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Withybush paediatric care gone for good in yet another blow for hospital

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OVER seven years after “temporarily” closing Withybush’s 24-hour Paediatric Ambulatory Care Unit (PACU), Hywel Dda UHB decided to close the department permanently on Thursday, November 30.
In January, the Board will meet to receive the plan for its implementation plan to make the change permanent.

A FOREGONE CONCLUSION

Describing the Board’s decision as a foregone conclusion would be grossly unfair. But, as Thursday’s meeting chugged along, it became clear it was.
Bluntly, the Board has neither the money, resources, nor staff to return paediatric care to Withybush. It didn’t have them before the consultation began. In the interim period, the only thing that changed was the catastrophically worse financial performance that led to the Board being subject to enhanced monitoring by the Welsh Government.
The Board’s ability to deliver its preferred option, which included returning some outpatient services for children to Withybush, is doubtful.
However, it now needs a plan to implement its plan. That plan to have a plan for its implementation plan will be discussed in January when the Board will discuss the planned plan for a plan.
If the planned plan for a plan doesn’t work out, the Board will go back to the drawing board to draw up another plan for its plan.

A “TEMPORARY” PROBLEM

In three years, the Board moved from a 24/7 service to a promise to return to a 12/7 service to a bold attempt to preserve an 8/7 service.
As our columnist Badger noted five years ago, the next step was bound to be a 0/7 service.
And then Covid came along.
PACU was closed, and its services “temporarily” transferred to Glangwili during the pandemic.
At the end of the pandemic, PACU didn’t return.
Instead, the Board justified its continued cessation because of the risk of a spike in respiratory viruses.
When that spike didn’t happen, the Board consulted on a “permanent solution”.
And that permanent solution – as glaringly obvious for years – was permanent closure.

A DECADE OF WORTHLESS REASSURANCE

In 2014, the Board stopped providing 24-hour paediatric care at
Withybush. At the time, it said that a 12-hour provision was deliverable, and it planned to return 24-hour paediatric care to Withybush once it recruited clinical staff.
By then, there was only ONE advert for a single paediatric consultant at Withybush and NONE for nurses specialising in paediatric care.
At one point at the end of 2015, the Board suspended its recruitment campaign for posts at WithyWithybush’s after claiming to have recruited staff to fill vacancies there. It announced an intention to launch a more focused campaign later.
In November 2016, the Board restated its commitment to maintaining the Paediatric Ambulatory Care Unit’s opening hours at Withybush from 10am-10pm, even though it faced “renewed and significant workforce challenges at the consultant level”.
In 2017, CEO Steve Moore said the Board was clear: “The changes to paediatric services are temporary and in response to us needing to ensure a safe and reliable service for our families with the consultant paediatricians available.”
After ending the 12-hour PACU cover, the Board did not launch an effort to recruit for three months after its closure.
By the end of the same year, the Board said: “Unfortunately, we have not been able to recruit a sufficient number of consultants to support the re-establishment of the 12-hour PACU service, although our recruitment efforts continue.
“In the meantime, the Health Board is working with staff and partners to explore a number of ideas to support a sustainable PACU service for the longer term.”
In 2018, the Community Health Council issued a report.
It said: “The health board needs to do all it can to resolve the current temporary reduced hours arrangements in PACU”.

CONSULT THE PUBLIC, THEN IGNORE THEM

Thursday’s meeting continued to offer mealy-mouthed platitudes instead of health services.

Board members suggested that parents of children in need of paediatric care would be reassured by the clarity the permanent removal of a key service from Pembrokeshire would provide.
Discussing the lack of transport options, Board members said they would publicise the availability of the Designated Ambulance Vehicle and the use of a taxi service to ferry children and parents from Glangwili.
The disconnection between the Pembrokeshire public and the Board over the issues could not be more complete.
Board members said that the main problem with the attitude of Pembrokeshire’s concerned parents was communication.
Pembrokeshire’s respondents to the Board’s conscientious rubber-stamping process were clear the issue was not communication but concern about timely treatment close to home.
70% said PACU should return to Withybush. The Board’s alternative, closing PACU for good, was overwhelmingly rejected.
If communication were the issue, not the provision of treatment at Withybush, the Board could have resolved it by being straightforward and transparent.
It wasn’t.
All the communication in the world, delivered by the best communicators money can buy, cannot circumvent that epic failure of honesty.
Describing the Board’s decision as a foregone conclusion would be grossly unfair. But, as the meeting ground on, it became clear it was.
Bluntly, the Board has neither the money, resources, nor staff to return paediatric care to Withybush. It didn’t have them before the consultation began. In the interim period, the only thing that changed was the catastrophically worse financial performance that led to the Board being subject to enhanced monitoring by the Welsh Government.

TOTAL DISCONNECTION

Board members suggested that parents of children in need of paediatric care would be reassured by the clarity the permanent removal of a key service from Pembrokeshire would provide.
Discussing the lack of transport options, Board members said they would publicise the availability of the Designated Ambulance Vehicle and the use of a taxi service to ferry children and parents from Glangwili.
The disconnection between the Pembrokeshire public and the Board over the issues could not be more complete.
Board members said that the main problem with the attitude of Pembrokeshire’s concerned parents was communication.
Pembrokeshire’s respondents to the Board’s conscientious rubber-stamping process were clear the issue was not communication but concern about timely treatment close to home.
If communication was the issue, not the provision of treatment at Withybush, the Board could have resolved issues by being honest and transparent from the outset. It wasn’t. All the communication in the world, delivered by the best communicators money can buy, cannot circumvent that epic failure.

PERMANENT CLOSURE “BETTER”

Six years ago, “temporary” became the status quo.
Then “temporary” became a further “temporary reduction”. During Covid, the whole service was “temporarily” withdrawn.
So intense was Board members’ collective delusion at Thursday’s meeting that the permanent removal of the PACU service and its replacement with a vague promise of some outpatient clinics for children returning to Withybush sometime over the rainbow was represented as an improvement on the current position.
Even this Thursday morning, the current position was “temporary”, not permanent.
The Health Board’s thesaurus must look very peculiar.
Its word games demonstrate the extent to which the Board had long dispensed with the pretence of PACU’s closure temporary nature.
In the meantime, the Board plans to tell more people about its Dedicated Ambulance Vehicle and plans to fund taxis for distressed parents and sick and injured children.
You can bet that’ll make everything better.

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Health

Extra funding to upgrade NHS Wales digital services and equipment

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THE NHS will benefit from £10m in additional capital funding to upgrade scanning equipment and digital infrastructure.

The funding package includes:

  • £5m for digital services to modernise elements of the IT infrastructure and support the provision of modernised and efficient patient care.
  • £1m to upgrade MRI scanners.
  • £1.3m for ultrasound scanning equipment.

The extra funding is being made available today as the Welsh Government publishes its second supplementary budget – an annual, end-of-year budget, which formalises changes made during 2023-24.

This year, the second supplementary budget includes changes the Finance Minister announced in October 2023 to provide additional support to the NHS and Transport for Wales.

The Welsh Government provided additional in-year support of £425m to the NHS and £125m to Transport for Wales to help meet increased cost pressures and, in the case of health boards, rising demand.

The second supplementary budget also details some of the additional funding made available to Wales as a result of decisions made by the UK Government to increase spending in devolved areas.

But notification of the additional consequential funding has come too late to be spent in this financial year. The additional revenue and capital funding will be put into the Wales Reserve for use in 2024-25 and 2025-26.

As the figures were published, Rebecca Evans, Minister for Finance and Local Government said:

“The UK Government confirmed the final sums last week, leaving us only one week to allocate additional funds.
“I’m pleased that we have been able to direct much-needed funding to maintain the fabric of our NHS.

“But at a time when public sector budgets have been squeezed so tightly, this is another example of why we need greater borrowing powers to be able to respond quickly to emerging needs.

“Unlike the UK Government, we cannot borrow to fund day-to-day spending so we are dependent on Barnett consequentials which often come late in the year and with little or no notice.

“As it is, we have been forced to plan based on best guesses about what we will receive from the UK Treasury – this is simply not acceptable.”

Eluned Morgan, Minister for Health and Social Services added:

“This additional capital funding, together with the in-year revenue funding is welcome.

“But the NHS is facing the toughest financial pressures in recent history due to inflation and increased demand in both planned and emergency care. Health boards have had to make some very difficult decisions despite the additional injection of funding over and above their allocated budgets.”

The supplementary budget is due to be debated on Tuesday 12 March, after the Welsh Government’s Final Budget 2024-25 on Tuesday 27 February

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Health

New X-ray equipment plan at Tenby Cottage Hospital revealed

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X-RAY services at Tenby Cottage Hospital are to receive a major boost thanks to an investment of £625,000 in brand new equipment which is being installed at the Hywel Dda Health Board-run site over the next few weeks.

The equipment, funded by Welsh Government, will allow the unit not only to provide the highest quality images but will also mean patients with reduced mobility or advanced clinical needs can be more easily accommodated.

However, in order to install the new equipment, x-ray services will be temporarily unavailable in Tenby Cottage Hospital until Friday, 19April 2024.

Over the next few weeks, imaging for GP patients will be provided on an appointment only basis at South Pembrokeshire Hospital in Pembroke Dock between 9-5pm.

Patients attending the Minor Injuries walk-in centre can still attend Tenby Cottage Hospital but may be sent to Withybush if an x-ray is required. Alternatively, patients can choose to attend Withybush Emergency Department directly.

John Evans, Pembrokeshire County Director for Hywel Dda said: “We are delighted that Tenby Cottage Hospital will be receiving brand new and up to date x-ray equipment thanks to this investment from Welsh Government.

“We apologise for any inconvenience caused over the short period of time while the equipment is being installed but look forward to providing an improved level of care for Tenby community patients into the future.”

Patients needing further help or information should contact the radiology departments at Withybush Hospital on 01437 773385 or South Pembrokeshire Hospital on 01437 774018.

The health board is reminding people not to attend busy A&E departments unless they have a critical, life-threatening emergency and asking people to choose their healthcare services very carefully, so that only people with urgent or emergency care needs are being seen in A&E. 

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Health

NHS facing unprecedented winter pressures amid record demand

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THE NHS in Wales has been facing significant challenges this winter, with an exceptionally high number of emergency calls and delays that have put immense pressure on its staff and resources, according to the latest activity and performance statistics.

In January, the ambulance service received 5,009 red (life-threatening) calls, accounting for 13.9% of all calls. Despite a slight decrease from December, with an average of 162 life-threatening calls per day, this figure remains the third highest on record. The response times for these urgent calls have also been under scrutiny, with 48.8% of red calls receiving an emergency response within eight minutes, marking the second highest achievement for this metric. The average response time for these calls was 8 minutes and 11 seconds.

The performance data also revealed that approximately 27,000 hours were lost due to handover delays at hospitals, highlighting the systemic pressures faced by the health service. Despite these challenges, nearly all health boards came close to meeting the target for 97% of patient pathways waiting less than two years by 2024, missing it by a mere 0.03%.

Nesta Lloyd-Jones, Assistant Director of the Welsh NHS Confederation, commented on the impact of the winter pressures and the exceptional demand on NHS services. “The monumental efforts of our staff have led to some improvements, such as a decrease in the number of people waiting the longest for treatment in December. However, the progress is threatened by the junior doctor strike action in January and February, which has led to a significant number of planned care procedures being postponed.”

Lloyd-Jones stressed the need for comprehensive planning and significant investment in NHS infrastructure and social care to ensure the health service can continue to improve and meet the demands placed upon it. “Good planning alone is not enough. Without significant capital investment and a whole-nation approach to health and wellbeing, alongside substantial changes to social care funding and provision, the progress of NHS leaders will be limited.”

The Welsh NHS Confederation, which represents the seven local health boards, three NHS trusts, and other health organisations in Wales, has been vocal about the challenges faced by the NHS and the need for strategic investment and support to navigate through these difficult times.

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