A Hospital Too Far? Week In Week Out

Tonight - to hospitals, one battle to save their services. What we

want is a function of all A&E. you are talking about an A&E

department, it should be a priority. As the NHS in Wales plans to make

cuts and centralise, what could it mean for us? Patients can give up

because they are far away from services. It has push us over the

edge. As hospitals struggle to recruit, we discover the risks to

patients. It is unfair and it is a serious problem. And as the rest of

Wales gears up the change, could this be coming to a hospital near

That was a nice book. I don't weep -- I don't think we can take them

with us. John and Ann Johnson fear services at their local hospital

are going, said they are going as well. This was our corner of heaven.

It certainly was. Ann is from north Wales, but she has settled in Powys

for 15 years. Ill health has blighted their retirement. It seems

every year after 60 you aged five years and been start to wear out. I

get up in the morning and the first steps are like walking on razor

blades. I have had mind the done. I have got it in my hands. My thumb

doesn't work. Picking things up is difficult. There is nothing wrong

with her voice though. And my pointing finger is all right.

is not well either. Now 73, an accident in the garden revealed he

had a heart problem. I was doing some hedge cutting and went up an

extra step and when I came to in a pool of blood I had my first atrial

fibrillation. It is the stage before a stroke. We had been away

and whenever we come back, we had baked beans on toast. My favourite

meal. We love it. We had bacon on it. Some bacon stuck in my throat

and it started to bleed. I could not get it out and I could not

breathe. She called an ambulance and we waited and waited. And not

only was he bleeding, his throat was closing up and swelling up.

was a bit frightened. The breathing was getting more difficult.

John was taken to hospital, but it has left them feeling vulnerable,

particularly with talk of moving emergency surgery from their

nearest hospital 30 miles away to Carmarthen, even further. A I don't

think about myself in an emergency. It is him. And vice-versa. I would

be sitting here the lights going out of him waiting for an ambulance

to arrive. It's bad enough having to go to Aberystwyth which is a

long journey if you are in pain. Three miles. -- 33 miles. And my

husband, with his heart thing, you have the golden hour and if you

have the right treatment with in that golden hour, you have a chance

of survival. You have taken this huge decision to leave your dream

home. It has pushed us over the edge. Yes. We have got to look

after us and that is what we are doing. All seven Welsh health

boards have to produce plans to save money and makes services safer.

Hywel Dda is the first ball to stop the process and it serves a vast

area. Saving money and improving services is a huge task. The

population is small and spread out. The board says it cannot provide

every service at every hospital. It has started a listening and

engaging process. Here, the nearest A&E department is 30 miles away. It

would take to about 45 minutes. Like the rest of Wales, Llanidloes

is ageing. It is predicted the number of Welsh over 75s will

double by 2020. The Johnsons's local health centre is not just a

doctor's surgery, it is also a minor casualty unit, often

stabilising patients for transferred to the nearest major

A&E at Aberystwyth. Every now and again we have a patient who becomes

acutely unwell to the point where they need rapid transfer to

hospital and the air ambulance appears and takes them and it all

works extremely well, but that so - - but that is for the minority of

the time. It does not happen at night or in bad weather. You cannot

rely on getting ambulances within a certain time frame which people in

city areas will bounce -- would find unacceptable. This is

Bronglais. Hair other changes they are planning: -- here are the

changes they are planning. People have quoted that golden hour and

you can just about make that from here to Bronglais. If services are

moved further away, it is just but achievable. Llanelli has the

largest population in the Hywel Dda area. The male voice choir singing

to save accident and emergency services and the local hospital.

They lost emergency surgery here five years ago. Now it could be

downgraded further. Unhappy residents are setting out from west

Wales to take their message to the Assembly in Cardiff Bay, all 10

coaches of them. We are not going to be pushed around any more. We

are sick and tired of listening to our health board tell us they are

listening to worse. So we have gone a step further and we are going to

make them listen. Tony says he owes his life to Prince Philip Hospital.

He has mass killer disease, heart disease, asthma, diabetes, sleep

apnoea and a chest infection. Fair to say he has not been well. I am

therefore different things virtually every couple of months,

so I could probably have my own bed down there with my name on it. I'm

a regular at the Prince Philip Hospital and thank God it is there.

Without it, I would be doing a lot of travelling, or somebody would be

taking me around a lot. He says Le Nani should not be part of NHS

changes affecting rural West Wales. We have proved that the population

covered by the Prince Philip Hospital is the greatest in the

area, said they are trying to move A&E, replace it with an urgent care

centre and move it to Glangwili. Len emma macro still has heavy

industry, the motorway is up the road and the population is growing.

There are plans for more housing. New mother Rebecca George says she

owes her life to The Memory Game hospital after a serious asthma

attack. -- to Llanelli hospital after a serious asthma attack.

was a five-minute ride, blue flashing light all the way down

with oxygen because when you can't breathe, you panic a little bit

more and it is very scary and frightening. There is nothing you

can do to control it. She is worried she may not make it if she

has to travel further during another serious asthma attack.

can't understand why, if you have to go out of the area, how much

difficult it would be. If you need the attention, you have to get it.

It's non-negotiable and that five- minute journey, I do things saved

my life. I guess there is a certain amount of money to go around.

Everyone gets that, but when you are talking about an A&E department,

it should be a priority. But those tasked with drawing up plans for

the future NHS says no-one can have every service on their doorstep.

Hywel Dda has to save over �100 million after the next few years

and like every other half ball across Wales, it has to make plans

in the face of financial pressures, an ageing population and a national

shortage of consultants. Nowhere is the staff shortage more acute than

in Welsh casualty departments. Not one of Our A&E units meets safety

is staffing guidelines. It is costing us dear. The main

difficulty is on a daily basis in all emergency departments. We are

not delivering the care we would like to deliver. It is a daily

occurrence that patients main weight 20, 24 hours within an

emergency department to get a bed. That is not good practice. We often

have to deliver care in in appropriate environments where we

have run out of trolleys, for instance. That background of

staffing problems, a lot of help boards are experiencing problems

with the equipment. And as pressure increases, so do the vacancies.

There are 80 jobs for middle grade and the senior personnel. Only half

the emergency vacancies were filled this year. We are facing difficult

times. In has been building over the next -- it has been building

over the past few years. The Health Board say huge cuts in funding are

causing them to make cuts. But nothing unites people more than the

risk of change. Aberystwyth also are campaigning to save their A&E

The consultants were concerned that if Bronglais was downgraded to an

urgent care centre, the board's promise to ensure that no-one

should be more than 60 minutes away from acute surgical or obstetric

care may not be met. Especially for populations to the north and east

of Aberystwyth. And they said that it is frankly dangerous to rely on

the availability of an ambulance, let alone a helicopter, for a truly

urgent transfer. It is sometimes impossible even now to get a blue

light ambulance when required. They are not the only ones worried. A

paramedic with many years of experience in mid and West Wales

contacted us. He agreed to talk to us anonymously. We've disguised his

voice. Real already transferring them huge differences -- distances.

To downgrade even further, my concern is myself and my colleagues

will be sat in the back of ambulances watching patients die.

There will be nothing we could do for them at other than drive a bit

quicker. That's not acceptable to us and certainly not to the patient.

How concerned would you be if you were a resident in mid-Wales?

Extremely concerned. If I had long ongoing health problems, there's

just no way of knowing those health problems would be adequately

treated close to home. The Welsh Ambulance Service told us it

continues to support the local health boards with their plans for

change. Hywel Dda's listening and engagement period turns into a

formal consultation in the Autumn. Kathryn Davies is on the executive

board. Hello. She says there have to be changes, but insists the

board has listened to the public. Our intention is to retain a full

A&E service at Bronglais. This includes recruiting to the two

surgical positions that are currently vacant. As you know we

have had 15 applicants to these posts. And it is our intention to

recruit into those posts on a full- time basis. This will retain

emergency surgery and surgical back-up for the surgical function

at Bronglais. What if it's impossible to recruit? That's a

scenario that faces every unit across Wales. As part of our

planning processes, obviously we will deal with that situation

should it arise. The big picture of our NHS future depends on the small

print in the jobs being advertised. Irene's lived in Llanidloes for 20

years. She's clocked up more than 700 miles in outpatients

appointments after being diagnosed with cancer. Since August, you have

been to Swansea. Cardiff. Llanelli. Carmarthen. And then I would have

gone to have offered West. The appointment was going to be at 9am

in the morning. I would have to start out at about 5:30am in the

morning. I got the cancer, then, and I was really feeling quite sick.

So, you went hundreds of miles. Hundreds of miles. If it wasn't for

the kindness of my neighbours and friends to take me all those

distances, it was the anxiety and distress of waiting for the results

between each journey. I thought each journey was going to be the

last one but they kept sending me on. It's really altered my life,

you know. I'm not the same person any more. Irene was offered surgery

in Carmarthen that might have removed the cancer completely. She

didn't want to risk the procedure and chose to have chemotherapy

instead at Bronglais hospital in When you were weighing it all up,

did the distances that you would have to travel play a part in

making that decision? Yes. I had to make the decision there and then.

When I weighed up my chances, that's when I decided to go for

chemotherapy, because I would be able to have that at my local

hospital and not have to go to come Martin. Every time. Irene's GP

understands her decision. Patients eventually sometimes just give up

because they are just so far away from these definitive centres which

may well provide the best possible care, but it's so far away for

patients, and it is so inaccessible for their families and friends,

that they give up on it, really. It's a massive commitment to keep

going down to hospitals to 0.5 hours away from where you live when

you are elderly, feeling sick. You can understand why people might

just think, no, I won't bother. Those who live in the Mid-Wales

countryside face hospital journeys that many in urban areas would find

mind-boggling. Aberystwyth is around 45 minutes away. Shrewsbury,

an hour and a quarter. Cardiff, Swansea, Llanelli and Carmarthen

around two hours. And a trip to Haverfordwest takes two and a half

hours. Increasingly, health boards are centralizing to concentrate

their specialist services at one base. In Llanidloes, Ann Johnson's

family history means regular cancer checks. I'm from a cancer family.

My mother died on a 35 minute journey because her babble became

obstructed. -- bowel. What chance have we got, really? I feel we have

got to go somewhere where we can get the help we need, hopefully

when we needed. It is in storage. I hope it's nice and dry. Her husband

John goes to his local surgery for a fortnightly blood test to check

his warfaring dose. Something he'd probably go to hospital for if he

We are very fortunate to have one of these machines here. Yes, it

does save a lot, doesn't it? This is the way the NHS in Wales wants

to go. Delivering more of its care in the community. But for John,

it's not enough. If I was to have another heart problem, and it was

important, or my wife Paddy DVT and it was important, we would want to

know we could get decent attention without travelling a couple of

hours to get there. The air has to be a compromise. We can't all live

within the catchment areas of the best surgeon in the land of. There

comes a point away you have to have no service or a safe service many

miles away or you have a service which is not quite as good as the

major centres but is good enough to provide a basic level of care. We

need to insure it is good enough. The Llanelli campaigners know

people won't accept change if it means losing their A&E. We have got

25,000 signatures and I never thought we would achieve that.

Retired midwife Luvain Roberts was chair of Hywel Dda Community Health

council. When she found out about proposals to make Prince Philip an

urgent care centre, she took a stand. I stood up, took my barge

off and threw it on the table and said, I cannot sanction this and I

walked out. Me, personally, every area should have a functioning A&E.

To see to the needs of society. I don't think it's asking a lot. They

had been chipping away gradually over the years, and I think they

have got to point now, where enough is enough, they won't take any more.

We have a big fight ahead of us. But I feel, I want a functioning

A&E for Llanelli, which the area deserves, not a Mickey Mouse one.

So what is the difference between A&E and an urgent care centre? Well,

there are different levels of A&E, ranging from full trauma centres to

units open for only core hours. Add to that the fact there is no set

definition of an urgent care centre in Wales and you have confusion on

your hands. Increasingly, the public are confused about what to

expect behind that door, and that is a key issue. You don't want

someone going in the middle of the night to a Department expecting to

find a certain service behind the door, and finding it's not staffed

appropriately, because that is more dangerous than travelling a little

bit further to an appropriate department. Prince Philip is

classed as a level 2 A&E. It can't provide emergency surgery and

doesn't even have a resident consultant overnight. I think there

is confusion and I think the health board has to clarify the situation

once and for all. With the NHS facing crisis point, we wanted to

find out if patients are being put at risk. We obtained copies of the

corporate risk registers for six of Wales' seven health boards. Betsi

Cadwaladr in North Wales wouldn't release theirs at present. These

documents contain the board's own assessment of the risks their

patients face. We asked one of Britain's leading medical

negligence lawyers to look at them. Staffing levels are not being

maintained at a level they should be. It is impacting upon clinical

care. This situation is going to get worse. Service suspension for

part of a 24 hour period, four out of five. The register that really

stands out is Hywel Dda's. I find that really, really shocking, that

statement. How are they managing that? And patients most at risk?

Anyone turning up to Prince Philip Hospital in Llanelli in an

emergency when there's not sufficient medical cover. This is

someone turning up at the in the department at Prince Philip

Hospital in Llanelli, in an emergency situation. It is saying,

we have identified the maximum risk in relation to patient care. We're

talking about unidentifiable serious risk, on the risk register,

for about 18 months but, on the face of it, has not progressed.

concerned are you about that risk? I don't think you could be more

concerned. The point is, it is up there, bright red, glowing, it's a

serious problem. In fact, what is even more concerning, is that this

was identified as a serious problem. According to this, as far back as

December 2010. This has been a serious risk since 2010. As I said,

we have current processes in place which mitigate against those risks.

Hywel Dda spent �10 million on locum medical staff. That is part

of the mitigation process to ensure that we have workforce on the

ground, here and now. That, in itself, is not a sustainable model

going forward. She concedes there's a risk to patient care. We're at a

point in time where we need to bring an honest debate with our

public. The A and D in Prince Philip is not a full a indeed, and

I think we need to start that debate and ensure people don't

present at accident and emergency expecting a full set of services --

A&E. Make way for Llanelli. Cardiff Bay, Llanelli's protestors

hope people power will make a difference to the plans to change

the NHS in West Wales. Their petition is one of the largest ever

received by the assembly. We will have four hospitals at the end of

this five-year process. You need to look at the geographical location

of Prince Philip, as a whole, and not just in isolation. It is 10

miles from Marsden Hospital, and half an hour to Glangwilli hospital.

We need to look at what is safe and sustainable going forward for our

population. There could be more protests to come. Assembly

government tells me change has to happen if the NHS in Wales is to

continue to deliver a safe services. But with every Welsh committee

facing change, some are asking who is looking at the bigger picture?

I'm sure people in the assembly will tell you there is a strategy

and all the health boards will have individual strategies but doesn't

really feel like that strategy applies to people like me on the

ground. They head home. They are not prepared to compromise. We are

going to take them on of. We are going to push them. We are not

going to be forced to take an urgent care centre. These people

are standing up for a cause they believe in, we all believe in.

Getting access to healthcare, wherever you live, is important.

For Ann and John, it means leaving their home behind. They know their

quality of life will change but they feel the NHS changes leave