:00:09. > :00:16.Tonight - to hospitals, one battle to save their services. What we
:00:16. > :00:22.want is a function of all A&E. you are talking about an A&E
:00:22. > :00:28.department, it should be a priority. As the NHS in Wales plans to make
:00:28. > :00:32.cuts and centralise, what could it mean for us? Patients can give up
:00:32. > :00:38.because they are far away from services. It has push us over the
:00:38. > :00:46.edge. As hospitals struggle to recruit, we discover the risks to
:00:46. > :00:49.patients. It is unfair and it is a serious problem. And as the rest of
:00:49. > :00:59.Wales gears up the change, could this be coming to a hospital near
:00:59. > :01:14.
:01:14. > :01:19.That was a nice book. I don't weep -- I don't think we can take them
:01:19. > :01:26.with us. John and Ann Johnson fear services at their local hospital
:01:27. > :01:36.are going, said they are going as well. This was our corner of heaven.
:01:37. > :01:43.
:01:43. > :01:46.It certainly was. Ann is from north Wales, but she has settled in Powys
:01:46. > :01:54.for 15 years. Ill health has blighted their retirement. It seems
:01:54. > :01:59.every year after 60 you aged five years and been start to wear out. I
:01:59. > :02:06.get up in the morning and the first steps are like walking on razor
:02:06. > :02:11.blades. I have had mind the done. I have got it in my hands. My thumb
:02:11. > :02:17.doesn't work. Picking things up is difficult. There is nothing wrong
:02:17. > :02:22.with her voice though. And my pointing finger is all right.
:02:22. > :02:27.is not well either. Now 73, an accident in the garden revealed he
:02:27. > :02:37.had a heart problem. I was doing some hedge cutting and went up an
:02:37. > :02:41.
:02:41. > :02:48.extra step and when I came to in a pool of blood I had my first atrial
:02:48. > :02:52.fibrillation. It is the stage before a stroke. We had been away
:02:52. > :03:00.and whenever we come back, we had baked beans on toast. My favourite
:03:00. > :03:05.meal. We love it. We had bacon on it. Some bacon stuck in my throat
:03:05. > :03:09.and it started to bleed. I could not get it out and I could not
:03:09. > :03:15.breathe. She called an ambulance and we waited and waited. And not
:03:15. > :03:18.only was he bleeding, his throat was closing up and swelling up.
:03:18. > :03:24.was a bit frightened. The breathing was getting more difficult.
:03:24. > :03:27.John was taken to hospital, but it has left them feeling vulnerable,
:03:27. > :03:33.particularly with talk of moving emergency surgery from their
:03:33. > :03:43.nearest hospital 30 miles away to Carmarthen, even further. A I don't
:03:43. > :03:49.think about myself in an emergency. It is him. And vice-versa. I would
:03:49. > :03:53.be sitting here the lights going out of him waiting for an ambulance
:03:53. > :04:03.to arrive. It's bad enough having to go to Aberystwyth which is a
:04:03. > :04:04.
:04:04. > :04:09.long journey if you are in pain. Three miles. -- 33 miles. And my
:04:09. > :04:12.husband, with his heart thing, you have the golden hour and if you
:04:12. > :04:20.have the right treatment with in that golden hour, you have a chance
:04:20. > :04:26.of survival. You have taken this huge decision to leave your dream
:04:26. > :04:33.home. It has pushed us over the edge. Yes. We have got to look
:04:33. > :04:39.after us and that is what we are doing. All seven Welsh health
:04:39. > :04:43.boards have to produce plans to save money and makes services safer.
:04:43. > :04:53.Hywel Dda is the first ball to stop the process and it serves a vast
:04:53. > :04:57.
:04:57. > :05:01.area. Saving money and improving services is a huge task. The
:05:01. > :05:09.population is small and spread out. The board says it cannot provide
:05:09. > :05:19.every service at every hospital. It has started a listening and
:05:19. > :05:19.
:05:19. > :05:25.engaging process. Here, the nearest A&E department is 30 miles away. It
:05:25. > :05:30.would take to about 45 minutes. Like the rest of Wales, Llanidloes
:05:30. > :05:37.is ageing. It is predicted the number of Welsh over 75s will
:05:37. > :05:42.double by 2020. The Johnsons's local health centre is not just a
:05:42. > :05:48.doctor's surgery, it is also a minor casualty unit, often
:05:48. > :05:53.stabilising patients for transferred to the nearest major
:05:53. > :05:56.A&E at Aberystwyth. Every now and again we have a patient who becomes
:05:56. > :06:00.acutely unwell to the point where they need rapid transfer to
:06:00. > :06:08.hospital and the air ambulance appears and takes them and it all
:06:08. > :06:12.works extremely well, but that so - - but that is for the minority of
:06:12. > :06:18.the time. It does not happen at night or in bad weather. You cannot
:06:18. > :06:28.rely on getting ambulances within a certain time frame which people in
:06:28. > :06:31.
:06:31. > :06:41.city areas will bounce -- would find unacceptable. This is
:06:41. > :06:46.
:06:46. > :06:55.Bronglais. Hair other changes they are planning: -- here are the
:06:55. > :07:03.changes they are planning. People have quoted that golden hour and
:07:03. > :07:12.you can just about make that from here to Bronglais. If services are
:07:12. > :07:18.moved further away, it is just but achievable. Llanelli has the
:07:18. > :07:23.largest population in the Hywel Dda area. The male voice choir singing
:07:23. > :07:28.to save accident and emergency services and the local hospital.
:07:28. > :07:34.They lost emergency surgery here five years ago. Now it could be
:07:34. > :07:39.downgraded further. Unhappy residents are setting out from west
:07:39. > :07:47.Wales to take their message to the Assembly in Cardiff Bay, all 10
:07:47. > :07:53.coaches of them. We are not going to be pushed around any more. We
:07:53. > :07:57.are sick and tired of listening to our health board tell us they are
:07:57. > :08:07.listening to worse. So we have gone a step further and we are going to
:08:07. > :08:07.
:08:07. > :08:13.make them listen. Tony says he owes his life to Prince Philip Hospital.
:08:13. > :08:18.He has mass killer disease, heart disease, asthma, diabetes, sleep
:08:18. > :08:25.apnoea and a chest infection. Fair to say he has not been well. I am
:08:25. > :08:28.therefore different things virtually every couple of months,
:08:28. > :08:33.so I could probably have my own bed down there with my name on it. I'm
:08:33. > :08:38.a regular at the Prince Philip Hospital and thank God it is there.
:08:38. > :08:43.Without it, I would be doing a lot of travelling, or somebody would be
:08:43. > :08:49.taking me around a lot. He says Le Nani should not be part of NHS
:08:49. > :08:54.changes affecting rural West Wales. We have proved that the population
:08:54. > :09:01.covered by the Prince Philip Hospital is the greatest in the
:09:01. > :09:07.area, said they are trying to move A&E, replace it with an urgent care
:09:07. > :09:16.centre and move it to Glangwili. Len emma macro still has heavy
:09:16. > :09:23.industry, the motorway is up the road and the population is growing.
:09:23. > :09:28.There are plans for more housing. New mother Rebecca George says she
:09:28. > :09:38.owes her life to The Memory Game hospital after a serious asthma
:09:38. > :09:46.
:09:46. > :09:49.attack. -- to Llanelli hospital after a serious asthma attack.
:09:49. > :09:53.was a five-minute ride, blue flashing light all the way down
:09:54. > :09:57.with oxygen because when you can't breathe, you panic a little bit
:09:57. > :10:02.more and it is very scary and frightening. There is nothing you
:10:02. > :10:08.can do to control it. She is worried she may not make it if she
:10:08. > :10:12.has to travel further during another serious asthma attack.
:10:12. > :10:17.can't understand why, if you have to go out of the area, how much
:10:17. > :10:24.difficult it would be. If you need the attention, you have to get it.
:10:24. > :10:32.It's non-negotiable and that five- minute journey, I do things saved
:10:32. > :10:39.my life. I guess there is a certain amount of money to go around.
:10:39. > :10:47.Everyone gets that, but when you are talking about an A&E department,
:10:47. > :10:52.it should be a priority. But those tasked with drawing up plans for
:10:52. > :10:57.the future NHS says no-one can have every service on their doorstep.
:10:57. > :11:02.Hywel Dda has to save over �100 million after the next few years
:11:02. > :11:06.and like every other half ball across Wales, it has to make plans
:11:07. > :11:12.in the face of financial pressures, an ageing population and a national
:11:12. > :11:19.shortage of consultants. Nowhere is the staff shortage more acute than
:11:19. > :11:26.in Welsh casualty departments. Not one of Our A&E units meets safety
:11:26. > :11:31.is staffing guidelines. It is costing us dear. The main
:11:31. > :11:36.difficulty is on a daily basis in all emergency departments. We are
:11:36. > :11:42.not delivering the care we would like to deliver. It is a daily
:11:42. > :11:48.occurrence that patients main weight 20, 24 hours within an
:11:49. > :11:51.emergency department to get a bed. That is not good practice. We often
:11:51. > :12:01.have to deliver care in in appropriate environments where we
:12:01. > :12:10.have run out of trolleys, for instance. That background of
:12:10. > :12:20.staffing problems, a lot of help boards are experiencing problems
:12:20. > :12:30.with the equipment. And as pressure increases, so do the vacancies.
:12:30. > :12:30.
:12:30. > :12:34.There are 80 jobs for middle grade and the senior personnel. Only half
:12:34. > :12:43.the emergency vacancies were filled this year. We are facing difficult
:12:43. > :12:48.times. In has been building over the next -- it has been building
:12:48. > :12:58.over the past few years. The Health Board say huge cuts in funding are
:12:58. > :13:08.causing them to make cuts. But nothing unites people more than the
:13:08. > :13:10.
:13:11. > :13:18.risk of change. Aberystwyth also are campaigning to save their A&E
:13:18. > :13:20.The consultants were concerned that if Bronglais was downgraded to an
:13:20. > :13:23.urgent care centre, the board's promise to ensure that no-one
:13:23. > :13:33.should be more than 60 minutes away from acute surgical or obstetric
:13:33. > :13:40.care may not be met. Especially for populations to the north and east
:13:40. > :13:43.of Aberystwyth. And they said that it is frankly dangerous to rely on
:13:43. > :13:48.the availability of an ambulance, let alone a helicopter, for a truly
:13:48. > :13:54.urgent transfer. It is sometimes impossible even now to get a blue
:13:54. > :13:57.light ambulance when required. They are not the only ones worried. A
:13:57. > :14:01.paramedic with many years of experience in mid and West Wales
:14:01. > :14:11.contacted us. He agreed to talk to us anonymously. We've disguised his
:14:11. > :14:12.
:14:12. > :14:17.voice. Real already transferring them huge differences -- distances.
:14:18. > :14:21.To downgrade even further, my concern is myself and my colleagues
:14:22. > :14:26.will be sat in the back of ambulances watching patients die.
:14:26. > :14:32.There will be nothing we could do for them at other than drive a bit
:14:32. > :14:36.quicker. That's not acceptable to us and certainly not to the patient.
:14:37. > :14:42.How concerned would you be if you were a resident in mid-Wales?
:14:43. > :14:46.Extremely concerned. If I had long ongoing health problems, there's
:14:46. > :14:51.just no way of knowing those health problems would be adequately
:14:51. > :14:53.treated close to home. The Welsh Ambulance Service told us it
:14:53. > :14:57.continues to support the local health boards with their plans for
:14:57. > :15:03.change. Hywel Dda's listening and engagement period turns into a
:15:03. > :15:12.formal consultation in the Autumn. Kathryn Davies is on the executive
:15:12. > :15:17.board. Hello. She says there have to be changes, but insists the
:15:17. > :15:25.board has listened to the public. Our intention is to retain a full
:15:25. > :15:30.A&E service at Bronglais. This includes recruiting to the two
:15:30. > :15:34.surgical positions that are currently vacant. As you know we
:15:34. > :15:41.have had 15 applicants to these posts. And it is our intention to
:15:42. > :15:44.recruit into those posts on a full- time basis. This will retain
:15:44. > :15:54.emergency surgery and surgical back-up for the surgical function
:15:54. > :15:54.
:15:54. > :16:02.at Bronglais. What if it's impossible to recruit? That's a
:16:02. > :16:06.scenario that faces every unit across Wales. As part of our
:16:06. > :16:10.planning processes, obviously we will deal with that situation
:16:10. > :16:14.should it arise. The big picture of our NHS future depends on the small
:16:14. > :16:19.print in the jobs being advertised. Irene's lived in Llanidloes for 20
:16:19. > :16:29.years. She's clocked up more than 700 miles in outpatients
:16:29. > :16:30.
:16:30. > :16:39.appointments after being diagnosed with cancer. Since August, you have
:16:39. > :16:43.been to Swansea. Cardiff. Llanelli. Carmarthen. And then I would have
:16:43. > :16:49.gone to have offered West. The appointment was going to be at 9am
:16:49. > :16:57.in the morning. I would have to start out at about 5:30am in the
:16:57. > :17:03.morning. I got the cancer, then, and I was really feeling quite sick.
:17:03. > :17:05.So, you went hundreds of miles. Hundreds of miles. If it wasn't for
:17:05. > :17:14.the kindness of my neighbours and friends to take me all those
:17:14. > :17:19.distances, it was the anxiety and distress of waiting for the results
:17:19. > :17:24.between each journey. I thought each journey was going to be the
:17:24. > :17:27.last one but they kept sending me on. It's really altered my life,
:17:27. > :17:30.you know. I'm not the same person any more. Irene was offered surgery
:17:30. > :17:33.in Carmarthen that might have removed the cancer completely. She
:17:33. > :17:42.didn't want to risk the procedure and chose to have chemotherapy
:17:42. > :17:47.instead at Bronglais hospital in When you were weighing it all up,
:17:47. > :17:54.did the distances that you would have to travel play a part in
:17:54. > :18:02.making that decision? Yes. I had to make the decision there and then.
:18:02. > :18:07.When I weighed up my chances, that's when I decided to go for
:18:07. > :18:13.chemotherapy, because I would be able to have that at my local
:18:13. > :18:22.hospital and not have to go to come Martin. Every time. Irene's GP
:18:22. > :18:26.understands her decision. Patients eventually sometimes just give up
:18:26. > :18:31.because they are just so far away from these definitive centres which
:18:31. > :18:36.may well provide the best possible care, but it's so far away for
:18:36. > :18:41.patients, and it is so inaccessible for their families and friends,
:18:41. > :18:48.that they give up on it, really. It's a massive commitment to keep
:18:48. > :18:53.going down to hospitals to 0.5 hours away from where you live when
:18:53. > :18:57.you are elderly, feeling sick. You can understand why people might
:18:57. > :18:59.just think, no, I won't bother. Those who live in the Mid-Wales
:18:59. > :19:05.countryside face hospital journeys that many in urban areas would find
:19:05. > :19:08.mind-boggling. Aberystwyth is around 45 minutes away. Shrewsbury,
:19:08. > :19:12.an hour and a quarter. Cardiff, Swansea, Llanelli and Carmarthen
:19:13. > :19:16.around two hours. And a trip to Haverfordwest takes two and a half
:19:16. > :19:22.hours. Increasingly, health boards are centralizing to concentrate
:19:22. > :19:32.their specialist services at one base. In Llanidloes, Ann Johnson's
:19:32. > :19:35.
:19:35. > :19:42.family history means regular cancer checks. I'm from a cancer family.
:19:42. > :19:52.My mother died on a 35 minute journey because her babble became
:19:52. > :19:54.
:19:54. > :19:57.obstructed. -- bowel. What chance have we got, really? I feel we have
:19:57. > :20:05.got to go somewhere where we can get the help we need, hopefully
:20:05. > :20:08.when we needed. It is in storage. I hope it's nice and dry. Her husband
:20:09. > :20:12.John goes to his local surgery for a fortnightly blood test to check
:20:12. > :20:22.his warfaring dose. Something he'd probably go to hospital for if he
:20:22. > :20:28.
:20:28. > :20:32.We are very fortunate to have one of these machines here. Yes, it
:20:32. > :20:35.does save a lot, doesn't it? This is the way the NHS in Wales wants
:20:35. > :20:43.to go. Delivering more of its care in the community. But for John,
:20:43. > :20:51.it's not enough. If I was to have another heart problem, and it was
:20:51. > :20:55.important, or my wife Paddy DVT and it was important, we would want to
:20:55. > :21:01.know we could get decent attention without travelling a couple of
:21:01. > :21:06.hours to get there. The air has to be a compromise. We can't all live
:21:06. > :21:11.within the catchment areas of the best surgeon in the land of. There
:21:11. > :21:18.comes a point away you have to have no service or a safe service many
:21:18. > :21:24.miles away or you have a service which is not quite as good as the
:21:24. > :21:27.major centres but is good enough to provide a basic level of care. We
:21:27. > :21:36.need to insure it is good enough. The Llanelli campaigners know
:21:36. > :21:39.people won't accept change if it means losing their A&E. We have got
:21:39. > :21:42.25,000 signatures and I never thought we would achieve that.
:21:42. > :21:45.Retired midwife Luvain Roberts was chair of Hywel Dda Community Health
:21:45. > :21:55.council. When she found out about proposals to make Prince Philip an
:21:55. > :21:56.
:21:56. > :22:00.urgent care centre, she took a stand. I stood up, took my barge
:22:00. > :22:09.off and threw it on the table and said, I cannot sanction this and I
:22:09. > :22:19.walked out. Me, personally, every area should have a functioning A&E.
:22:19. > :22:21.To see to the needs of society. I don't think it's asking a lot. They
:22:21. > :22:29.had been chipping away gradually over the years, and I think they
:22:29. > :22:38.have got to point now, where enough is enough, they won't take any more.
:22:38. > :22:48.We have a big fight ahead of us. But I feel, I want a functioning
:22:48. > :22:49.
:22:50. > :22:53.A&E for Llanelli, which the area deserves, not a Mickey Mouse one.
:22:53. > :22:56.So what is the difference between A&E and an urgent care centre? Well,
:22:56. > :23:00.there are different levels of A&E, ranging from full trauma centres to
:23:00. > :23:03.units open for only core hours. Add to that the fact there is no set
:23:03. > :23:06.definition of an urgent care centre in Wales and you have confusion on
:23:06. > :23:10.your hands. Increasingly, the public are confused about what to
:23:10. > :23:14.expect behind that door, and that is a key issue. You don't want
:23:14. > :23:19.someone going in the middle of the night to a Department expecting to
:23:19. > :23:22.find a certain service behind the door, and finding it's not staffed
:23:22. > :23:30.appropriately, because that is more dangerous than travelling a little
:23:30. > :23:33.bit further to an appropriate department. Prince Philip is
:23:33. > :23:43.classed as a level 2 A&E. It can't provide emergency surgery and
:23:43. > :23:54.
:23:54. > :23:58.doesn't even have a resident consultant overnight. I think there
:23:58. > :24:02.is confusion and I think the health board has to clarify the situation
:24:02. > :24:07.once and for all. With the NHS facing crisis point, we wanted to
:24:07. > :24:12.find out if patients are being put at risk. We obtained copies of the
:24:12. > :24:16.corporate risk registers for six of Wales' seven health boards. Betsi
:24:16. > :24:18.Cadwaladr in North Wales wouldn't release theirs at present. These
:24:18. > :24:23.documents contain the board's own assessment of the risks their
:24:23. > :24:29.patients face. We asked one of Britain's leading medical
:24:29. > :24:33.negligence lawyers to look at them. Staffing levels are not being
:24:33. > :24:40.maintained at a level they should be. It is impacting upon clinical
:24:40. > :24:46.care. This situation is going to get worse. Service suspension for
:24:46. > :24:52.part of a 24 hour period, four out of five. The register that really
:24:52. > :24:57.stands out is Hywel Dda's. I find that really, really shocking, that
:24:57. > :25:00.statement. How are they managing that? And patients most at risk?
:25:00. > :25:04.Anyone turning up to Prince Philip Hospital in Llanelli in an
:25:04. > :25:07.emergency when there's not sufficient medical cover. This is
:25:07. > :25:12.someone turning up at the in the department at Prince Philip
:25:12. > :25:17.Hospital in Llanelli, in an emergency situation. It is saying,
:25:17. > :25:23.we have identified the maximum risk in relation to patient care. We're
:25:23. > :25:28.talking about unidentifiable serious risk, on the risk register,
:25:28. > :25:32.for about 18 months but, on the face of it, has not progressed.
:25:32. > :25:37.concerned are you about that risk? I don't think you could be more
:25:37. > :25:43.concerned. The point is, it is up there, bright red, glowing, it's a
:25:43. > :25:50.serious problem. In fact, what is even more concerning, is that this
:25:50. > :25:59.was identified as a serious problem. According to this, as far back as
:25:59. > :26:04.December 2010. This has been a serious risk since 2010. As I said,
:26:04. > :26:09.we have current processes in place which mitigate against those risks.
:26:09. > :26:13.Hywel Dda spent �10 million on locum medical staff. That is part
:26:13. > :26:18.of the mitigation process to ensure that we have workforce on the
:26:18. > :26:24.ground, here and now. That, in itself, is not a sustainable model
:26:24. > :26:28.going forward. She concedes there's a risk to patient care. We're at a
:26:28. > :26:35.point in time where we need to bring an honest debate with our
:26:35. > :26:40.public. The A and D in Prince Philip is not a full a indeed, and
:26:40. > :26:44.I think we need to start that debate and ensure people don't
:26:44. > :26:49.present at accident and emergency expecting a full set of services --
:26:49. > :26:52.A&E. Make way for Llanelli. Cardiff Bay, Llanelli's protestors
:26:52. > :26:58.hope people power will make a difference to the plans to change
:26:58. > :27:04.the NHS in West Wales. Their petition is one of the largest ever
:27:04. > :27:10.received by the assembly. We will have four hospitals at the end of
:27:10. > :27:18.this five-year process. You need to look at the geographical location
:27:18. > :27:24.of Prince Philip, as a whole, and not just in isolation. It is 10
:27:25. > :27:29.miles from Marsden Hospital, and half an hour to Glangwilli hospital.
:27:29. > :27:39.We need to look at what is safe and sustainable going forward for our
:27:39. > :27:39.
:27:39. > :27:47.population. There could be more protests to come. Assembly
:27:47. > :27:54.government tells me change has to happen if the NHS in Wales is to
:27:54. > :28:00.continue to deliver a safe services. But with every Welsh committee
:28:00. > :28:04.facing change, some are asking who is looking at the bigger picture?
:28:04. > :28:09.I'm sure people in the assembly will tell you there is a strategy
:28:09. > :28:16.and all the health boards will have individual strategies but doesn't
:28:16. > :28:25.really feel like that strategy applies to people like me on the
:28:25. > :28:30.ground. They head home. They are not prepared to compromise. We are
:28:30. > :28:34.going to take them on of. We are going to push them. We are not
:28:34. > :28:41.going to be forced to take an urgent care centre. These people
:28:41. > :28:45.are standing up for a cause they believe in, we all believe in.
:28:45. > :28:48.Getting access to healthcare, wherever you live, is important.
:28:48. > :28:51.For Ann and John, it means leaving their home behind. They know their
:28:51. > :28:55.quality of life will change but they feel the NHS changes leave