What Major Changes Is the Health Board Making That Patients Are Worried About?

The Hywel Dda health board has recently approved significant changes to its services, notably reducing the number of specialist stroke units from four to one, a decision that has sparked concern among patients and community members. The board asserts that these changes aim to strengthen vulnerable services and ensure their sustainability, rather than saving money. As the health board moves forward with these proposals, many are left questioning the implications for patient care and access to vital services.

Last updated: 24 October 2023 (BST)

What’s happening now

The Hywel Dda health board has made the controversial decision to reduce its specialist stroke units from four to a single unit located at Glangwili Hospital in Carmarthen. This decision comes amidst broader changes affecting nine clinical services, including the cessation of emergency general surgery at Withybush Hospital and the reclassification of Llanelli's intensive care unit to an enhanced care unit. While the health board insists these changes are not financially motivated, many patients and community members express concerns about the impact on care quality and accessibility.

Key takeaways

The number of specialist stroke units will drop from four to one, located at Glangwili Hospital.
Emergency general surgery will be discontinued at Withybush Hospital, with same-day emergency care being enhanced instead.
Llanelli's intensive care unit will transition to an enhanced care unit, limiting the level of critical care provided.
Concerns have been raised about patient access and the rationale behind centralising services.
The changes are positioned as necessary for creating sustainable health services amid staffing and resource challenges.

Timeline: how we got here

The path to these significant changes began with a public consultation in summer 2023, where various options for the future of nine clinical services were presented. Following this, a two-day meeting in Carmarthen resulted in the board's decisions on 23 October 2023. Key milestones include:

Summer 2023: Public consultation on the future of nine clinical services.
October 2023: Health board meeting approving changes, including the reduction of stroke units.

What’s new vs what’s known

New today/this week

The most significant development is the reduction of stroke units from four to one. This decision has generated substantial public outcry, with many questioning the logic of centralising such a critical service. Additionally, the health board has decided to stop emergency general surgery at Withybush Hospital, which will now focus on enhanced same-day emergency care.

What was already established

Prior to these decisions, there was ongoing concern regarding the viability of various health services within the Hywel Dda area. The need for a review of services was highlighted due to staffing issues and the fragility of current operations. The health board had previously communicated the necessity for changes to ensure sustainable healthcare delivery, reflecting trends seen across the UK.

Impact for the UK

Consumers and households

The changes are likely to have a direct impact on patient access to critical care services. Patients requiring stroke treatment will need to travel further to reach the single remaining stroke unit, potentially affecting timely care. Concerns about ambulance availability and transportation times have been raised, especially for those living in more remote areas. The shift in services could place additional pressure on families who may need to travel lengthy distances for care.

Businesses and jobs

For healthcare staff, the centralisation of services could lead to shifts in staffing needs across the health board. While some positions may become redundant, there may also be opportunities for increased roles at the centralised unit. However, the ongoing challenges of staffing shortages in the NHS mean that recruitment and retention will remain critical issues moving forward.

Policy and regulation

The Hywel Dda health board operates under the scrutiny of both national and local governance structures. Upcoming consultations and regulatory reviews will be essential to assess how these changes are implemented and their effectiveness in improving patient care. The health board's commitment to sustainability will be further tested as public trust remains fragile.

Numbers that matter

4: The number of stroke units currently operating in the Hywel Dda area, which will reduce to 1.
9: Total number of clinical services affected by the recent health board decisions.
2: Hours of travel cited by community members for reaching the new stroke unit from certain areas.
4000+: Number of respondents who contributed to the public consultation.
3: Hospitals that will maintain intensive care units post-changes (Aberystwyth, Carmarthen, Haverfordwest).

Definitions and jargon buster

Stroke Unit: A specialised medical facility that provides comprehensive care for patients who have suffered a stroke.
Enhanced Care Unit: A unit designed to care for stable patients requiring less intensive monitoring and treatment than those in an ICU.
Public Consultation: A process by which the public is invited to give feedback on proposed changes to services.
Critical Care: Medical care for patients whose conditions are life-threatening and who require comprehensive monitoring and intervention.

How to think about the next steps

Near term (0–4 weeks)

In the immediate future, patients are advised to continue accessing services as usual. The health board will likely initiate further public communication efforts to clarify the changes and address concerns.

Medium term (1–6 months)

As the changes are phased in, the health board will monitor the impact on patient care and access. Ongoing feedback from patients and healthcare professionals will be crucial in assessing the effectiveness of the new service configurations.

Signals to watch

Patient feedback on access to stroke services following the centralisation.
Changes in ambulance response times and transport logistics for patients needing critical care.
Staffing levels and recruitment efforts at the newly centralised stroke unit.

Practical guidance

Do

Stay informed about the changes and how they may affect your access to services.
Engage with local health boards to voice your concerns and experiences.
Consider alternative transport options for accessing distant services, especially for emergency care.

Don’t

Don’t hesitate to seek clarification from healthcare providers about how changes will impact your care.
Don’t ignore signs of stroke or critical health issues; timely access to care remains vital.
Don’t assume services will remain the same; stay updated on developments from the health board.

Checklist

Are you aware of where the new stroke unit will be located?
Do you know how to access emergency transport if needed?
Have you discussed any concerns with your healthcare provider?
Are you keeping track of updates from the health board regarding service changes?
Do you have a contingency plan for accessing healthcare services in case of emergencies?

Risks, caveats, and uncertainties

There are several uncertainties surrounding the proposed changes, including how effectively the health board will be able to implement them without compromising patient care. The transition to a single stroke unit could lead to delays in treatment for some patients, particularly those in more remote areas. Furthermore, the health board must address the fragile public trust in their decision-making processes and ensure that patient safety remains a priority.

Bottom line

The recent decisions made by the Hywel Dda health board reflect broader challenges faced by the NHS in the UK, including resource limitations and the need for sustainable service delivery. While the changes aim to strengthen health services, many patients and community members remain concerned about access and quality of care. It will be crucial for the health board to communicate transparently and effectively as these changes take shape.

FAQs

What are the main changes to stroke services in Hywel Dda?

The main change is the reduction of stroke units from four to one, which will be located at Glangwili Hospital in Carmarthen, with a treat and transfer service available at other locations.

Why is Hywel Dda health board making these changes?

The health board states that the changes aim to strengthen vulnerable services and ensure their sustainability, rather than being driven by cost-cutting measures.

How will these changes affect patients?

Patients may experience longer travel times to access stroke care and other services, raising concerns about timely access to critical treatment.