Wales needs coherent strategy for specialist NHS services

In recent months there have been a number of proposals to alter the configuration of services in the different Health boards across Wales. However, the question must first be asked is what we should expect from the NHS at our local general hospitals and which specialist services we should expect to have to travel to obtain.

Tomorrow – Can Welsh stronghold ensure continuance of free health care?  Julian Tudor Hart asks whether we can defend the NHS in Wales from increasing commercialisation outside our borders.

With other conditions and diseases, there are centres of excellence which patients request to visit in order to seek specialist advice and treatment which is not available at their local hospitals. Since becoming an AM, I’ve had a constituent contact me about supporting a referral to the Nuffield Hospital in Oxford because that is where the expertise existed for a certain knee problem. Another constituent requested my help in supporting a referral to Moorfields Hospital in London, which is one of the world’s leading eye hospitals.Rare diseases and conditions may well require a British response with one ‘centre of excellence’ dealing with everyone who is afflicted by it. Pro rata, a disease or condition affecting less than a hundred people in Britain, would affect only five in Wales. In these circumstances it is inevitable that expertise and facilities will exist in only one hospital with a limited number of specialist clinical staff.

Within Wales we also have our own medical centres of excellence concentrating on various medical specialisms. In 2010, Morriston Hospital’s Welsh Centre for Burns and Plastic Surgery had the proud honour of becoming a regional centre of excellence for Wales and the South West of England. The Welsh Centre moved to Swansea in 1994, from Chepstow’s St. Lawrence Hospital, and since then has become well established within Morriston Hospital leading to their centre for excellence status.

Another example can be seen with the neurosurgery department in Cardiff that provides specialised neurosurgical care for approximately 2.3 million people living in South, Mid and West Wales. The team is based on Heath Park at the University Hospital of Wales where they work closely with a wide range of related specialists.

Different practices currently exist within Wales in order to provide services across a region. For example, Oncology services in north Wales are managed by the Cancer Clinical Programme Group within the Betsi Cadwaladr University Health Board which acts as a regional centre. Chemotherapy is delivered on an ‘out-patient’ basis on all three acute hospital sites in north Wales using dedicated facilities. Meanwhile, inpatient facilities are at the North Wales Cancer Treatment Centre in Bangor. Referrals are made to Manchester for very rare cancers or very specialist cancer treatment.

Within the Hywel Dda and Abertawe Bro Morgannwg University health boards, a hub and spoke model for renal services is used. The nephrology service within Abertawe Bro Morgannwg University health board is based within Morriston Hospital and has responsibility for the care of patients with kidney disease living anywhere in south west Wales, stretching from Fishguard to Bridgend. It receives referrals from GPs throughout this large geographical area as well as from clinicians based in the seven surrounding district general hospitals. There is a main unit in Morriston, which is also clinically responsible for satellite dialysis units in the areas of Aberystwyth, Carmarthen and Haverfordwest.

We need to decide what are the basic services that all district general hospitals should provide and how general hospitals within and between health boards can be organised to effectively and efficiently provide the medical services on which patients rely. Whilst we all want hospital treatment as near as possible to where we live, we also want the best possible treatment and the best chance of survival. Sometimes the two are mutually incompatible.

All patients who need to be in a hospital bed should have access to comprehensive medical cover, along with diagnostic and rehabilitation facilities, enabling them to begin their rehabilitation promptly, without having to move between hospitals. This will assist quicker recovery, quicker discharge from hospital and improve patient health outcomes. We also need to strengthen community services, helping people to live as independently as possible in their communities. Given the choice, most people do not wish to go into hospital, and prefer to stay in their own homes.

Reconfiguration of the NHS is inevitable and has happened continuously since the birth of Nye Bevan’s brainchild back in 1948. Here’s something to consider: just how many TB sanatoriums are left in Wales?

What we have is services which need to be provided at different levels. What we need is a coherent strategy so that we know where each service is going to be provided and the medical reason why it is being provided in that way.