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00:00 Then Iíll ask Deleth Jewell to introduce her short debate.
00:03 Deleth Jewell (Deleth Jewell MP): Thank you.
00:07 Iíve agreed to give a minute of my time to my fellow Member, Peredr Owen-Griffiths.
00:14 We all know that the National Health Service has a special place in our hearts, but perhaps
00:20 that is even more true in south-east Wales, which is the birthplace of the National Health
00:27 Service.
00:28 The hospitals led the way with the health service that was based there as health provision
00:32 in Tredegar, which was a model for these isles.
00:36 I think that my remarks today on how we can get to hospitals in the south-east and our
00:41 ability to access care when we arriveóIíd say at the start how much I value the dedication
00:48 of hard-working front-line staff who make the NHS the jewel that it is in spite of the
00:54 challenges that they face.
00:55 You are heroes in our midst.
00:58 Those challenges do exist, of course.
01:00 In this short debate, Iíll give up most of my time to quoting direct words of othersópatients
01:06 and people working in the NHS.
01:08 Firstly, Iíd like to relay the experience earlier this year that one of my constituents,
01:14 Hugh Evans, had when he tried to access emergency care.
01:17 Iím quoting Dr Evansís words.
01:20 ëI underwent a procedure at Llanddoch Hospital.
01:23 I was referred to them because of it needing their expertise.
01:26 It was a complex procedure.
01:28 That all went well.
01:29 I was home the same day.
01:30 Everything was great until it wasnít.
01:33 At about 9 oíclock Sunday 5 March, I suffered a large and continuing haemorrhage with no
01:38 warning signs.
01:39 My wife called for an ambulance and was told the wait would be three hours.
01:44 As my wife pointed out to the operator, I would be dead by the time an ambulance arrived.
01:49 We had no choice other than for my wife to get me from home to the Grange in her car,
01:55 which she did rather well.
01:57 Now, the hospital was great.
01:58 One stabilised because I had been collapsing, loss of blood, in shock, but once stabilised,
02:03 the bleeding stopped, vital signs improved, and it was then a matter of observing me until
02:08 the risk of a further bleed rescinded.
02:11 My constituent goes on to make the following points.
02:13 The ambulance service strategy relies upon their paramedics getting to people quickly
02:18 to stabilise them, which they cannot do, it seems.
02:23 The current situation places the emphasis on people getting themselves to A&E with whatever
02:27 condition theyíre suffering from, and assumes theyíre able to arrange and cope with it
02:31 all.
02:32 The ambulance service has lost control over managing its emergency response, so the rationale
02:38 of ambulances and quick-response paramedics getting to people quickly, maybe obviating
02:43 the need for people to turn up at A&E, has collapsed with people racing around the area
02:47 in their own cars, conveying patients who should be in a blue-light vehicle.
02:51 I was lucky.
02:53 People must be dying because they cannot access the appropriate emergency healthcare.
02:58 I wanted Adil Baloa to quote many of his words in full because of how powerful that testimony
03:03 is, and I know from talking to this constituent, this is a constituent who is a huge supporter
03:09 of the NHS.
03:10 He wants the NHS to succeed.
03:14 I would ask the Minister, when the Minister is responding to the short debate, what assurances
03:19 could be given to my constituent about the state of the health service in the south-east.
03:24 To move on to another area, my colleague, Preridr, and I, and other Members, have highlighted
03:29 in the past the difficulty of getting to hospitals, as well as to routine hospital appointments.
03:36 Iíd ask again if the Minister could respond to what consideration the Welsh Government
03:39 gives to ensure subsidised public transport to hospitals.
03:44 I would quote directly a consultant from Merthyr, who is quoted in the BMA Cymru Pressures portal,
03:51 and I quote, ëThe dangerously low staffing levels, poor working conditions, underpaid
03:57 overworked staff, lack of beds, lack of resources are all, only but a few reasons why the patientís
04:05 access to secondary healthcare is severely compromised.
04:08 To further complicate matters, the centralisation of certain services has made access to certain
04:13 specialties even worse, and as many would describe, is a matter of postcode lottery.
04:19 Furthermore, the insistence of the leaders and employers that a hospital like Prince
04:23 Charles, where there is a huge amount of renovation and modernisation work taking place, with
04:28 contractors all over the place, remains a hot site.
04:30 It is a disgrace, and I have to say that doctors do feel extremely frustrated all the time
04:35 now because of the current situation theyíre finding themselves in.
04:39 They go on to say, ëI am extremely sorry if they feel that my feedback is negative,
04:44 but Iím honestly trying to do all that I can to help alert those who can help fix the
04:52 problem to do something about it before it is too late.í I see doctors thinking about
04:57 it in the process of finding other places of work, which is quite often in other countries.
05:03 I would pick up on the point about centralisation of services and the closure of many community
05:10 hospitals, and the effect thatís had on a lack of step-down provision to many of our
05:16 communities.
05:17 Iíd highlight the example of the Rumley Valley.
05:20 I was born in the Caerphilly Miners Hospital, and when Caerphilly Miners was closed, the
05:26 community was assured that there would be a replacement general hospital.
05:31 Then some years went by, and then without any real explanationóand as far as I have
05:35 been able to ascertain, there hasnít really been a public, full explanation of thisóthat
05:41 that plan was downgraded, and Ysbyty Astrudfawr has become a minor injuries hospital.
05:47 Now, again, as I would say with Prince Charles, as I would say with the Grange, the staff
05:52 who work in these hospitals are fantastic.
05:55 They are so dedicated, and the care that people receive is wonderful, but in order to get
06:03 to those appointments, in order to get to those hospitals, people have to travel across
06:08 different valleys.
06:11 Last year, I had been contacted by one constituent who lived in Abergavenny, who was having to
06:15 go toófrom memory, and they did give their permission for me to quote them, but I think
06:22 from memory it was for a breast clinic appointment, which was in Ysbyty Astrudfawr.
06:28 I at the same time, or around the same time, had been contacted by a constituent living
06:31 in Caerphilly who had to go to Neville Hall Hospital for something else, and so they would
06:37 have been crossing one another on the different roads in the valleys.
06:43 Now, if people donít have access to a car, which is more prevalent, of course, in communities
06:49 like the valleys, then itís even more difficult, and so I really would welcome the Ministerís
06:53 comments on what could be done with public transport more, because that is an ongoing
06:56 issue with access to the Grange.
06:59 But this situation locally, to me, has meant that in the Rhymney Valley there isnít an
07:04 A&E.
07:05 But when people do get to an A&E, the situation is also far from being ideal.
07:10 The Royal College of Emergency Medicine analysis has found that an Arranbevan University health
07:14 board is the worst performing for four-hour waits of any health board, with less than
07:19 half of patients waiting less than four hours.
07:23 I think it was 49.6% in September, which is a significant decrease from pre-pandemic September
07:30 2019.
07:31 The figure was 66%, and September 2015 was 85.8%.
07:35 Iím just quoting that 2015 to 2019 decrease to show that this isnít simply due to COVID,
07:40 though I know that that is going to be part of the factor.
07:43 Now, the figures for bed occupancy for the whole of Wales is around 95%.
07:47 Now, that is far from ideal, but in an Arranbevan University health board they were on average
07:52 at 98% occupancy for the first six months of this year.
07:55 There is just so little space for anything to go wrong.
08:01 With a lack of acute beds and staff in hospitals, that leads to high hospital occupancy, excessively
08:06 long waits for access to hospital care.
08:08 And Iíd ask what steps the Government would take, or can take, to address this issue,
08:14 to tackle it and to improve patient flow through hospitals through this winter and beyond.
08:20 Last month, the Royal College of Nursing published ëPromoting Efficiency and Saving Money in
08:25 Health and Social Care in Walesí, and in that there were some interesting points raised
08:29 on issues like prescribing, technology, but one thing they say is that workforce investment
08:35 should be the Welsh Governmentís first priority to address efficiency.
08:38 So, in closing, Iíd ask, when the Minister responds, if she could set out, please, what
08:44 action the Welsh Government will take to address the chronic understaffing of hospitals and
08:50 in the wider Welsh NHS, and what could be done to incentivise doctors, nurses and other
08:55 staff to train and stay working within our NHS.
08:58 Now, Dirprwy Lywydd, we are so proud of our NHS in Wales.
09:02 That remains particularly true in the Valleys, but too many patients feel worried that when
09:07 they are unwell, they may not be able to be assured that the ambulance will get to them
09:13 in time, they may have to wait an excessive amount of time for treatment and they may
09:18 be expected to travel too far to get to that help.
09:22 So, we all want our NHS to succeed, and Iíd ask what actions can be taken, please, to
09:28 change this situation.
09:29 Diolch yn fawr.
09:30 Y Llywydd / The Llywydd: Arweinydd y Prif Weinidog, Rhun ap Iorwerth.
09:33 Rhun ap Iorwerth AM: Thank you, and thank you to Dylaith for giving me an opportunity
09:37 to contribute to this debate.
09:38 I work very closely with her on these issues, and Iím aware of some of the situations that
09:45 she has mentioned this afternoon.
09:47 The introduction of some extra bus services when the Grange opened is still causing problems
09:54 for many people from all over the region to get there using public transport.
10:00 The issue was highlighted by Plaid Cymru councillors Charlotte Bishop and Steve Skivens when they
10:06 attempted to get to the hospital from Abertridwr by public transport.
10:10 It took them two hours, two buses and £9.10 each to get from Abertridwr to the Grange.
10:19 This is one example.
10:21 I have family members currently in hospital, and they moved from the Grange to Ystraddaur.
10:33 The care is excellent, but family are having to travel and not be able to use public transport.
10:40 Luckily, theyíve got cars and are able to go and visit, and one member of the family
10:47 is in there probably long term now.
10:51 It means that theyíre travelling on a daily basis, but they luckily have a car to do that.
10:56 Another family member fairly recently wanted to use public transport to get to Griffith
11:00 Town Hospital from Caerphilly for an out-patients appointment.
11:08 It was virtually impossible to get there in the time required.
11:11 So, itís these things that are real-life examples of issues of using public transport
11:18 to get to our hospitals and that link-up between services.
11:24 So, what Iíd like to understand is what the Welsh Government can do to try and work through
11:30 some of this.
11:31 Is it helping to support volunteers and volunteering car-share schemes, which I know people who
11:39 do volunteer their time to be able to do that, or is it getting better bus services, better
11:44 train services, linking up some of this stuff?
11:47 But, yes, so if you could comment on what could be done and what solutions we could
11:55 come up with to support our communities, but also our staff in our hospitals, who, again,
12:06 all have to possibly drive there because they canít get to shifts on time on buses and
12:11 trains.
12:12 Diolch yn fawr.
12:13 Y Llywydd / The Llywydd: I call on the Minister for Health and Social Services to reply to
12:18 the debate.
12:19 Eluned Morgan.
12:20 Eluned Morgan AM: Diolch yn fawr, Llywydd.
12:22 I welcome the opportunity to talk about access to hospital care in south-east Wales.
12:27 The Welsh Government remains committed to ensuring patients are able to access safe
12:31 and high-quality health and care services as close to home as possible.
12:36 Health boards across Wales, not just in south-east Wales, are working extremely hard, as you
12:42 have pointed out, in very challenging circumstances, in planning and delivering their services
12:47 in line with the needs of the local population.
12:50 Now, youíll be aware that the Ynnir Ymbefyn University Local Health Board has implemented
12:54 its clinical futures strategy, and work continues to deliver their ambitions for patients.
13:01 The opening of the Grange University Hospital as part of a new network of hospitals was
13:07 a fundamental milestone in the delivery of that strategy, and that's been essential
13:12 as they look to achieve greater stability for their services and for their workforce.
13:18 Essential also to deliver improved services and an enhanced quality of care, the more
13:24 effective use of estate and wider systems opportunities.
13:29 Now, what you all know is that there has been a massive increase in demandóa massive increase
13:37 in demand.
13:38 The ageing population is putting pressure on the NHS like we've never seen before.
13:43 We have a sicker population, so, despite the fact that we've got more doctors than ever,
13:49 more nurses than ever, more allied healthcare professionals than ever, it's not meeting
13:54 the demand.
13:55 That is very difficult, particularly when you've got some of the kinds of financial
13:59 challenges that we're faced with today.
14:01 So, I'm sureóI know you understand that, but I think there does need to be an understanding.
14:06 It's not a lack of effort here; we're putting huge efforts in.
14:09 There's massive new investment in these services.
14:14 There are significantly more beds per head of population in Wales than there are in England,
14:20 for example.
14:22 You talked aboutóyou asked about workforce.
14:24 Well, you know, we spend a quarter of a billion pounds a year investing in the future workforce.
14:31 VolunteeringóI'll come on to transport in a bit, but I think, and I recognise, that
14:39 that is an issue for some people.
14:42 Now, as you expect, the health board continues in and out of Bevan to reflect on the impact
14:48 of the changes that have been made with the opening of the Grange, and has already identified
14:53 a number of benefits as a result of that.
14:55 So, we've got a more resilient and flexible critical care service.
14:59 I think that's important.
15:01 We've got to understand, you know, you do need to focus and concentrate specialists
15:06 in one area, which is simply partly because there's a workforce challenge.
15:12 You know, we know there are going to be 10 million shortfall in terms of health workers
15:17 across the world by 2030.
15:19 This is not going away any time soon, and it's not a Welsh-only issue.
15:24 This is an issue that lots and lots of countries are confronting.
15:27 So, we do have to try and make the system that we have more resilient.
15:32 We've got more sustainable services for women and children, more resilient specialist acute
15:36 services.
15:37 We've got additional emergency department and recess capacity.
15:41 Now, it might not feel like that, but that's because the demand's increased, but we have
15:46 put in additional capacity.
15:48 We've got increased diagnostic capacity.
15:52 We have improved recruitment.
15:54 I remember when the Grange first opened, there were real issues around the workforce.
15:59 Now, all of that's been sorted out, so there are significant improvements that I think
16:07 have happened.
16:08 Our ability, of course, at the same time as trying to deal with emergency care, to deal
16:15 with planned care and effective elective care, that's also a challenge that we're trying
16:22 to face.
16:23 That's very difficult.
16:24 So, in lots of areas, you can separate that.
16:29 In places like Aneirin Bevan, it's a lot more difficult because of the way the population
16:35 is spread around.
16:38 I think that there have been huge efforts by Aneirin Bevan University Health Board and
16:43 its staff.
16:44 I recognise that further improvements are required to deliver the kind of sustainable
16:49 services that we want to see.
16:52 I know that the performance against emergency measures is not where we nor the board want
16:57 it to be, but we've got the six goals for urgent and emergency care to improve access
17:04 for people so they get the right care at the right place the first time.
17:08 So, there's a huge amount of investment gone into that—£25 million per year.
17:12 Six million of that has gone directly into Aneirin Bevan.
17:16 We've got the 111 service.
17:17 We've got the 111 Press 2 service.
17:20 All of that is deflecting people away.
17:23 We also, of course, have the new urgent primary care centres—one's at the Royal Gwent,
17:30 one's at Neville Hall, one at Sputney-stradvaud.
17:33 So 1,400 patients a month that would have gone to emergency care now don't go there.
17:38 So, these are additional things that we've put in place to deflect people away from those
17:44 pressure points that we know exist.
17:47 We are exploring how we maximise the use of resources, and some of you will be aware that
17:54 there's currently a public engagement exercise going on on the use of minor injuries units
18:01 in that particular health board, Neville Hall, and the suggestion is that it reduces its
18:09 hours from 24 hours a day to 18 hours a day.
18:13 That's because, actually, on average, there's only one patient there between 1 am and 7
18:18 am, and the community is very upset about it.
18:21 But we've also got to think about efficiencies and how we get the maximum amount for the
18:27 amount of money that we're investing.
18:28 So, very, very difficult decisions that we're trying to make.
18:32 The same thing with the minor injuries unit at Sputney-stradvaud.
18:37 So, for similar reasons, the temporary arrangements they're suggesting should be made permanent.
18:43 - If we are on that one, you've quoted the Abercovenny Hospital at Neville Hall.
18:50 What were the figures around the overnight staying at Stradvaud?
18:56 Because you've often talked about the one person in the evening in Neville Hall.
19:01 What was the similar figure in Stradvaud?
19:04 - Well, I'll have to get back to you on that, but obviously, that has been reduced for a
19:09 time.
19:10 So, at the moment, obviously, there are no figures, but we can look back at what the
19:14 figures were.
19:15 But, you know, the other thing we've got to remember, of course, is that very often centralization
19:21 gives better clinical outcomes.
19:24 Safety's got to be the number one priority for us.
19:27 That has got to be the guiding principle for us.
19:31 And of course, we all want, ideally, to have our services as close to home as possible.
19:36 But actually, if there's a really good clinical case for people to travel and for us to gather
19:43 that expertise in one place, I think we have got to pay attention to what the clinical
19:49 evidence suggests is right for us.
19:52 What I recognize, then, is that a transport issue comes into the equation, which is why
19:58 I'm glad to see that, as you recognize, there's a bit of improvement in terms of some of the
20:04 transport links to the Grange.
20:05 Obviously, I don't think it's ever going to be enough, but there are alternatives.
20:11 You know, the voluntary system for getting people to hospital is really effective.
20:16 I mean, perhaps people don't know about it, and that's something that we probably need
20:20 to make people aware of.
20:23 So, my 94-year-old auntie this week was taken from St David's to Swansea for an operation.
20:31 She had no means of transport.
20:33 She got on the voluntary transport system.
20:36 It all worked perfectly well.
20:38 So, it does exist.
20:40 Perhaps people are not as aware of the facilities and the availability of those kinds of services.
20:46 We've also got the same-day emergency care services that have been opened in the Grange.
20:51 £3.5 million we spent on that, and, again, that's making a tangible difference, helping
20:57 patients to bypass the emergency services.
21:01 And around 600 patients per month are treated in the SDEG service at the moment at the Grange.
21:13 So, I think there's been a great deal of investment.
21:20 The patient flow system is also in place.
21:25 We've also allocated an additional £300,000 to provide the e-triage resource at the Grange
21:32 Hospital also.
21:35 And there is a lot more resource that they've requested in order to make environmental improvements
21:46 to the emergency department in the Greater Grange.
21:49 A quarter of a million pounds was provided last year.
21:54 They are alsoóor we, rather, are waiting for a business case for them in order to change
22:03 the system in the Grange.
22:05 I think things are improving.
22:07 The problem is that demand is increasing constantly, and the fact is that it's very difficult for
22:13 us, particularly under current circumstances, to find money to respond to what is needed.
22:25 Work has been done, and I think things have improved, but I do think that people have
22:31 to recognise that there is a cap on how much we can spend in this area.
22:37 We all have to make decisions as to how we spend that money.
22:41 You as a party have decided where you want to focus resources, and we also make decisions.
22:50 This is, of course, a priority for us, and that's why you've seen recently that we have
22:55 looked across Government to buy funds from other departments in order to help the NHS.
23:03 Thank you.
23:04 Yulí Davies AM: I thank the Minister, and thank you to Delith.
23:08 That brings today's proceedings to a close.
23:10 Thank you.
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