The Aber Group met on Friday last and discussed matters relating to Bronglais Hospital and the knock-on effects now being felt in South Gwynedd, North and Mid Powys, and concluded that for the following reasons matters could not be left as they were.
There is evidence of
1. Resource reduction [beds, nursing staff numbers, clinic cancellation including consultant clinics in outlying areas and more].
2. A managed slide of service provision to the South, compounded by managerial interference in natural consultant to consultant referral pathways.
3. A failure to develop appropriate Community Services to the required degree to ensure that the policy of In Patient number reduction is safe.
The group was of the opinion that these changes were taking place without the consent and approval of the people of Mid Wales, and without any obvious management plan or guiding strategy being made apparent.
A health board such as Hywel Dda is normally required when change of this magnitude is proposed to inform all and sundry, and in particular to have prepared an Impact Assessment plan for consideration and for full public approval. We can find only scant evidence of such planning made public.
One of the few times where a board can act is for reasons of safety. We feel that this reason has been given too often by the Board and usually for the reason of staffing shortages, brought about by staff planning failure we perceive of its own making.
The inability of the Board of Hywel Dda to spell out its thinking in plans to both the public, and perhaps more importantly to its staff, is producing both general anger and discontent, and a loss of staff morale. Staff at Bronglais continue to give high levels of clinical care to individual cases, and their results [case outcomes] are among the better rankings for Wales. That said, the staff tell us that services left to clinicians to develop unfettered by management at a local level would produce smoother, more seamless care. They cannot say what they think for reasons brought about by contractual gagging and of fear, laden with top down and little if any room for the bottom up approach. Good health care needs once more to be owned by the people it seeks to care for, and the staff who so devotedly provide that care.
The Clinical Forum appointed to give expert guidance to the Minister, said that Hywel Dda Health Board should develop two hubs of hospital care. One in the South of its area and one in the North to meet the needs of Mid Wales at Bronglais. The aBer group is of the opinion that this is not happening. We are aware of arguments to the contrary involving the new 24 hr patient assessment unit and day case facilities in the £39 million Front of House building. That investment is now old. It does not meet the needs of people of Mid Wales, and Bronglais Consultant staff requirements on our behalf, for an expanded in patient capability to undertake safely the major surgical and medical interventions of which they are capable. Obviating unnecessary and sometimes risky travel elsewhere. We would remind the public and the Minister that the current 3 storey building was originally approved by the then Minister Mrs Hart as a 5 storey £49 million block. The two floors removed, on the say of then new and still Chief Executive of Hywel Dda, would have contained the modern theatres and intensive care facilities that are now necessary.
Secondly the clinical forum advised the Minister that Hywel Dda Health Board ought not to devolve budgets to county based groupings on what we believe to be the correct assumption that this would adversely impact upon the development of Bronglais as the vital hub for hospital care in Mid Wales. We have concerns as a group that as county based budgets now in use, contrary to that advice, will depend on demography and previous year activity. Such a budget process will adversely and increasingly impact upon Bronglais.
Put simply if, for reason 1. given above, there are less major in patient operations and less clinics, with no compensatory spending elsewhere, are reasons to argue the case for year to year- on reduced budgets. We are seeking budget based, activity based, and resource based evidence over the three counties of Hywel Dda over a 3 year period to clarify the position.
Aber group concluded that we could not let matters stand as they are. It was agreed that with the help and agreement of the A.M. Elin Jones, and the other cross party Mid Wales A.M.s, that we seek a meeting with the Minister. At this meeting a small group of clinicians would outline the above to the Minister and at the same time present ideas concerning the development of Bronglais as a Rural Health Hub. Workable suggestions for community based rural health care in Mid Wales in the current financial crisis would be made, ensuring good foundations for further developments in better times.