The South Wales Programme - Health Consultation

Ellie Spencer was going door to door with the booklets for the health consultation last night. It's huge - 47 pages - and even then it provides links to websites where there is even more information to look at. The consultation finishes on the 19th July, and it covers consultant-led maternity services and neonatal services (loosely pregnancies with problems and premature babies), inpatient children's services and emergency medicine, which covers A&E services. Five local health boards are coming together for this, across South Wales and South Powys.
I think that's possibly one of the problems. South Powys doesn't really fit with South Wales, and it doesn't really fit with anywhere else either - and it's a huge area with a small population. A lot of people who need hospital treatment around here go to Hereford rather than Nevill Hall in Abergavenny, and the English health boards have plans of their own that may not mesh well with the plans for South Wales.
Anyway, on the plus side the brochure is written in plain English, and there are addresses and websites and emails to contact for people who have views about the proposed changes.
Early on in the brochure, they say this about their plans: "We acknowledge that in the future some of our patients may have to travel a bit further to access a small percentage of our services."
Hmm - "may have to travel a bit further" is a bit of a problem in an area where ambulances can't always get to patients in their target times now - and even without the changes ambulances that are supposed to be providing cover for South Powys have been called as far afield as Cardiff or Montgomeryshire. If there are changes that affect lengths of journeys for treatment, then the size of the ambulance fleet needs to be increased to provide adequate cover for everyone.
But they have thought of this: "The Welsh Ambulance Service will play a key role in taking patients to the right place for the right services." Here they give an example of what they mean. Terry has fallen off a ladder, and his partner Clare calls 999 for an emergency ambulance - but it doesn't say anything in this example about how long Terry will have to lie at the bottom of the ladder waiting for that ambulance, nor how far the ambulance will then have to travel to get him to the right hospital. Poor Terry.
So that's a concern.
While we're on the subject of travelling to and from hospitals, the brochure also mentions families visiting their loved ones in hospital, and the availability of public transport.
A few years ago, I got what I think was food poisoning - I was up all night throwing up, anyway - and eventually, in desperation, I called an ambulance. It arrived - that wasn't a problem at all. The problem was getting home from Abergavenny after I'd been treated. It's difficult to get to Abergavenny from Hay by public transport, so I hadn't visited for years. I didn't have a clue where the bus station was, and the people in the office didn't have a clue about buses either. Their suggestions included "Can't you get a taxi?" (which would have cost far more than I could afford) and "Can't one of your friends pick you up?" (my friends were all at work, and I didn't have their phone numbers with me anyway). Eventually, one of them dug out a bus timetable from the back of a file somewhere and suggested that I should go to Monmouth. I'm not sure what I would have done in Monmouth - I have no idea about how to get from there to Hay either. I just wanted to get to Brecon, and then I knew I could get home (bearing in mind that I was tanked up to the gills with morphine and clutching a little bag of pills to take later). They did, bless them, call a taxi to take me to the bus station, or I'd have been wandering round Abergavenny all day, but it took me around three hours to get home.
So if some patients may have to travel a bit further in future, it's going to be even more difficult to get home after treatment.

Another major problem mentioned in the brochure is the difficulty of attracting new doctors to the area, especially consultants in a speciality. They point out that, with the seven hospitals across South Wales presently providing specialist care of one sort or another, some consultants don't see enough patients to keep up their expertise in that speciality, so the idea is to centralise the patients in fewer hospitals, with the hope that the health boards will then be able to attract the staff they need to the area. (I'm now wondering why we can't have roving teams of specialists, honing their skills by covering several hospitals.... Maybe it's a silly idea - I don't know.)
This points up a problem further along the system than the health boards, because they say this: "If we were to continue providing these services in all existing hospitals in South Wales, to meet these standards we would need to recruit very many more doctors, considerably more than we would need to recruit if we concentrate these services in fewer hospitals. We know these doctors simply aren't there." So there seems to be a problem with the training of doctors, especially in emergency medicine, which has existed for some time, so there aren't enough of them.
The quotation above also touches on another problem - that of cost. Fewer doctors in fewer centres means a lower cost overall - the option for change that seems to be preferred by the writers of the brochure would cost 14 million pounds - not the cheapest, but balancing the advantages against the disadvantages such as travel times.
"Finance is an important consideration in the South Wales Programme but it is not the main reason for change," they say.

Another financial consideration is the proposal to build an entirely new hospital at Cwmbran as one of the new specialist centres for the area. Work hasn't started on building it yet, and it won't be ready until 2018 or 2019. It seems worrying to pin one's hopes for the success of a plan on a major element that hasn't actually been built yet.

Finally, they say that most health care in the region will not change - it will still be provided locally - and therefore the primary health care and GP services are important to the success of the health service overall.
"The contribution of primary care, especially GPs and their teams, will be critical in providing the integrated care patients need. We fully accept that in some areas we will need to strengthen our GP services, particularly in the out-of-hours period."
There are concerns locally about the Haygarth practice, and how long it takes to get an appointment with a doctor there.

So that's what I've got out of reading the South Wales Programme, and now I'm going to send my thoughts to the email address they give - swpresponse@wales.nhs.uk
They also give more information at www.wales.nhs.uk/swp