Minutes:
The Committee welcomed representatives of the Aneurin Bevan University Health Board to the meeting - Mr. N. Wood, Chief Operating Officer and Mrs. P. Hapgood, Assistant Divisional Nurse, Community, to the meeting to provide an overview of community health facilities (Chepstow and South Wales) from the ABUHB’s perspective.
The Clinical Future Strategies for the future development and delivery of health services in the region were introduced. It was explained that new and existing hospitals are being evaluated from an estate and service perspective to ensure they are fit for purpose for the future. It was explained that permission has been granted by the Welsh Government to construct a 462 bed Specialist and Critical Care Centre (SCCC) in Llanfrechfa. This will provide a highly specialised environment to support the treatment of patients who need complex and acute emergency care in the region and will open in 2021.
It was explained that Accident and Emergency services for ambulance patients will be provided in the SCCC with support from the regional hospitals for minor injuries (Ysbytty Ystrad Fawr, Ysbytty Aneurin Bevan, Nevill Hall and Royal Gwent Hospitals). It was noted that patients referred via their GP will still go to the Royal Gwent Hospital.
It was explained that the Health Board is currently consulting upon a “Care Closer to Home” strategy for the Greater Gwent region. The strategy proposes that as many services as possible would be delivered locally in integrated hubs in Monmouth and Chepstow.
It was confirmed that there will not be a Minor Injury Unit in Chepstow Hospital. A Member stated that a petition, with 2500 signatures had been met with indifference and questioned why there had been no public consultation on this important matter. It was added that many residents in the Chepstow area travel to Lydney and District Hospital for minor injury services. It was suggested that the decision was revisited particularly in view of the changing needs of the population and the availability of public transport services.
It was confirmed that the Health Board is aware of the use of Lydney and District Hospital and that discussions are in progress with GPs in Monmouth and Chepstow about delivering minor injury care locally in primary care centres to improve access to services in these areas. Reference was also made to the difficulties in accessing a GP in Chepstow, noting that when GPs are nearing retirement, it is difficult to arrange replacements.
The Health Board representatives acknowledged and understand the concerns expressed regarding service changes and confirmed that engagement is a priority. It was explained that there are a number of choices in order to provide a more consolidated approach particularly in areas such as Monmouth and Chepstow. It was explained that bigger, integrated centres that deliver more services can use the workforce more effectively. It was explained that there are challenges to overcome in relation to elderly and mental health patients are availability, and also e.g. lack of availability of domiciliary care.
A Member queried how the example of Caldicot Greyhill Surgery, which provides a lot of services, fits into the strategy. It was explained that this is an example of a neighbourhood care network trialled by some GPs in the South Monmouthshire area.
It was added that the development of resource centres around GP practices was proposed moving away from the old model of self-employed/ GP owned surgeries.
A Member recalled a previous plan to bring services closer that did not proceed and conversely, some services were removed adding that the SCCC was planned in 2008. It was commented that there had been enough discussion and consultation, and that action was now required. In response, it was explained that the SCCC had been proposed in 2003 but only authorised by Welsh Government on 31 October 2016. Further, it was explained that without the SCCC, the plan to bring services closer is not deliverable citing insufficient capital investment in the Royal Gwent and Nevill Hall Hospitals from Welsh Government. It was commented that there is a £7 million annual budget for updates. It was confirmed that the Care Closer to Home Strategy could have been delivered earlier but the decision on the SCCC was awaited. Now that the decision is received, the strategy can be implemented.
It was confirmed that 48 beds for care of elderly and a mental health ward have been removed from Chepstow Hospital but that re-enablement services remain the same. It was commented, in response to a query, that there are 8 radiographer vacancies across the Health Board and attempts to recruit sonographers who can interpret images have proved difficult. It was confirmed that radiography equipment is still in place in Chepstow
It was confirmed that rumours that Ysbytty Aneurin Bevan is to close are incorrect. The facility will not close and will continue to provide minor injury services, 96 beds for rehabilitation and care of the elderly, and will be a support ward to free up acute beds for Nevill Hall Hospital for the winter months.
In terms of stroke and rehabilitation, it was explained that an integrated partnership model has been adopted with discharge liaison nurses to aid quicker re-ablement. Additionally, for fall patients, care workers looking after them at home will start the relationship in hospital and will continue at home. It was confirmed that strike and rehabilitation services will continue in Chepstow Hospital.
A Member queried why it takes so long to transfer x-ray results to the GP, especially as the images are digital. It was explained that an ultrasound/x ray has to be seen by a superviser who will look at the image in detail to interpret, noting that non-urgent, low priority images will take 2/3 weeks to return to the GP.
It was also questioned what is proposed regarding mental health services in the area noting that it can take over 6 months for a therapy referral, or for a patient to be seen, suggesting that it may be quicker to go to the voluntary sector or privately.
It was acknowledged that the Health Board has been poor at delivering primary mental health care. It was explained that it is a Welsh Government requirement that 80% of mental health patients should be seen in 28 days and therapy should be provided within a further 28 days. It was reported that a year ago only 30% of patients were being seen, or provided with therapy within the target times. This was due to underinvestment in therapies and reliance on the voluntary sector. The Health Board is building that service back up whilst managing the back log. Currently, 80% are seen within 28 days and 70% are provided with therapy.
It was reported that the wait for childrens’ mental health services has reduced from was 17/18 weeks to 16 weeks.
It was noted that there is a significant problem with patients who don’t attend appointments (20% -30%). To combat this, text and e mail reminders are being sent for some services. This approach will be deployed for mental health appointments.
In response to a query, it was confirmed that there was no significant issue with collection of debts, nor a high level of overseas patients.
A Member acknowledged that the Accident and Emergency Services in Nevill Hall Hospital and Royal Gwent Hospital are bottlenecks in the system, and queried if the closure of minor injuries units impacts on ambulance services. It was confirmed that there is a minor injuries unit in Ysbytty Aneurin Bevan and a wider facility at Ysbytty Ystrad Fawr and 2 Accident and Emergency facilities. It was added that numbers of patients being seen are stable and not increasing. The intention is to consolidate such services to a small number of sites and it was confirmed that most minor injuries are dealt with in Accident and Emergency. The view was expressed that it is major injuries causing the blockage in the system caused by the inability to move patients through and out of the system. It was added that there is a considerable admission of patients by GPs noting a 26% increase over the last two years.
It was confirmed that a trial at Nevill Hall for last 6-8 week, has taken place where GP referred patients are rapid triaged and moved on. It was commented that volumes of frail elderly for short or long term admission have seen a massive increase. The Committee was advised that minor injuries don’t always contribute to congestion in the system.
It was noted that the Health Board are looking to appoint 3 Physician Assistants which could relieve GP costs. It was suggested that a Sister led minor injury unit supported by a doctor on call released from local surgeries could be a useful solution.
The issue of additional demand for services from 500 plus houses being constructed in Chepstow and Severnside was raised.
Members of the Public in attendance at the meeting were satisfied that the pain points of their interest had been covered. They added some information about their personal experience that the people delivering services were great but that the system was not, citing in particular that staffing levels appeared to be very low.
The Health Board representatives were willing to return to discuss services further and were thanked for their attendance.