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Health

Concerns over standards at A&E following report highlighting ‘significant challenges’

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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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Community

A further two Pembrokeshire day care centres may close if petitions fail

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TWO PETITIONS, calling on Pembrokeshire County Council to keep day care centres in the county open have been launched, with the creator of one calling on all affected to unite together.

Earlier this year, senior councillors backed plans to close two of the county’s centres for older adults and those with learning disabilities, Portfield SAC, Haverfordwest, and Avenue SAC, Tenby; service users moving to other centres in the county.

The county council is currently changing care provision for older adults and those with learning disabilities, and fears have been raised recently that Pembroke Dock’s Anchorage day care centre is to close.

A series of engagement events have taken place at The Anchorage recently, outlining the reasons and the options in continued service.

One parent, who wished to remain anonymous, said: “One young woman who attends ran out of the first meeting sobbing when she was told it was going to close.

“Another, at the second meeting, tried to address the meeting, but was so choked up at the thought of not seeing her friends any more she could hardly speak.”

It now is feared Narberth’s Lee Davies Day Care Centre and Crymych’s Bro Preseli Day Centre could also close, with concerns it is due solely to budgetary reasons.

An e-petition on the council’s own website, by John Llewellyn of Living Memory Group, entitled against the closure of the Lee Davies and Bro Preseli day care centres, has attracted some 254 signatures to date.

It states: “We call on Pembrokeshire County Council to Review the closure of the Lee Davies Day Care Centre at Bloomfield’s and the Bro Preseli Day Centre at Crymych.

“Staff at both day care centres were informed in mid-March that both facilities would be closing due to PCC budget cuts. Both centres are an essential outlet for the wellbeing of the attendees and their families.”

Change.org petition, called Save the Lee Davies Day Centre Narberth, has also been started by Kate Schofield, the twin sister of one of the centre users, which has attracted 186 signatures.

She says her sister has already seen “her beloved Avenue Centre close,” and could “lose her old and new friends at the Lee Davies Centre”.

That petition reads: “Pembrokeshire County Council are currently reviewing the day centre provision in Pembrokeshire.  They have posted some petitions where you can merely sign your name, but this is not proper consultation, and in reality decisions about services provided for older people and vulnerable adults many with complex learning disabilities are being made by councillors who are driven purely by budget savings.

“If we lose the Lee Davies Centre there will be little or no provision in south Pembrokeshire, The Avenue in Tenby has closed, The Anchorage will close very shortly and in Haverfordwest, Portfield has also been closed.

“Please sign, comment and share let’s show PCC that we care even if they clearly don’t.  We have until early June to make our feelings known, so please sign today.”

Kate added: “My sister has Down’s Syndrome and because of our age has always only had the option of day care services.

“Over the last few years she has, like the rest of us, come through Covid. The day, whilst out for a walk, she started laughing while hugging a tree because she couldn’t hug me will stay with me forever.

“She’s seen her beloved Avenue Centre close and now will possibly lose her old and new friends at the Lee Davies Centre, this is one of the many reasons I have raised this petition.”

Kate, who said she was moved to tears by the plight of Anchorage centre users, finished by saying: “I don’t believe PCC, and indeed the Cabinet Member for Social Care & Safeguarding, have any regard for older people with learning disabilities, profoundly disabled adults and indeed older people in general.

“They talk about stress and mental health but have no regard to what they are doing to carers and attendees across these centres.”

She finished: “We need to all join forces, Lee Davies, Bro Preseli and The Anchorage to fight PCC.”

Kate may be contacted on 01646 651049.

A spokesman for Pembrokeshire County Council said: “Pembrokeshire County Council is working with trustees at both Lee Davies and Bro Preseli in order to maintain current service provision wherever possible.

“The services remain committed to develop a hybrid social enterprise model during 2024/25.”

Anchorage plea: A plea by a concerned parent to keep the “safe and happy place” Anchorage centre open – which had also attracted a council e-petition – was recently heard at a full council meeting.

Responding at that meeting, Cabinet Member for Social Care & Safeguarding Cllr Tessa Hodgson said: “All service users of the Anchorage will be offered alternative day centre arrangements in order to preserve their independence and also to support the caring needs of their families, these assessments are still taking place and are likely to continue to do so at least until the end of May.”

The anchorage petition, which closed today, May 24, attracted 402 signatures.

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Health

Highest waiting lists on record in: NHS performance under scrutiny

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THE latest NHS performance figures for Wales reveal the highest waiting lists on record, sparking a wave of criticism and concern from various stakeholders. The data, which covers March and April 2024, underscores the immense pressure faced by the Welsh health service, particularly in comparison to other parts of the UK.

Conservative Criticism of Labour Government

Sam Rowlands, the Welsh Conservative Shadow Health Minister, has sharply criticised the Labour-run Welsh Government, attributing the record-high waiting lists to their management. “These atrocious statistics stand as a stark warning as to what a Labour Government looks like and why Labour cannot be trusted to run the health service,” Rowlands remarked. He highlighted the contrast with England, where he claims progress is being made to cut waiting lists. Rowlands also accused the Welsh Government of misallocating funds received from the UK Conservative Government, spending them on initiatives like 20mph speed limits and expanding the Senedd, instead of bolstering NHS resources.

The statistics are indeed sobering: the number of patient pathways increased from over 762,500 to just under 768,900 in March, the highest figure on record, equating to 1-in-4 of the Welsh population. Additionally, 599,100 individual patients were waiting for treatment in March, marking an increase of nearly 8,000 compared to February. Despite promises from the Labour Health Minister to eliminate two-year waits by March 2023, over 20,000 patients are still waiting this long.

Macmillan Cancer Support’s Concerns

Macmillan Cancer Support has also weighed in on the troubling figures, particularly focusing on cancer treatment delays. Glenn Page, Policy and Public Affairs Manager at Macmillan Cancer Support, acknowledged some improvements in cancer waiting times but stressed that many people are still being let down. “Healthcare professionals are working around the clock, but these treatment delays are having a devastating impact on people living with cancer and throwing lives into chaos,” Page said.

In March 2024, more than 600 cancer patients in Wales waited over 62 days to start treatment from first being suspected of having cancer. This figure, representing 40% of those who started treatment that month, highlights the ongoing struggles within the NHS. While there was an improvement from the previous month, the national cancer waiting times target was still missed. Particularly concerning are the delays faced by patients with gynaecological cancers, with only 31.8% starting treatment on time.

NHS Confederation’s Response

The Welsh NHS Confederation has provided a more nuanced perspective, acknowledging the high demand but also highlighting areas of progress. Darren Hughes, Director of the Welsh NHS Confederation, noted that emergency departments experienced their busiest April on record. Despite this, there were improvements in performance against four and twelve-hour targets, and the average time spent in emergency departments decreased.

Hughes pointed out that the number of pathways waiting over two years has fallen for the twenty-fourth consecutive month, showing a 71% drop since its peak post-pandemic. However, he emphasised the need for greater investment in prevention, primary, community, and social care to manage demand sustainably. “If governments do not act now, the situation will only deteriorate as demand continues to rise,” he warned.

Welsh Government’s Stand

In response, a Welsh Government spokesperson acknowledged the challenges but also highlighted the strides being made in reducing waiting times and improving access to care. “Long waiting times are continuing to come down – these figures show they have fallen every month for two years and there has been a 71% reduction in long waits since their peak post-pandemic,” the spokesperson said. They also pointed to improvements in diagnostic waiting times and cancer treatment performance.

However, they admitted that ambulance performance remains suboptimal, despite improvements in response times for the most critical calls. The Welsh Government reiterated their commitment to supporting NHS staff and focusing on further reducing waiting times.

Conclusion

The latest NHS Wales performance figures have sparked a heated debate about the effectiveness of the current management under the Labour-run Welsh Government. While some progress has been acknowledged, the record-high waiting lists and persistent treatment delays underscore the urgent need for comprehensive reforms and increased investment in healthcare resources. The coming months will be critical in determining whether these issues can be effectively addressed to meet the growing demands on the Welsh NHS.

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Health

Decades of failure and denial over tainted blood scandal revealed

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ON MONDAY evening (May 20), Rishi Sunak apologised on behalf of the British government to the victims of the contaminated blood scandal.

After a five-year public inquiry, the Prime Minister offered an “unequivocal” apology for the findings published in Sir Brian Langstaff’s report earlier on May 20.

The findings were damning.

They included the revelation that ministers, doctors and civil servants knew the risks of the blood products given to haemophiliacs and people needing blood transfusions.

Victims were “gaslit” by claims that the mass infection of those patients with HIV and hepatitis C was inadvertent, that screening started as soon as it could, and that no one could have stopped it sooner.

None of those things were true.

Under successive Labour and Conservative Governments, the Department of Health and HM Treasury fought against a public inquiry and the idea of paying compensation to those affected by being given tainted blood products.

Officials fobbed off ministers who tried to look into what had happened, complaining that they had too much sympathy for the victims.

When briefing documents for ministers got close to revealing the truth, civil servants doctored their content to misrepresent their authors’ findings.

While Mr Sunak apologised for the failures of the British state and Sir Kier Starmer for a “failure of politics”, the blame doesn’t rest only at Westminster’s door.

Welsh Government ministers are specifically mentioned for refusing to hold a public inquiry and not seeking advice specific to Wales. Instead, despite having responsibility for the NHS in Wales, they slavishly followed Westminster’s line.

Welsh Government ministers failed to examine the strength of the evidence UK ministers and officials relied upon or assess the evidence available in Wales.

Had they done so, they would have found key claims – that all infections were inadvertent and patients received the best possible treatments – were untrue and unfounded.

Only in 2017 did the Welsh Government change tack, when then-Health Minister Vaughan Gething wrote to his UK counterpart, Jeremy Hunt, to request a UK-wide public inquiry.

Ironically, only Theresa May’s political weakness following the 2017 General Election led the Westminster Government to order a public inquiry. Mrs May feared losing a Commons vote on the demand for one.

The worst elements of the scandal are clinical and institutional.

Clinicians, Department of Health officials, and others concealed the truth to avoid blame and liability.
The inquiry pointed to medical advice on the dangers of blood and plasma dating back 40 years and court rulings that showed other countries had started screening sooner.

Doctors claimed they hadn’t seen evidence of infection through those products even while treating people who had contracted AIDS from their treatment with them.

Documents disappeared, were “lost”, and patient records were deleted.

Leading clinicians withheld critical information from patients and their families.
Children with haemophilia were treated as guinea pigs.

The list of severe historic and continuing failings is almost unending.

The government’s easiest task is paying compensation. Addressing the culture of secrecy and institutional arrogance will be much harder.

For more on this story, see this week’s edition of The Pembrokeshire Herald.

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