Health reform: Prince Philip A&E to become nurse-led unit

Controversial plans to turn the A&E service at Prince Philip Hospital in Llanelli into a nurse-led unit supported by GPs have been approved.

It was one of several disputed changes to hospital services in west Wales proposed by Hywel Dda Health Board referred to the health minister.

Mark Drakeford appointed a panel of experts to assess the plans.

He said he also backed the "general thrust" of changes to neonatal care but had not yet approved them.

Mr Drakeford told AMs on Tuesday he wanted more consideration of the idea of developing a 24-hour emergency baby transport service before any neonatal proposals were given the final approval.

He has also asked the health board to do further work on how its obstetric, midwifery, and gynaecological services will fit in with the plans.

Mr Drakeford said he endorsed the "underlying model" that more complicated care for babies should be centralised in one location.

Campaigners in Pembrokeshire had opposed the move as it would lead to the closure of the special care baby unit at Withybush Hospital, Haverfordwest, with services moving to the West Wales General Hospital in Carmarthen.

Judicial review

The minister said his decisions were based on the recommendations of a panel of experts set up after the Hywel Dda Community Health Council (CHC) patient watchdog objected to some of the board's proposals.

Campaigners in Llanelli have been given leave for a judicial review of the A&E changes, but Mr Drakeford told AMs on Tuesday that he would approve them.

"At Prince Philip Hospital, in 2011-12 its emergency department saw 33,000 patients, of which 6,500 were major cases," he said.

"422 of these needed to be transferred to another hospital.

"The remaining 80% of patients were treated at the hospital and the decision I have made today means that this position will be no different in the future."

The Conservatives' shadow health minister Darren Millar criticised the Welsh government for confirming "more hospital downgrading in Wales, despite previous assurances that this would not happen".

He said: "As Labour's leader talked about the NHS on a conference stage in Brighton, his party's only health minister was announcing hospital downgrading in Wales. That's the real life example of what truly happens to the NHS in Labour's hands.

"As an axe continues to hang unacceptably over Withybush Hospital's special care baby unit, families will remain worried and concerned.

"Patients should not be forced to travel further for treatment and these reforms have been driven by Labour's record-breaking NHS budget cuts."

Plaid Cymru health spokesperson Elin Jones said: "Plaid Cymru is clear that centralising life-saving services away from patients is wrong and it shouldn't happen.

"Consultant-led emergency services are an essential part of a safe, modern NHS service."

Watchdog worried

The announcements were the latest development in a lengthy process which started long before the Hywel Dda health board made final recommendations in January on wide-ranging proposals including:

• Redesigning emergency care at Prince Philip Hospital to be a nurse-led service supported by doctors, although the hospital would retain a 24/7 emergency medical assessment and admissions unit

• Centralising more complex (level two) baby care at West Wales General Hospital which would lead to the closure of the specialist baby care unit at Withybush Hospital

• Closing two minor injuries units at Tenby and Pembroke Dock with staff redeployed to Withybush

• Closing Mynydd Mawr Community Hospital in Tumble with services delivered in the community and at Prince Philip Hospital

In February the CHC decided it could not support most of the proposals and referred them to the then health minister Lesley Griffiths for a decision.

In one of her last actions as health minister, Ms Griffiths told the CHC in March that its referral did not satisfy Welsh government rules as it had not proposed alternatives.

In April the CHC said it could not accept the health board's neonatal and A&E changes and referred those proposals for a second time to the Welsh government.

Meanwhile, the CHC was able to "conditionally accept" the closure of the two minor injuries units and the closure of Mynydd Mawr hospital which are now in the process of being implemented.

In response, the newly appointed health minister Mark Drakeford set up a scrutiny panel led by chief medical officer Dr Ruth Hussey to "consider these issues" and "examine all relevant documentation".

The judicial review of the A&E changes at Prince Philip Hospital is due to take place in November.