Thursday, 21 January 2016

The long Slow Decline of Llanelli's Emergency Hospital Care

Prince Philip Hospital was opened in 1990 as a new district general hospital for Llanelli. I started working there in 1994 and was chucked out in 2005. My experience was initially of an expanding, vibrant hospital, but this was soon followed by a long period of contraction of services, mainly billed as "wonderful improvements."

On the Welsh medical recruitment website Prince Philip hospital is described as a DGH with 204 acute and elective beds (acute =emergency and elective = planned treatment, in doctor speak) with acute medicine and acute surgery on-site. In fact, emergency surgery went long ago, which limits the emergency medical admissions significantly.

In the past 25 years we have also lost other services, including the children's ward. Maternity services were fought for but never achieved, probably as both Singleton Hospital in Swansea and Glangwili in Carmarthen needed Llanelli patients to keep their own numbers up. No wonder Hywel Dda Health Board have trouble recruiting doctors when they are not even sure what their own hospitals do.

Up until this year we had, least on paper, an Accident and Emergency Department. I've recently been informed that the A&E signs will be changed as "they will not be applicable in the future." Essentially, if you're planning on having any sudden life-or-death health crises you may want to find another town to live in. Carmarthen is a safe bet; that's where the bulk of council staff are housed.

Patients in need of emergency care could be shunted to facilities hours away
The existing A&E will become a "walk in" Minor Injuries Unit. All minor injuries and minor illnesses will be treated either by GPs or Emergency Nurse Practitioners. This is the "Front of House" arrangement. Specialist Nurses may also deal with alcohol and drug dependency issues. Some patients may come to the MIU who need hospital care, some may be eligible to be admitted to the hospital or sent on to other hospitals. A lot of "mays," basically.

As a retired doctor myself, I'm aware this system could be very fragile. The staffing may not yet be secured, and even if it is fully staffed this year, this may very well not be maintained. Safety depends on the patients being admitted having efficient transfer when needed to other units, and the lead consultant in charge already admits that transfer waits to other hospitals is an issue.

Most people want reassurance that if they suddenly become ill there are emergency services they can access quickly and efficiently. In reality, the most serious health issue locally is the long wait many have for an ambulance. People like to be admitted to a local hospital where they can feel close to their families and communities. These are not unreasonable demands, but they are fast becoming luxuries.

Politically the long slow decline of emergency care reflects the political power within Carmarthenshire. The chain of mergers which eventually formed Hywel Dda University Health Board have not been kind to Llanelli, as clearly we are of secondary importance to other parts of west Wales. A post industrial town with the highest population in  the Hywel Dda area has been regarded by our government as undeserving of even a basic district general hospital.

I believe that the Welsh Health Service should be run as a single unit. Compared to England and Scotland we have had fewer resources and a sicker population.  Yes, our Government should have demanded parity with England at the time of devolution in 1999 and not allowed the historical inequality to be perpetuated to the present day.
Patients may have no idea if they qualify for local treatment until they've been processed

The severe Crisis now is the ambulance service. Those who are ill or injured and not suitable for treatment at Prince Philip Hospital will need transport somewhere else. This will take longer and need more ambulances. If the ambulance situation does not improve substantially, more people will die unnecessarily.

Organising a Welsh National Health Service strictly within local government boundaries is not helping, as the boundaries of counties are not boundaries to travel and people will chose go to their nearest hospital A&E, for obvious reasons. If I collapse or am injured on a Llanelli Street and Carmarthen has no beds an ambulance may end up taking me to Haverfordwest or Aberystwyth because I am in the county Dyfed, even though other hospitals are minutes away.

In a culture of spin and joyous welcome of any Health Service changes as "huge improvements," we need central monitoring using real figures and objective assessment. Transparency and honesty is lacking in this growing Health Crisis.

The Hywel Dda Chair and Chief Executive recently told Carmarthenshire County Council that they were waiting for local youngsters to get through medical school and come back as young doctors to fill the medical vacancies they have. Until then as many things as possible will be done by nurses, ancillary staff and anyone else they can find. Not a promising outlook.




For further reading this report is available in full for download from the Royal College of Physicians:
https://www.rcplondon.ac.uk/guidelines-policy/rising-challenge-improving-acute-care-meeting-patients-needs-wales

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