1.104 Consultees proposed several mitigations that could strengthen any chosen model:
- invest in mobile bowel screening units to reduce travel burdens for rural populations.
- workforce development, including expanded nurse endoscopist training to support extended hours or increased activity.
- ensure hospital transport services times are altered to reflect any extended hours.
- clinical safety mitigations, such as ensuring rapid transfer pathways for high-risk patients.
1.105 Consultees proposed other potential alternatives and suggestions, including the following:
- a modified version of Option C, with urology and respiratory services consolidated at Glangwili instead of Prince Philip.
- retain some respiratory and urology endoscopy capacity at Glangwili to maintain safe multidisciplinary management of complex patients (especially those needing interventional radiology).
- consideration of Bronglais as a potential hub, recognising its established JAG-accredited unit and positive patient feedback.
- hybrid models, such as combining extended hours (Option C) with additional physical capacity (Option A).
- ensure the bowel screening community site in Option B has a cancer focus.
- retain some endoscopy sessions at each acute hospital, maintaining local access and in particular supporting frail or complex patients.
- provide services, especially bowel screening, at other locations or settings including GP surgeries and community sites such as Llandovery, South Pembrokeshire and Tenby Hospitals and Cardigan ICC.
- if urology is consolidated on one site, urology endoscopy could follow, with other endoscopy expertise built around that.
- develop a lead lined room to allow the provision of Endoscopic Retrograde Cholangiopancreatography (ERCP)19 at Withybush
- maintain services at Withybush to take advantage of the new fluoroscopy machine to offer ERCP) and potentially reduce the demand for MRI studies.
1.106 For further details, see the endoscopy sections in the individual consultation method chapters.
19 A procedure that combines upper gastrointestinal (GI) endoscopy and x-rays to find and treat problems of the bile and pancreatic ducts.