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Watchdog fears extra demand on Morriston Hospital's A&E unit

By South Wales Evening Post  |  Posted: November 28, 2012

By Paul Lewis

The A&E department at Morriston Hospital

The A&E department at Morriston Hospital

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A HEALTH watchdog has warned that Morriston Hospital will become swamped with patients if the A&E department in Bridgend is closed.

It says Swansea people had not realised potential changes to services elsewhere would have knock-on implications that could directly affect them.

Abertawe Bro Morgannwg University Health Board is carrying out a public engagement exercise into its Changing For The Better programme, which could see big changes to the way health is delivered in this area.

As part of this exercise, it has organised a series of drop-in events across the board area, including Swansea and Neath Port Talbot.

But ABM Community Health Council members were told the turn-out for many of these had been extremely poor.

By way of contrast, there had been a much bigger response in Bridgend, where Princess of Wales Hospital could lose A&E under the wider South Wales Programme.

If that happens, its patients would have to go to another hospital, such as the Royal Glamorgan in Llantrisant.

CHC chairman Emrys Davies said: "What we are seeing is that the further west you go, the less interest there is.

"It's interesting, because if the South Wales Programme does come to fruition, the feeling I am picking up is that people will not want to go to Royal Glamorgan.

"They will either come this way (to Morriston) or carry on along the M4 the other way to Cardiff.

"That is the issue, and so people in Swansea will be affected if there is an increased level in A&E, which they don't appreciate at the moment."

The CHC will now ask ABM to consider holding a version of the drop-in events in hospital foyers.

This, they felt, would be more likely to attract comments from visitors and patients who had a vested interest in any possible hospital changes.

They also predicted there could more be greater public interest after the engagement for Changing For The Better (C4B) and the South Wales Programme ended next month and actual proposals start to emerge.

The biggest potential biggest change in this area would see the shifting of all services for mums and babies from Singleton across the city to Morriston.

Under the South Wales Programme, Morriston will be guaranteed regional hospital status, meaning it will offer the full range of specialties.

Whether Princess of Wales retains A&E and other key services depends on whether it too is given regional designation.

An ABMU spokeswoman said: "If these changes do go ahead there will be additional pressure on Morriston anyway as it will be a regional hospital.

"We are already considering, as part of C4B, what services we can move from Morriston to other hospitals such as Singleton and Neath Port Talbot, which would help reduce that pressure."

However, she said, it was not just about which hospital provided what services, as the C4B had to be considered in its entirety.

"A great deal of emphasis will be placed on improving services in the community," she added.

"The idea is to provide care early on to prevent as many people as possible reaching crisis point where they have to be admitted into hospital. Over time that is going to make a huge difference in terms of reducing the pressure on hospitals."

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  • ABM_Health  |  November 29 2012, 6:20PM

    To answer Ladymaise, Unless there is an urgent safety issue, like there was with NPT Hospital in the summer - no major service change will take place without public consultation. The UK-wide National Burns Care Group took the decision to make the Welsh Centre for Burns and Plastic Surgery a regional burns centre covering Wales and the South West of England. This followed an extensive evaluation of the services provided at hospitals across the UK offering burn care against national standards. Neurosurgery moved to one site in Wales, in UHW in Cardiff in 2009. Population numbers in South Wales were too small to sustain a tertiary service like neurosurgery on two separate sites, and there were persistent issues over shortages of neurosurgeons. However head injuries are still dealt with at Morriston Hospital, and only the most serious (which require surgery) go to UHW. Our doctors and the UHW doctors work very closely together to ensure patients with head injuries receive the appropriate care. Morriston also continues to have a spinal surgery service. Morriston Hospital has an excellent trauma service and treats patients from a very wide area across South West Wales and large parts of Powys. The UK's TARN (Trauma Audit Research Network) data shows that Morriston Hospital's survival rate for trauma patients is higher than expected – an additional 1.7 additional lives per 100 trauma cases. I hope this helps.

  • ladymaise  |  November 29 2012, 5:33PM

    Road monkey FACT Burns Review stated that to have regional status then you must have Paediatric ICU as part of being awarded the centre for excellence within its remit., Nobody had what was required so the goalposts were moved to suit proposed regions. Morriston rightly won and has a very good Burns regional service and committed staff, however if a child with serious burns arrives and needs ventilatory support then it goes to Frenchay (England)who lost the bid for regional status in the first place. FACT Morriston Used to have major trauma Centre status , when Neuro left so did that status. FACT Do not trust ABUMHB because things will change yet again and goalposts will be moved without public consultation, REACT ? how is that doing ABUM, hope it is not being used as a holding bay for the ABUM to meet WAST targets. Not a fairy story but FACT as stated by ABUM themselves , see earlier reply.

  • ABM_Health  |  November 29 2012, 4:46PM

    To answer Richard Corso, Many of the ideas you put forward are already taking place. We already have a procurement organisation called Welsh Health Supplies, for example, which buys items on behalf of Welsh Health Boards. The Welsh Assembly also has a campaign in place to attact doctors - Medical Careers Wales. Here's a link to its website: http://tinyurl.com/csl63qd if you want to find out more. I cannot comment on issues around attaching conditions to doctors' training - that is beyond my scope as it would be at Welsh Government level and possibly UK-employment law level. As far as using GPs - we do work very closely with GPs and the GP Out of Hours service is hospital based. However there is also a shortage of GPs, which is likely to get worse because of a large number due to retire shortly. Nurses and other healthcare practitioners are upskilling to take on more and more work which was once done only by doctors - nurse prescribing is one example. In ABMU we have also just invested in a service with the Welsh Ambulance Service for a team of Advanced Paramedic Practitioners. These APPS have all the skilled of regular paramedics, but can also assess and treat people with chronic illnesses and in many cases deliver the care at their homes so they don't need to come to hospital. So many of the the points you raised are good ones which are already being taken up. One last point - our laptops are pretty basic, and in many cases staff are using laptops which are several years old, and certainly not 'massively expensive'!

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  • RichardCorso  |  November 29 2012, 4:21PM

    If the Welsh NHS or should that not now be renamed the Welsh Health Service (WHS) as it's now separate from the once British NHS was a private company then it would by now be declare bankrupt as it's already eating into next years Budget my many £millions at an alarming rate. Shouldn't there be a complete rethink of how the Welsh Health Service is to be restructured to meet future needs. Why given the size of Wales is there not a single Health Authority? Why given the size of Wales is there no single purchasing authority, Why given the size of Wales is there no single co-ordination authority dealing with the most serious problem of Doctor recruitment. Why hasn't an emergency plan been implemented to use GP's in Hospitals and for lesser medical issues use Paramedics and Senior Nursing staff that could be monitored by Doctors to deal with minor surgery or medical issues. When training Doctors in Wales is there no contractual terms and conditions agreed that they stay in Wales for a minimum period say 5 years after qualification before they can be released to other locations. An incentive could be arranged that the cost to train these Doctors could be reduced and paid for by the Welsh Health Authority giving the above contractual terms and conditions. Are there possible future Doctors within the existing nursing staff that could be encouraged to train? Seems to me that the Health Authorities are too busy on day to day issues to look further than their massively expensive laptops!! No wonder any medical staff worth their salt are leaving Wales and Britain for overseas opportunities that have seen what mess we have here and a glad to leave it. Too many little empire builders in the NHS and WHS for anything serious to be done to sort not fix the problems. Seems like a complete reboot (complete rethink) of the NHS and WHS structure is needed and fast before the NHS and WHS is "flat-lining"

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  • ABM_Health  |  November 29 2012, 12:48PM

    Finance is not the only driver behind this. The problem is a shortage of doctors, not a shortage of money to pay their salaries. We are having great difficulty recruiting doctors, and there is demand all over the UK for their services. You also have to remember that when new doctors qualify, that's only the start. They then need to continue to train and gain experience. The Wales Deanery, which is responsible for the post-graduate training of junior doctors, needs to ensure that there are a sufficient number of senior doctors in hospitals to supervise them. If we don't have enough, then junior doctors will be moved to other hospitals .... this also destabilises services, and it's what happened at Neath Port Talbot Hospital in the summer with Acute Medicine. There are two change programmes going on at the moment, ABMU's Changing for the Better and the South Wales Programme, and they overlap to a degree. There's a lot of media focus on the South Wales Programme issues because of the regional centres idea. However Changing for the Better is very much wider than that, and looks at a major change to the way we use the £3milllion a day that ABMU currently spends on providing healthcare. We want to distribute that £3million a day differently, so more is spent on community-based care than it is now, and less on hospital care. This is because we want to provide much more support for people with long-term illnesses, and for frail and elderly people, so they they are better supported and managed earlier on before they become so ill that they need to go to hospital. Put simply, focusing more on prevention than cure. There are likely to be financial benefits from this because people will be kept as healthy and independent as possible for as long as possible. At the moment we think we are waiting too late when we could intervent much earlier if we had stronger community services. So all this needs to be seen in a much wider context. If we do nothing, then it is inevitable that services will start to unravel because they are not designed to meet the huge challenges we're facing. Please come along to one of our events, and visit our website to find out more. http://tinyurl.com/83r2pmv

  • susiqzz  |  November 29 2012, 11:47AM

    You're absolutely right, ABM, there is a nationwide specialist shortage....so that means that the best Doctors will have their pick of where to work...and that's not going to be a unit with the sword of Damocles hanging over it, or a lab open only every other Wednesday. They'll go to the "regional" or "area" units. Remember Dr Beeching....he closed down sections of the railway without realising that all the stations "downhill" would suffer. Actions which cost far more money than they saved. Remember when the mines shut...and all the village shops went under! Downgrading a hospital department has consequences far beyond its own doors, it's not just those particular patients who are "inconvenienced".

  • GorsseinonJoe  |  November 29 2012, 10:42AM

    ABM, thanks for the response, however, it is about finances, if doctors can't be paid a similar wage, then this is driven by finance. Removing, transferring or closing wards or services is about finances, someone is saying that there isn't enough money to serve the people who need treatment in the number of service points available. Your comments are very good at deflecting the need for financial cuts to what will be best for the patient. I can tell you that, what is good for the patients, it is for ABM and every other Health Authority to get it's finances in order, stop wasting money and give the patients what they want. The attendance at your "drop in" events for your "C4B" ( HOW NAFF IS THAT?) is low because no-one believes that anything they say will have an impact on what you (ABM) will do anyway. Call it apathy if you want but people have given up thinking they have a say. You are a part of a bureaucratic, politically driven organisation that thinks nothing of spending millions on indirect costs and can only see savings on the front line where it affects patients and not the hierarchy. Your turn......

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  • ABM_Health  |  November 29 2012, 10:11AM

    To respond to some of the points being raised: Doctor shortages - There is actually a UK-wide shortage of some doctors - it doesn't only affect Wales. There are many reasons for the shortage, one of the main ones being modern European employment laws which stopped the practice of doctors working extremely long hours. Now their hours are limited, but that means we need many more doctors to cover the same services. There is also a lot of demand for doctors in countries like Australia and Canada and many UK doctors are emigrating, while at the same time it is more difficult for overseas doctors to come to the UK, or if they are here, to retain a visa. Other issues have also affected UK doctor availability, including changes to the way they progress through their post-graduate training - which means there are fewer middle-grade doctors - plus many new doctors, particularly women, are choosing not to work full time to balance work with family commitments. Burns - Morriston Hospital is indeed the regional burns centre for burns and plastic surgery, not just for most of Wales (north Wales patients go to England) but also for the South West of England. This status was awarded three years ago after a very long UK audit procedure which looked at results and outcomes against UK burns standards. Our Burns Centre does treat children, both as outpatients and inpatients, and anyone who saw BBC X-ray on Monday will have seen one of our Burns Consultants on there warning about the dangers of hair straighteners to young children, because of the number of cases we are treating. It is also true that the Burns Centre doesn't have an intensive care unit for children. There is only one paediatric intensive care unit (PICU) inthe whole of Wales, and that is in Cardiff. There cannot be more than one PICU in Wales because our population is too small. You need a minimum number of cases to ensure that the highly-skilled specialists retain their skills and ensure these very sick children get the highest possible standard of care. What this means in practice is that the vast majority of children with burns, including very serious burns, are treated in Morriston. But if a child is critically ill and needs extended ventilation (life-support), then they are transferred to the children's burns centre in Bristol which has a PICU, until they are well enough to return here for all the rest of their care. The numbers of children needing to go to Bristol is very small, fewer than four or five a year.

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  • roadmonkey  |  November 29 2012, 8:10AM

    Ladymaise – I very much doubt that you do know what's going on. The Welsh Centre for Burns and Plastic Surgery, based in Morriston Hospital treats around 750 patients a year, of which half need inpatient treatment. Approximately half of those are children. The unit has a paeds specialist consultant and a childrens ward. The Centre has been assessed against national standards and scored highest when compared to other burn services in England. http://tinyurl.com/cfrm6bx I suggest you get your facts rights - or more accurately - stop making them up.

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  • ladymaise  |  November 28 2012, 10:03PM

    Roadmonkey, The Criteria to have super Burns regional status in the whole of Britain included the provision of having paediatric Burns within the region to have the status. UnfortunatelyMorriston does not have this and has not had the paeds burns icu status for many years, therefore they do not meet the criteria, but still won !!!!!!! I do know what is going on unlike you. Just keep trolling Neath and PT issues and leave National Health problems to people in the know and understand the problems.

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