the worst affected areas of Wales at the moment. This is putting huge pressure on our services and the NHS.
“This virus does not discriminate – it is affecting people young and old. I would appeal to anyone who has not yet had the vaccine to go and get it as soon as possible. We should also remain vigilant when socialising and follow the measures in place to protect us.”
Councillor Ellen ap Gwynn, Leader of Ceredigion County Council, said “Although Wales is now in Alert Level 0, COVID-19 is still spreading in our communities. We must all continue to consider how we keep each other safe and reduce the risk of spreading the coronavirus. It remains good practice to maintain social distancing and to limit our contacts as much as possible.
“We urge all Ceredigion residents aged 16 and above to ensure that they take up the offer of both doses of the COVID-19 vaccination. It’s easy to go and get the vaccine with walk-in clinics available. Having both doses will not only protect you, but also your family, friends and colleagues. We also look forward to 12-15 year-olds becoming protected through vaccination.”
David Simpson, Leader of Pembrokeshire County Council, said: “It has been easy to think we are through the worst of this pandemic, but the recent weeks have been a reminder how we must all continue to tackle this issue collectively. These past 18 months have been very tough and lockdown restrictions have changed our lives.
“In the past few weeks we have experienced a high volume of visitors to the county which can at times add additional pressures on our services.
“I cannot emphasise enough that this pandemic has not ended. Covid-19 has not gone away and we must all continue to work together and redouble our efforts, particularly as we head into autumn and winter.
“Please continue to socially distance where possible, wear face coverings where required, continue regular handwashing and choose outdoor activities or meet people outdoors over indoors.
“If you have COVID-19 symptoms, get tested. Don’t risk spreading this virus. These are simple actions that we can all take to help. They really do make a difference.
“Our front-line teams are working hard to support our communities and ensure we deliver key services. I would ask for your support to help us to keep Pembrokeshire open and welcoming to all.”
Over half a million doses of vaccine have been delivered in total with 91% of the eligible population having had at least a single dose.
A 3rd dose is soon to be offered to a well-defined group of immunocompromised people. The single dose vaccine for 12-15 year olds will be given out at Mass Vaccination Centres (MVCs) during evenings and weekends starting in early October.
From 27th September booster doses will be given with GPs delivering them to care homes, and the MVCs will be used for everyone else. GPs will be concentrating on administering flu vaccines.
Cases of RSV which can be serious in children under 5 are expected to peak in late October/early November and the HB has been asked to prepare for a 50% increase in cases.
What local Heath Board is doing?
Vaccination – Hywel Dda University Health Board, Public Health Wales and Carmarthenshire, Ceredigion and Pembrokeshire local authorities together regularly monitor, review and agree actions needed to respond and manage the ongoing pandemic. This is co-ordinated through the Hywel Dda Regional Incident Management Team, established at the beginning of the pandemic, and continues to be further supported by county specific teams.
Health care – Board says it has taken steps to ensure it can care for those most critically ill in our hospitals by postponing some operations temporarily and realigning our workforce; has further limited visiting in areas affected by COVID-19.
Supporting communities – through the local county incident management teams (IMTs), local authorities are providing guidance and support to schools following the recent return of pupils.
Health
New NHS data shows the same old problems
ALTHOUGH the latest batch of NHS performance data contained some good news for the Welsh government, chronic problems with meeting targets remain the headline.
The Welsh Government announced further funding to reduce waiting lists earlier this week. Following that announcement, the Health Minister, Jeremy Miles, led a Welsh Parliament debate on waiting times on Tuesday, November 19.
HARD FIGURES
The number of patient pathways increased from 800,163 in August to 801,307 in September, the highest figure on record, equivalent to one-quarter of the Welsh population.
There were still around 618,200 individual patients waiting for treatment in September.
Two-year waits remain at 23,701 in Wales. Eluned Morgan promised to eliminate these waits by March 2023 and again by March this year. The dial is moving slowly in the right direction, but progress is painfully small.
At the end of September, the average (median) time patient pathways had been waiting for treatment was 22.7 weeks.
In October, only 50.4% of red calls (the most serious) received an emergency/ambulance response within eight minutes. This is a tiny improvement but a long way short of the Welsh Government’s performance target for the Welsh Ambulance Service. The Ambulance Service has never hit any of its performance targets since the Welsh Government first set them.
Performance worsened against the 62-day target for patients starting cancer treatment; it is now 55% as of September.
MINISTER FINDS THE POSITIVES
Wales’s Health Minister, Jeremy Miles, responded to the data: “I’m pleased to see the number of patient pathways waiting more than a year and two years for treatment have fallen in the last month.
“This shows positive progress is being made across Wales to reduce the longest waiting times. I hope to see this continue.
“While there has been a small rise in the overall number of patient pathways waiting to start treatment, more than half are waiting less than 26 weeks, and there was a fall in the number waiting more than 36 weeks in September.
“We recognise the impact long waits for treatment can have on someone’s life, both mentally and physically, so we have a laser-like focus on reducing the longest waits and improving access to patient care.
“More than 1,800 people started cancer treatment in September, and nearly 14,000 people received the good news they didn’t have cancer.
“There were also reductions in the long waits for both diagnostics and therapies services and some reductions in the numbers of pathway of care delays.
“Urgent and emergency care services continue to be under great pressure – in October, the Welsh Ambulance Service received the second highest number and proportion of immediately life-threatening calls per day on record, but more than half of these calls received a response within eight minutes.”
NHS “AT CRISIS POINT”
Sam Rowlands MS, Welsh Conservative Shadow Health Minister, said: “I fear that we are at a crisis point as waiting list figures continue to head in the wrong direction in Labour-run Wales.
“The Labour Health Minister’s latest initiatives, even if his expectations are met, will barely scratch the surface in terms of tackling these excessive, record-breaking waits for treatment. Something needs to change fast.
“The Welsh Conservatives will stand up for the Welsh people’s priorities by eliminating restrictive guidance blocking cross-border and cross-sector working and by enacting a substantial workforce plan to boost staffing numbers, with a tuition fee refund for healthcare workers at its heart.”
LOCAL TRENDS
The month-to-month performance data provide a limited snapshot of the details. Their nature encourages politicians to exchange barbs and engage in self-praise. Specious comparisons between Welsh NHS performance and English NHS performance crumble under the gentlest scrutiny, not least as the English NHS counts waiting times and collates patient data differently from the Welsh.
Long-term trends are more revealing.
Immediately before the Covid pandemic (data released in March 2020), 1.6% of patients in the Hywel Dda UHB area waited over 36 weeks from referral to treatment. 85.7% of patients went from referral to treatment within 26 weeks.
By March 2022, 35.2% of patients in the local health board area were waiting for more than 36 weeks, and the percentage seen within 26 weeks had fallen to 56.7%. By the following March, just over 60% were seen within 26 weeks, and the proportion of patients waiting more than 36 weeks had fallen to 28.2%.
If you move forward to September 2024, Hywel Dda UHB’s performance figures have marginally slipped. There are no peaks and troughs in the performance data; they remain steadily bumping along at the same level and are far worse than they were in March 2020.
The Health Minister’s honest acknowledgement that the £50m funding injection to address waiting times is a short-term measure to boost performance and not a long-term solution highlights the scale of the problem. The question of waiting lists is not how much money it will take to tackle them but how much money will be spent before radical reform tackles systemic problems with healthcare delivery.
Placing Hywel Dda’s difficulties in a national perspective, the Welsh Government’s planned care recovery plan established a target to eliminate two-year waits in most specialities by March 2023. ‘Most’ refers to all specialities, excluding seven recognised as exceptionally challenging even prior to the pandemic.
Those specialisms, which include Orthopaedics, ENT, and Gynaecology, are large areas of surgical practice. They are excluded from targeted improvements because tackling them is too difficult. Proposals to establish surgical hubs made by the Welsh Conservatives have not attracted Welsh Government support as resources and staffing remain highly problematic. However, a quick win for the Welsh Government on the longest waiting times is potentially available.
Charity
‘Grave concerns’ over national insurance hike
SENEDD Members expressed grave concerns about the impact of the UK Government’s national insurance tax hike on GPs, universities and charities in Wales.
Plaid Cymru leader Rhun ap Iorwerth warned the rise in employer national insurance contributions from 13.8% to 15% in April will have a disproportionate impact in Wales.
He told the Senedd: “Labour are quick to accuse others of fantasy economics whilst their own plans represent nightmare economics for thousands of employers and employees.”
Raising concerns about the impact on job creation and wages, he said employment levels are at their lowest for almost a decade – lower than anywhere else in the UK.
He accused Labour of breaking a manifesto pledge as he pointed to an Office for Budgetary Responsibility (OBR) assessment that three quarters of the cost will be passed to workers.
Leading a debate on November 20, Mr ap Iorwerth called on the UK Treasury to fully cover the added cost to public sector employers in Wales.
He said: “It’s not the private sector only … bearing the brunt. Charities, GPs, universities – sectors already feeling the squeeze, to say the very least – have been taken to the brink.”
He pointed to “eye-watering” bills of £90,000 for some GPs, with the British Medical Association warning some surgeries could close as a consequence.
Mr ap Iorwerth said mental health charity Plattform faces a £250,000 annual bill and Welsh universities, “already crippled by financial challenges”, will face significant further pressures.
Plaid Cymru’s motion urged Welsh ministers to press the UK Government to apply a wider definition of the public sector workforce to include universities, GPs and charities.
Peter Fox, the Conservatives’ shadow finance secretary, similarly accused Labour of breaking a manifesto commitment not to raise tax on working people.
The former council leader said: “Time and time again – the chancellor went on TV and made the claim, only to u-turn after they got into power.”
Mr Fox, who represents Monmouth, said even a 1% rise in employer national insurance contributions for the public sector would cost Welsh taxpayers an extra £100m.
He told the Senedd: “The UK Government has said that it will provide funding to cover the cost of national insurance contributions for those workers.
“However, this will still come out of the taxpayer’s pocket … ultimately it is the taxpayers who are going to pay for the Chancellor’s tax increase.”
Luke Fletcher, Plaid Cymru’s shadow economy secretary, warned the national insurance rise will be a drag on an “already anaemic” Welsh jobs market.
His colleague Sioned Williams, who also represents South Wales West, described the chancellor’s “back-of-a-fag-packet” plans as senseless.
She raised concerns about six-figure increases in tax bills for charities including Tenovus, Marie Curie, Citizens Advice Cymru and the Wastesavers Charitable Trust.
Cefin Campbell, Plaid’ Cymru’s shadow education secretary, said the national insurance increase will cost Welsh universities an estimated extra £20m a year.
The Mid and West Wales MS warned: “Without a shadow of a doubt, these additional costs could push our higher education institutions over the precipice.”
Labour’s Hefin David said difficult decisions had to be made to fill a £22bn “black hole” left by the Tories but he rejected Plaid Cymru claims of a return to austerity.
Dr David told the Senedd: “Yes, tough decisions have to be made but I think that in the longer term, this is to everyone’s benefit.”
Andrew RT Davies, leader of the Conservative opposition, disputed the “incorrect” £22bn figure, saying the OBR found a £9bn gap.
Replying to the debate, Mark Drakeford stressed that neither he nor the Welsh Government has responsibility for national insurance contributions.
Wales’ finance secretary, who was appointed in September, criticised “fantasy economics” from opposition members on the Plaid Cymru and Conservative benches.
Deriding the “politics of the playground”, he said: “Both of them are willing to spend money on almost anything; neither of them are willing to raise the money necessary from anyone.”
Prof Drakeford said the chancellor returned national insurance broadly to where it had been as a share of gross domestic product for 13 of the 14 Conservative years.
The former First Minister pointed out that the UK Government offset national insurance rises on small employers by more than doubling the employment allowance.
He told the debating chamber or Siambr: “If you want to pay for things, you have to find the money to do so. That is what the chancellor had to do. That is how we will get the money that will come to public services here in Wales.”
Senedd Members voted 25-19 against Plaid Cymru’s motion.
Health
NHS staff at risk during pandemic due to PPE issues, Covid Inquiry hears
NHS staff in Wales may have put their health at risk during the Covid-19 pandemic by treating patients without adequate personal protective equipment (PPE), former health minister Vaughan Gething has admitted.
Giving evidence to the Covid inquiry, Gething acknowledged significant challenges in distributing PPE despite assurances that national-level supplies were maintained. He revealed that stocks of key items ran out far quicker than anticipated, with some equipment deemed unfit for purpose and discarded.
“There were some very real challenges,” Gething said, noting that gloves, expected to last 15 weeks, were depleted within 11 days. Aprons and other essentials soon became critical concerns. He also condemned opportunistic profiteering during the crisis, calling some suppliers “shysters” who exploited global demand to sell inadequate equipment.
The Welsh Conservatives described the revelations as “completely unacceptable” for NHS staff, while Plaid Cymru accused the Labour-led Welsh Government of “significantly letting down” frontline workers.
The inquiry also heard of chaotic conditions in some hospitals. An email from a consultant at Prince Charles Hospital in March 2020 described a dire situation, with staff lacking protection, low morale, and masks unavailable.
In some instances, healthcare workers resorted to makeshift solutions, including wearing bin bags or purchasing their own safety gear. Trade unions highlighted that schools even stepped in to produce masks and hand sanitiser for local health services.
When asked whether healthcare workers treated Covid-19 patients with inadequate PPE during the first wave, Gething replied, “I’m afraid that’s possible.”
Decisions under pressure
The session also addressed difficult decisions made during the pandemic. Evidence was presented that some patients with little chance of survival were not admitted to critical care due to limited space.
“It’s very upsetting to read,” Gething said, acknowledging the heartbreaking choices faced by medical teams, though he claimed to be unaware of specific instances.
Gething, who served as health minister until May 2021, conceded that delays in tackling hospital-acquired infections could have contributed to the challenges. He admitted he might have acted earlier in forming a task group to address the issue, which worsened during the second wave.
First Minister reflects on birthing partner rules
Current First Minister Eluned Morgan also testified, reflecting on delayed decisions to allow birthing partners in hospitals during the pandemic.
Morgan, who succeeded Gething as health minister in May 2021, acknowledged that guidance was not updated until May 2022, more than a year after England implemented similar changes.
“If I had my time again, that’s one of the things I definitely would have changed,” Morgan said, calling the delay regrettable for new parents.
She also defended the decision not to launch a national investigation into hospital-acquired infections, citing extensive reviews conducted by health boards. However, Morgan acknowledged shortcomings in resuming routine surgery and criticised poor management at some facilities.
The inquiry continues to examine decisions made by Welsh ministers and NHS leaders during the pandemic, focusing on lessons learned to prevent similar issues in future crises.
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