One of the key challenges we face is the fragility of some of our services. This is particularly the case in maintaining so many medical rotas, and this means that we cannot continue to run all acute services at both Glangwili and Withybush hospitals.
We have had to respond to changing needs and expectation on our doctors during the last 20 years and our doctor on-call rotas have had to change. To improve training opportunities and performance, doctors both in training and at consultant level are expected to be on-call less frequently and work fewer hours than in the past. At the same time, standards and expectations of care have increased, with timely access to senior decision-makers required to assess patients in our hospitals throughout the week and weekend. Other health organisations in Wales and across the UK can offer less frequent more attractive on-call rotas.
This has all resulted in a challenge for the health board in providing enough doctors in all our hospitals to continue to provide services. This means we rely too much on temporary staff to deliver services. This is not the safest way to provide care. It is also expensive and whilst money is not an overriding factor in why we need to change, it plays a significant part in us being able to provide better healthcare and to better support services in community and primary care.
Another benefit of aligning some of our specialist staff, is allowing them the opportunity to see sufficient patients to maintain and build their expertise in certain areas and to work in networks. This will bring opportunities to provide a wider range of services within Hywel Dda than is currently possible. By providing and supporting specialisms we can provide safer services and improve outcomes for patients.
Of course, it’s not only medical staff where we have challenges to recruit, this is also true in nursing and other professions. We routinely can have as many as 950 whole time equivalent vacancies (which is about 10% of our staff). This makes some of our services very fragile, difficult to sustain and not the highest quality that we want to provide.
Bronglais, Glangwili, Prince Philip and Withybush hospitals will continue to provide a range of important services for the local population, alongside the new Urgent and Planned Care Hospital in the south of our area. This means that people’s care would predominantly still be provided locally.