South Wales NHS: Plan to centralise services on five sites
South Wales NHS: Plan to centralise services on five sites
(35 minutes later)
Health boards across south Wales have are discussing whether to centralise key services into five hospitals.
Health boards across south Wales are deciding on a recommendation for key services to be centralised into five hospitals, with two backing it so far.
It means services would be focused on the University Hospital of Wales in Cardiff, Morriston Hospital in Swansea, a new hospital near Cwmbran, Prince Charles Hospital in Merthyr and the Princess of Wales Hospital, Bridgend.
Cardiff's University Hospital of Wales, Morriston Hospital in Swansea, a new hospital near Cwmbran, Prince Charles Hospital in Merthyr and the Princess of Wales Hospital, Bridgend, are the five.
Some services would be downgraded at the Royal Glamorgan in Llantrisant.
Services include A&E, specialist care for mothers, babies and children.
The recommendation needs to be accepted by the five south Wales health boards.
But the Royal Glamorgan in Llantrisant would see some services downgraded.
The proposal involves centralising high level emergency care - A&E - and specialist care for mothers, newborn babies and children, at fewer hospitals.
The future for the Royal Glamorgan would see it become a "beacon site" for developing a new model of acute medicine for people with chronic illnesses.
Four suggested options all included retaining the services in hospitals in Cardiff and Swansea.
The proposed changes come amid concerns that services across eight hospitals are currently spread too thinly. However, managers insist no individual A&E department would close.
Any final decision will be scrutinised by five Community Health Councils (CHC).
There are also concerns that professional standards of care are not being met, junior doctors do not get the training they need and senior doctors do not get to see enough patients.
The plans to centralise services follow concerns they are spread too thinly across the region.
The recommendation needs to be accepted by the five south Wales health boards who are meeting on Thursday.
However, some opponents warn patients could face greater risks if they have to travel further for treatment.
Cardiff and Vale along with Powys are the first to approve the recommendations.
61,000 responses
Any final decision will be scrutinised by five Community Health Councils (CHCs) at a later date.
Since the start of 2012, senior managers and medical professionals from five health boards - Abertawe Bro Morgannwg, Cwm Taf, Cardiff and Vale, Aneurin Bevan, Powys and the Welsh Ambulance Service - have been working together in the South Wales Programme (SWP) to develop proposals involving hospitals from Swansea to Newport.
Since the start of 2012, senior managers and medical professionals from five health boards - Abertawe Bro Morgannwg, Cwm Taf, Cardiff and Vale, Aneurin Bevan, Powys and the Welsh Ambulance Service - have been working together in the South Wales Programme (SWP) to develop proposals involving hospitals from Swansea to Newport.
Services considered include obstetrics, neonatal, paediatrics and A&E - although managers insist no individual A&E department would close.
The issue has been the subject of much debate.
The services are provided by eight hospitals, but health bosses claim the current system is unsustainable and patients could suffer.
Paul Hollard, programme director for the SWP said: "We have spent the last six months analysing in detail what the public, patients and healthcare professionals have told us.
Last May, the SWP launched an eight-week public consultation on four proposed models - two of which involved centralising those services at five sites in south Wales and two which involved concentrating those services at four hospital sites.
"There was a huge contribution to the consultation with more than 61,000 responses and we learned a lot during that process.
In all of the suggested models, the services would be retained at University Hospital of Wales in Cardiff and Morriston Hospital in Swansea.
"It is clear patients and the public want to maintain as many local services as possible, but not at the expense of clinical quality.
The options:
"However, we also know that the way some services are currently organised makes it very difficult for us to consistently meet the standards of care our patients deserve.
All four options include a plan to build a new hospital at Llanfrechfa Grange, near Cwmbran, which would incorporate the A&E, obstetric and paediatric services currently delivered at Nevill Hall hospital in Abergavenny and the Royal Gwent Hospital in Newport.
"We believe that to be able to meet these standards, these specialist services - consultant-led maternity and neonatal care, inpatient children's services and emergency medicine - should be centralised in five centres as a starting point towards the development of the three acute care alliances.
During the consultation, 50 public meetings were held and the SWP received 61,422 responses. Seven petitions were submitted, containing 6,367 signatures.
Sharing expertise
Supporters of hospital reconfiguration claim the changes are essential to make sure that patients get the best care, and say some units do not meet UK-wide professional standards.
"This is the best way to ensure all patients get the care they need, when they need it and that it is delivered by highly-trained and experienced staff."
If services are spread too thinly they claim doctors do not get to see enough patients to keep their skills up to scratch and problems can arise in attracting and providing adequate training to junior doctors.
Care alliances would would be set up alongside the five sites and would see clinicians from different hospitals working together across health board boundaries to provide care for patients.
Further, those who support change argue that as medicine gets more advanced, hospitals have no option but to specialise.
They would share information, skills and expertise and the alliances would decide which work goes where.
They say the model of care - developed in the 1950s centred around district general hospitals, providing similar services in each locality - is outdated.
That includes being involved with the centralising of services like consultant-led maternity and neonatal care, along with inpatient children's services and A&E.
They argue the changes would also help tackle other challenges such as an ageing population as well as the financial pressures.
The alliances would also ensure patients continue to have access to local assessment, care, treatment and follow-ups.
Some respondents - most notably Plaid Cymru assembly members, MPs and councillors - opposed the South Wales Programme, arguing that it would be unnecessary if the Welsh government recruited extra doctors.
But there may be occasions - as happens now - when some patients with complex conditions need to travel to a specialist centre.
The Conservatives' assembly leader, Andrew RT Davies, said in his submission he was "convinced that these proposals would not be necessary given adequate expenditure by the Welsh government".
However, if an alliance was to propose any changes, it would have to go out to consultation.
In total, 3.3% of respondents argued to maintain the status quo.
Mr Hollard added: "It has become increasingly evident the traditional way of working, in which hospitals work in isolation, is not sustainable.
Several professional medical bodies claim the proposed changes do not go far enough to tackle the challenges the NHS faces.
"We need to be innovative and make ambitious changes to deliver high-class care to people as locally as possible.
A spokesperson said: "The case for service change is well established and clinically supported.
"These acute care alliances will form the back bone of our long-term plans to ensure this can happen."
"As we near the end of the process, the time has come to stop playing politics on this vital issue and allow health boards to reconfigure services to put them on a safe, sustainable footing for the future."
In its submission, the Academy of Medical Royal Colleges Wales Committee argued all the proposed models could prove unsustainable in the long term.
It said a proper emergency and complex acute care service could not be sustained in more than three centres in south Wales.
Other respondents expressed concern about the capacity of the Welsh Ambulance Service to cope with lengthened journey times, while some were worried that centralising services on to fewer sites would lead to increased pressures on A&E departments and longer ambulance handover times.
Many respondents suggested public transport routes and timetables needed to be better aligned to hospital services and visiting times.
The majority of the public responses supported a five-site model.
The SWP's final recommendation was revealed on Thursday.
The health boards will now meet to decide whether to back the plan. It is unclear what would happen if a health board rejected the plan put forward by the SWP, but if that happens, BBC Wales understands the whole process of NHS reorganisation in south Wales could be jeopardised.
Even if all health boards agree, the plans would be scrutinised further by the five south Wales CHCs.
If any CHC objects, the proposals would be sent to the Welsh government for a final decision.
BBC Wales understands an appeal is likely.
It is also understood that, if health boards back the reorganisation plans, they will also approve a mechanism to allow the SWP group to be reconvened to make future decisions about the provision of other services.
This would allow the health boards once again to work together to plan services across their boundaries.
Health managers have stressed the final decision will not be based solely on the consultation responses.
In November Paul Hollard, programme director for the SWP, said: "It is important the public understands the consultation responses on their own will not determine the outcome of the South Wales Programme.
"The responses, together with the evidence gathered to support the consultation, the equality impact assessment and further work carried out in response to issues raised during the consultation, will be used by the health boards and the community health councils to reach a decision."
