Hywel Dda under pressure as doctor says ‘Glangwili will not cope’ once Withybush has been downgraded..

The Pembrokeshire Herald reports June 2nd 2014: ‘Glangwili will not cope’

THE PEMBROKESHIRE Herald has received the explosive full text of a letter sent by a senior clinician at Withybush Hospital, which condemns the Health Board’s proposals for future paediatric care in Haverfordwest as “untested” and “untried”.  

The open letter, from Paediatrician Martin Simmonds, was sent to the Board a week after it announced plans to transfer key neonatal services away from Withybush as of August 1. Dr Simmonds letter, exposes the fact that clinicians DO NOT endorse the Health Board’s policy and have grave reservations about the Board’s decision to press ahead regardless of clinician’s concerns.

The Herald’s article (Big Holes in Board’s “safety net”) in our May 9 edition revealed startling deficiencies in the Health Board’s rationale underpinning ending service provision at Withybush. It now appears that the concerns of campaigners and families who contacted us before that article (“Big Holes in Health Board’s Safety Net”) are shared by those clinicians which the Health Board has claimed support the changes being made.

Peter Milewski, a retired consultant surgeon who worked at Withybush for many years, told the Herald: “It feels like a train crash is about to happen.”

Open letter to Hywel Dda University Health Board 

Please reconsider the proposed Paediatric service model for Withybush Hospital. It must be postponed. This may be our last opportunity to be heard and have our concerns communicated to the Health Board Executive. At a meeting earlier this year (of the dozens I have attended), I said that although not our preferred model a PAU model could be considered if the middle grade rota couldn’t be sustained. It was an untested, untried suggestion without research or risk assessment. A few months later it emerged as the Health Board’s preferred service model. I note that historically the public have received reassurances that these decisions were “clinician led”. I understand the importance of this statement to give credibility to the plans. However, a Health Board statement says that the majority of clinicians support this plan. I am not one of them. I do not know of any Paediatricians in Hywel Dda who have given their support to this service model. Work undertaken by two senior nurses at Withybush, both of whom I regret to say are now absent through illness, have produced research indicating that the risk assessment for a PAU here indicates that it is neither safe or resilient enough to serve the needs of the local population this remote from the hub Paediatric inpatient base. We keep being told to provide answers and not to continually raise concerns and objections to the proposals. The impression is that until we provide the “desired” answer we are hindering the Health Board’s attempt to move forward. We are not “yes” men, we are professionals working in a vocation we are passionate about, with a fear that irreversible harm will occur if the current proposals go through. It has become increasingly difficult to have confidence that our concerns reach the Health Board. Tensions and divisions amongst staff are emerging as the “who knew what and when” charade continues. Don’t tell us NOT to mention potential clinical scenarios in the future that are of “low frequency”. Don’t insult our intelligence or compassion. We are not shroud waving; we just feel it isn’t as safe a service as it should be. Glangwili will not cope with the additional work coming its way this winter, either physically or with respect to workforce issues. Families will end up travelling out of hours from here to Glangwili and then instructed to go to Bronglais to be admitted. We will have babies with bronchiolitis that have to be transferred in an ambulance despite potential deterioration en route because if we insisted on keeping them here to administer supportive treatment, I would be guilty of professional misconduct. A&E staff have only one Consultant with Paediatric experience: that is not sufficient to say they can manage out of hours. I don’t expect the current reliance on locum middle grades to be sustainable once they learn of the absence of local Paediatric support at night. Our concerns: 1. I am not a conspiracy theorist but when the Chairman and Chief Executive elect to move on this summer and the two most senior Paediatricians in Glangwili opt for unexpected early retirement before August 1 it is concerning. 2. Midwifery led services and A&E appear to have been given reassurances about the level of Paediatric support they can expect that we do not recognise in the proposed Paediatric model. 3. Our nurses have spent a considerable amount of time involved in Estates planning at Glangwili. Estates, up until last week I believe, didn’t even know about a planned PAU located within ward 14. This does not give the impression of any concern about how Withybush will manage a seismic change in service in August. You can imagine how valued that makes our staff feel. Please tell them that Dr Simmonds got it wrong about the PAU model, go public and punish him as you see fit. I would rather be a “fall guy” to save the Health Board’s blushes than have the whispered comments in the years to come that I was the architect of this proposal. Tell them we can staff a 24- hour Paediatric unit at Withybush with recently secured middle grade staffing. No, tell them we demand a 24-hour service here such that we can admit a child overnight and discharge the next morning or administer phototherapy for the jaundiced baby from St Davids who must otherwise travel to Glangwili for admission. Tell them we can develop a specialist Paediatric nurse role in A&E but that it will take time. Tell them that unless we stop this process now, this winter will see greater challenges and upset than there needs to be, adversely affecting the health of families and staff both here and at Glangwili. Martin Simmonds Paediatrician Withybush Hospital.

The Pembrokeshire Herald asked the Health Board for a response to Martin Simmonds’ letter. A Health Board spokesperson said: “We welcome the fact that Dr. Simmonds has recognised that change is needed and we want to reassure our patients and we are continuously working with our clinical teams and Welsh Government to find the right solutions and ensure ‘safety nets’ are in place as instructed by the Minister following an independent review of these services by an expert panel. The safety of these services is paramount and we are being very clear that only when we are confident our solutions are safe and sustainable will we implement them.”

I wrote to the Herald but this does not mean I support the downgrading without prior investment in both Hospitals, General Practice and Road infrastructure:

Readers of the Herald might reflect the services in West Cornwall, where there is a comparable population and distances between Hospitals. (Penzance and Newlyn population is 25,800 and Haverfordwest is 13,469) The West Cornish population (128,000 by summing electoral wards) is similar (Pembrokeshire 122,400), and the birth rate west of Truro is probably similar to Pembrokeshire’s. There are 5400 deliveries for 536,000 people. In Pembrokeshire there were 1277 deliveries for 122,400 people. The fertility rate is 1.98 for all Cornwall and 2.21 for Pembrokeshire.

Penzance Hospital has been downgraded slowly, and is now an acute GP Out-of-Hours service, and a geriatric hospital. There has been no outcry, and there is no “SPAT”.

One specialist neonatal ambulance “may not always be enough” on rare occasions. There are general ambulances to cover when this is necessary in Cornwall, but there is no standby neonatal ambulance unit at Penzance.. I gather this would be the case in Pembrokeshire.

Maternal and neonatal mortality in Cornwall is no worse since Penzance was downgraded to a Midwifery Led Unit, and may even be better.

The big difference has been the politics. Somehow the management have made the change without social distress and outcry.

With an increasingly elderly population, and declining birth rate, (in both regions) the services and buildings we have in Pembrokeshire are probably best used for the same purposes as Penzance. This does not mean there cannot be local radiology and out patients, but specialist services such as neonatology are best done by centres that do lots of them…. If you do it often it will be done well, but if you do it rarely it will be done less well…

On the isle of Skye there are approximately 900 deliveries per annum, and the birth rate is 2.23. They are very grateful for the service they have…… But of course they have never had a DGH. It is much harder to remove facilities than to enhance them!

 

What is disappointing to me is that the GPs on the Health Board, and on the Local Medical Committee (BMA) have not been heard in the debate. These are the opinions your reporters should be canvassing… But they seem muzzled and unwilling to speak up. In a utilitarian decision making process we have to consider the benefits to the many against, in this case, a very small few.. These quite rightly are decisions we ask trained professionals to take. I hope factual information helps your readers..

Yours sincerely.

This entry was posted in A Personal View, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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