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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

Have your say on new West Wales learning disability strategy

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RESIDENTS across Ceredigion, Pembrokeshire and Carmarthenshire are being invited to help shape a new regional Learning Disability Strategy.

Views sought on five-year plan

The strategy, covering 2026 to 2031, will set out the future direction of services and support for neurodivergent people and people with a learning disability across west Wales.

Over the past two years, Ceredigion County Council, Pembrokeshire County Council, Carmarthenshire County Council and Hywel Dda University Health Board have been working with people with lived experience to help shape the proposals.

At present, each county has its own Learning Disability Strategy. The new plan would bring these together into one regional approach, aimed at making services more consistent and joined-up across the three counties.

The draft recommendations have been developed and reviewed by the Regional Improving Lives Partnership, which includes the three county councils, Hywel Dda University Health Board, The Dream Team, Carmarthenshire People First, Pembrokeshire People First, the West Wales Regional Partnership, and projects funded through the Regional Integration Fund.

Cllr Alun Williams, Ceredigion County Council Cabinet Member for Through Age Wellbeing, said: “We’re committed to ensuring that people with a learning disability and neurodivergent people are at the heart of shaping services that affect them.

“We encourage everyone to take part and share their views to help us develop a strategy that truly meets the needs of communities across West Wales.”

The consultation is open until Sunday, July 5.

Residents can complete the West Wales Learning Disability Strategy Survey online, or request a paper copy from a Ceredigion library or leisure centre. Paper copies can also be requested by calling 01437 764551 or emailing [email protected].

Completed questionnaires should be returned to Norman Industries, Units 1-2, Snowdrop Lane, Haverfordwest, Pembrokeshire, SA61 1JB.

 

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Health

Withybush Emergency Department wins national award for green improvements

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WITHYBUSH HOSPITAL’S Emergency Department has won national recognition for work to cut waste, reduce emissions and save money.

The department, based at Hywel Dda University Health Board’s Withybush Hospital in Haverfordwest, has been awarded Bronze accreditation by the Royal College of Emergency Medicine as part of its Green ED programme.

The scheme recognises emergency departments which introduce practical changes to reduce their environmental impact while maintaining safe patient care.

At Withybush, the work was led by a small team made up of consultant Dr Vicki Hughes, resident doctor Dr Lizzie Caisley, ED secretary Janet Bird, and ED clinical fellow Dr Oyewale Osundeyi.

Their changes included replacing plastic medicine pots with paper alternatives, reducing unnecessary cannulas, improving waste segregation, and reviewing computer screen brightness and older equipment to identify where energy savings could be made.

Dr Osundeyi led a project to increase recycling and reduce waste sent for incineration.

He said: “Trying to reduce waste comes with a lot of challenges, because you are trying to change people’s habits and trying to make sure people understand the importance, but we were lucky to get a lot of people involved from the estates team to the nursing departments who helped us achieve this.”

The department also targeted unnecessary coagulation testing in admission bloods, a project led by Dr Caisley.

The change is expected to save around £30,000 a year, as well as cutting carbon emissions.

Dr Caisley said: “By reviewing our routine practices, I was able to identify simple changes that benefit both patients and the environment. It shows how quality improvement work can deliver meaningful financial and environmental savings.”

ED secretary Janet Bird supported the work by gathering information, co-ordinating meetings and helping to put sustainability plans into action.

She said she also created a Green ED information board and presented the programme at resident doctor induction sessions to raise awareness of the changes already introduced.

Dr Hughes said: “A group of individuals, cutting across resident doctors, nurses, administrative staff, and myself as a senior consultant, all got involved in this work.

“There were many different elements to achieving this bronze award. The next step is making sure the team is supported to build on it.”

Withybush was one of eleven emergency departments across England and Wales recognised through the programme.

Together, those departments are estimated to have achieved £216,000 in cost savings and 131,502kg of CO2e savings through more sustainable working practices.

Dr Ian Higginson, President of the Royal College of Emergency Medicine, said: “On behalf of the College – a massive congratulations to the team at Withybush General Hospital who have been awarded a Bronze accreditation through our GreenED programme.

“This accomplishment has been driven by a dedicated, innovative team, who have reduced emissions, as well as waste and saved costs – all to tackle the climate crisis.

“A healthier planet means healthier patients, and we have a duty to act to protect both.

“As a College, we are proud to support Emergency Departments across the UK, and beyond, in playing their part to become more environmentally friendly.”

 

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Health

NHS waiting lists falling — but west Wales faces fresh healthcare uncertainty

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Improving treatment figures welcomed, but local concerns grow over pharmacy changes, service reorganisation and access to care

WAITING times across NHS Wales are continuing to improve, according to the latest national figures — but patients in west Wales may question whether those improvements are being felt on the ground as concerns continue over changing local services, pharmacy provision and healthcare access.

New figures released by the Welsh Government show there were just under 666,700 referral-to-treatment patient pathways waiting to start treatment in March — down by around 21,300 compared with February and the lowest level recorded since August 2021.

It marks the tenth consecutive month that waiting lists have fallen, while the proportion of pathways waiting less than 26 weeks rose to 65.9 per cent — the highest figure since May 2020.

The average waiting time for treatment also dropped to 15.5 weeks, the lowest level since April 2020.

However, despite the improving national picture, NHS leaders have warned that Wales remains under significant pressure and that progress must not mask wider challenges facing the health service.

Responding to the figures, the Welsh NHS Confederation said scheduled care was “going in the right direction” but cautioned that emergency pressures, social care pressures and financial constraints remain major concerns.

The organisation’s director, Darren Hughes, said NHS leaders were ready to work with the new Welsh Government as part of its first 100 days in office, but stressed that reforms would require difficult decisions and honest conversations with the public.

He said: “While it’s not a perfect picture across the board, with high demand on urgent and emergency care, scheduled care waits continue to go in the right direction.

“Now is the time to build on this progress and make further inroads into the backlog of care that has built up in recent years.”

But for many people in Pembrokeshire, Carmarthenshire and Ceredigion, improving national statistics may feel at odds with the reality of healthcare closer to home.

Recent changes affecting community pharmacy provision, alongside continuing concerns over access to services, travel distances and healthcare reorganisation within the Hywel Dda University Health Board area, have left some residents questioning whether NHS recovery is being experienced equally across Wales.

Community pharmacy provision has become an increasing concern locally following recent changes affecting some chemist services, raising fears over access to medication and frontline healthcare support — particularly in rural areas where alternatives may involve lengthy travel.

At the same time, debates around the future location of services, staffing shortages and the long-term sustainability of care in west Wales continue to generate concern among patients and campaigners.

For many residents, the NHS debate is no longer only about waiting times — but whether services remain accessible in the first place.

The figures also require some caution. NHS waiting-list totals are measured in “patient pathways” rather than individual patients, meaning one person can appear on the list more than once if waiting for multiple treatments or appointments.

The Welsh NHS Confederation warned that any future improvements would need a “whole-system approach”, involving primary care, community healthcare and social care, alongside action to reduce demand before patients require hospital treatment.

Mr Hughes added that NHS organisations also face tightening budgets and renewed inflationary pressures linked to global events.

He warned: “NHS leaders will need clarity from political leaders on a focused set of priorities and the backing to make the difficult decisions required to reform services, being honest with the public around timelines and expectations.”

Professor Jon Barry, Director in Wales at the Royal College of Surgeons of England (RCS England), said: “The new Welsh Government inherits a significant challenge, and these figures reflect the reality across Wales – long waits, repeated delays, and too many people left in pain. 

“There were commitments during the election campaign to develop a clear plan for expanding elective capacity, including early work to establish new surgical hubs across Wales. The priority now is to start delivering on those plans without delay. 

“More surgical hubs will help bring down long waits and ensure fewer patients are left dealing with uncertainty and disruption to their daily lives while they wait for treatment.” 

The Herald has approached Hywel Dda University Health Board for comment on how improving national waiting-time figures compare with the experience of patients in west Wales, including concerns around pharmacy provision, service changes and access to local care.

The Welsh Government has also been asked what the new administration’s healthcare priorities will mean for communities in rural Wales over the coming months.

Welsh Government response

The Welsh Government said it had pledged to “pick up the pace” to ensure people across Wales are seen faster for NHS treatment.

Health and Care Minister Mabon ap Gwynfor said: “Too many people are waiting too long for NHS treatment. That is the reality and it is an issue we are determined to fix.

“It is people’s lives we are talking about – and my job is to make sure the Welsh Government works closely with the NHS to ensure people who need treatment get it much quicker.”

The new minister said improvements were needed not only in waiting lists, but also in ambulance response times and emergency department access.

The Welsh Government said it would commission an independent review of NHS performance in Wales within its first 100 days, with a particular focus on the impact of waiting lists on population health.

It also plans to set up an expert task group to develop plans for up to ten new elective care hubs across Wales, with a delivery plan due by the end of 2026.

Mr ap Gwynfor added: “Today’s figures are a starting point. We will be honest with the people of Wales about the progress we make, and we will rightly be judged on results. We intend to meet the scale of the challenge ahead.”

 

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