South Wales NHS: Cwm Taf health board rejects shake-up recommendation

Plans to centralise vital services into five south Wales hospitals face uncertainty after a key recommendation for it was rejected by a health board.

Cwm Taf went against the proposals relating to A&E, specialist care for mothers, newborn babies and children.

The Royal Glamorgan hospital in Llantrisant, which comes under Cwm Taf, would see some services moved under the plans.

Health minister Mark Drakeford said Cwm Taf would not hold up changes.

The other four health boards backed the recommendation.

Since the start of 2012, senior managers and medical professionals from the five health boards and the Welsh Ambulance Service have been working together in the South Wales Programme (SWP) to develop proposals for hospitals from Swansea to Newport.

The proposed changes come amid concerns that services across eight hospitals are currently spread too thinly. However, managers insist no individual A&E department would close.

There are also concerns that professional standards of care are not being met, junior doctors do not get the training they need and senior doctors do not get to see enough patients.

Cardiff's University Hospital of Wales, Morriston Hospital in Swansea, a new hospital near Cwmbran, Prince Charles Hospital in Merthyr and the Princess of Wales Hospital, Bridgend, are the five hospitals where services would be centralised.

The future for the Royal Glamorgan would see it become a "beacon site" for developing a new model of acute medicine for people with chronic illnesses.

But the recommendation needed to be accepted by the five south Wales health boards and the ambulance service who met on Thursday.

Cardiff and Vale, Abertawe Bro Morgannwg (ABM), Aneurin Bevan and Powys health boards all approved the proposal.

A spokesperson for ABM said: "Working together in this way will help to support key services, making them stronger and more sustainable."

An Aneurin Bevan spokesperson added: "We fully recognise the seriousness of the issues highlighted in the case for change."

However, Cwm Taf has proposed an alternative model which has led to confusion over whether the reorganisation plan will be accepted.

It backed the most of the proposals, but instead of moving services from the Royal Glamorgan, it proposed an alternative which would see the Royal Glamorgan and Princess of Wales (which comes under ABM health board) sharing services as a "starting point" to centralising units.

In a joint statement, Cwm Taf chairman Dr Chris Jones and chief executive Allison Williams said: "Providing integrated services from these two hospitals will preserve services in as many centres as possible - and local access for local communities."

Talks will take place next week to find a solution.

Paul Hollard, programme director for the SWP said: "We will work together to discuss these and consider the next steps so that the South Wales Programme work can proceed with minimum delay.

Huge contribution

"It is vital that we get this right to ensure the best healthcare possible for the people of south Wales and south Powys."

If a solution can be found, a final decision will be scrutinised by five Community Health Councils (CHCs) - watchdogs - at a later date.

Should they not be happy, the matter will be referred to the Welsh government.

And the early indication is that it could be referred after Cardiff and Vale CHC said it was disappointed about the recommendation being supported by its health board.

Cwm Taf CHC was disappointed the health board was not able to support the CHC's own preferred option.

The issue has been the subject of much debate.

Mr Hollard said the last six months has been spent analysing the views of 61,000 responses from the public, patients and healthcare professionals.

"It is clear patients and the public want to maintain as many local services as possible, but not at the expense of clinical quality," he said.

"However, we also know that the way some services are currently organised makes it very difficult for us to consistently meet the standards of care our patients deserve.

"We believe that to be able to meet these standards, these specialist services - consultant-led maternity and neonatal care, inpatient children's services and emergency medicine - should be centralised in five centres as a starting point towards the development of the three acute care alliances.

Sharing expertise

"This is the best way to ensure all patients get the care they need, when they need it and that it is delivered by highly-trained and experienced staff."

Care alliances would be set up alongside the five sites and would see clinicians from different hospitals working together across health board boundaries to provide care for patients.

They would share information, skills and expertise and the alliances would decide which work goes where.

That includes being involved with the centralising of services like consultant-led maternity and neonatal care, along with inpatient children's services and A&E.

The alliances would also ensure patients continue to have access to local assessment, care, treatment and follow-ups.

But there may be occasions - as happens now - when some patients with complex conditions need to travel to a specialist centre.

However, if an alliance was to propose any changes, it would have to go out to consultation.

Mr Hollard added: "It has become increasingly evident the traditional way of working, in which hospitals work in isolation, is not sustainable.

"We need to be innovative and make ambitious changes to deliver high-class care to people as locally as possible.

"These acute care alliances will form the back bone of our long-term plans to ensure this can happen."

Health Minister Mark Drakeford said Cwm Taf's proposal would be scrutinised.

"However, given the unanimous agreement on the overall model, it should not hold up work to implement the changes to service provision," he said.