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Health

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

Bathing water samplers set for a busy season of water quality checks

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WHILE families across Wales start making plans for the summer, samplers from Natural Resources Wales (NRW) are embarking on their annual programme of bathing water quality tests.

This year, there are 110 designated bathing waters which will be sampled multiple times between 15th May-30th September, in line with the UK Bathing Water Regulations. 109 of these are coastal waters, and one inland lake (Llyn Padarn).

Last month the Welsh Government announced that Nefyn Beach in Gwynedd had been added to the list of designations, following a successful application.

Bathing water samples are sent to NRW’s laboratory in Swansea, where they are tested for levels of Escherichia coli (E. coli) and intestinal enterococci (IE).

Results from a four-year rolling period then determine the classification for the next bathing water season; excellent, good, satisfactory or poor.

Last year, 98% of Wales’s designated bathing waters met stringent environmental standards, with 80 out of 109 meeting the ‘excellent’ criteria.

Clare Pillman, Chief Executive of NRW said:

“More and more people are enjoying the benefits of open water swimming, and where better to take a dip than at one of the many fantastic bathing waters Wales has to offer.

“Our blue waters offer a wealth of recreation opportunities, providing a vital boost to Wales’ tourism sector and the health and well-being of our communities.

“Our teams continue to work hard to tackle the many sources of pollution which threaten our water quality, including from agriculture and storm overflows. Much progress is being made, and we are pressing for record levels of water company investment for the environment in the coming years to safeguard the future health of our waters.”

Prior to the start of the traditional bathing water season, NRW officers undertake a number of pre-season checks and samples. This includes checking to ensure permit conditions for nearby discharges are being complied with.

Issues or deteriorations flagged in last year’s results are investigated by local teams to identify any sources of pollution which may be contributing to high bacteria levels found in samples.

Information about where to find designated bathing waters, and the standard of bathing water is available on NRW’s website.

Visit the Adventure Smart website for information about swimming safely in open waters.

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Community

Further pleas to save Anchorage Day Centre

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A PLEA by a concerned parent to keep Pembroke Dock’s Anchorage Day Centre open was heard at a full meeting of Pembrokeshire County Council.

The Anchorage Day Care Centre in Pembroke Dock has been a “safe and happy place” for adults with learning difficulties and additional needs for decades.

In more recent years it has expanded to support elderly dementia sufferers.

But now the centre is expected to close, with services instead being offered elsewhere in the county, including Haverfordwest and Milford Haven.

A series of engagement events have taken place at The Anchorage recently, outlining the reasons and the options in continued service.

One parent, who wished to remain anonymous, said: “One young woman who attends ran out of the first meeting sobbing when she was told it was going to close. Another, at the second meeting, tried to address the meeting but was so choked up at the thought of not seeing her friends anymore she could hardly speak.”

In a submitted question heard at the May 9 meeting of Pembrokeshire County Council, concerned parent Peter Welsh asked: “Is the council aware of the huge impact the impending closure of the Anchorage Adult Day-care Centre in Pembroke Dock is already having to the health and mental wellbeing of my daughter and 20 other vulnerable adults with special needs and learning difficulties, who are unable to cope with changes to routine, or to process and understand what is happening to them?

“And would the council, therefore, please review its closure decision and retain the centre and the vital and invaluable service it provides not only to the individuals concerned but also to the parents?

“If not, what specific measures does the cabinet member have in place to support my daughter and these other individuals who need extra assistance to enable them to maintain their independence, value and allow their carers to have valuable respite from their caring responsibilities and what are the estimated costs for these substitute measures?”

Responding, Cabinet Member for Social Care & Safeguarding Cllr Tessa Hodgson said an engagement with service users, carers and families was made immediately after staff were informed about the potential closure following the council’s March budget setting.

Members were told two sessions were held with all concerned, with a list of alternative day opportunities in the county outlined, with opportunities to attend short sessions at the other centres being available so they “can fully explore which opportunity is best suited to their needs and wants”.

“All service users of the Anchorage will be offered alternative day centre arrangements in order to preserve their independence and also to support the caring needs of their families, these assessments are still taking place and are likely to continue to do so at least until the end of May.”

Cllr Hodgson said she was unable to provide estimated costs of the new arrangements until all the assessments were in place, hoping to update members at a future date.

An online e-petition, on the council’s own website has been launched calling for the Anchorage to stay open.

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Health

Calls for Welsh Govt to improve both maternity and neonatal safety

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LEADING pregnancy charities have urged the Welsh Government to take stronger measures to enhance maternity and neonatal services, in order to realise the substantial changes necessary to reduce infant mortality. The Sands and Tommy’s Joint Policy Unit released a revealing report today, stating that initiatives in Wales are inadequate to instigate the vital transformation required to prevent baby deaths.

The report, titled “Saving Babies’ Lives 2024: Progress Report,” notes that strides toward diminishing stillbirths and neonatal deaths have halted in Wales, mirroring a stagnant situation across the UK. The findings suggest that with improved care, as many as 800 infant lives could have been saved throughout the UK last year. The document emphasises the urgent need for meaningful action to tackle the severe and enduring disparities in baby loss and pregnancy complications across different demographic groups.

Particularly alarming is the continuing disparity in outcomes for infants from varied ethnic backgrounds and socio-economic statuses. The report underscores that the stillbirth rate in Wales has exceeded that of any other UK nation since 2014, with minimal improvement in neonatal mortality rates over the past decade. Unlike England, which aims to halve the rates of stillbirth, neonatal death, preterm birth, maternal death, and brain injury by 2025 relative to 2010, Wales has set no similar goals.

Moreover, the report criticises the Welsh Government for the insufficient number of reviews conducted following infant deaths, which are crucial for understanding potential lessons and providing grieving parents with needed explanations.

Robert Wilson, head of the Sands and Tommy’s Joint Policy Unit, commented, “Our report unequivocally shows that the Welsh Government must establish clear targets for reducing pregnancy loss and baby deaths, and for eliminating inequalities. These targets should catalyse a thorough suite of policy measures, adequately supported by necessary funding and resources.”

The report provides specific recommendations to enhance maternity safety in Wales, including the consistent involvement of staff and patients, especially bereaved parents, in assessing the quality of maternity and neonatal services. It also calls for transparent and independently overseen reviews of individual services, and improvements in the completion rate of reviews following a baby’s death.

The Joint Policy Unit is advocating for a unified commitment across all four UK nations to eradicate inequalities in pregnancy and baby loss. Disturbingly, the 2021 data revealed that the rate of stillbirths and neonatal deaths among Black babies was almost double that of White babies, and significantly higher than the overall UK rate. This disparity was similarly stark between the most and least deprived areas in the UK.

The report also highlights that only about 2% of public and charity health research funding has been allocated to reproductive health and childbirth over the last two decades, signalling a need for increased investment in these crucial areas.

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