The medical model is changing. More specialisation raises standards, and chances of a long life. Specialist units with teams of professionals raise standards quicker than smaller units. Recruitment of altruistic young doctors, and other staff, is easier in specialist (tertiary) units. Hywel Dda has none of these.
In my own area, a rural English speaking part of West Wales, with a population 3 times the size in summer, the threat to close our hospital is about to cause civil unrest. A new build in Pembrokeshire would reassure the Medical Executive Committee of local consultants, but the politics of Wales mean that it could be over the border in Carmarthenshire. This is a completely different area, and the two tribes are separated at County Council as well as Hospital. The majority English speakers feel threatened by a minority Welsh speaking “caste” taking over the culture of their hospital. This may not happen, but it is the perceived threat. In addition there is difficulty recruiting doctors to West Wales, Carmarthen more so than Pembrokeshire, and the lack of choice for patients within their post code rationed region, is demoralising. It splits the population.
The demographics, and especially in the future, mean that more and more elderly will retire to Pembrokeshire. There are two towns with building consent to expand in the National Park, Freshwater East and Broadhaven. This is where the population will expand. This is where demand will come from.
The poor road and transport links, and the absence of a routine air ambulance, mean that if services are moved East of Narberth, patients from Dale and St David’s will have too far, too slowly, to travel.
The sensible option is to close Carmarthen, (already falling down), and Llanelli, which is near to Swansea, and to combine the Swansea and Hywel Dda trusts. In this way there would be more choice for patients, and recruitment would be less of a problem. If the trust insisted appointees did some of their time in Withybush there would be fairness and service. But this is not one of the options offered by Hywel Dda, as this would require a change in the rules of the game, decided by the Welsh Government. Indeed, common sense would make all of Wales into one trust. Then there would be maximal choice (In Wales) and although there are two waiting lists (one for English – fast, and one for Welsh – slow) at Oswestry, it would enhance choice and standards.
My solution puts the Welsh speaking area of Carmarthen between two larger English speaking areas, which would not be politically acceptable. It has to have stroke thrombolysis and stent insertion, as well as radiotherapy services.
In the 1970s a new DGH was built to replace the old first world war “county Hospital”. The population supported Eirian Williams in his endeavours to keep Pembrokeshire’s hospital. Not many of his supporters are still alive, but the principle he applied still remains: there is more pride and cultural affinity with ones own hospital. In the future many services will be in the community and closer to the patient. Whatever decision is taken is relatively short term, as we have to start putting money into community care. If the new hospital goes ahead, then the former DGHs could be reclassified as “community care” and rehabilitation and recovery can happen at these places. In the end we can only have quality care in hospital if there is enough capacity to leave the hospital.
Look at the Hywel Dda site for “transforming” services”, and fill out the feedback Questionnaire.