1.46 Some Prince Philip staff (including consultant physicians) considered a medical ECU as a pragmatic and potentially safer alternative to the current ICU model. However, they strongly emphasised the need for appropriate staffing at all levels to manage the ECU and provide outreach support across wards; adequate bed provision (six to eight was suggested); fully funded multidisciplinary team structures; formal transfer protocols between hospitals within and outside Hywel Dda); close collaboration between Prince Philip and the Glangwili ICU team; and robust clinical governance.
1.47 As noted above, across the different consultation methods, there was strong concern regarding the transfer of critically ill patients over long distances, particularly from Pembrokeshire and other rural areas. Participants highlighted the potential clinical risks of transfer and delayed intervention, particularly in the context of the current and future capacity of the Welsh Ambulance Service Trust (WAST).
1.48 More generally, while some members of the public accepted the principle of travelling further for specialist care, many felt that geography, seasonal tourism pressures, and rural transport networks mean that centralised critical care may reduce timely access to life-saving treatment.
1.49 Consultees across several activities emphasised that changes to critical care provision are closely linked to and could have consequences for the viability of other services, including stroke care, emergency general surgery, high-risk surgery, medicine, anaesthesia, endoscopy, renal services, haematology, oncology, medical assessment units, post-anaesthetic care units (PACUs), and elective surgery.
1.50 Concerns were also raised that reducing on-site critical care capability could destabilise emergency departments and acute medical pathways, limiting hospitals’ ability to manage serious clinical deterioration; and that once ICU services are removed from local hospitals, it becomes far more likely that surgical services will follow.
1.51 Specifically, there was scepticism around the feasibility of providing a stroke unit at Prince Philip in the absence of a co-located ICU; and examples of occasionally (e.g., during winter pressures) needing to transfer patients further away to hospitals in Swansea or Cardiff. In this respect, the West Wales Renal Service and consultant physicians at Prince Philip were concerned that unless change is properly managed and resourced, removing ICU services from some Hywel Dda sites could result in greater pressure on services at Morriston Hospital.
1.52 Hywel Dda Clinical Health Psychology and Critical Care Clinical Psychology departments also highlighted the importance of considering the psychological care of Hywel Dda critical care staff and patients in any future changes.