HYWEL DDA University Health Board has approved a proposal to replace inpatient beds at Tregaron Community Hospital with enhanced community-based healthcare services. This decision comes after a public engagement exercise and is part of the Cylch Caron project aimed at transforming healthcare delivery in north Ceredigion.

The approved model will see the removal of nine inpatient beds at Tregaron Hospital, shifting focus to providing care in or close to patients’ homes. According to the health board, this move is designed to create a more sustainable, safer service across Ceredigion, improving patient care and allowing people to avoid hospital stays unless necessary. The model will allow staff to work in different ways, offering more support in the community and strengthening community-based nursing services.

A vision for integrated care

The Cylch Caron project, a collaborative effort between Ceredigion County Council, the health board, and the Welsh Government, plans to establish an integrated resource centre in Tregaron. This centre will bring together healthcare, social care, and housing services in a central hub for the town and its surrounding rural areas. The health board believes this model is already successful in south Ceredigion and will provide high-quality patient care by enhancing collaboration across healthcare and support services.

Peter Skitt, County Director for Ceredigion, acknowledged the emotional attachment the local community has to Tregaron Hospital. “We want to do the right thing for our patients and our staff who care for them, and this isn’t always by the traditional model of providing care in a hospital bed,” Skitt said. The health board aims to use the new model to support up to 40 people in their homes, compared to the nine patients who would be accommodated in hospital beds.

Despite the health board’s assurances, the plan to remove inpatient beds has sparked significant concern within the community and among local politicians. During the public engagement period, fears were raised about the future of healthcare services in Tregaron.

Elin Jones, Member of the Senedd for Ceredigion, and Ben Lake, the local MP, have been vocal in their concerns. They argue that the inpatient beds at Tregaron Hospital should remain until the new Cylch Caron centre is operational. “It was always expected that beds would remain in use at Tregaron Hospital until the Cylch Caron project was up and running,” said Elin Jones. The delay in the project’s completion, now expected to take another three to five years, has led to worries about a potential gap in healthcare provision.

Similarly, Tregaron Town Council has expressed “disappointment and anger” over the health board’s decision, stating that decommissioning the beds before the Cylch Caron project opens could dilute local healthcare resources. Tregaron County Councillor Ifan Davies described the hospital as a “special resource for the area,” emphasising its long-standing role in providing care to the community.

The Health Board’s justification

The health board, however, remains firm on the benefits of the new model. It argues that the change will help avoid the risks of hospital stays for patients who are medically fit to be in their home environments. The board has also noted that the staffing situation at Tregaron Hospital has become fragile, with recruitment efforts failing to address the shortages. “Despite efforts to recruit to positions, our current level of staffing is insufficient, and our staffing rotas are fragile,” said Skitt.

This proposal, according to the health board, is an opportunity to strengthen its resilience ahead of the winter months when healthcare services face significant pressures. By adopting the community care model now, they aim to avoid a situation where they might be forced to close beds without notice.

The transition to the new model of care will be phased. Current inpatients at Tregaron Hospital will follow normal discharge procedures, and further admissions will cease immediately. The hospital building will continue to serve as a hub for community staff and as a facility for outpatient services until the integrated resource centre is operational.

Dr Sion James, Deputy Medical Director of Primary Care and a local GP, supports the Cylch Caron vision. He describes the project as a unique opportunity to offer a range of services in a central hub for Tregaron and surrounding rural areas, aiming to create an innovative, sustainable model of community-based care.

While the new community healthcare model promises to provide enhanced nursing support in patients’ homes, local politicians and residents remain concerned about the potential loss of a valued healthcare facility. The health board’s assurances of a safer, more sustainable service will be tested in the coming months as Tregaron’s community adjusts to these changes. For many, the focus now shifts to how well the new model will meet the area’s healthcare needs in practice, especially as the Cylch Caron centre remains years away from completion.

ALMOST three quarters of haematology consultants in Wales will near retirement age in the next decade, with a critical shortfall of replacements, a charity warned. 

Blood Cancer UK (BCUK) launched an action plan, entitled ‘Taking blood cancer out of the shadows’, at the Pierhead in Cardiff Bay on September 24 

Ceri Bygrave, a consultant haematologist at the University Hospital of Wales, Heath, Cardiff, was part of the charity’s task force which produced the recommendations. 

Dr Bygrave said: “The haematology workforce is overstretched and understaffed, with critical staff shortages and increasingly complex treatments leaving people delivering NHS blood cancer care under major pressure. 

“This is a particular challenge in Wales where by 2032, 74% of permanent haematology consultants will reach the age of 60 with a shortfall in trainees to replace them.” 

Dr Bygrave said: “The crumbling NHS infrastructure that exists in Wales and a woeful IT infrastructure that lags a long way behind other centres in England are all things that compromise blood cancer patient care on a daily basis. 

“To improve blood cancer survival, future NHS workforce plans must include an increase in the number of and support for blood cancer clinical nurse specialists, as well as action to turn around the drop in the number of clinicians doing blood cancer research.” 

Helen Rowntree, the charity’s chief executive, said huge strides have been made in research in the past 60 years but blood cancer remains the UK’s third largest cancer killer. 

Ms Rowntree said: “Needless lives are being lost and for those living with blood cancer there’s a real fear that they’re not getting the best care and support. 

“The blood cancer community deserves better. The drivers of better survival in high-performing countries urgently need to be understood and implemented.” 

Sam Rowlands, the Conservatives’ shadow health secretary, said blood cancer requires more attention in Wales as he called for targeted intervention. 

Mr Rowlands said: “Barely half of cancer patients are receiving treatment within the 62-day target time in Labour-run Wales and there is no clear trend of improvement.

“The action plan from BCUK provides a blueprint for bold action, the fact that only one hospital in the whole of Wales provides groundbreaking CAR-T therapy isn’t good enough. 

“If we boost staffing levels as the Conservatives have proposed and invest in provision, we can also put forward a faster diagnostic standard, as is the case in England, of 28 days. 

“We should also have more ambition in collecting information on cancer treatments in Wales to perfect treatments and improve prospects.” 

David Rees, who sponsored the event and chairs the Senedd’s cross-party group on cancer, described the charity’s report as sobering. 

He said the report highlights the complexity in diagnostics and treatment which often leads to missed early diagnosis, treatment disparities within Wales and gaps in clinical expertise. 

The Labour MS for Aberavon added: “I know that there are issues involved in data collection for blood cancer too, which can help inform good clinical practice and patient pathways.” 

Mr Rees said: “Patients across Wales need to have confidence … that when they present themselves to their GP or A&E department, the diagnostic services are available and can deliver timely data that can lead to early treatment. 

“Patients should expect no less.” 

He pledged to keep pressure on ministers to act on expert reports, saying he was confident two Labour governments can together meet the challenge of modernising the NHS. 

Research found 29% of people with blood cancer in Wales visited their GP three or more times before diagnosis, with BCUK warning delays can have devastating consequences. 

The charity also raised concerns that nearly 30% of blood cancer patients in Wales do not know who their clinical nurse specialist is. 

The Welsh Government highlighted a 50% increase in haematology specialty and associate specialist doctors, and a 9% increase in consultants over the past decade. 

A spokesman said: “We have made cancer one of the NHS’s top planning priorities and have launched a national programme to support recovery in cancer waiting times. 

“We have received the charity’s blood cancer action plan and are considering the implications for our approach in Wales.” 

PLAID Cymru’s shadow health and social care secretary warned that new Wales-wide standards for commissioning care may be unachievable due to financial pressures.

Mabon ap Gwynfor raised concerns about the national rules for councils and health boards on commissioning care and support, which came into force on September 1.

He welcomed the reform’s overall aims but cautioned that councils, which will primarily be responsible for implementation, are already “hurtling” into an existential crisis.

Mr ap Gwynfor said councils are contending with a 3.8% increase in spending pressures this year compared with a 0.3% rise in funding, with a projected £750m shortfall by 2027.

He told the Senedd: “There remains widespread concern that the principles and standards outlined in this framework, as worthy as they are, will be unachievable in practical terms.”

Mr ap Gwynfor, who represents Dwyfor Meirionnydd, said non-ring-fenced parts of the Welsh budget, which include social care, are facing a £683m real-terms cut over five years.

Dawn Bowden, Wales’ social care minister, argued the bulk of the reforms ask councils and health boards to do things differently rather than to do more.

“It’s about moving away from complexity towards simplicity,” she said in a statement to the Senedd on September 24.

“It’s about moving away from price towards social value and quality, and it’s about moving away from reactive commissioning and towards managing the market.”

Altaf Hussain, the Conservatives’ shadow social care minister, described the new code as a welcome step in ensuring a uniform approach to care commissioning.

But Dr Hussain was concerned that moving away from price-driven contracts could have a detrimental impact on council and health board budgets.

Jane Dodds, the Liberal Democrats’ leader in Wales, broadly backed the reforms but raised concerns about social care recruitment and retention in rural Wales.

She warned: “People in our care sector and our health sector are really overwhelmed at the moment and to pile on them, yet again, another change is a real challenge.”

Labour’s Julie Morgan, who was previously social care minister, described the reforms as a building block towards the vision of a national care service.

She stressed the importance of better pay, saying care workers can get much more to do a similar job in the NHS which makes retention difficult.

Ms Bowden said the new national office for care and support within the Welsh Government, which was established in April, will play a key role in implementing the framework.

Wales-wide commissioning rules form part of a swathe of reforms proposed by the Welsh Government in an effort to tackle the social care crisis.

The ambition, agreed as part of the cooperation deal with Plaid Cymru, is to establish a national care and support service – free at the point of need, similar to the NHS.

An implementation plan was published by the Welsh Government in December, with the reforms expected to take at least ten years.

Phase one includes establishing national commissioning arrangements, a voluntary pay framework, and a national office for care and support.

Political opponents have cautioned of the potential negative consequences of imposing a litany of changes on a sector already struggling to cope.

A lack of funding is the crux of the crisis but it is often the elephant in the room.

The scale of the issue means Wales is reliant on Westminster bringing forward reforms in England, which would result in consequential funding for the Welsh Government.

But, for decades, successive Conservative- and Labour-led governments appear to have kicked social care into the long grass.

Before a u-turn in September 2022, Boris Johnson’s UK Government proposed a health and social care levy which was expected to raise about £13bn a year.

And Carwyn Jones’ Welsh Government, which cut health to protect social care spending, commissioned independent research on paying for Wales’ social care needs.

Gerry Holtham, an economist, proposed a similar levy or tax increase in 2018.