HEALTH BOSS’ ‘REAL SAFETY CONCERNS’
THE Royal Glamorgan Hospital’s A&E department is unsustainable in its current state due to a desperate shortage of consultants, a health chief has warned.
Dr Nick Lyons, Cwm Taf Morgannwg University Health Board’s new medical director, admitted there are now “real safety concerns” which cannot be ignored at the emergency unit.
A severe lack of doctors led to the Llantrisant-based hospital diverting ambulances to other A&E departments on Christmas Day and Boxing Day last year.
It is understood that its one remaining permanent consultant will be leaving at the end of March, meaning the department will be run entirely by locums from April onwards.
The health board has now unveiled two preferred options for the future of the hospital, one of which is to scrap A&E entirely and turn it into a 24-hour minor injuries unit (MIU).
The other is to retain A&E, but only run it during the day, for example from 8am to 8pm, and then revert to a nurse-led MIU service at night.
Dr Lyons, a qualified GP who worked as medical director in East Anglia, Weston-super-Mare and the Channel Islands before being appointed by Cwm Taf in October 2019, said maintaining the status quo was not an option.
“I absolutely hear the frustrations of people. You only have to look on social media to see some of the concerns,” said Dr Lyons, speaking from the hospital yesterday.
“All I would say is that no decision has been made yet, and this is just the start of the conversation with our local population to understand how we can ensure there are sustainable, safe services. Is it right for us to pretend that everything is going to be okay, but continue to provide a service that has real safety concerns about it going forward? That is not the right thing to do.”
Dr Lyons admitted that ever since the South Wales Programme model was first introduced in 2014 there has been a real struggle to convince consultants to work in the Royal Glamorgan’s A&E department due to the uncertainty around its future.
“A decision was made [through the South Wales Programme] that the Royal Glamorgan would have a nurse-led minor injuries unit instead of having a consultant-led emergency department,” he said.
“Now that has been the case for the past six years, but we haven’t enacted it, and that has made it really difficult to attract doctors to work in the department because it wasn’t clear what the future was.
“It’s not right that such indecision lies over this site.”
He said he had “huge admiration” for staff currently working at the emergency unit during such difficult and challenging times.
“However, in real life it means that doctors only come here for very short periods of time – sometimes for single shifts – and that makes it a lot harder to give continuity of care, because teamwork in an area like an emergency department is really important,” he added. “We are maintaining staffing levels but with very short-term doctor shifts, which doesn’t give the quality of care that for me, as medical director, I think we should be giving our patients.”
He confirmed that the Royal Glamorgan A&E department currently has three consultants – one permanent and two locums – with some others being brought in occasionally on a shift-by-shift basis.
“But since 2014 consultant bodies have gradually been eroded as people have retired or taken on other opportunities,” he admitted.
Dr Lyons said that while locums are more expensive, money was not the motivating factor behind the proposals being outlined by the health board.
“Yes, locums are more expensive but that’s missing the point of this completely,” he said. “What we are also doing is working across the health board to see how our emergency department consultants in Merthyr (Prince Charles) and Bridgend (Princess of Wales) can effectively support us here as well.
“But all three departments are short-staffed. We should have between 35 and 45 consultants and we actually have across the whole health board just over 12. Once the future of the emergency department here is absolutely clear and we have worked out how many consultants we need across our health board, I think we can improve recuitment.
“If fact, only two weeks ago we recruited two more emergency department (ED) consultants to the health board. Although primarily working in Princess of Wales, that team will be able to support here more effectively.”
Dr Lyons, who trained to become a doctor in Wales, stressed that the issue of consultant vacancies is a UKwide issue.
“We know there are over 1,000 vacancies across the UK. ED consultants are highly-trained people who take a long time to train, so it’s going to be a very long time before we are able, as a country, to be able to catch up. I think ED departments have always been very challenging environments, but there are a group of doctors who absolutely love that.
“But we are also short of doctors in paediatrics and obstetrics and gynaecology, so if you are a young doctor deciding where your career is going to go, there are a large number of choices at the moment.
“But doing shift work and working nights, in challenging circumstances, will put some doctors off.”
One of the biggest public concerns is that people living in more remote areas of the Rhondda will take an excessive amount of time reaching A&E if the Royal Glamorgan A&E were to shut completely.
“We need to ensure that when something goes wrong, when they are feeling scared or ill, that they can access care. Will that be in exactly the same way as we offer it now? No, because we know that’s not sustainable,” said Dr Lyons. “But at the heart of our plans we will be making sure that there is the right and safe access for patients. We have a number of meetings planned over the next few weeks to really understand what the challenges are and how we can most effectively do it.
“And part of our planning is to see what other services we can put in to ensure that people do have the appropriate access to GPs and primary care teams. We need to look at our community hospitals to make sure that the MIUs there can respond to the demand people have.
“Not everyone needs to come down to the Royal Glamorgan when many of the issues could be effectively treated closer to home.”
Dr Lyons also stressed that despite consultant shortages, keeping the A&E open during the day between 8am and 8pm was not a “pie-in-thesky” idea.
“There are other units around the UK where that has been done successfully,” he said.
“There are a group of doctors who love working in an emergency department but wouldn’t necessarily want to be on call at night, and therefore it could be quite attractive.
“Also, if we rotate through our three emergency departments in our health board, it looks a lot more possible that we can do that and really ensure there’s high-quality staff here for the hours that the department remains delivering that traditional ED service.”
The are additional worries that the downgrade of A&E will also affect response times of the Welsh Ambulance Service, as vehicles many have to travel further to hand over patients to hospitals.
Crews were ordered to take their seriously ill and injured patients to neighbouring hospitals on Christmas Day and Boxing Day when the Royal Glamorgan could not staff its emergency department.
Dr Lyons, who said he was told this was the first time such a call had ever been made, added: “We are very grateful to our ambulance service colleagues for supporting us on those two nights, and part of our planning is working with our partners – and vital to that is the role of the ambulance service.”
While consultant-led services, such as maternity, have already been stripped from the hospital, Dr Lyons said its future remains secure through introducing other services.
“While we have been dwelling on the challenges coming out of the South Wales Programme, as a result of it a new inpatient medical facility was built, a diagnostic hub where patients have faster access to scans has already taken place. So is the Royal Glamorgan secure in its future? Absolutely.”
Assembly Member for Pontypridd Mick Antoniw has called on the Welsh Government to urgently intervene to prevent the downgrading or removal of A&E services at the Royal Glamorgan.
Assembly Member for Rhondda Leanne Wood has proposed that the hospital could be established as an “A&E Centre of Research” to safeguard its future, making the department a more attractive place for consultants looking to build up experience and carry on learning throughout their career.
A board meeting to discuss the proposals is taking place today at Ynysmeurig House, Abercynon, from 10.30am.