Rural areas have often had to combine oncology with palliative and terminal care on the same ward in a local DGH (District General Hospital). This is sensible use of limited resources which have to be rationed in rural areas. In a tertiary centre they will rightly be separate. Dr Barnes has run this service in Pembrokeshire with great care despite being the only provider, and without local consultant support. An exit interview with NHSreality has been offered…. The threat of being unable to recruit any form of replacement is great. Some years ago, as a member of the LHB (Local Health Board) I promoted the idea that four GPs, all with Diplomas of Palliative Care, should be asked to cover the palliative and terminal care at Withybush. This was rejected, and subsequently few doctors have completed the diploma as no recognition was given. The chance seems to have gone, as all four of these physicians have retired now!
MANY PEOPLE have used the cancer services at Withybush Hospital over the years and have got used to the “glue” which sticks it together, namely Dr Anne Barnes MBE.
Not many people are aware that she has decided to leave in July of this year. Dr Barnes is a true professional and when questioned is not one to complain, but when reading between the lines it is obvious that Dr Barnes has reached the end of her tether. A total lack of support from the Hywel Dda Health Board has left Dr Barnes close to exhaustion and burn out. Many cancer patients will be aware she rarely takes leave, gets in early and leaves late, comes in to work on days off etc. Yet Dr Barnes is treated with contempt by the ‘powers that be’ because they know she will not let her patients down and they take advantage of her goodwill. In short, the health board is aware that she will go the extra mile and are happy to take advantage of this. She has been working alone in Ward 10 for far too long and when the palliative care consultant left it was just expected that she would take up the slack and do that job as well. A job advertisment for a consultant was drawn up, agreed and then left unadvertised so that the time limit lapsed. I am informed that a new advert was sent for approval at regional level, and after nearly two years without a consultant, has just been advertised. On April 6 I received a letter from the vice-chair of Hywel Dda Health Board, Mrs Sian-Marie James after I asked her what happens when Dr Barnes leaves? The letter said: “Whilst it is not possible for us to discuss with you the detailed personal arrangements affecting members of staff, I do know that Dr Barnes has been very open regarding her intention to retire this year. Because of this, and other challenges affecting our oncology service, we have therefore set up a review group to look at the best service model for the future. We face serious recruitment challenges. At present, we have visiting consultants from Abertawe Bro Morgannwg University Health Board who are working significantly above normal capacity and we are unable to offer appropriate sub-specialisation opportunities for existing consultants. There are also other issues, including capacity problems related to pharmacy services.” It has now come to light that one of the visiting consultants mentioned above, Dr Maung Moe, is also leaving his position which leaves us in an even bigger hole. The letter went on to say: “Dr Barnes is a key member of this review group, which includes membership from the Hywel Dda Community Health Council, as well as public health professionals and clinicians from ABMU Health Board. The future arrangements for supporting oncology services at Withybush Hospital will therefore depend on the output from this group.” From the outset, it was agreed that any developments proposed by this project group would be in line with the Calman-Hine principles, in particular that ‘care should be provided as close to patient’s home as is compatible with high quality, safe and effective treatment’. The areas the review group will focus on include: • Staffing issues: including inequity of staffing provision across the three counties, review of job plans, improved ways of working alongside current capacity issues; • Aseptic unit provision: issues being experienced around activity, patient waiting times and staffing pressures; • Information management: ensuring activity is consistently monitored; • Cross border working arrangements: maximising the way Hywel Dda works with its partners; • Transport issues: service pressure for those travelling to Singleton for radiotherapy, ensuring safe transfer of patients back from Cardiff (for those having pet scans or nuclear medicine); • Development of an acute oncology service/developing a new service model: updating services, consideration of patient pathways, shared post opportunities, repatriation issues, etc. I know this group was not set up because Dr Barnes announced that she was leaving. This group was announced before Dr Barnes informed them that she was going, and now visiting consultant Dr Moe is going as well. The group was set up because the Hywel Dda Health Board knows that they have let things slide and now we face a crisis with the delivery of services for cancer patients at Withybush Hospital. Some Cancer Patients are already facing journeys to Prince Philip Hospital in Llanelli to see Consultants they would recently have seen locally. The wig service at Withybush Hospital for chemotherapy patients was removed and the contract given to a local hair salon. As a private company this obviously made the cost much more expensive for patients. After a fight this service was reinstated at Withybush Hospital, but not sure for how long as an all-Wales Review is taking place into this service. If you have concerns about cancer services or any other services at Withybush Hospital I urge you to contact your MP, your assembly member, local councillor, the community health council, Hywel Dda Health Board.