Matching the Best in the World The South Wales Programme Dr Catherine Norton, Clinical Director for Child Health Cardiff & Vale UHB

What is the South Wales Programme? The South Wales Programme brings together the five health boards in South Wales, including Cardiff and Vale The aim of the programme is to look at how best in the future to deliver a small number of important, specialist services, which face issues that individual LHBs cannot solve alone

Which services are being discussed? Obstetrics Neonatal care Paediatrics Accident and emergency Major trauma

So what do we need to do? We need to think about: How we can provide the “routine” elements of these services locally Whether we should centralise the specialist element of these services at fewer sites

What are the main issues these services face? Difficulty in providing the highest quality care and meeting standards, 24/7, because of our clinical expertise being spread too thinly across too many hospital sites Difficulty in providing trainee doctors and specialists with the right number of patients to give them the right experience to develop their skills UK-wide medical recruitment difficulties, which are the result of a national shortage of doctors training in these specialties Resourcing that is not fit for the long-term and which we have to address A lack of focus on “time to specialist care” as opposed to “time to any hospital”

What’s happening at the moment? We want to make sure everyone understands the problem And then help us come up with the solution This process is called “engagement” There are no firm options at this stage and no concrete decisions to make, so it’s a good time to get involved in the debate

What do our doctors and other clinical staff think? More than 300 doctors and other clinical staff have helped drive the thinking so far They believe that the current pattern of service delivery can’t continue Clinicians have told us that we need to think about basing the specialist element of these services at 4/5 hospitals, or 2/3 in the case of services for babies born very early (neonatal care)

Where are these services currently provided?

Obstetrics: what are the issues? Some women need an obstetrician to be present during labour Not all the obstetric units in South Wales comply with expert standards It’s important that obstetric units are supported by a 24/7 paediatric service on the same hospital site

Obstetrics: clinical advice so far Antenatal and community midwifery services should continue as they are Women should still have the choice of a home birth or a birth at a midwifery-led unit, as now Consultant-delivered obstetric care should be concentrated on four or five hospital sites

Neonatal care: what are the issues? There should be separate staffing rotas for neonatal care. This isn’t the case everywhere Care should be provided by doctors with specialist training in neonatology. Again, this doesn’t happen everywhere

Neonatal care: clinical advice so far To achieve separate rotas for neonatal care, we need to centralise services High dependency neonatal care should be concentrated on four or five hospital sites, providing those sites also have obstetric and paediatric services Intensive neonatal care should be concentrated on only two or three of those sites

Paediatrics: what are the issues? Sick and injured children should be assessed within four hours by a doctor with specialist training Children admitted to hospital overnight should be seen once every 24 hours by a consultant or someone with equivalent specialist training Specialist training for paediatricians should be based in hospitals seeing at least 4,000 attendances a year Not all of these things currently happen consistently everywhere

Paediatrics: clinical advice so far Most children can continue to be cared for safely and well by local paediatric services For the small number of children who need to be admitted to a hospital, inpatient services should be concentrated on four or five hospital sites Very specialist children’s services and intensive care should stay at UHW, as is the case now

A&E and Trauma: what are the issues? Doctors trained & experienced in emergency medicine should be available 24/7. This is not the case everywhere A&E depts should have 24-hour access to diagnostic facilities, like x-ray, ultrasound and CT scanning. Again, this isn’t always the case Doctors training in emergency medicine are at a premium because of a UK-wide shortage. Wales in no exception We currently don’t have a formal trauma centre (s) in South Wales

A&E and Trauma: clinical advice so far We should consider developing a trauma centre. If so, that could be at one site (UHW or Morriston) or split over both Consultant-delivered A&E services should be centralised at four or five hospital sites We should continue to provide local emergency services at all existing sites that have an A&E department, but we need to think differently about how those services are provided

What does all this mean in reality? Most (90%+) hospital-based services will continue to be delivered locally Community services will continue to be developed, to bring care even closer to home For these important specialist services, we need to consider whether the pattern of services across South Wales should change

What’s the impact for Cardiff and Vale? We are already a major specialist centre The services concerned will continue to be provided at Cardiff and Vale But services could change in neighbouring health board areas (mainly Cwm Taf and Abertawe Bro Morgannwg) that could impact on Cardiff and Vale We need to recognise that not everything can be provided on the UHW site

What are we doing now? Looking at the possible scenarios of where services might be based and assessing what each scenario could mean for Cardiff and Vale and the services we provide, should the pattern of services change in surrounding health board areas

And . . . Listening to what our staff, patients and residents think about the issues we’ve outlined and the clinical advice we’ve had so far We’re not making decisions We’re trying to establish whether, on the basis of what we know, we agree that change is needed

What have been people saying so far? Generally, people recognise the need for change Need to consider impact carefully Access to services and transport (medical and public) is critical Will these changes resolve the issues completely? To what extent is finance an issue?

What do you think? Engagement phase runs until December 19, 2012 We will review your feedback, as a UHB and on a regional basis Based on what we’ve heard from everyone, we’ll draw up options for formal public consultation This is scheduled to start early next year

How can you find out more? Go to our website at www.cardiffandvaleuhb.wales.nhs.uk/swp You’ll find all the information, event schedule and feedback details you’ll need Or email us at southwales.programme.cav@wales.nhs.uk You can also contact our local CHC at: tfh@cavogchc.org.uk

Thanks for your attention Any Questions?