Local Health Board Reconfiguration Plans – Update

20 January 2013

Article by Victoria Paris, National Assembly for Wales Research Service

Hywel Dda University Health Board

In January 2013 the Hywel Dda University Health Board published their final proposals for health service reconfiguration in West Wales.  Following the formal consultation, the Hywel Dda Community Health Council (CHC) corresponded with the Health Board raising some concerns with regard to the proposals.  Although some issues were resolved, some matters of concern to the CHC remained (A&E services at Prince Philip Hospital, Llanelli; and neonatal Services – specifically in relation to Glangwili and Withybush Hospitals).  The Minister for Health and Social Services, Mark Drakeford AM, established an independent Scrutiny Panel to examine all relevant documentation and consider the issues.

In September 2013 the Panel submitted its report which strongly supported the case for replacement of A&E services at Prince Philip Hospital, Llanelli, and which proposed that an Emergency Nurse Practitioner Unit supported by General Practitioners should form the future model of care at the Hospital.  In December 2013 the Minister stated that the model of emergency care at Prince Philip Hospital will be clinically led by doctors and delivered in conjunction with emergency nurse practitioners.

With regard to neonatal services, while in the main the Health Board’s original proposals were endorsed (i.e. a stratified service with services at Bronglais, Withybush and Glangwili providing care for the vast majority of babies born in those communities, a Level Two neonatal unit at Glangwili for births in the wider Hywel Dda area which need a higher level of care, and the very small number of complex births requiring Level Three care continuing to receive services through those provided by the Abertawe Bro Morgannwg University Health Board), the Panel was unable to reach a final conclusion.  The Panel stated that they could not make a decision until clear and definite plans for obstetric and midwifery services have been agreed for the Hywel Dda area.  However, the Panel did propose that where the need for a Level Two service emerges on an unplanned basis the current neonatal transport service is extended to operate on a 24 hour basis.  The Minister stated that the Health Board must carry out a further piece of work in respect of its obstetric, midwifery and gynaecology services, explicitly setting out the way in which these services are linked to its proposals for changes to neonatal services, and on their response to the Panel’s proposal of the neonatal transport service being extended to operate on a 24 hour basis.  It was expected that this work would be completed by the end of 2013.  Once the additional work has been completed the Panel will reconvene and provide advice to the Minister.  The Minister is expected to make a statement in Plenary on 21 January 2014.

Betsi Cadwaladr University Health Board

In January 2013 the Betsi Cadwaladr University Health Board published its final proposals for changes to healthcare services in North Wales in four areas (Localities and Community services; Neonatal Intensive Care Services; Older People with Mental Health Needs; and Vascular Services).  In March 2013, the Betsi Cadwaladr CHC referred elements of the Health Board’s proposals to the former Minister for Health and Social Services, Lesley Griffiths AM, for determination.  The Minister, Mark Drakeford AM, has subsequently received a joint letter from the CHC and the Health Board (July 2013) which confirms agreement has been reached on the outstanding issues and that the CHC is now content.  The Welsh Government has agreed to work with partners across the public service to better understand the local transport access issues and identify joint opportunities for improvement.

South Wales Programme

In May 2013 the South Wales Programme launched their consultation document on the future of consultant-led maternity services, neonatal care, inpatient children’s services and emergency medicine (A&E).  It was originally stated that the Health Boards (which constitute the South Wales Programme) would meet in October 2013 to make a decision about the outcome of the South Wales Programme.  However, due to the high number of consultation responses (more than 61,000 responses) this was postponed to allow for appropriate analysis.

While it is unclear at the moment which options some CHCs favour (Abertawe Bro Morgannwg, Aneurin Bevan, Brecknock and Radnor, Cardiff and Vale, and Cwm Taf CHCs cover the South Wales Programme area) three CHCs have made clear their views:

Aneurin Bevan CHC favour option 3 – five sites: University Hospital of Wales (Cardiff), Morriston Hospital (Swansea); Specialist Critical Care Centre (SCCC) (Cwmbran); Prince Charles Hospital (Merthyr); Princess of Wales Hospital (Bridgend).

Brecknock and Radnor CHC favour option 1 – four sites: University Hospital of Wales (Cardiff), Morriston Hospital (Swansea); Specialist Critical Care Centre (SCCC) (Cwmbran); Prince Charles Hospital (Merthyr).

Cardiff and Vale of Glamorgan CHC favour option 2 – four sites: University Hospital of Wales (Cardiff), Morriston Hospital (Swansea); Specialist Critical Care Centre (SCCC) (Cwmbran); Royal Glamorgan Hospital (Llantrisant) (as the CHC had concerns over the sustainability of the 5-Centre models).

The South Wales Programme board has been working to develop and agree a set of recommendations to take to special board meetings.  It is anticipated that the special health board and Welsh Ambulance Services NHS Trust meetings will be rescheduled for early in 2014.  Individual health boards will consider the programme board’s recommendation, together with all the other information gathered about the South Wales Programme and consultation, and the feedback from the individual CHCs, when making their decisions about the outcome of the consultation.