Frequently asked questions

Thank you for your interest in the children and young people's services consultation. This consultation has now concluded. 

Process

What is this consultation about?

We want your views on how we provide urgent and emergency children and young people’s (paediatric) services for people who live in, or visit, areas that are serviced by Withybush Hospital and Glangwili Hospital. This consultation shares the three options for how urgent and emergency children and young people’s care at Withybush and Glangwili hospitals could be delivered in the future.

Why do we need to change the current service?

The current urgent and emergency children’s services in the south of the Hywel Dda region were developed following a series of temporary changes made since 2016.

Temporary service change 1:

Temporary reduction in the operating hours of the Paediatric Ambulatory Care Unit at Withybush Hospital. From 5 December 2016 the Withybush Hospital Paediatric Ambulatory Care Unit operating hours changed from 10am – 10pm, to 10am – 6pm, seven days per week.

Changes were also made to the staffing rotas (shifts/times our staff work) with a temporary merger of the paediatric overnight consultant on-call rotas for Withybush Hospital and Glangwili Hospital. This meant we had one consultant rota for the south of the health board based at Glangwili Hospital.

Some of the Withybush consultants participated in the Glangwili on-call rota following the reduction in operating hours.

Reason for temporary change 1:

These changes were made due to significant recruitment challenges. This had an effect on the availability of on-site consultant support and supervision for the Paediatric Ambulatory Care Unit at Withybush Hospital. This was a proactive step taken to reduce the increasing risk of closing the Paediatric Ambulatory Care Unit service at Withybush Hospital at short notice due to lack of staff.

Temporary service change 2:

From 21 March 2020, the Paediatric Ambulatory Care Unit at Withybush Hospital, also known as Puffin Ward, was temporarily closed.

Reason for temporary change 2: 

The COVID-19 pandemic meant that the health board had to change the way it worked. For the duration of the COVID-19 pandemic, the Paediatric Ambulatory Care Unit was converted into a Minor Injury Unit for adults and children. Families with children suffering minor injuries were still able to access care at Withybush Hospital via the Minor Injury Unit, but those children with more acute illness (illnesses needing assessment at the time of becoming unwell) were directed to Glangwili Hospital in Carmarthen.

Temporary service change 3:

On 30 September 2021, the Board agreed to continue with the temporary closure of the Paediatric Ambulatory Care Unit at Withybush Hospital.

Reason for temporary change 3: Welsh Government directed all health boards to enhance and strengthen paediatric service provision as they expected a surge in Respiratory Syncytial Virus (RSV), a common virus that causes cold-like symptoms and can lead to children needing hospital care. The health board had already started to see an increased number of children with RSV both in our community (at GP surgeries and pharmacies) and in our hospitals. Public Health Wales expected this situation to last until March 2022.

Following the three temporary changes, we now need to implement a longer-term solution.

How is the public involved in the selection of the three proposed options for paediatric care in Glangwili and Withybush?

We are holding drop-in events, in person and on digital platforms. Details of the events can be found on our website - Future Children Services (opens in new tab) and on our social media pages. We really appreciate you taking the time to give us your views – every person’s input matters.

How long is the public involved in the options selection for paediatric care in Glangwili and Withybush?

Between 26 May and 24 August 2023, Hywel Dda University Health Board (UHB) will be inviting members of the public, staff and partner organisations, to share their views about urgent and emergency children and young people’s (paediatric) services at Withybush and Glangwili Hospitals. This is part of the Health Board’s wider strategy to improve health and care in the region. The deadline to tell us what you think, so that your opinions can be included in the consultation, is 24 August 2023.

The Consultation Options
 

What are the three options for paediatric care proposed in the consultation?

We have developed three options for how we think services can be provided in the future, up until the development of our proposed new urgent and planned care hospital. Some things are the same for all three options, but there are also new and unique elements for each option. Please see the consultation documents for detailed information (website address)

Option 1: This option builds on what is currently being provided following the temporary measures introduced in 2021 due to COVID-19. The PACU model would remain at Glangwili Hospital, but with no PACU at Withybush Hospital. Having no PACU at Withybush Hospital means a child with an acute illness (an illness needing assessment) requiring admission (an overnight stay) would be treated at the 24-hour inpatient unit at Glangwili Hospital. Booked outpatient appointments (for children not needing immediate assessment, an overnight stay, or for those without longer term conditions) at Withybush Hospital will be available as part of this option. This is in addition to a Rapid Access Clinic, a service which enables children and young people who have been referred by a GP/emergency department (A&E) for nonemergency care, to be seen by a paediatrician at Withybush Hospital within 72 hours.

Option 2: This option builds on what existed following the 2016 temporary change, when the opening hours of PACU at Withybush Hospital were reduced to eight hours a day, seven days a week, rather than a 12-hour, seven days a week service. The PACU at Withybush Hospital would reopen 10am – 6pm, Monday to Friday. It would be staffed 10am – 8pm, but no referrals would be received from GPs/primary care services after 6pm. Booked outpatient appointments (for children not needing immediate assessment, an overnight stay, or for those without longer term conditions) at Withybush Hospital will be available as part of this option. This is in addition to a Rapid Access Clinic, a service for children and young people who have been referred by a GP/emergency department (A&E) to be seen by a paediatrician at Withybush Hospital within 72 hours.

Option 3: Option 3 is the same as Option 2 but with some extra services:

Same as Option 2, PACU at Withybush Hospital from 10am – 6pm, Monday to Friday. The level of outpatient activity is likely to be restricted due to the space required to deliver the PACU, but with some extra services like provision of some nonemergency treatments such as radiology, and day care for those, for example, returning for medication or dressing change.

What do you mean by Paediatric Ambulatory Care Unit (PACU)?

A Paediatric Ambulatory Care Unit offers same day care to children and young people at a hospital. This means they are assessed, observed, diagnosed, treated, and return home on the same day, without being admitted and needing to stay overnight. There are clear procedures for access, discharge, or transfer to and from the service. You cannot access the PACU without a referral from a health professional such as a GP.

What do you mean by a Dedicated Ambulance Vehicle (DAV)?

A Dedicated Ambulance Vehicle supports the emergency/urgent transfer of women and children whose clinical care falls within the following categories:

• Maternity/Obstetric
• Gynaecology
• Paediatric
• Neonatal

Staffed by the Welsh Ambulance Service, this is a dedicated resource that is in place to support Pembrokeshire patients who will be travelling between Withybush Hospital and Glangwili Hospital, as well as to support paediatric emergencies and emergencies during childbirth.

What are the costs of each option?

The estimated additional cost of each option is as follows:
Option 1: £880,000
Option 2: £1.3 million
Option 3: £1.3 million + in-house training costs.
 

What are the similarities and differences between the three options?

There are several factors that are similar and different across the three options. You can see a summary of what is the same, and what is different below:

Rapid Access Clinic

When children and young people are referred, they are seen quickly by a children’s doctor at Withybush Hospital within 3 days.

Option 1: Yes
Option 2: Some (lack of space due to PACU*)
Option 3: Some (lack of space due to PACU*)
 

Booked outpatient appointments

at Withybush Hospital if they don’t need an assessment or overnight stay.

Option 1: Yes
Option 2: Some (lack of space due to PACU*)
Option 3: Some (lack of space due to PACU*)
 

Paediatric Ambulatory Care Unit at Withybush Hospital

open from 10am to 6pm, Monday to Friday. Doctors and nurses at this unit can assess and treat ill children on the same day. They don’t have to stay overnight.

Option 1: No
Option 2: Yes
Option 3: Yes
 

Some non-emergency treatment

and day care like returning for medication or dressing change.

Option 1: No
Option 2: No
Option 3: Yes
 

What is the same in all three options?

• Minor Injury Units for under 16s at both Glangwili and Withybush hospitals
• Emergency care (accident & emergency) for under 16s still provided at Glangwili Hospital
• No overnight/weekend paediatric care at Withybush Hospital
• Children’s services at Glangwili Hospital would remain as they are, with investment in staffing
• the PACU model in Carmarthen to permanently support the treatment of children and young
• people who would have previously attended Withybush Hospital
• Procedures in place to ensure children and young people arriving at Withybush Hospital with
• a critical condition have the best care at the most appropriate location
• Dedicated Ambulance Vehicle (DAV) remains to support the emergency/urgent transfer of
• children and young people from Pembrokeshire to Glangwili Hospital
• Improved telephone/digital links between Pembrokeshire GP surgeries and paediatric staff
• at Withybush Hospital

Workforce

What are your workforce challenges?

Our services are fragile, and this is partly because of how our hospitals are currently working, and how we are stretching our clinical teams across our two main hospitals. This is despite trying to recruit teams on many occasions to support these services. We are committed to building a resilient workforce and will continue our efforts to recruit and retain the skilled staff that we need.

Safety

What systems are in place to ensure the safety of children and young people with an emergency health issue now?

Systems are already in place to ensure that any child or young person with critical conditions arriving at Hospital has the best care available and in the most appropriate place. This will continue as part of the new service.

What can I do to be more involved in transformation of health services?

Siarad Iechyd / Talking Health is an involvement and engagement scheme which gives local people an opportunity to have their say in how local health services are planned, developed and delivered. It is important that we listen to, and take action on, the views, opinions and ideas of people in our communities to help us to improve what we do.

Members will receive updates on their health services and will be able to take part in ongoing discussions about health matters through events, readers' panels, interest groups and surveys. To join:

Fill in the online form here (opens in new tab)

Email: hyweldda.engagement@wales.nhs.uk

Telephone: 01554 899 056 (please leave a message and we will call you back so you do not have to pay for the call)

Post: FREEPOST HYWEL DDA HEALTH BOARD

Timeframes

When do you think you will choose the best option?

The Board will meet later in the year (expected to be towards the end of 2023) to choose the most appropriate option. Board members will consider all they have heard leading up to, and during, this consultation, including the Equality Impact Assessments, which will consider how people could be impacted and what needs to be done to reduce negative impacts. They will also consider any new information that may come to light as a result of the consultation.

Board members will consider all they have heard leading up to and during this consultation. Your views, along with other evidence and considerations, will help Hywel Dda University Health Board choose the most appropriate option for the future of urgent and emergency children and young people’s services at Withybush and Glangwili hospitals