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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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Health

NHS Wales app gives tutor fresh start after mental health struggles

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A TUTOR who struggled with depression and anxiety found “life-changing” online support through a free NHS Wales service.

Former maths teacher Iain Messenger had experienced anxiety for decades but said looming retirement and the collapse of his marriage were the final straw.

He called the NHS 111 press 2 mental health service after experiencing crippling panic attacks, low self-esteem and ‘dark thoughts’.

He was signposted to SilverCloud Wales, an online platform offering guided self-help programmes for mental health and wellbeing.

Speaking out to coincide with Time to Talk Day – the nation’s biggest mental health conversation – 58-year-old Iain said: “The sense of hopelessness dissipated almost immediately.

“I realised I wasn’t the only one – other people were dealing with the exact same problems and feelings. I no longer felt alone.”

The former teacher, who lives near Welshpool, decided in 2024 to quit the classroom and focus on private tutoring.

But handing in his notice coincided with a marital breakdown, and he began each day of his final months in work battling panic attacks.

“I was struggling with my close relationships, and basic decision-making always turned into a drama,” Iain explained.

“I felt useless, wandering about not able to focus on anything. I couldn’t even read a book or watch the TV.

“I had some pretty dark thoughts – that I was a disaster, and no use to my family. I was in a real mess.”

Iain said seeking help through 111 press 2 in June last year was a ‘huge’ and ‘humbling’ step.

“It’s a bloke thing – you put on a front and pretend you’re OK,” he explained. “And I was typical in that regard, I wouldn’t really speak to anybody.

“You feel like the only person in the world who can’t do life, but then when you phone 111 press 2 and they go through the list of questions, it’s instantly relatable. You realise you’re not the first person to be there.”

Iain was referred for counselling but was advised to try SilverCloud while he waited for an appointment.

The platform features online courses based on cognitive behavioural therapy for issues including depression, anxiety, poor sleep and stress.

Access is free to anyone in Wales aged 16 or over, without seeing a GP.

“I was sceptical at first,” Iain admitted. “I just couldn’t see how an online platform was going to work, I thought I needed someone to press the right buttons and fix me.

“But going through the programme, there were scenarios that described exactly how I was feeling. I identified with so much of what was being said.

“And I was now actively doing something to get well. Just having a plan in place meant I went almost immediately from hopeless to hopeful.”

SilverCloud Wales is managed by NHS Wales’ Online CBT Service, based at Powys Teaching Health Board.

Over 41,000 people have accessed the Wales-wide service since it piloted in Powys in 2018.

As well as programmes for adults, the platform has courses for students and young people, and for parents supporting children and teens with anxiety.

SilverCloud’s three most popular programmes – addressing anxiety and depression – are also available in Welsh.

Online CBT Service project manager Fionnuala Clayton said: “Time to Talk Day reminds us how important it is to speak up when you’re struggling – it’s often the first step to feeling better.

“But we know that isn’t always easy, and that’s where SilverCloud can help. It offers flexible, confidential support you can access straight away, without waiting for a GP appointment. We’re delighted to see the difference it’s made to Iain’s life.”

Iain added: “I’m still using the lessons I picked up through SilverCloud, and they’re becoming more embedded in my thinking.

“I’m grateful – on a daily basis – for the things I learned. It’s been lifechanging.”

Sign up to SilverCloud at: nhswales.silvercloudhealth.com/signup

Cover image:

Former maths teacher: Iain Messenger 

 

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Health

Charity urges end to detaining autistic people in mental health hospitals

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Welsh campaigners say new law could free dozens from inappropriate units and save up to £14m a year

THE NATIONAL AUTISTIC SOCIETY CYMRU is urging the next Welsh Government to introduce an Autism and Learning Disability Bill to prevent autistic people being unnecessarily detained in mental health hospitals, warning the current system is both harmful and costly.

Around 140 autistic people and people with a learning disability from Wales are currently being held in mental health units, despite campaigners saying such settings are unsuitable for most.

Families and advocates report repeated concerns including abuse, overmedication, excessive restraint and solitary confinement.

The charity says many people remain detained for years rather than months, with the average stay approaching five years. Placements are often far from home, leaving relatives facing long journeys to visit loved ones and making it harder to maintain family support.

Campaigners argue that failures in existing laws and weak duties on public bodies mean families struggle to challenge decisions or secure appropriate community care.

Community care cheaper

The organisation says keeping people in hospital is also significantly more expensive than supporting them locally.

Community support can cost from around £13,000 a year for those living with friends or family, rising to about £80,000 for supported accommodation. By contrast, the average inpatient placement costs about £214,000 per person each year.

Even the most intensive community packages are estimated to be between £130,000 and £200,000 cheaper annually than hospital care.

If the number of people in hospital units were halved, the charity says Wales could save between £9 million and £14 million a year.

However, it argues those savings will not be realised without new legislation to reform how services are planned and delivered.

‘Stolen lives’

Through its Stolen Lives campaign, families have shared accounts of relatives who they believe could have remained in the community with the right support, but were instead sectioned when local services broke down.

The charity says hospital should be a last resort, not the default when care systems fail.

It is calling for a dedicated Autism and Learning Disability Act that would:

– strengthen legal rights to support
– improve coordination between services
– increase accountability when systems fail

James Radcliffe, External Affairs Manager for the charity in Wales, said: “The next Welsh government has the opportunity to end the unnecessary detention of autistic people. Currently existing laws are failing to protect autistic people.

“Families are unable to challenge services to allow them to bring their loved ones home.

“An Autism and Learning Disability Bill could end this injustice and end this human rights failure. It would strengthen the protections and rights for autistic people and people with a learning disability and it would also save the taxpayer millions.”

 

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Health

The growing popularity of overseas medical care

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With waiting lists ever increasing and appointments seemingly booked up forever, more and more people are seeking alternative methods to get the medical care they need. While going private is an option for some, for others, the costs are simply too high, treatments are not specialised enough, or waiting lists remain lengthy. This is why many people are starting to go abroad for their treatment needs. So, with that in mind, let’s explore why overseas medical care has grown in popularity. 

Shorter wait times 

In 2024, more than 500,000 Britons chose to get treated abroad to avoid lengthy wait times on the NHS, more than double compared to numbers reported in 2021. With waiting lists continuously on the rise, it’s becoming increasingly difficult for people to get the treatment they need when they need it. The result is more and more people heading overseas to receive the right medical care. 

Lower costs

The expense of going private in the UK versus going private abroad is significant. For example a hip replacement in the UK costs around £12,000 to £18,000 privately, but will cost around £1,600 to £5,000 in India. These reduced expenses make medical care more accessible to those on lower incomes, increasing the appeal of overseas medical care. 

Specialised treatments or experimental therapies

Some countries have dedicated more time and effort into certain health conditions than others. For example many people seek epilepsy treatment in Germany, thanks to the country’s reputation for advanced investment into the condition. 

Some tests, treatments, and experimental therapies aren’t available in the UK, causing people to venture further afield to make progress with their health. 

Easier access to information

Thanks to technology like the internet and social media, it’s now easier than ever to research practices, facilities, and treatment options in different countries. Those who are dubious about going abroad for medical treatment, can now get the reassurance they need to go ahead. 

And it’s not just the treatment itself, but the travel and accommodation, too. It’s never been easier to compare prices for airplane tickets, hotels, and transfers, making the entire process straightforward. 

What does the future of medical care look like?

It’s evident that for Brits, going overseas is becoming increasingly popular. As NHS wait times and private costs increase, the appeal of treatment overbroad will likely continue to rise. 

 

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