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

2. 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

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

4. 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

5. 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”

6. 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

7. 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)

8. Where are these services currently provided?

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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?

22. 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

23. How can you find out more?
Go to our website at
You’ll find all the information, event
schedule and feedback details you’ll need
Or us at
You can also contact our local CHC at:

24. Thanks for your attention
Any Questions?