Hywel Dda health Board is pushing ahead with controversial service changes to maternity and paediatric care at Withybush Hospital, staff have been told this week.
The changes include moving to a 12 hours a day paediatric service at Withybush Hospital and a three-bed midwife-led maternity unit at the hospital.
The changes continue to cause concern.
One nurse who did not wish to be named contacted the Western Telegraph to say staff were told the changes would come in on August 1 and that they were fearful that Glangwili would not be ready to cope.
The employee said: “We worried that there is no clear-cut plan in place to support the move and in order to cope with the inevitable influx of young patients from Pembrokeshire.”
In a lengthy statement (see below), Hywel Dda Health Board said a staff consultation on the changes will run until May 22, and outlined new “service models” for Maternity and Obstetric Services, Gynaecology, Neonatal services and Paediatrics at Withybush Hospital.
A stand alone Midwife Led Unit for low risk deliveries will contain three beds staffed by a midwife and a health care support worker. During a birth, the mother’s community midwife will also attend to support the delivery. All GP and 999 obstetric referrals will go to Glangwili Hospital.
Withybush Hospital will continue to provide an Early pregnancy unit with increased hours to “reduce the number of patients being transferred to Glangwili”.
The neonatal unit (SCBU) at will close and the number of cots at Glangwili will increase by one.
Paediatrics services will only be provided for 12 hours per day at Withybush “because of ongoing and well documented recruitment problems”.
There will be a Paediatric Ambulatory Unit seven days a week, comprising of a short stay paediatric unit open every day and a paediatric diagnostic unit open Monday to Friday. Out of hours, ill children will be referred to Glangwili Hospital.
The Health Board’s statement also says there will be “robust transport” to support these service changes, and solutions to create “additional capacity” on the Glangwili site have commenced, with a completion date to support the service change in August.
This is the information sent out by Hywel Dda Health Board in full:
Staff consultation 1 to 22 May 2014 – Staff consultation with staff affected by the change Staff consultation briefing documents, in line with the Organisational Change Policy, will be issued to affected staff on Thursday 1 May 2014 following discussion and approval by the Maternity, Neonates, Paediatrics and Gynaecology Services Programme Board on Tuesday 29 April 2014.
Documents will be distributed using all available channels via email and recognising a significant number of affected staff have limited computer access hard copies will also be provided via line managers. We recognise that change can be difficult and the consultation documents will provide contacts for support from HR. Those staff affected by the change will also be offered one-to-one discussions as part of the process and in line with the Organisational Change Policy.
The staff consultation will run for three weeks, closing on 22 May 2014.
The Service Models At the April meeting of the Maternity, Neonates, Paediatrics and Gynaecology Programme Board the following service models were confirmed:
Maternity and Obstetric Services
• At Withybush Hospital a stand alone Midwifery Led Unit for low risk deliveries will contain three beds staffed by a midwife and a health care support worker. During a birth, the mother’s community midwife will also attend to support the delivery.
• To support the “safety net” requirements in line with Ministerial requirements there will be a band 7 midwife in the Midwifery Led Unit at Withybush Hospital at all times. In addition to support the ‘safety net’ there will be a supernumerary band 7 midwife at Glangwili Hospital to specifically coordinate women from Pembrokeshire who choose or need to deliver their baby at Glangwili Hospital.
• The Midwifery Led Unit will be run in line with All Wales Guidelines for Midwifery Led Care.
• Any deviation from the normal care pathway will be transferred to Glangwili Hospital in accordance with these guidelines.
• Withybush Hospital will continue to provide outpatient antenatal clinics and preoperative assessments.
• All GP and 999 obstetric referrals will go to Glangwili Hospital.
• At Glangwili Hospital the Midwifery Led Unit will contain four beds and the All Wales Midwifery Led Care guidelines will be used as criteria, pathway and transfer through the Normal Care Pathway.
• We are predicting that around 2280 births will take place within the obstetric unit at Glangwili Hospital. This is broken down as 1320 from existing consultant led births at Glangwili Hospital and an additional 960 consultant births from Withybush Hospital.
• It is estimated that a minimum of 20 per cent of the current births at Glangwili Hospital will choose to deliver in the Midwifery Led Unit and we initially estimate that 10 per cent of low risk women from Pembrokeshire will choose to travel and deliver at the MLU at Glangwili Hospital.
• We are planning for 10 per cent of the current Withybush births will choose to deliver at the MLU at Withybush and that this number will grow once confidence in the service grows.
• Withybush Hospital will provide:
o Early pregnancy unit
o Day case procedures o Elective surgery
o Patients requiring inpatient care will be admitted to the joint surgical and gynaecology ward as they do now
o In hours there will be a consultant gynaecologist in the hospital, out of hours there will be a consultant gynaecologist on call locally
• As an enhancement to the current service and to reduce the number of patients needing transfer to Glangwili and to reduce avoidable admissions the operational hours of the early pregnancy unit will increase. The hours have to be finalised but it is anticipated that the unit will be open from 9am to 7pm Monday to Friday.
• All 999 referrals in and out of hours will be triaged by ambulance staff, supported by A&E/on call Obs & Gynae consultant and referred to either Glangwili or Withybush Hospital as appropriate.
• A&E walk-ins will be referred in hours to the early pregnancy clinic for assessment. Out of hours patients will be referred to next day early pregnancy clinic or if they require inpatient admission they will either be admitted to Withybush or if appropriate transferred to Glangwili Hospital. For the very rare occasion that there is a collapsed patient requiring urgent surgery a decision will be made by A&E supported by the on call gynaecologist on whether it is safe to transfer the patient or to manage at Withybush Hospital Neonatal Services As previously agreed in the Minister’s decision and by the Board the neonatal unit (SCBU) at Withybush Hospital will close. Due to the medical staffing imperative described later on in this briefing this closure will take place in August 2014. Neonatal services for the university health board will be provided at Glangwili Hospital.
The neonatal unit at Glangwili Hospital will contain:
• Four high dependency cots
• Eight special care cots
• One stabilisation cot. This is an increase of one cot from current establishment. These cot numbers are supported by All Wales Neonatal Network from their capacity review.
• Paediatrics services can only be provided for 12 hours per day at Withybush Hospital because of ongoing and well documented recruitment problems. Recruitment issues remain severe and this has been confirmed by a recent all Wales survey of Paediatric recruitment.
• There will be a Paediatric Ambulatory Unit at Withybush Hospital seven days a week. This unit will comprise a short stay paediatric unit open everyday and a paediatric diagnostic unit open Monday to Friday. The operational hours of these services will be further discussed in the sub group but it is anticipated that the short stay unit will be open from 10am to 8pm for admissions and a further two hours to make decisions and transfer any children requiring transfer to the acute paediatric unit at Glangwili. The Diagnostic unit will be open 9am to 5pm.
• The Short Stay Assessment Unit (SSAU) will be staffed by consultants, middle grade doctors and paediatric nurses.
• GP and 999 referrals in hours may be triaged by SSAU staff or by ambulance supported by SSAU staff to either Glangwili Hospital or to the SSAU.
• GP and 999 referrals out of hours will be triaged by ambulance staff to either Glangwili Hospital or to Withybush Hospital’s A&E department if a minor injury
• Walk-ins at A&E at Withybush will continue to manage minor injuries and illnesses as before, in hours and out of hours. In hours unwell children will be referred to the SSAU and out of hours they will be referred to Glangwili Hospital. Patients requiring surgical assessment will be triaged by SSAU according to agreed patient pathways. Those requiring surgery will be transferred to Glangwili Hospital.
• Further work is being carried out to work out detailed pathways including ambulance resuscitation for collapsed patients and transfer.
• There will be robust transport to support these service changes. A range of options are being discussed with WAST who are part of the Programme Board and both Sub Groups.
• WAST staff will be an integral part of the new service models and will be fully trained to support the new service • Wherever appropriate WAST and UHB staff will receive joint training to fully emphasise the team approach to service delivery.
• The estates solutions to create additional capacity on the Glangwili site have commenced, with a completion date to support the service change in August. This plan is currently running to time.
• Work will also be undertaken at Withybush to create a purpose designed MLU.
Key dates and next steps
• August 2014 - Paediatric medical recruitment issues remain severe. This is well documented and has been confirmed by a recent all Wales survey of Paediatric recruitment. In addition, all paediatric training doctors must work on one site out of hours and in a 1:11 rota from 1 August 2014. This is on instruction by the body responsible for post graduate medical training, the Wales Deanery. As a result, we cannot safely staff paediatrics and neonatal services at Withybush Hospital and also from August we are losing three obstetric training doctors. Therefore all of our planning is to implement the new service models from August 2014.
• Policies and protocols are being developed by the sub groups to support the new models. These include the protocols for transfer in collaboration with WAST colleagues.
• A training needs analysis is being developed and a training programme established.
• As stated above the staff consultation briefing document is being sent to all staff affected by these changes on 1st May.
• The equality impact of these changes is on-going.
• The Programme Board and both sub groups continue to meet monthly.