The Talking Point #18: Hywel Dda hospital re-organisation – A familiar refrain



(Title Image: Wales Online)

Hywel Dda health board – which serves Carmarthenshire, Pembrokeshire and Ceredigion – are preparing for a public consultation on proposals to reorganise hospital services.

A document leaked to BBC Wales revealed the closure of Haverfordwest’s Withybush Hospital features prominently in the plans – though any hospital closure(s) would mean a new hospital could be built at a central location.

Any proposed hospital closure or downgrade in services immediately provokes a reaction.

On the one hand, you have the clinical experts and Welsh Government telling people to “look at the evidence” and to stand ready to support hard decisions to prevent the NHS from collapsing or becoming “unsustainable”.

On the other hand, you have opposition politicians (and some Labour ones too) pledging to fight to defend local hospital services come hell or high water.

Technocrats vs Populists as I recently covered on State of Wales (with a follow-up by Ifan Morgan Jones on Nation.Cymru)

It’s all very familiar to me because it’s exactly the same thing we heard in south Wales when the South Wales Programme was going through the motions in 2013-14. At that time it was A&E and children’s services at Llantrisant’s Royal Glamorgan Hospital under threat.

We were told “look at the evidence“, “if we don’t make hard decisions the NHS will become dangerous and collapse” etc. Despite all that, as of 2018 the Royal Glamorgan Hospital still has its A&E department (though you need a referral to use it AFAIK) and, after the pressure put on hospitals over the winter, it’s fortunate it did so – though children’s services have been downgraded.

In principle, it’s right that the most highly-specialised medical services are centralised. It’s also right that A&Es should be reserved for emergencies only and that patients may, in some cases, be better off going to a GP, minor injuries unit or pharmacist.

If we want to attract and retain more doctors and medical students, then their working environment needs to be modern, technologically advanced and provide opportunities for them to take part in world-leading research and training.

All those statements line up with support for hospital downgrades and closures, but the key thing missing from all these reorganisations is the impact on patient experience and an explanation as to why these new policies will improve their health.

The South Wales Programme – at heart – wasn’t about patient outcomes. It was about training workloads for junior doctors and consultants. We would have/will see far more patients forced into a smaller number of beds because – as Borthlas recently said – it’s what governments, civil servants and clinical experts are telling each other to do.

But it’s not what we want.

I’d imagine most people reading this don’t want to spend more time than they need to in A&E departments or see relatives stuck on beds in corridors. If we suffer a heart attack or stroke, we want an ambulance to turn up on time and get us to a hospital as quickly as possible. I doubt many people want to travel hours to receive cancer treatment or dialysis – even if it’s “world-beating”.

The health boards and government, when they come up with these grand schemes, need to explain in as simple terms as possible how they will improve outcomes for patients. The opposition needs to understand that shouting about problems doesn’t fix anything or mean services are okey-dokey as they are.

So my advice to anyone living in the area is that when the consultation starts, look at the evidence for yourselves. Don’t let anyone else convince you one way or another and if you don’t understand anything, badger people until they explain it in a way that you do understand.

Most importantly of all ask, “Will this improve my own or my family’s health?”

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