OVERCROWDING and patients sleeping on floor at a west Wales A&E were some of the issues raised by a report raising serious concerns, but also saying that there had been some improvements made to a hospital’s standards of care.

The health board involved, Hywel Dda, now says it has come up with a plan to address the issues raised by a report published by Healthcare Inspectorate Wales (HIW) who carried out an inspection of the emergency department at Glangwili Hospital, Carmarthen, in December.

Despite the best efforts of staff, the independent body said patients did not always receive consistently safe care.

Hywel Dda health board said it recognised “significant challenges” within the department.

Although patients and carers were said to be “generally satisfied with the service”, HIW identified several issues with the service provided at the department.

The report highlighting concerns at Glangwili came out at the same time that figures were released saying that waiting times at Welsh A&E departments had fallen slightly. Responding to those Emergency Department performance figures for February 2023 for Wales, Dr Suresh Pillai, Vice President of the Royal College of Emergency Medicine Wales, said: “We welcome the improvement in Emergency Department performance shown in February’s data. The reduction in patients facing four-, eight- and 12-hour waits is a testament to the hard and skilled work of Emergency Medicine staff who continue to tackle the crisis in Emergency Care.

“While we welcome this improvement, the situation remains serious. Exit block – where patients cannot be admitted from the Emergency Department to a bed because out of the limited bed base, many are taken up by patients who are unable to be discharged in a timely way causing a ‘traffic jam’ in the system – remains a significant issue in Emergency Departments in Wales. On the ground we continue to face severe problems around flow throughout our hospitals and delays to patient care.

“We must see faster and more tangible action around discharging patients and social care.

“We are pleased to have met with the Health Minister, Eluned Morgan MS. We recognise that there is the political will to engage with the issues facing Emergency Care. The Welsh Government is focused on delivering the six-goal programme.

“As part of this they are appointing Clinical Leads for each of the Six Goals with some overlap instead of the current model of one for all Unscheduled Care. We look forward to engaging with these Leads and would be pleased to continue engaging with the Health Minister and the Welsh Government and have further such meetings.

“There is an ongoing retention and recruitment crisis in Emergency Medicine in Wales. Our workforce census, published earlier this year, made this clear. Not only are junior doctors’ continuing to be stretched, but difficulties in recruiting persist. It is vital that both retention and recruitment in Emergency Medicine is recognised and made a priority by the Welsh government, otherwise Emergency Care will remain in crisis to the detriment of patients and existing staff.”

The report highlighted the following areas where the service is doing well or actions are already in place, including:

• pressure damage care and prevention;
• assessing and monitoring patients waiting in ambulances to maintain patient safety;
• availability of food and fluids;
• triage and supervision of areas by staff;
• easy navigation of patient records, handwritten entries were legible and logically set out.

But the report, by Healthcare Inspectorate Wales (HIW), found that patients at an accident and emergency department in Wales were not consistently receiving safe care.

The HIW carried out three unannounced inspections at Glangwili General Hospital in Carmarthen in December 2022 and identified several areas requiring immediate action by the health board.

The report found that overcrowding, a lack of toilet and washing facilities, and patients waiting in non-designated areas of the unit were having a negative impact on patients’ privacy, dignity, and infection prevention and control procedures. Delays in children being seen were also identified in the Paediatric Care and Assessment Unit (PACU).

Although patients and carers were generally satisfied with the services they received, frustration was expressed around waiting times and the lack of updates on patients’ care and treatment.

The health board has produced a comprehensive plan to improve the emergency department.

Andrew Carruthers, of Hywel Dda health board, said: “While the report states that generally patients and carers were satisfied with the service they had received at the emergency department at Glangwili Hospital, we do, however, recognise that there are significant challenges within the department.

“We also recognise the regrettable impact these have on our patients and their experience of using our services.

“We wish to reassure people that we are focusing on our improvement plan to address the recommendations of the report, and to provide ongoing assurances for our communities of the quality of the services we have to offer and provide.”

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AN INNOVATIVE project which is helping patients in west Wales to receive the care they need as close to home, Delta Wellbeing’s, now has a rapid response team. The company says that this is helping to prevent unnecessary ambulance callouts and hospital admissions across the area by attending non-medical emergencies and supporting people in their own homes.

During February, the team, according to their own figures, attended a total of 407 callouts, with an average arrival time of 31 minutes, and only 6% needing to be escalated to emergency medical services.

A large majority of calls are for non-injurious falls, and the team aim to improve the experience and outcome of those who have fallen by working to reduce the time it takes to get to the client, to assess and support them at home, and to try and prevent future falls.

The service has helped to reduce the number of emergency ambulance callouts, enabling them to attend more life-threatening calls. It has also allowed the majority of clients, who are generally vulnerable or older, to stay at home, reducing hospital admissions.

The team is part of Delta Wellbeing’s CONNECT project, which is transforming the way social care is being delivered across Carmarthenshire, Ceredigion and Pembrokeshire, through a new model of self-help and pro-active care, helping people remain independent for longer at home and reducing demand on long-term or acute care.

The service includes bespoke TEC equipment, wellbeing assessment, pro-active wellbeing calls, access to the 24/7 response team and pro-active support pathways, all of which, support residents to maintain independence and remain safe at home.

Carmarthenshire County Council’s Cabinet Member for Health and Social Care Cllr Jane Tremlett told The Pembrokeshire Herald: “The response service responds to calls within 45 minutes for non-medical emergencies, avoiding inappropriate hospital admission and use of ambulances, and ensuring clients who suffer a fall at home are not impacted significantly by lying on the floor for a long length of time.

“Research shows that the impact of falling is considerable, with a negative effect on independence and quality of life. Someone left lying on the floor for more than one hour is more likely to suffer serious injuries and be admitted to hospital, and subsequently moved into long-term care.

“Being able to attend site within one hour and lift clients off the floor not only provides them with the best outcomes but can also have a significant impact on reducing and, in some cases, stopping the need for ongoing support and care.”

Since January 2020, the rapid response team has attended more than 11,391 call outs; of which 37% were for non-injurious falls, 27% were for a ‘no response’ following an alarm activation, and 28% were for other assistance or welfare check. Figures show only 713 of those, or 6%, needed to be escalated to emergency medical services.

CONNECT is funded by the Welsh Government’s Transformation Fund through the West Wales Care Partnership and provides an enhanced wrap-around lifeline and telecare service shaping the future of health and social care across west Wales. A total of 5,703 residents have signed up for the service since it was launched.

Rhian Matthews, Integrated System Director for Hywel Dda University Health Board and Carmarthenshire County Council, said: “The older adult population tell us that what’s important to them is that they remain as well and independent as they possibly can for as long as they possible can and within their own home and communities.

“Through Delta CONNECT we are able to keep checking in on our vulnerable and older population to make sure they are keeping well and independent as they possibly can be, and when they are struggling Delta CONNECT is able to provide a timely response to their needs which allows us to put support in place before things become any worse. This helps us to avoid a hospital admission and protects their independence and reduces the reliance on social care support.

“And if someone falls at home or they need any type of assistance, Delta’s rapid response team works closely with the Welsh Ambulance Service, and make sure they are only taken to hospital when it is absolutely necessary for them to do so. If someone is taken to hospital by an ambulance and we believe that individual could go home with a little bit of wrap-around care from Delta CONNECT and the rapid responders, then we do that to support them and their families.”

Delta Wellbeing is a Local Authority Trading Company, owned by Carmarthenshire County Council, which provides assistive technology and proactive monitoring to support older and vulnerable people to live more independently.

THE STROKE ASSOCIATION is calling for support to sign petition as stroke recovery services are under threat in Carmarthenshire, Ceredigion and Pembrokeshire

People who have a stroke in the Hywel Dda health board area are at risk of being abandoned, according to the leading stroke charity.

The Stroke Association is deeply concerned that, as of 2023-24, the funding for the Life After Stroke service in Hywel Dda UHB is unlikely to provide a quality and equitable service for those most vulnerable stroke survivors in Carmarthenshire, Ceredigion and Pembrokeshire.

The Stroke Association’s Life After Stroke Service has been supporting stroke survivors in the Hywel Dda Health Board area for more than a decade. The service provides a life-line for people after they leave hospital; helping stroke survivors and their loved ones set their own goals for recovery, manage their condition and become more independent. 

In 2022 alone, the Stroke Association provided specialised person-centred support to more than 250 new stroke survivors and their carers in the Hywel Dda health board area; reducing hospital readmissions, supporting mental health needs and most importantly, supporting stroke survivor independence.

Katie Chappelle, Associate Director Wales, Stroke Association said “Hywel Dda University Health Board has been de-prioritising stroke services for years. There has been no inflation increase in our funding for over six years, resulting in a real-terms cut for stroke support services. Part of the service has historically been provided by Carmarthenshire Local Authority, but they have now withdrawn this money, due to changes in how they pay for community-based prevention services.

 With this support coming to an end, we want to work closely with Hywel Dda UHB to design an effective and quality service which continues to support stroke survivors and their loved ones to rebuild life after stroke.  We urge the Health Board to reconsider their upcoming tender, and include the additional adequate funding needed to deliver an equal stroke recovery service across all three areas for stroke survivors in the years ahead.

“Charities are integral to the healthy functioning of our society and should be accepted as a partner in the health and social care system, particularly at times of strain, rather than seen as a “nice to have”. This means supporting charities with long-term funding and integrating them into decision making. Charities are often best placed to engage with a wide range of people, particularly those who are seldom heard. At the Stroke Association we ensure that stroke survivors have a voice in the decisions that affect them. If there is a failure to recognise, respect and realise the true value of the work that charities do, there is a risk of losing essential provision and the person-centred approach that charities bring to our society.”

There are almost 10,000 stroke survivors living in the Hywel Dda Health Board area. Without this essential service, stroke survivors risk feeling abandoned after they leave hospital, placing further pressure on health and social services, at a time of great strain. 47% of stroke survivors within the health board are registered with GP surgeries that are in the Local Authority area of Carmarthenshire. The other 20% live in Ceredigion and 33% in Pembrokeshire highlighting a need for a service in all three areas.  (Data is from GP register 2019-2020)

Dave Jones, from Ammanford, Carmarthenshire had a stroke in 2017 at 36 years old. He was young, fit and healthy and he never expected it. “When I came out of hospital, I had double vision, my right arm and right leg didn’t work. I couldn’t speak properly. I got to the point of I didn’t want to be here. I actually got to the steps of ending it all. The support I have received from the Stroke Association has been invaluable.”  

The dad of two continued, “My co-ordinator has been a huge help to me. She is always there whenever I need her. I would never have got to where I have got without her.” 

Dave is part of a young men’s peer group based in Carmarthen “we help each other through it and meet up and talk about our experience, it is a massive help to me. Without the opportunity and help to set up this group by the Stroke Association who knows where we would all be. It has been a real saviour to many of us.”

As Dave continues to rebuild his life he has recently become a Stroke Association support co-ordinator, “It is a fantastic organisation that has helped me so much and I want to give back and help others as I know first-hand how important the Life After Stroke service is for stroke survivors.”

Adam Price MS for Carmarthen East & Dinefwr said that“having met with the Stroke Association recently, I am fully aware of the excellent service they provide to stroke survivors across my constituency. Despite a shrinking budget and significant pressures, the Life After Stroke service has continued to provide vital support to patients across the Hywel Dda area.

 “It is vital that stroke recovery services do not get left behind, and we must do whatever we can to save our stroke recovery service. I would urge members of the public to sign this petition to demonstrate just how much support there is for the Life After Stroke service in Carmarthenshire.”

When stroke strikes, part of your brain shuts down. And so does a part of you. Recovery is tough, but with the right specialist support and a ton of courage and determination, the brain can adapt. The Stroke Association is here to support people to rebuild their lives after stroke.  

The Stroke Association has delivered a stroke recovery service across all three areas of Hywel Dda health board for more than a decade. We support stroke survivors, their families, and carers to rebuild their lives after stroke.

To help save our stroke recovery service in Hywel Dda please sign our petition to show your support here