NHS shakeup: Morriston Hospital set to be a regional centre
MORRISTON Hospital will become one of a handful of hospitals in Wales to have regional centre status as part of the biggest shake-up of the NHS in Wales for decades.
South Wales health chiefs say specialist services are spread across too many sites and need to be concentrated in either four or five hospitals.
These regional centres would have a major A&E department, consultant-led obstetric deliveries, inpatient paediatric beds and associated services, highly- specialised neonatal units, all levels of critical care, surgical emergencies and specialist emergency gastroenterology and cardiology.
Abertawe Bro Morgannwg University Health Board, Aneurin Bevan, Cardiff and Vale, Cwm Taf and Powys have been working together to examine the issues facing consultant-led obstetric, paediatric and neonatal and accident and emergency services in South Wales.
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Called the South Wales Programme (SWP), the process has involved more than 300 clinicians and others looking at how the NHS in Wales can care for the sickest and most seriously-injured patients.
Health officials say the care patients receive has improved but the way specialist services are currently provided, combined with changes to the way doctors are trained and the ongoing UK-wide medical recruitment difficulties, means this care could be better.
South Wales Programme lead chief executive Andrew Goodall said: “We want patients in South Wales to have access to the best quality care, which matches the best in the world, whatever day of the week they need it.
“To do this, we need to look at the way these services are provided across the whole of South Wales, rather than just in individual health board areas.”
The SWP identifies Morriston Hospital, University of Wales in Cardiff and the new Specialist and Critical Care Centre in Gwent as regional centres.
There are three other hospitals now providing the key services identified: Princess of Wales, Bridgend, Prince Charles, Merthyr Tydfil, and the Royal Glamorgan in Llantrisant.
But the SWP concludes only one or two of these could continue to do so, though the hospital or hospitals not becoming a regional centre would still provide a range of local services.
Cwm Taf Health Board medical director Kamal Asaad said: “It is important to remember this process is not about the future of individual hospitals and the overwhelming majority of patients will continue to be cared for at their local hospital, as they are now.
“Most healthcare is not provided in hospitals, but in the community by family doctors, district nurses, health visitors and the like, and we are continuing to invest heavily in our community services.
“This programme is about a small number of specialist, but important services, which depend on having access to highly-qualified, skilled staff. We have a responsibility to ensure these services are delivered to the highest possible standards for our sickest and most seriously-injured patients, who need highly specialised, consultant-led care.”
ABMU’s medical director Dr Bruce Ferguson added: “We want to be confident that the small number of patients who need this specialist care are able to receive it at the first opportunity.
“The debate we want with the public is about how and where best to deliver these services to achieve this ambition.”
Morriston’s role as a centre for specialist emergency and complex care, not just in the ABMU area but beyond, has been confirmed in principle by the recommendations of the South Wales Programme.
But the details will depend on what happens with Bridgend’s Princess of Wales Hospital as any changes there could affect the number of patients Morriston sees.
Morriston does not have two services that would normally be expected of a regional centre. While it has inpatient children’s wards, it does not have a maternity and newborn baby unit (neonatal intensive care) as these are currently at Singleton.
“Moving obstetric and neonatal services from Singleton to Morriston should be considered so they are part of the regional centre of excellence, as soon as the money to build this becomes available,” Changing For The Better (C4B states.
“This could include the midwife-led unit for Swansea, currently at Singleton, so it is alongside the consultant unit at Morriston.
“Also, emergency and complex elective gynaecology could move to Morriston Hospital.”
C4B also states that, if Morriston was to take on more of the complex and specialist work, it would have to work with other hospitals so they could deal with Morriston’s less complex work.
At the same time, work will start next month on detailed proposals for a major trauma — such as multiple injuries sust- ained in a car crash — service covering the entire South Wales area.
This could be based at Morriston or University Hospital of Wales in Cardiff, or split between the two sites.
Singleton has already seen some services expand with the transfer of beds and services from Hill House.
It will further expand with the development of the new children’s development centre for Swansea and as a centre of excellence for ambulatory care services in Swansea. These include day-case and short-stay surgery, an increased range of outpatient services, diagnostic services and next-day assessment services for GPs.
According to C4B: “The changes planned for Morriston to further develop its regional centre role will require us to look at whether other services can be transferred to Singleton.”
Maternity and neonatal specialist critical care services, along with gynaecology, could move to Morriston (as detailed above).
But a service ABM says needs to be looked at in more detail is Singleton’s acute medical services for patients referred by their GPs as emergencies not including strokes and heart attacks.
“Depending on the future pattern of unscheduled care services we need to decide if we can continue this service in the future, bearing in mind the difficulties we have recruiting doctors and the requirements of quality standards.
“We are doing more work to understand how a redesigned clinical service could work effectively and safely for the future.”
NEATH PORT TALBOT HOSPITAL
The South Wales Programme recommendations are unlikely to have a direct effect. New and expanded services have already been announced but some additional unspecified services now provided at Morriston could move there.
PRINCESS OF WALES HOSPITAL
Depending on what happens with the South Wales Programme, the hospital could expand its role to become a regional centre. Or the regional centre could be developed in Llantrisant or Merthyr Tydfil’s existing hospitals.
Should that prove to be the case, Princess of Wales would continue to provide most of its existing services including outpatients, antenatal care, planned surgery and diagnostic tests. However, complex care would be provided at a regional centre.
Also available in Princess of Wales would be a paediatric assessment unit, but without overnight hospital care, a minor injury unit and a midwife-led birthing centre.
C4B states: “We would also wish to see some patients with more minor surgical emergencies continuing to have their treatment locally at Princess of Wales Hospital.”