Minutes:
The Chair, on behalf of the Area Committee, welcomed Bronwen John, Head of Service, Aneurin Bevan University Health Board, to the meeting to provide an update on progress against points identified at the Area Committee meeting held on the 17th April and the intentions for Chepstow Community Hospital.
It was explained that there is a clear role in the All Wales Strategy for community hospitals to be utilised as local health, wellbeing and social centres so that there is a locally available range of services delivered either at home, at the GP surgery or another local setting.
Regarding the reduction in beds, it was explained that the new model is that many more people are looked after in own homes rather than in hospital. In Monmouthshire, there is strong integrated care through primary, secondary and third sector care.
It was explained that two wards have been moved upstairs and now operate as one unit. This is beneficial in terms of working practices and is safer for patients. The move has created space for the establishment of a frailty assessment unit. The project is currently awaiting funding and it is planned to appoint a consultant for very frail people living in the community who want to stay at home. The unit will have the ability to access x ray and diagnostic tests so that the patient is enabled to have a short period for tests and assessments then is able to return home as soon as possible. If a return home is not possible, a bed can be arranged in Chepstow or the Royal Gwent Hospital for further treatment as necessary.
It was explained that main services include Outpatient Services for a wide range of clinics, primary care, mental health services using the former Minor Injuries Unit. There is also a large older adult mental health facility. Extensive work is planned to increase capacity for consulting rooms and for the provision of local operations. There is a bid to create more capacity in the day hospital area.
One of the benefits of moving the wards upstairs has allowed the older adult community mental health team to have office accommodation in the former Caerwent ward which is working well next to the clinics on the same corridor. There are likely to be other proposals for the remaining parts of Caerwent and St Arvans wards yet to be confirmed.
It is also hoped to develop an integrated children and families base similar to the pilot project in Caldicot where families experience seamless delivery of services from all sectors.
Regarding the DVT pathway model, it was explained that this has changed and it is proposed that Monmouthshire GPs pilot this service instead. This is awaiting costing and approval but the intention is to start before the end of February 2020 if agreed.
In terms of Audiology, additional timetabled slots have improved access for patients
The Care of the Elderly Service with a specialist from the Royal Gwent Hospital continues and it was highlighted that the frailty model will positively impact on services to elderly people; those with specific, urgent problems will be able to attend to a weekly clinic pending the appointment of a consultant. Outreach services will cover the remainder of services. The Committee were reminded that, when open, the most acute cases will be dealt with in The Grange Hospital, medical admissions will be in the district hospital (Royal Gwent) and other procedures can be handled in local hospitals including Chepstow.
There was no information on the issue previously raised about cold meals in the Royal Gwent Hospital as no further details had been supplied. It was agreed to pass the feedback received to the relevant team for follow up.
A list of Outpatients services will be updated and recirculated to the Committee.
It was confirmed that beds are used to accommodate local patients for terminal care who choose to die at home with support from St. David’s Hospice and District Nurses. There are no plans for specialist palliative care beds at Chepstow Hospital. The definition of specialist palliative care was requested.
In response to a query about delays in relation to x ray diagnosis, it was explained that there is a national problem due to high demand and insufficient radiologists. Diagnoses have to be prioritised accordingly and whilst there is no short term solution, more radiologists are being trained.
Referring to the discontinuation of the Minor Injuries Unit, it was queried if there is scope to provide a nurse-led facility as an alternative, referring to the model in Ebbw Vale. It was explained that there is concern nationally about Minor Injuries Units and the decision to close units is due to the risk to patients who may have received inappropriate treatment from non-specialist nurses who have been expected to cover a range of services. In the future, The Grange Hospital will have a major accident unit and Nevill Hall, Ysbytty Ystrad Fawr and Royal Gwent Hospital will provide appropriate minor injury services. There are no plans to change the new approach. A Member commented that the reason given for the closure had been lack of staffing locally but rumoured locally that staffing was deliberately cut. It was re-emphasised that the decision was taken for the clinical safety of patients.
A Member commented that the wait for standard GP appointments of 5-6 weeks for non-urgent matters was unacceptable. It was confirmed that the ratio of GPs to patients in Chepstow is accurate. It was not thought to be related to the numbers of elderly population and was queried if there may be unrealistic expectations. GP surgeries manage their own appointment systems and concerns can be raised with the practice direct.
It was confirmed that negotiations are in process to locate a defibrillator outside the hospital and a decision on funding to do so is awaited.
In response to a question from a Member, it was responded that there are regular cross border meetings and some issues involving interpretation of responsibilities have been identified. It was made clear that financial responsibility for patients living in Gloucestershire accessing GP services in Monmouthshire rests with Wales. A discharge liaison service is now in use to enable transfer to Chepstow and Lydney District Hospital and vice versa.
In response to a second question, it was explained that the suggestion that GP surgeries offer an optional enhanced service for minor injuries has not been taken up by practices in Chepstow; the Health Board has no influence over this decision. Enquiries should be directed to the respective practices. It was confirmed that it is likely that the Minor Injuries service in the Forest of Dean will be discontinued.
Regarding residential development in the Chepstow area and concerns about pressure on primary care services, it was confirmed that the Health Board maintains a close relationship with the Planners and that funding is allocated per patient.
A Member of the Public criticised the amount of money that the changes cost and was not in favour of the amount of change. It was explained that the national model is being followed and the changes are not specific to Chepstow.
In response to a question, it was confirmed that there is no connection between GP services in Chepstow and Chepstow Hospital medical services (unlike the different model in Monnow Vale Hospital where GPs control medical services).
With regard to housing development close to Chepstow, it was confirmed that there is liaison with Forest of Dean Planning Department and that branch surgeries are also consulted.
The representative of the Health Board was thanked for attending the meeting and for the offer to return to answer future specific questions.