The Golden Hour

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The Golden Hour
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Map of Wales Acute Hospitals
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(No Transcript)
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Borders

• Artificial lines on map mean that money cannot
  easily follow the patient.
• Social care, health care boundary means that the
  money cannot easily follow the patient.

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Care Closer to Home

• Community services are a fantastic idea.
• How is it to be resourced? Resources removed
  from hospital e.g. ART team.
• Where are the services?

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Women and Children's Services

• Level 2 neonatal unit
• Midwife led unit will it work?
• Can a hospital provide gynaecological services
  without presence of experienced general surgeons?
• Paediatric service must provide support for
  maternity service

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Unplanned Care

• Outcomes are better if senior doctors are
  available
• CEPOD Theatre (been here before)
• A E is it safe with no colorectal surgeon on
  site?
• Half a hospital is more dangerous.

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Planned Care

• Open to discussion as journeys, support and
  return home can be planned.
• Lack of community services, delayed return home.
• Waiting times levelled up not down
• Can Gynaecology and Obstetrics be split?
• Unintended consequences

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Staffing problems

• Chicken or egg? Other institutions can recruit.
• Volume of work/specialist centres. Is a surgeon
  in one location doing fifty procedures any less
  likely to be skilled than one of four doing two
  hundred procedures? Team working does not have
  to be geographically constrained.

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More frequently asked questions

• How is the Health Board going to ensure that
  residents or visitors to rural Mid Wales have an
  equal chance of an equally good outcome to a
  medical emergency as a resident of Carmarthen
  does?
• Is it not just as fair for a patient to travel
  North on the A487 as South to receive treatment?
• What happens to a mother whose
  labour develops complications that
  need rapid intervention?

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More Questions

• Who is to bear the cost of transport?
• Who are the clinicians and doctors who have
  decided on models of care and where do they
  live/work?
• If there are not the resources to provide
  services as now on hospital sites, where will the
  resources to provide that care in patients' homes
  come from?

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Your Input

• Patient stories are very good illustration of
  inadequacies of planned service model
• Reply not on questionnaire
• Finally if you read the discussion document you
  will be struck by the lack of reference to
  patients/public/service-users.
• Listening or telling (selling)???

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Equity

• Equity is the equal access/resourcing/treatment
  of people in equal need
• Care must be based not on what is uniformly
  convenient for the few or even majority but on
  what is possible, equal and effective for each
  and every community member.
• (Quotes from two Academics studying the plans or
  models designed by the current management of
  Hywel Dda HB)

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Map of Wales Acute Hospitals