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20/9/07 Reply to proposed Trust Merger docoument (download below) The merger of the three Trusts is a “Fall Back” position of the “Designed to Deliver” process which was so soundly rejected by the people of Pembrokeshire in 2006. The merger of the three Trusts was voted on at each meeting and rejected every time with almost 100% unanimity even though in the “Designed to Deliver” document it was clear that this was not part of the consultation process but a given that had to happen.
Once more there is no evidence presented within the new document to suggest that the merger is anything more than an opportunity to create a situation where the original preferred option of “Designed to Deliver” i.e. to centralise inpatient services in Carmarthen can be facilitated.
Clearly there is going to be a squeeze on the financial support for the NHS in Wales as evidenced by the suggestion on page 19 and 20 that £23 million will need to be saved in the first 5 years of any MegaTrust predominantly in salaries. The easiest way for any Trust to save significant sums of money is to close wards and thereby save close to £1 million every year for each 30 bedded ward that is closed.
The Executive Summary is interesting as it makes no sense.
The creation of a single integrated trust to serve the counties of Ceredigion, Pembrokeshire and Carmarthenshire would facilitate:considerable improvements in the modernisation, design, planning and delivery of services; this is already happening, there is a lot of work already going on in Carmarthen and a lot planned for WGH unless it is stopped by the merger. · the provision of a total integrated service bringing together acute, communityand mental health services across the whole area; these need to be provided close to peoples homes and a single large Trust would be detrimental. · responding to the ever-increasing demands for new services, new drugs, new clinical practices and technological advances; why not give the planning forum more time along with inter Trust negotiation. · economies of scale so that one large trust would have financial depth and stability currently not enjoyed by three smaller trusts. Also having a mechanism to deal with the existing combined outstanding loan of £37 million; savings are unlikely with this model unless inpatient services are centralised · reduction in management costs, releasing £2 million savings per annum to invest in direct patient care; will not happen if services remain as they are at each hospital = a need for centralisation of inpatient services. · the opportunity to transfer or develop specialist services into a local setting; already happening cf breast cancer by Mr Maxwell · the recruitment and development opportunities for staff; already have excellent recruitment and development opportunities at WGH, which might reduce across a larger Trust especially is there is a financial squeeze. · assisting in the interface with Regional Commissioning, Three Counties Planning Forum since one trust would be the principal partner for the area; LHBs have to deal with many Trusts across Wales and into England therefore a single Trust across Dyfed is irrelevant. · the improvement of clinical governance and patient safety through wider clinical audit and health care standards. Each hospital would without doubt continue this separately because of Geography.
Page 4 bottom paragraph; There is a chance that the local discourse which is happening might be jeopardised by a bigger more distant Trust and therefore not improve it.
Page 5; The improvement of local health services through the closer integration of primary, community, acute and social services; this is already happening and a single Trust would not help as it would be far removed.
Page 6; Patients would have easier access to, and better movement between the services they require; patients already have choice.
Page 8; The improvement in links with GPs and the further development of primary care; already happening and the good work could be jeopardised if a more distant organisation were to be installed.
Page 9; The development of stronger relationships with, and greater accountability to, the local public; A single Trust would be further removed from the local public. |
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SWAT statement on the WAG approval of £8.75m for A&E development at Withybush Hospital.
A development of this nature is long overdue and there is agreement and approval in all quarters, including SWAT, that the money is now available and the project will go ahead. However, this does not in any way imply a 'victory' for the hospital, and should not obscure the remaining very real risk to core services such as Maternity, Paediatrics, Trauma and Cancer treatment. The Pembrokeshire people must remain vigilant and ensure that the A&E development does not become merely a 'stabilize and transfer' facility. The excessive number of beds planned (20, with 5 'flexible' beds, rather than the 10-15 that would have been adequate) clearly implies a plan to close a further ward. It cannot be staffed fully without doing this. It is what would be needed, not only to allow a decision to send some patients home or to social care, but also to keep others until transferred East rather than into wards on site. Withybush Hospital already has the highest bed occupancy in Wales. Any further bed closures (even of part of a ward) would be a disaster unless and until vastly improved community resources enable more patients to be managed at home. This will not be for a long time yet. Even once the unit is built, and even if community facilities are improved sufficiently to allow safe discharges, much development of on-site supporting facilities will be required to make it work properly. These include social services, immediate investigation facilities, and 'hot' clinics. Signed, Chris Overton, Cherie Harvey, Tony Miles, David Williams, Maureen Molyneux, Elizabeth David, John Phillips, John Gossage, Vip Vipulendran, Gustav vas Falcao, Peter Milewski, Glan Phillips, Ken Harries, Bill Phipin
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