Simon Thomas says we should by looking for ways of sustaining the health service across rural Wales not running it downSeptember 18th, 2012
During last year’s Assembly election, Plaid was accused of scaremongering about plans to remove important services from some district general hospitals. Since then, we have seen services withdrawn from several hospitals. For example, minor injuries units closed without notice or warning, the mental health ward closed in Aberystwyth’s Bronglais Hospital without notice or warning, and major changes to acute medical services in Neath Port Talbot hospital. This is only the beginning. All health boards in Wales are preparing for long battles over the future of health services in their areas.
There is long standing political dimension to this. The Labour party believes that the Welsh health service needs to go through major changes which involve delivering major secondary care services from fewer sites in Wales. You can trace Labour’s pursuit of this idea back for at least a decade, firstly by the proposals from the then Welsh Office Minister John Owen Jones at the fag end of non-devolved government, and then more specifically through Welsh Government strategies such as Designed for Life and the more recent Together for Health. All argued for fewer sites providing the full range of hospital services.
Plaid remains unconvinced that this particular model of secondary care is appropriate for a largely rural based population, as is the case across much of Wales. District General Hospitals perform an essential role in providing good quality care to our population. Increasing the distances between each Accident and Emergency centre will not enhance health outcomes. A study carried out at the University of Sheffield Medical research Unit demonstrated quite clearly the relationship between distance and mortality in emergency situations. The study looked at the outcomes of 10,315 patients with life threatening conditions and found that:
“Increased journey distance to hospital appears to be associated with increased risk of mortality. Our data suggest that a 10‐km increase in straight‐line distance is associated with around a 1 per cent absolute increase in mortality.” (Emergency Medicine Journal, September 2007)
Labour is perfectly entitled to believe that we should be running the health service in a different manner. Just as we are entitled – indeed have a duty -to scrutinise and question their plans, and offer alternatives.
But we have been prevented from doing so by the refusal of the Welsh Government to outline how they want the health service to look and make the case for their policy. Indeed, Labour is content to have it both ways, with the Cabinet making the decision that there will be fewer sites providing accident and emergency in March whilst ensuring that no announcement of this policy was to occur until after local elections. They are content for their backbenchers to campaign against the removal of services in local hospitals, whilst their voting records give the go ahead for these major changes. It is cynical politics at its worst.
Even more disappointingly, the Minister hides behind local health boards and expects them to take the flack for proposals that are often unpopular. Instead of making the case that their changes will lead to better outcomes, the Welsh Government has left it to local health boards to outline their reasons for service changes that now seem to boil down to an inability to get the staff needed for an all Wales health service.
It is predictable that such an approach has led to mistrust amongst the population. If we are to achieve any consensus, the debate needs to be conducted in complete openness and honesty. Reports being touted as neutral when the fingerprints of the Welsh Government are all over them do not help. The sudden closures of wards and withdrawal of services – without consultation – do not help. Hywel Dda mid and WestWales health board revealing that its proposals for a nurse-led ‘local accident centre’ in Llanelli merely constitutes a ‘re-brand’ also does not help.
In Llanelli, Plaid has called for a halt to the centralisation of services. However, we do not want Prince Philip Hospital to remain as it is. We want improvements not a re-brand.
It is essential that Prince Philip Hospital contains the equipment and staff necessary to stabilise patients who self-present or deteriorate at the hospital. It is also vital that emergency paramedic led ambulances are on hand to transfer patients to Morriston or Glangwilli for emergency surgery, with Carmarthenshire Council making improvements to the transport system as a matter of urgency. We also want an immediate end to the appalling situation of patients being left stranded in Carmarthen following discharge, and having to fork out for taxis to take them home.
In order for the above to happen, we need a doctor led service in Prince Philip, with 24/7 access to diagnostics and senior consultant advice through use of the latest ICT technology. We also need investment in mobile treatment centres and an all-weather air-ambulance service to mitigate the risks posed by patients having to travel increased distances to A+E. If we really must go down the road of having fewer A+E departments in Wales then let us at least ensure the risks of this are reduced.
We need to ensure Morriston Hospital will also be able to have the capacity to deal with emergency surgery given the expected increase in volume it will have. It is important to note changes in Neath Port Talbot and Singleton Hospitals are occurring which will increase the pressure on Morriston. Given the lack of direction and leadership from the Welsh Government, we cannot be certain of their consideration. Indeed, at the public meeting in Llanelli, Hywel Dda health board confirmed no such risk assessment had yet been made.
In the longer term, we need to constantly look at the demand for emergency surgery in Llanelli. With the Swansea bay area increasingly adopting a city region approach to development it is likely that the populations served by Prince Philip will only increase. With Llanelli already one of the poorer areas of wales, inevitably this will mean a greater demand on health services generally.
The priority should be restoring the health service in Wales rather than finding ways of reducing what’s on offer by centralisation of key emergency functions. This means producing and training more doctors and nurses, undertaking the long term workforce planning that has – as its starting point – the aim of providing an all Wales health service. We should be investing in our network of district general hospitals instead of looking for ways to manage their decline.