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Health

Consultation reveals lack of public trust in health board

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EARLIER this week, Hywel Dda UHB published the results of a consultation into the future configuration of its clinical services.

It is widely accepted that the current provision of clinical services is unsustainable. The Board cannot recruit enough staff to fill vacancies, particularly in rural areas, despite the existing staff shortages there. Only Prince Philip Hospital in Llanelli, situated close to the medical faculty and research facilities in Swansea, experiences relatively little difficulty recruiting and retaining staff.

A QUESTION OF TRUST

Public reactions online to the publication of the results, particularly in Pembrokeshire, were plentiful and mostly negative. Those initial reactions were predictable, even where the report’s details had not been read. However, an examination of the consultation’s findings paints a troubling picture for the Board.

Many of the approximately 4,000 respondents to the consultation said they understood the practical difficulties of delivering healthcare across rural Wales with limited resources. However, many also said they did not expect the Health Board to act in good faith upon its findings. Using the definition of ‘many’ adopted by ORS, a slight majority of respondents to the consultation said, in terms, that they did not trust their local health board.

We asked the Health Board to respond to those findings.

The Board told us: “We hope that by giving the people and communities in Hywel Dda the chance to share their views, we can work together on planning for the future of health care that is safe, accessible, sustainable and kind. More than 4,000 people engaged with us by attending our events, held throughout the Hywel Dda area, neighbouring Health Boards, and online.

“At the Extraordinary Board meeting on the 18 and 19 February, the Board will be considering 48 options across the nine services, 22 of which are alternative options generated directly through staff, public and stakeholder feedback during the consultation process. This reflects our genuine commitment to listening to our communities. There are no preferred options.”

The A&E at Withybush Hospital has been under immense pressure (Pic Herald)

THE ROAD AHEAD

The consultation report included a large range of responses expressing serious concerns about access to services close to home. Respondents aired even stronger misgivings about the linked issue of transport for those attending hospital appointments. Simply put, options that proposed centralising services in one centre or another met with almost universal short shrift from the public.

The options proposed by the Board contained no hint of a transport assessment if key services were centralised, particularly from rural areas. Concerns about transport links, a bugbear for respondents from Pembrokeshire, were expressed by members of the public living in Ceredigion, in rural Carmarthenshire east and north of the M4 and A40.

Without a massive investment in patient transport services or a massively expanded public transport system, it is difficult to see how the Board could reasonably expect a patient with a debilitating condition to reach an appointment many miles away. Therefore, we asked the Board what transport it had commissioned to justify and underpin the options in the consultation.

The Board said: “We carried out Equality Impact Assessment (EqIA) and Quality Impact Assessment (QIA) during options development. Alongside this, there is a dedicated Patient and Travel Insights assessment to explore how changes could affect journeys and access to care. This includes analysis of travel times, transport patterns and the potential effects on different groups.

“We have carefully considered how proposed changes to healthcare services could impact travel and transport for patients, loved ones, and our staff. Some options may involve longer travel times for some people to ensure they can access better-quality care. We have worked with partners such as the Welsh Ambulance Service, the University NHS Trust, and the Adult Critical Care Transfer Service to ensure appropriate transport arrangements have been considered.

“We will continue to work with partners to understand how we can reduce the impact of any changes on travel and transport.”

A DIGITAL FUTURE?

This is at least the fourth consultation this reporter has reported on in the last eleven years. Each has suggested the future provision of healthcare services through technological solutions.

If patients must travel further for appointments, many of which will be clinically routine, remote medical appointments would go some way to addressing that issue. On the surface, it’s a win-win.

Progress has been slow. The technical demands of remote consultation and creaking IT infrastructure have delayed rollout. The risks attendant upon assessing a patient’s condition over a videolink remain undiminished. Moreover, a significant number of older patients either cannot or will not access services online. Rural broadband roll-out, which remains piecemeal, has not been the cure-all previously imagined.

We asked how the options accounted for the factors listed above.

The Board’s response stated that: “Digital is increasingly becoming the means by which we all interact with each other and with everything around us. However, we understand that some members of our Hywel Dda population cannot always access services online, or prefer not to, and we will support them in accessing healthcare in the way that is most convenient for them.”

The problems west Wales has in attracting and retaining healthcare staff are well known

FINDING (AND KEEPING) STAFF

The problems west Wales has in attracting and retaining healthcare staff are well known. They are chronic and, despite numerous initiatives, have not gone away. Rural areas are a hard sell to young professionals, especially those ambitious to specialise in cutting-edge practice areas. All principal research centres are based in or close to cities. In South Wales, that means Swansea, Cardiff, and Bristol. It follows that the more distant a post is from those centres, the less likely an early-career professional will apply for it.

Meanwhile, working conditions, shift patterns, and travel times to and from workplaces, often miles from home, mean that agency working (less secure, but better paid and more flexible) is an attractive alternative to direct employment. Despite Welsh Government diktats to cut the use of agency staff, healthcare delivery operates in the real world.

The Board told us: “Staff recruitment and retention are challenges across the NHS, especially in rural areas. We continue to recruit staff by offering them competitive remuneration packages and excellent opportunities to work, train and progress in our hospitals and health sites.

“An important motivation for the CSP programme was the expectation that more sustainable, higher-quality services would be more attractive to staff, helping with both retention and recruitment.

“Some options seek to recruit more substantive staff rather than temporary staff, which will be better for our clinical teams and improve patient care. Some options provide current staff with chances to work more closely together in teams and offer more training opportunities.”

There have been many protests as services have been salami-sliced away at Pembrokeshire’s main hospital (Pic: Herald)

PEMBROKESHIRE FIGHTS FOR WITHYBUSH

Opposition to the options proposed by the Health Board was predictably strongest when it came to removing services from local hospitals. In Ceredigion, a 16,000-signature petition opposed the removal or reduction of stroke services at Bronglais. In Llanelli, an option to close the Emergency Care Unit drew a negative reaction. In Llandovery, the loss of radiology services garnered a similarly trenchant response. In particular, a large majority of responses rejected proposals to introduce a treat-and-transfer system.

Against that background, it is hardly surprising that Pembrokeshire respondents stood firmly against any further reduction in services provided in the county, and particularly at Withybush. Having experienced the salami-slicing of services away from Haverfordwest, and in the face of repeatedly broken assurances regarding the return of services ‘temporarily’ removed, those reactions are unsurprising. Those feelings are not limited to the public. One staff member was directly quoted in the consultation report claiming that cuts to Withybush were baked into the options the Board presented.

We asked the Board to provide specific reassurance about maintaining current service provision at Withybush and other Pembrokeshire hospitals.

Whether the Board’s response addresses that question, the reader can decide.

“Withybush Hospital will have an important role to play in the health care of the region, and our long-term plan for our hospital sites has been set out in our A Healthier Mid and West Wales strategy. In the interim, our CSP consultation has included our thinking on the role of each of our acute sites. For example, we anticipate that Withybush Hospital will provide more planned care, and initial access to acute care would remain on site, with transfers to Glangwili Hospital for patients with the highest needs.”

Tory Senedd Members Samuel Kurtz and Paul Davies have been fighting for the services to be retained at Withybush Hospital (Pic: Supplied)

PEMBROKESHIRE MSs RESPOND

Local Welsh Conservative Senedd Members Paul Davies MS and Samuel Kurtz MS have warned that any decision which undermines the future of A&E services at Withybush Hospital would be “wholly unacceptable”, ahead of a crucial Hywel Dda University Health Board meeting in February.

Paul Davies MS, joined by fellow Welsh Conservative Senedd Member Samuel Kurtz MS, said Withybush Hospital must be protected as a vital lifeline for Pembrokeshire, and that communities are deeply concerned about the potential consequences of the Health Board’s proposals.

Paul Davies MS said: “People in Pembrokeshire are deeply worried about what these proposals could mean for Withybush Hospital. Over many years, we have seen a gradual erosion of services, and communities are understandably anxious that this process will continue.

“Withybush Hospital is not a ‘nice to have’ — it is a vital lifeline for a large, rural population. Any changes must strengthen services in Pembrokeshire, not weaken them. I will not support decisions that place patients at greater risk or force them to travel unreasonable distances for essential care.”

The loss of the special care baby unit at Withybush Hospital was a major blow for Pembrokeshire (Pic: File)

Samuel Kurtz MS added, “People in Pembrokeshire have heard this story before. Time and again, we are told services are fragile, and the result is that Withybush loses out.

“The loss of SCBU, consultant-led maternity and children’s A&E is still deeply felt locally. Removing one service often makes others unviable, and that is exactly what people are worried about now.

“Any decision that threatens the long-term viability of A&E at Withybush Hospital is a red line. It would be wholly unacceptable and would be met with fierce opposition from the community.”

Mr Kurtz also stressed that rurality, transport challenges and ambulance pressures must be central to decision-making, not treated as secondary considerations.

“Pembrokeshire is a rural county. Asking patients to travel further for emergency or urgent care is not a theoretical issue — it affects safety, outcomes, families and staff.

He continued: “There is also deep frustration that these decisions continue to be made in the shadow of the so-called ‘super hospital’ elsewhere in west Wales, which has never come to fruition. Pembrokeshire cannot be left with a slow erosion of services while waiting for something that may not materialise for a decade or more.”

Both Senedd members have written to Hywel Dda University Health Board and the Welsh Government ahead of the February meeting.

Paul Davies MS concluded: “We will be watching the outcome of this meeting very closely. Withybush Hospital is vital to Pembrokeshire. It must be properly supported, not hollowed out.”

 

Business

Specialist clinic launched in Haverfordwest to treat common eye condition

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A HAVERFORDWEST opticians has launched a specialist clinic for dry eye disease, offering new support for people living with the common condition.

Specsavers Haverfordwest has introduced its Advanced Dry Eye Clinic to give customers access to in-depth diagnosis and targeted treatment for dry eye.

Dry eye is a common, but often misunderstood, condition where the eyes do not produce enough tears, or the tears evaporate too quickly, leading to discomfort, irritation and sometimes blurred vision.

It can be linked to a range of factors, including increased screen use, contact lens wear, ageing and environmental conditions. As many as one in three people suffer from dry eye and most causes can be treated.

Many people are surprised to learn that watery eyes can actually be a sign of dry eye, as the eyes produce poor-quality reflex tears in response to irritation. The new service provides an in-depth approach to diagnosing and managing the condition.

While many high street opticians now offer dry eye clinics, Specsavers Haverfordwest provides a wider range of specialist treatments and technology that are not commonly available.

Using advanced imaging to assess the eyes and tear glands, the team can identify the underlying cause of symptoms and create a personalised treatment plan for each customer.

Whilst there are a range of different treatments available, the major investment has been in the introduction of eye-light devices, bringing advanced IPL (Intense Pulsed Light) and LLLT (Low-Level Light Therapy) treatments to customers suffering from dry eye symptoms.

Designed to target the underlying causes of dry eye disease, the eye-light device combines clinically proven light-based therapies to help improve tear quality, reduce inflammation, and restore eye comfort. The treatment is safe, non-invasive, and suitable for many patients experiencing irritation, burning, watery eyes or discomfort linked to screen use and modern lifestyles.

The clinic also supports contact lens wearers experiencing discomfort, helping them return to comfortable, everyday use.

Some of the first customers to use the clinic have already noticed improvements in their symptoms.

Danielle Thomas says: ‘I honestly can’t believe the difference. I’d been struggling with sore, gritty eyes for years and had given up wearing my contact lenses altogether – they just became too uncomfortable. I was constantly using drops with very little relief.

‘From the moment I walked into the dry eye treatment room, it felt completely different to a normal appointment. The environment is calm, almost spa-like and the whole experience was surprisingly relaxing. The treatments were comfortable and the team explained everything so clearly. After just three sessions the improvement was notable – my eyes feel normal again.

‘The constant irritation and watering have gone and I’m now back in contact lenses comfortably, which I never thought would be possible. It’s genuinely been life changing. I wish I’d known about it sooner.’

Wayne Jones, optometrist and retail director at Specsavers Haverfordwest, adds: ‘Dry eye is something we see very frequently, yet it’s still widely dismissed as a minor irritation. In reality, it can have a real impact on comfort, vision and overall quality of life.

‘What many people don’t realise is that, in many cases, there is an underlying cause that can be identified and treated.

‘By launching this clinic, we’re able to offer a much more detailed and personalised level of care here in West Wales, helping us support more customers locally. We would encourage anyone experiencing persistent symptoms such as dryness, irritation or blurred vision to have their eyes checked, as there’s often a treatable cause.’

People interested in using the clinic should call Specsavers Haverfordwest on 01437 767788 to book an initial assessment and discuss treatment options.

 

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Health

Wales has highest stillbirth rate in UK for third year running, charity says

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Sands calls for urgent targets to reduce baby deaths and improve mental health support for bereaved parents

WALES has recorded the highest stillbirth rate in the UK for the third year in a row, according to baby loss charity Sands.

The charity has called for urgent action from the Welsh Government following the publication of the latest MBRRACE-UK perinatal mortality surveillance report, which tracks stillbirths and neonatal deaths across the UK.

Sands says there has been a lack of political focus on maternity safety and saving babies’ lives in Wales, despite repeated reviews.

The charity is calling for clear national targets to reduce stillbirths and neonatal deaths, as well as action to eliminate inequalities linked to ethnicity and deprivation.

Aidan Smith, Wales campaign lead for Sands, said: “There has been a lack of political focus and attention on maternity safety and saving babies’ lives in Wales in recent years.

“There has been review after review, but little change. At Sands, we are supporting bereaved parents across Wales to campaign for targets to reduce stillbirths and neonatal deaths and eliminate inequalities by ethnicity and deprivation.

“Bereaved parents are calling for accountability. Targets to reduce stillbirths and neonatal deaths will help ensure that saving babies’ lives becomes the political priority it should be.”

Sands says England introduced targets to reduce baby deaths in 2015, helping focus political decision-making and transparency.

Mr Smith said analysis by the Sands and Tommy’s Joint Policy Unit suggested that more than 1,000 babies in Wales may have survived if stillbirth and neonatal mortality rates had matched the best performing countries in Europe between 2019 and 2023.

The charity wants the Welsh Government to introduce new targets running to 2035, including reducing the stillbirth rate to 2.0 stillbirths per 1,000 total births, and reducing neonatal mortality to 0.5 deaths per 1,000 live births for babies born at 24 weeks’ gestation and over.

It is also calling for inequalities in baby loss linked to ethnicity and deprivation to be eliminated.

Mr Smith said Wales also needed better monitoring of maternity outcomes, including a national data dashboard to track changes over time and identify differences between health boards and population groups.

He said more complete data was needed on ethnicity and social risk factors to understand which families were most at risk of pregnancy and baby loss.

Sands has also raised concern about a lack of specialist psychological support for bereaved parents in Wales.

Mr Smith said there was currently only one specialist NHS service providing mental health support to bereaved parents, the Onnen service in Cardiff and Vale.

He said: “The Welsh Government must evaluate the Onnen service in Cardiff and Vale and expand this to all health boards across Wales.

“All bereaved parents in Wales should have access to specialist psychological support regardless of where they live, the type of pregnancy or baby loss they experienced, or how long ago it was.”

The Welsh Government said support was available to families affected by pregnancy loss and pointed to work taking place across health boards.

A Welsh Government spokesperson said: “The loss of a baby at any stage of pregnancy is devastating. Families who experience pregnancy loss at maternity units in Wales are supported by bereavement midwives, in conjunction with Sands, and offered memory boxes, which include a certificate of birth.

“Since 2016, stillbirth rates in Wales have shown a downward trend. The latest Perinatal Mortality Surveillance report acknowledges that in Scotland, Wales, and Northern Ireland, year-to-year variation in rates is often more pronounced because of lower birth numbers.

“All health boards are committed to improving quality and safety in perinatal care – through enhanced clinical reviews, early warning surveillance, safer preterm birth care, and structured learning from incidents.”

Hywel Dda University Health Board said it recognised “how devastating the loss of a baby is for parents and their families” and said its maternity and neonatal teams worked to provide safe, compassionate and supportive care.

Dana Scott, Director of Midwifery and Professional Governance for Women and Children at Hywel Dda, said the health board had “robust safety measures and clear clinical processes” in place across its maternity services.

She said Hywel Dda’s review processes were aligned with MBRRACE-UK and the Perinatal Mortality Review Tool, ensuring the health board listened, learned and reflected on each baby loss.

Ms Scott added that every family affected by stillbirth or neonatal death had access to dedicated bereavement midwives and nurses, as well as psychological support, follow-up care and opportunities for memory-making.

She said the health board also worked closely with its local Sands group and remained committed to learning from national reports to improve maternity safety locally.

Sands said the new Welsh Government now had an opportunity to act.

Mr Smith added: “Bereaved parents across Wales are campaigning for accountability and change. The new Welsh Government has a chance to reset the narrative by implementing targets to save babies’ lives, eliminating inequalities in loss by ethnicity and deprivation, and rolling out specialist mental health support for bereaved parents across Wales.”

Sands provides support to anyone affected by pregnancy loss or the death of a baby, including a confidential helpline, email support, online groups and local peer-support networks.

 

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Community

Transgender people “feel under siege” says Sioned Williams

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TRANSGENDER people “feel under siege”, Wales’ Deputy First Minister has said.

Sioned Williams faced questions on gender identity guidance in schools, and the implementation of single-sex spaces, during her first appearance at Questions to the Deputy First Minister.

Serving as both Deputy First Minister and cabinet secretary for social justice and equality, Ms Williams was questioned by opposition politicians on Wednesday June 10, about the Welsh Government’s response to the Cass Review, and the implementation of the Supreme Court’s ruling on single-sex spaces.

The session opened with questions from Blaenau Gwent Caerffili Rhymni’s Reform MS Catherine Cullen, who asked how the Welsh Government would work with education ministers to prioritise “objective, evidence-based safeguarding standards” in schools.

Catherine Cullen, Reform MS for Blaenau Gwent Caerffili Rhymni
Catherine Cullen, Reform MS for Blaenau Gwent Caerffili Rhymni

She said: “We sit here today with one non-negotiable duty: the absolute safety of Welsh children in schools.

“When the Cass review explicitly warned that social transition – that is, changing a child’s name, pronouns or uniform at school – is not a neutral act and carries severe psychological risks, Plaid Cymru voted against these recommendations.”

She continued: “[Plaid’s] manifesto demands a demedicalised self-declaration system that actively pushes gender identity theories through the school system.”

In response, Ms Williams said the Welsh Government remained committed to improving literacy and numeracy standards, and stressed the importance of creating a supportive environment in which all children can fulfil their potential.

She told members that education officials had developed draft guidance for schools on supporting transgender, non-binary and gender-questioning learners, and said the education minister recognised the need to proceed with “leadership and sensitivity”.

Questions then turned to the implementation of single-sex spaces following the Supreme Court’s ruling on the definition of sex under the Equality Act.

Reform UK MS Art Wright, of Casnewydd Islwyn, asked about the Welsh Government’s plans to implement single-sex spaces across Wales, while Conservative MS Natasha Asghar, of the same constituency, accused the previous Labour administration of “dragging its heels” in responding to the judgment.

Art Wright, Reform MS for Casnewydd Islwyn
Art Wright, Reform MS for Casnewydd Islwyn

Ms Asghar said she had received correspondence from a Welsh Government employee claiming staff were still working under policies that allowed “men who identify as women to use women’s single-sex spaces from the first day of self-identification”.

Reading from the email that was sent to her, she said: “A government cannot pick and choose which laws it follows, yet that is exactly what seems to be happening within the Welsh Government itself.”

Casnewydd Islwyn's Conservative MS Natasha Asghar
Casnewydd Islwyn’s Conservative MS Natasha Asghar

Responding, Ms Williams said the Welsh Government respected the Supreme Court ruling and was working to ensure devolved policies and practices complied with the law.

“This work has to be done carefully and consistently, and across a range of devolved areas,” she said.

However, the Deputy First Minister also emphasised that the Equality Act continues to protect people with the protected characteristic of gender reassignment from discrimination and harassment.

She added: “This is a community that feels under siege at the moment, and we must be sensitive to that.

“We need to look at the practical steps that we can take whilst complying with the Supreme Court ruling, and then, in seeing the code of practice that will come forward, if it is passed in Westminster, we will need to consider how we do that.”

Ms Williams said work was continuing across government departments to ensure Welsh Government policies comply with the law while maintaining protections for transgender people.

Ms Williams, who represents the Brycheiniog Tawe Nedd constituency, also reaffirmed her support for universal free school meals during the session, after Senedd Members raised concerns about food poverty and access to nutritious food for children.

Huw Thomas, Labour MS for Caerdydd Penarth, drew attention to the work of the previous Labour government in introducing universal free school meals for primary school children across Wales.

Mr Thomas said: “For too many of our pupils, this is the only proper meal of the day that they have every day – hugely important – and yet we know that food costs have risen dramatically in recent years.

“So, my question is: when councils tell Welsh Government what the cost of supplying these meals are, will you accept and respect their advice and fund it, or else risk affecting the quality and provenance of the food served to our young people?”

Ms Williams agreed that free school meals play a vital role in supporting children and families.

She said the scheme “really does help”, allowing children to receive the “nutritious hot meal that they so desperately need”.

While noting that responsibility for free school meals sits within the education portfolio, the Deputy First Minister said she would ensure the concerns raised within government.

The discussion also turned to nutrition during pregnancy and early childhood.

Welsh Liberal Democrat leader Jane Dodds said access to nutritious food in a child’s earliest years is critical to healthy development.

Jane Dodds, leader of the Welsh Liberal Democrats
Jane Dodds, leader of the Welsh Liberal Democrats

She said: “We know how important nutritious food is in brain development in babies, both in pregnancy and in those first 1,000 days.

“Key nutrients such as vitamin D are absolutely essential, and if you are poor and you are not able to afford a full range of nutritious food, then that hampers that child’s development from the very, very early point.”

Ms Dodds asked what steps the Welsh Government was taking to ensure babies and young children have access to healthy food during their first 1,000 days.

Responding, Ms Williams said she “wholeheartedly” agreed about the importance of nutrition in the early years.

She pointed to the Healthy Start scheme, which provides support for low-income pregnant women and families with young children, describing pregnancy as a “crucial part” of ensuring lifelong health.

The Deputy First Minister also highlighted the nursery milk scheme, which provides children under the age of five in approved childcare settings with a free daily portion of milk.

Ms Williams said ensuring children have access to nutritious food from pregnancy through early childhood remains an important part of tackling inequality and improving long-term health outcomes in Wales.

 

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