Dr Robertson-Steele: “24 hour services are no longer sustainable”

Tough questions at press conference

ON TUESDAY morning (Dec 2), at an emergency press briefing held at Withybush, Health Board executive members and Chair Bernadine Rees faced the press in attempt to play down the situation. Reporters were told that negative publicity in local newspapers, and blogging by pressure groups such as SWAT are to blame for the staffing shortages in Withybush hospital, Ms Rees claimed at the hastily arranged press conference.

Bernadine Rees called for everyone to work together to ensure that Pembrokeshire was a place medical specialists would like to come and work Speaking to The Herald on Tuesday Mr Rees referred to the adverse coverage the Board has had over Withybush Hospital: “Those who show an interest in working in Pembrokeshire, then go on to websites and with the plethora of jobs that are available they decide that perhaps Pembrokeshire is not the best place for them to go. You only have to look at the back pages of the British Medical Journal to see just how many vacancies there are across the UK. I cannot speak for the pressure groups but all I can say to them is to ask them to work with us to portray Pembrokeshire positively. We all want the same thing: to provide a sustainable future for health care in Pembrokeshire.”

The storm over the future of Withybush Hospital was rekindled when an internal document was leaked to the press. Re-assurances given to the media since the leak of the explosive letter have raised as many questions as they have provided answers. In particular, the Health Board appears to be contemplating a service model based around the Out of Hours GP Service while there is NO guarantee that 24/7 A&E services will be available after May 2015. The secret report reveals that since the downgrade in paediatric services overnight there has been increased burden on the out of hours service and that too is branded as ‘short staffed and at risk’. The leaked memo says that staffing issues led to the latest crisis in the service, and that a solution needs to be found.

It argues that Withybush should not provide services for patients where further or onward care is required, including those involving palliative care and oncology, to which the Board has made a very public and very recent public commitment, according to the document. Instead Dr Robertson-Steele, the hospital’s Clinical Director recommends: “Limiting provision at WGH to those services at WGH which are fully staffed and skilled.” SWAT chairman Dr Chris Overton told The Herald that the news was the ‘end game’ for Withybush Hospital. He added: “As predicted for many, many years, there will be nothing much will be left at the hospital.” The hospital action group has previously raised concerns that the knock on effect of services removal will result in changes having to be made at Withybush A&E.

LOCAL POLITICIANS REACT 

Stephen Crabb MP told The Herald: “This leaked document appears to confirm our worst fears about what the Board and Mark Drakeford have got planned for Withybush. A dark cloud is hanging over the future of our hospital. The removal of a 24 hour A&E service from Withybush is just unacceptable. The Welsh Health Minister should stop hiding away in Cardiff and come down to Pembrokeshire to either denounce these reckless plans or explain why he thinks they make our community safer. People in Pembrokeshire deserve more than behind-the-scenes plotting. Today the UK Government is giving Welsh Ministers an extra £70 million as a result of the increase in English NHS spending. I have asked that the Welsh Government confirm that it will use this money solely for Welsh health services. After all the recent cuts to services, Pembrokeshire should be first in the queue for this spending.”

Plaid Cymru Mid & West Assembly Member Simon Thomas said: “The people of Pembrokeshire deserve better A&E services. This development about emergency services at Withybush Hospital is very concerning indeed. Welsh Ministers rejected my concerns that losing 24/7 paediatrics would undermine the long term viability of A&E.” South Pembrokeshire MP Simon Hart told The Herald: “The Health Board has struggled with these staffing issues for years and has yet to solve the problem. If they are going to use “staff shortages” as an excuse to close any department where they can’t recruit then this will become self-fulfilling. We already know that one reason for the GP shortages in the county is the uncertainty over the future of the hospital. Mark Drakeford and the Welsh Government in Cardiff needs to get a grip of t h i s   situation and bring this uncertainty to an end.” Paul Davies AM told The Herald: “I’m appalled that A and E services at Withybush hospital could be at risk. Once again the people of Pembrokeshire are being treated like second class citizens and it’s quite clear that there is a drive to centralise services away from this area. I will be urging the Health Minister to come forward with a statement as a matter of urgency.”

William Powell, the Welsh Liberal Democrat AM for Mid and West Wales, added: “Having supported local campaigners in their efforts to protect these services since 2006, this is obviously a huge disappointment. Removing specialist services and a full A&E from Withybush will leave it as nothing more than a glorified cottage hospital, with no equivalent services for miles around. The people of Pembrokeshire deserve better.” Cllr Paul Miller, leader of the Labour Group on Pembrokeshire County Council told us: “Given the long history, I totally understand people’s concerns about this assurance and I’m going to keep working tirelessly to ensure pressure is kept up on this commitment. Acknowledging problems with communications and recruitment is one thing but now is the time to do something about it. I will not just sit on the side-lines and comment, I’m going to get stuck in and do whatever it takes. That said, if this commitment is not kept, then the Health Board should know that I will consider it my duty to do anything and everything in my power to force them to maintain this provision for the people I represent.”

THE BOARD’S RESPONSE  

The Health Board moved quickly in an attempt to quash rumours that it plans to further downgrade Withybush Hospital, but its initial response appeared to downplay the significance of the explosive memo’s origin. An initial press release sent out on Monday, December 1 said: “The document referred to is the viewpoint of a single consultant at one point in time and represents no decision by the University Health Board. Changes to paediatric services at the hospital have not resulted in this position, which is a reflection of the ongoing recruitment challenges discussed.”

However, Dr Robertson-Steele is both the Associate Medical Director for Quality and Safety for the Board AND Director of Clinical Care for Withybush Hospital. After Tuesday’s emergency press conference, the Board released a further and longer press statement which recapped its previous release and revealed that a meeting on the day of the leak had determined a plan to move forward. Medical Director Dr Sue Fish said: “Issues around recruitment, particularly into A&E posts, have been widely reported and continue to be a challenge faced by NHS organisations across the UK. At this meeting, alternative solutions for delivering a full, sustainable 24/7 service in the future have been identified to maintain this service in the weeks to come and to give us time to build in long term solutions. We would like to assure local people that we are fully committed to maintaining safe, high quality services at Withybush General Hospital.

As part of this planning process, University Health Board set up a Programme Board on October 1 which has been meeting on a regular basis to address these challenges in a planned way. They have been considering various contributions from a number of senior clinicians culminating in the -wide meeting. These contributions do not represent any decision taken by the University Health Board. We would like to assure people that this Programme Board, in partnership with our staff, will continue to plan the sustained future of this important service. Once these solutions have been agreed at Programme Board, we will be in a position to share this information more widely.” Dr Iain Robertson Steel added: “I would like to make it clear that this was a private and confidential paper that presents only one contribution from amongst a number being discussed and I am deeply distressed that this has been put into the public domain in this way.”

PRESSURE TO DELIVER 

The Board’s recruitment problems is part of a wider issue within the UK NHS. There is significant national shortage of qualified clinicians. In April of this year it was revealed that the NHS in England was actively recruiting overseas doctors to fill vacancies, including interviewing some prospective candidates via Skype. The Board have fought shy of giving an absolute unequivocal commitment to keeping A&E open 24/7 in the long term.

While it has long-trailed plans to reconfigure A&E services, the Board has not reached agreement with local GP practices to provide the service model it wishes to impose. May 2015 is not that far away and the Board will be under pressure to reach an acceptable long term solution which honours the commitment to retain a 24/7 service. One point raised in the leaked document appears to challenge the viability of the proposed scheme in any event. Dr Robertson-Steele, who should be well placed to know, states that the current Out of Hours GP Service one of those identified as suffering from staffing problems. It is difficult to see how the already stretched GP service will be able to cover up the cracks in the Board’s service provision at Withybush Hospital.  

Joyce questions strategy  

AT Assembly Question Time on Wednesday (Dec 3), Joyce Watson AM questioned deputy health minister, Vaughan Gething AM, about Withybush hospital A&E. 

Joyce Watson AM said:“First of all, I would like to thank Mark Drakeford for meeting with me yesterday at extremely short notice to discuss the situation at Withybush hospital. I, like everyone in Pembrokeshire, was hugely relieved by Hywel Dda Local Health Board’s categorical rebuttal of the claims that Withybush’s A&E department could be anything less than a 24/7 service. “You will know better than most, Deputy Minister, that the root cause of many of the pressures and pinch points in the service is recruitment.

Every time a leaked document creates a furore like this, Withybush, I suspect, becomes a less attractive prospect for an ambitious, newly qualified consultant, and it becomes a vicious circle. “Will you work to ensure that the health pressure groups work more closely with the health board to promote clear lines of communication? What can the Welsh Government do to further support recruitment in the west Wales NHS?” Vaughan Gething, Deputy Minister for Health:“I thank the Member for the question. I want to recognise at the outset and welcome the response of the clinical community across Hywel Dda to ensure that there is a future for 24-hour emergency-admission coverage. They have provided a solution for the next six months to allow them the space and time to deliver a longer term sustainable service. It is important to have that reassurance for the public.”