Shaking up services in South Wales
Posted on 27 November 2012 by members of the South Wales Programme
There’s a common saying in the NHS about making sure the patient gets the right care from the right person in the right place and at the right time. The truth is that, though on the whole patients receive good care and standards are improving, not all are getting the right care when they need it.
In some cases it can take some time for a patient to see the right clinician, especially if they are coming to hospital at night or at weekends when fewer senior doctors tend to be on duty.
There have been massive advances in medical care and technology, which mean we’re now able to treat diseases and injuries that would once have been life threatening. But this kind of high-tech medicine can only be delivered by teams of doctors, nurses and therapists who have specialist skills and works best when patients get to them as quickly as possible.
The real revolution in healthcare is happening in our communities, where more than 90% of patients are treated without needing hospital admission. Meanwhile, provision of our hospital services has been in a time warp, stuck in the 1960s, when we believed it was possible — and right — to provide as many services as possible on as many sites as possible.
This isn’t viable now, due to increasing specialisation and changes in the way doctors work and are trained. The European Working Time Directive means the days of over-tired juniors are long gone but we need twice as many to provide care.
Doctors-in-training want to come to busy hospitals, work in larger teams of medical staff and feel supported. We need to make changes to attract them to Wales, where this hasn’t always been the case. There’s been a significant impact on some of our key specialist services — notably obstetrics, paediatrics, neonatal care and emergency care. Recruiting doctors, including consultants, has been difficult and in many units we’ve resorted to using expensive sticking plasters, in the form of temporary locum staff, to keep these services going.
Locums may keep a service open but this model doesn’t give patients the best quality of care and takes a lot of money from other areas of the health service.
It’s for these reasons that frontline clinicians in the South Wales health boards have been working together as part of the South Wales Programme to devise solutions and propose ideas for the future of services that give patients better access to care around the clock.
Our clinicians believe that if consultant-led care were provided on four or five hospital sites across South Wales in the future we could have enough medical staff and meet the expert standards of care — matching the best in the world — in each of these areas.
This is about improving care for all patients, particularly those people who need to be seen by the most experienced clinicians and doctors as soon as they arrive at hospital. And, in the case of major trauma, it’s about reviewing the services already provided in Cardiff and Swansea to make sure they are as effective as possible.
It is very clear that we cannot continue to carry on as we are. The UK-wide shortage of medical staff means that the doctors we need aren’t waiting at the Severn Bridge to come into Wales. Despite our best efforts in recruitment over several years it remains a challenge to fill all our vacancies.
If we don’t take action now, there’s a real risk that we’ll be forced to take emergency measures when one of these services falls over. We’d rather take action in a calm and planned way, which is better for patients and staff, instead of reacting to crises.
As neighbouring health boards, we have a unique opportunity to work together in Wales to find a lasting solution for the people of South Wales and to provide better access to specialist care. We’re in the business of treating people. We want to be able to give them the best chances of surviving their illness or injury and recovering to live a full and independent life.
We want to work with the public and our staff over the next 12 weeks to design and create a new model of obstetric, paediatric, neonatal and accident and emergency care which will make sure that patients are getting the right care, from the right person in the right place and at the right time.
Bruce Ferguson, medical director, Abertawe Bro Morgannwg University Health Board; Grant Robinson, medical director, Aneurin Bevan Health Board; Graham Shortland, medical director, Cardiff and Vale University Health Board; Kamal Asaad, medical director, Cwm Taf Health Board, Brendan Lloyd, medical director, Powys Teaching Health Board
recruitment and retention of staff