Save Bronglais - Join aBer in our campaign to keep services at Bronglais Hospital

We are a campaign set up to protect services at Bronglais Hospital, Aberystwyth.  Despite the fact that Bronglais services a larger area than any other hospital in Wales, it is, rather incredibly, under threat of being downgraded.  Due to its strategic position in Mid Wales, services at Bronglais need to be enhanced, not reduced.


The Hywel Dda Health Board have steadfastly refused to listen to the people of Mid Wales, and are reluctant to share information about the true extent of their plans.

Join our campaign TODAY and fight to keep services at YOUR HOSPITAL.

Corporate manslaughter and the duty of care in the NHS.

After the dreadful revelations from the Stafford report the NHS across the UK has woken up to the fact that some services are unsafe- a fact that many service users have been stating for years, whilst often being portrayed as trouble-makers. Everyone welcomes the rigorous enforcement of decent standards of care within our NHS. It seems the main indicator that inspectors are using to identify poor standards is Hospital death rates. This coupled with whispers of corporate manslaughter proceedings, has led to the recent emphasis in public statements from Health Boards that they will not run unsafe services. As a result, where there are problems delivering a service, the easiest management option is to discontinue that service. The Hospital with the lowest death rates is one with no patients.

The exclusive emphasis on the safety of patients actually receiving care may well have a deleterious effect on the accessibility of care, especially in Mid Wales. With the undeniable problems of resources (money and manpower) the centralisation of services provides senior managers with solutions-economies of scale, easier oversight etc. It is vital in this atmosphere to remind the Welsh Health Boards that they have a duty of care to all the residents of Wales, not just those currently receiving care. There is an equal duty to provide timely emergency care to residents of remote villages in Mid Wales as well as those in large conurbations. The piecemeal centralisation of services by various Welsh and English Health organisations cannot deliver this equity. Someone has to set out a strategic plan of where services need to be located to provide this equity across Wales, and then managers must find a way to make those services safe. At the moment the pressure is the other way round, services are being made safe by a “concentration” policy leading to problems of access.

I finish by reminding everyone how the corporate manslaughter offence is described, remembering that Health Boards have a duty of care to all residents, not just patients.

 An organisation will be guilty of the new offence (corporate manslaughter) if all of the following apply:

The way in which its activities are managed or organised causes a person's death.

The person's death is the result of a gross breach of a relevant duty of care owed to that person.

The way in which senior management managed or organised the organisation's activities is a substantial element of the breach

Running unsafe services is a breach of the duty of care to patients, reorganising services so they are inaccessible to certain populations is equally a breach of the duty of care to those people.

Press Release by aBer group - 27 April 2013

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.

William Roberts

Press Release by aBer group in response to latest Health Board announcements

The aBer group would like to take this opportunity to thank all the people of Mid Wales who have helped in the campaign for a decent health service for our area. The result of the Hywel Dda consultation appears to be good news for Bronglais.

We now need to see developments that give substance to the promise of A&E and Surgery.  Without theatres, beds and staff to support Surgery the development of this service is impossible. Without appropriate services, staff and capacity in the body of the Hospital the front end (A&E) is merely an assessment centre. The aspiration to community services, without the necessary resources is merely a nice pipe dream.

We look forward to Hywel Dda Health Board making imminent announcements about the recruitment of the staff and allocation of the resources to deliver on their promises, so the people of Mid Wales have a decent Health service underpinned by a strong District General Hospital.

Press Release:

The retention of full Accident and Emergency and Orthopaedic services at Bronglais is very good news. They are significant components of Health Care required for the People of Mid Wales in Mid Wales. That said with gratitude and relief, we must continue to be concerned for the future.

Hywel Dda Board are committed to a ruthless and continuing reduction in the number of hospital beds except for Glangwili Hospital at Carmarthen. To the severe cuts to date in Ceredigion are now added further Community hospital cuts at Tregaron. These are in tandem with associated hospital nurse reductions and we see little evidence of any significant in crease in Community nurse numbers.

What is the significance of such a bed provision strategy?  With regard to Bronglais it is a significant loss of in-patient capacity, particularly with regard to pre planned major surgery. This is in the context of already high and unacceptable cancellation rates for such operations. The Community Hospital beds which previously enabled step down care out of Bronglais are now being cut, compounding the problem. The Board will argue that service requirements will be met by increased Day Case Surgery.  However that does not answer the problem posed.

What the Board is about in our view is creating a situation where inevitably all pre-planned major surgery will take place elsewhere, probably Carmarthen, with the exception of breast surgery at Llanelli.  Patients from Mid Wales, and surgeons based at Bronglais will be required to comply.  Breast care apart, this is not what the people of Mid Wales want, nor what large and significant numbers of them went to tell the Minister in Cardiff.

"Bigger is Better" is a constant Board and Ministerial refrain. Bronglais data negates this as we have shown recently(see "Small is beautiful"). Because of concerns for patient safety, equity and fairness, and a very practical professional overview the National Clinical Forum advised the Minister and Hywel Dda that in their view there had to be a strong and independent Hospital in Mid Wales at Bronglais. We remain unconvinced that Hywel Dda is adhering to this advice.

To show its commitment the Board must take steps to increase beds available at Bronglais.  It should advertise the now vacant Consultant surgeon post in the National Press, and cease to require consultants based at Bronglais to operate at Glangwili. Hospital nurse numbers need to be strengthened as well as skill balances ensured.

There needs to be an urgent and honest rengageament with the public concerning Obstetric arrangements at Bronglais and the provision of in patient Psychiatric services in Mid Wales.

Finally it must engage in a meaningful way with its Consultant staff (who have many new and exciting ideas) and others to develop and enact a Mid Wales Health plan which has a mind set, set apart from that of the M4 corridor but flexible and vibrant enough to to co work and network in the context of both new and old frameworks.

William Roberts. 17/1/2013.

Save Bronglais Campaign: Dyfi Valley - Campaign Statement

We are campaigning for Bronglais Hospital to be maintained and developed as a high quality District General Hospital for Mid Wales, and for integrated rural health care to be planned specifically for Mid Wales.   People in this region have a right to the same level of health care as the rest of the country.

The campaign in context.

The population outside the Hwyel Dda Health Board area that is most affected by changes to Bronglais Hospital is over 12,000 people covered by 4 GP practices and 3 community hospitals in Montgomeryshire (Powys teaching Health Board area) and Merionnydd (Betsi Cadwaladr University Health Board).   

In response to consultations initated by Hywel Dda, more than 1,000 people from the Dyfi Valley have participated in public and preparatory meetings since November 2011, specifically in relation to Bronglais Hospital.  A delegation of at least 100 joined a demonstration on the steps of the Senedd in Cardiff  in February this year. 300 or more have attended Powys and Hywel Dda Health Boards’ consultative meetings since then.  A database and mailing list contains close on 200 active contacts. Leaflet distribution has been carried out in most valley settlements and during Machynlleth street markets resulting in useful evidence and moving testimonials in support of Bronglais.  

Read more...

Make Your Voice Heard Before 29 October!

It is important to respond to the Health Board consultation - which closes on 29 October 2012.  The questionnaire can be found here, but please read this guide to responding first.

Community Hospitals  -  Maintain capacity until evidence of alternative community services is shown.
Level 2 Neonatal Unit  - Provide & develop maternity/paediatrics skills in Bronglais, to ensure safety of mother and baby.  Obstetric/paediatric service to be consultant delivered.
Emergency Care - Support Option B and demand backup within Bronglais.
Planned Care - Maintain skills and critical mass in Bronglais.
Use further comments boxes to demand a Mid Wales Health Care strategy
Write to the Health Minister:

Lesley Griffiths AM
Vernon House 
41 Rhosddu Road 
Wrexham LL11 2NS

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Or by telephone: 
Tel: 01978 355743     Fax: 01978 310051

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