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0:00:01 > 0:00:05Tonight, the biggest change to the NHS for years.
0:00:05 > 0:00:09During the summer, two health boards published their plans.
0:00:09 > 0:00:12Now, they want to hear the public's views.
0:00:12 > 0:00:15A number of people are ready to share their views.
0:00:15 > 0:00:17This is not significant change for Prince Philip.
0:00:18 > 0:00:20I'm going to answer the question.
0:00:20 > 0:00:23CROWD: Don't close the hospital!
0:00:23 > 0:00:27If they close the hospital, Blaenau will die.
0:00:27 > 0:00:31With an ageing population and a diminishing budget...
0:00:31 > 0:00:35..the challenges are huge. For some, change must happen.
0:00:35 > 0:00:40Some of the things taking place at Welsh hospitals aren't safe.
0:00:40 > 0:00:43Taro Naw reveals details of a confidential health board document..
0:00:44 > 0:00:48..which discusses the effect on jobs.
0:00:48 > 0:00:50888
0:00:50 > 0:00:52888
0:01:22 > 0:01:25Blaenau Ffestiniog, Gwynedd.
0:01:25 > 0:01:31Here, among slate quarries, a new kind of industry is succeeding.
0:01:33 > 0:01:36Downhill mountain biking.
0:01:41 > 0:01:46Despite the success of the site, one thing worries the scheme's leaders -
0:01:46 > 0:01:52Betsi Cadwaladr Health Board's plans to close the local hospital.
0:01:52 > 0:01:55It's the worst time to close Blaenau Hospital.
0:01:55 > 0:02:00The type of riding and skill levels here...
0:02:00 > 0:02:04..means accidents are going to be unavoidable.
0:02:04 > 0:02:10Everyone who rides mountain bikes understands what the dangers are.
0:02:10 > 0:02:15What we realize is that people pick up nasty cuts.
0:02:16 > 0:02:20The terrain we have here, with the slate...
0:02:20 > 0:02:23..means wounds have to be cleaned properly.
0:02:23 > 0:02:29Change is afoot across Wales, not just in Blaenau.
0:02:29 > 0:02:32The health boards are responding to the Welsh Government's policy...
0:02:32 > 0:02:35..of a five-year vision for the NHS.
0:02:36 > 0:02:39More care at home and centralization of some services.
0:02:41 > 0:02:44The plans for Blaenau Ffestiniog are part of the health board's plans...
0:02:44 > 0:02:46..to improve the service in North Wales.
0:02:47 > 0:02:52I cannot film inside the hospital because I do not have permission.
0:02:52 > 0:02:56But I can tell you there are 12 beds for inpatients.
0:02:56 > 0:02:59There is also a minor accident unit.
0:02:59 > 0:03:02Keeping the doors open costs £800,000 a year.
0:03:03 > 0:03:08Under the health board's plans, it would all disappear.
0:03:08 > 0:03:12I went to meet one family which insists the hospital is crucial.
0:03:13 > 0:03:16Good afternoon. I'm Garry. How are you?
0:03:16 > 0:03:21Sharon O'Neill and her mother, Jean Evans, live close to the hospital.
0:03:22 > 0:03:27When I visited, Sharon's father, Wil Evans, was in hospital.
0:03:27 > 0:03:31He had problems with his kidneys, his heart and dementia.
0:03:32 > 0:03:38When you look out of the window and see the hospital, how do you feel?
0:03:38 > 0:03:39I feel sad.
0:03:39 > 0:03:43I look up and I know my father is there.
0:03:43 > 0:03:49I say good morning when I open the curtains every morning.
0:03:49 > 0:03:53We don't know how long Dad will be with us.
0:03:53 > 0:03:55I want to be close to him.
0:03:55 > 0:03:58To see it not as a hospital...
0:03:58 > 0:04:03..because I've spent a lot of time there too with illnesses...
0:04:03 > 0:04:06They've been wonderful. I can't fault it.
0:04:06 > 0:04:11Aren't you being a little emotional, sentimental, perhaps?
0:04:11 > 0:04:15Things have moved on now and there are newer services?
0:04:15 > 0:04:18No, it's part of Blaenau. That was built for Blaenau people.
0:04:18 > 0:04:21The hospital opened in 1925...
0:04:21 > 0:04:24..in memory of those who died in World War I.
0:04:25 > 0:04:27Local slate workers paid for it.
0:04:29 > 0:04:32The name of Sharon O'Neill's uncle, her father's brother...
0:04:32 > 0:04:34..is on the memorial.
0:04:34 > 0:04:37Another relative helped build the hospital.
0:04:38 > 0:04:40They built the hospital for the area.
0:04:41 > 0:04:45If they decide to close it, they should hand it back.
0:04:45 > 0:04:49The community should then decide what to do with it.
0:04:50 > 0:04:56Last week, Wil Evans was moved to a nursing home 12 miles away.
0:04:56 > 0:05:00When I visited the family before he was moved...
0:05:00 > 0:05:04..the importance of having him nearby was clear.
0:05:04 > 0:05:06It means I can see the hospital from the house.
0:05:07 > 0:05:12And I know that if... I know he's dying. They told me he's dying.
0:05:13 > 0:05:14Yes.
0:05:21 > 0:05:22I'm sorry.
0:05:25 > 0:05:28It's the fact that if they move him from there...
0:05:28 > 0:05:32..it will be really difficult to go and visit.
0:05:34 > 0:05:39The health board says there have been staffing problems.
0:05:39 > 0:05:41Beds have had to be moved...
0:05:41 > 0:05:45..and the minor injuries unit temporary closed.
0:05:45 > 0:05:49The aim is to relocate the unit and the beds...
0:05:49 > 0:05:55..14 miles away to Alltwen Hospital in Tremadog.
0:05:57 > 0:05:59Staffing problems are an excuse...
0:05:59 > 0:06:02..according to the chairman of the hospital's protection board.
0:06:03 > 0:06:06They won't spend on overtime for current members of staff.
0:06:06 > 0:06:09They won't spend to bring in extra members of staff.
0:06:10 > 0:06:15That problem is a recent one. The health board created it.
0:06:15 > 0:06:20Alltwen Hospital was opened three years ago.
0:06:20 > 0:06:24The health board emphasises it has modern facilities...
0:06:25 > 0:06:27..and can treat more patients.
0:06:27 > 0:06:31Looking at the building, it's an old building.
0:06:31 > 0:06:36You now have an opportunity to get modern facilities.
0:06:37 > 0:06:42Until you've been inside, and heard people's experiences...
0:06:42 > 0:06:46..then you would never describe it as old or old fashioned.
0:06:47 > 0:06:49The care here is excellent.
0:06:50 > 0:06:54Travelling to Alltwen Hospital worries Sharon O'Neill.
0:06:54 > 0:06:59Buses are very rare here. They only go once every hour or so.
0:06:59 > 0:07:03I'm fortunate because I have a car.
0:07:03 > 0:07:09But what about the elderly who want to go to Alltwen?
0:07:09 > 0:07:10It will be difficult.
0:07:11 > 0:07:14It's a similar story across Wales.
0:07:14 > 0:07:19Services are being centralized, some community hospitals will close.
0:07:19 > 0:07:24The health boards say this will lead to better patient care.
0:07:24 > 0:07:28They say there are too many people are currently in hospital.
0:07:28 > 0:07:32It would be better to care for them in the community.
0:07:33 > 0:07:38By investing in home care, Betsi Cadwaladr Health Board...
0:07:39 > 0:07:42..acknowledges it won't be suitable for everybody.
0:07:42 > 0:07:45Those who have to travel further for hospital beds and their families...
0:07:46 > 0:07:48..will be given support.
0:07:48 > 0:07:54We have looked at the community transport system, buses, taxis...
0:07:54 > 0:07:57..and the third sector, such as the Red Cross...
0:07:57 > 0:08:01..to make sure we considered these things.
0:08:01 > 0:08:07But how do you explain the change to people in Blaenau Ffestiniog?
0:08:08 > 0:08:14One reason to close is because the building is no longer appropriate.
0:08:14 > 0:08:20There have been changes with nurses, staff...
0:08:20 > 0:08:23..and the problems we've had concerning staffing.
0:08:23 > 0:08:29We also need to move on with enhanced care at home in the area.
0:08:29 > 0:08:35We believe that is something that will bring much more...
0:08:35 > 0:08:40..of the care that is needed in that community.
0:08:40 > 0:08:46The enhanced care at home scheme...
0:08:46 > 0:08:50..has been run as a pilot scheme in Rhyl and Prestatyn.
0:08:51 > 0:08:53Three years ago, in-patient wards were closed...
0:08:54 > 0:08:56..at Rhyl's Royal Alexandra Hospital.
0:08:57 > 0:09:01The money was used to provide care at home.
0:09:02 > 0:09:06The aim is to extend the scheme throughout North Wales.
0:09:06 > 0:09:09Janet Binns is part of the pilot.
0:09:09 > 0:09:12As part of the scheme, a number of agencies co-operate...
0:09:13 > 0:09:17..including social workers, nurses, physiotherapists and consultants.
0:09:20 > 0:09:23This morning, we shall be visiting a woman.
0:09:24 > 0:09:27We shall be taking her blood pressure.
0:09:27 > 0:09:30We shall assess her to see how things are developing.
0:09:30 > 0:09:35Usually, the patient receives support for a fortnight.
0:09:35 > 0:09:40Without this service, the patients would have to go to hospital...
0:09:40 > 0:09:43..or they would have to stay there for a longer period.
0:09:43 > 0:09:47How are you? Can I come in?
0:09:47 > 0:09:48There we go.
0:09:48 > 0:09:51Right from the first night, they're absolutely marvellous.
0:09:52 > 0:09:55Absolutely marvellous, all of them.
0:09:55 > 0:10:00Not just the nurses, but the healthcare workers as well.
0:10:00 > 0:10:03A nurse visits the home every day.
0:10:04 > 0:10:06Also during the day...
0:10:06 > 0:10:10..a healthcare worker will help with the food and cleaning.
0:10:11 > 0:10:14They can have as many as four calls in a day.
0:10:15 > 0:10:20The agencies work successfully together according to Janet Binns.
0:10:20 > 0:10:24Feedback from patients has been very positive.
0:10:24 > 0:10:29If they are at home, they already feel better.
0:10:29 > 0:10:32They can see their families more easily.
0:10:33 > 0:10:38We are in an area where people have moved to other countries or areas.
0:10:38 > 0:10:45People can feel lost, especially in hospital without many visitors.
0:10:47 > 0:10:49Clarence Health Centre, Rhyl.
0:10:49 > 0:10:52The surgery is also part of the pilot scheme.
0:10:52 > 0:10:56Dr Gwyn Williams says the scheme has been excellent for some...
0:10:56 > 0:11:00..but not for everyone, especially those with mobility problems...
0:11:00 > 0:11:02..or those who live alone.
0:11:02 > 0:11:07A problem we've had is they've had to go to a community hospital...
0:11:07 > 0:11:11..in Holywell, Colwyn Bay or Denbigh.
0:11:11 > 0:11:15Because they are older, their friends are older...
0:11:15 > 0:11:19..and their partner is also older.
0:11:19 > 0:11:22They will have had difficulties when trying to visit.
0:11:22 > 0:11:28This adds to the isolation and hampers their recovery.
0:11:28 > 0:11:34The GP questions if there will be enough finance to extend the scheme.
0:11:36 > 0:11:40My main concern is if they will try and make the best of what's there.
0:11:40 > 0:11:47Will they be pushing community nurses into the scheme...
0:11:47 > 0:11:50..instead of employing staff for the scheme?
0:11:51 > 0:11:53That will add pressure on them.
0:11:55 > 0:11:57The health board says...
0:11:57 > 0:12:01..it does not intend to get rid of hospital beds entirely.
0:12:01 > 0:12:05The board is confident there will be enough money.
0:12:05 > 0:12:10We will have to reinvest the savings that we make.
0:12:11 > 0:12:14That is the way forward with our consultation plans.
0:12:14 > 0:12:19But changes will also take place in other areas.
0:12:19 > 0:12:24Back in Blaenau Ffestiniog, about 200 people are protesting...
0:12:24 > 0:12:28..outside last month's health board public meeting.
0:12:28 > 0:12:32CROWD: Don't close the hospital! Don't close the hospital!
0:12:32 > 0:12:38The emotion is clear and similar scenes can be found elsewhere.
0:12:38 > 0:12:44Recently, it became clear that every health board is behind...
0:12:44 > 0:12:47..when it comes to making savings.
0:12:47 > 0:12:51One health economist says savings isn't the only reason for change.
0:12:52 > 0:12:55The cost, not just the financial cost...
0:12:55 > 0:12:59..of running services at local hospitals is higher.
0:13:00 > 0:13:03If they're not secure, the standard won't be there...
0:13:03 > 0:13:07..to ensure patients get the required service.
0:13:07 > 0:13:09That is why we must change the system.
0:13:09 > 0:13:15A whole list of things makes the situation more complicated.
0:13:15 > 0:13:19There is less money to spend and more people are living longer.
0:13:19 > 0:13:23Health boards admit they don't always reach their targets.
0:13:23 > 0:13:28They say some services are in danger of collapsing...
0:13:28 > 0:13:31..because of a shortage of doctors.
0:13:31 > 0:13:34There's enough evidence and enough research has been done...
0:13:34 > 0:13:39..to show the system we have is unaffordable.
0:13:39 > 0:13:45People need to understand there are many more risks in the system...
0:13:45 > 0:13:50..if we retain the status quo. We also have financial problems.
0:00:00 > 0:00:00.
0:14:03 > 0:14:08Llanelli and a Hywel Dda health board public meeting.
0:14:08 > 0:14:13The health board wants to change things over the next five years...
0:14:13 > 0:14:15..as do other boards in Wales.
0:14:15 > 0:14:18They intend to invest £40 million in care in the community.
0:14:18 > 0:14:23But those gathered here only want to discuss one thing...
0:14:23 > 0:14:27..the emergency service plans for the local Prince Philip Hospital.
0:14:27 > 0:14:31Your have to go back to the drawing board. This is a bad idea.
0:14:32 > 0:14:36Let me tell you, moving A&E, people will die. No question.
0:14:40 > 0:14:44Under the plans, the A&E unit will change its name...
0:14:44 > 0:14:48..to the Local Accident Centre and will be led by nurses...
0:14:48 > 0:14:53..rather than by the current emergency consultant.
0:14:54 > 0:14:57They will be treating minor illnesses and injuries.
0:14:58 > 0:15:02This is not significant change, in terms of Prince Philip.
0:15:02 > 0:15:05Can I just answer the question?
0:15:06 > 0:15:10This is not significant change, in terms of Prince Philip.
0:15:10 > 0:15:13I'm going to answer the question, if you let me answer it.
0:15:14 > 0:15:18That was the clear message from the board, no significant change.
0:15:18 > 0:15:23Despite the unit's current name, it is misleading.
0:15:23 > 0:15:27We cannot continue to call it something which it isn't.
0:15:27 > 0:15:31Visitors to Llanelli would hope that there would be...
0:15:31 > 0:15:35..the whole range of back-up specialities in the hospital...
0:15:35 > 0:15:39..because it's says A&E above the door. It means something.
0:15:39 > 0:15:43If you have it there and there are not the appropriate specialists...
0:15:43 > 0:15:46..that is a recipe for disaster.
0:15:46 > 0:15:51There will also be an emergency assessment unit...
0:15:51 > 0:15:57..for conditions such as strokes, diabetes and heart problems.
0:15:57 > 0:16:00Geraint Hopkins attended the meeting.
0:16:00 > 0:16:03He disagrees there are no changes under the plans.
0:16:04 > 0:16:09Nothing against the nurses, but this nurse-led unit won't work.
0:16:09 > 0:16:15Say you go there with a headache, you're given paracetamol...
0:16:15 > 0:16:18..you could be having a brain haemorrhage.
0:16:18 > 0:16:22The nurses are not qualified to tell you what is wrong.
0:16:23 > 0:16:26The nurses will receive support and training...
0:16:27 > 0:16:31..from emergency consultants via video link, say Hywel Dda.
0:16:31 > 0:16:35As it is a 24-hour service, it will be better than the current system...
0:16:36 > 0:16:39..where GPs provide night time care.
0:16:41 > 0:16:44Geraint Hopkins is worried there will be extra pressure...
0:16:44 > 0:16:48..on the ambulance service with patients travelling further...
0:16:48 > 0:16:50..to Carmarthen or Swansea.
0:16:50 > 0:16:53He says the service is already under pressure.
0:16:53 > 0:16:56He recently called an ambulance for his wife...
0:16:56 > 0:17:00..who suffers from an unusual allergy.
0:17:01 > 0:17:05There was no ambulance available. I spoke to the woman on the phone.
0:17:05 > 0:17:10She told me, "You can't move her. You must leave her on the floor."
0:17:10 > 0:17:14"I have to get her to hospital in ten minutes...
0:17:14 > 0:17:17"..so they can give her hydrocortisone...
0:17:17 > 0:17:20"..or she'll have a second anaphylaxis
0:17:21 > 0:17:24She said, "I can't do anything." Well, she couldn't breathe.
0:17:25 > 0:17:29She was changing colour. Luckily, the rapid response turned up.
0:17:29 > 0:17:33While arguments remain over the name, one body is warning...
0:17:34 > 0:17:39..that a national policy is needed in naming emergency centres.
0:17:39 > 0:17:44With so many changes planned, there is the potential for confusion.
0:17:45 > 0:17:49We know they're called minor injury units, local accident centres...
0:17:49 > 0:17:53..but we also know of units that are called minor injury units...
0:17:53 > 0:17:57..that actually provide GP services.
0:17:57 > 0:17:59This where the confusion lies.
0:17:59 > 0:18:04It's making a decision on what we call them and what is provided...
0:18:04 > 0:18:07..so the public are clear what they can expect.
0:18:08 > 0:18:12A week ago, the South Wales health boards announced their plans.
0:18:12 > 0:18:16Some specialist services will be centralised..
0:18:17 > 0:18:21..with fewer hospitals providing full accident and emergency services.
0:18:25 > 0:18:28But the changes are not restricted to Wales.
0:18:28 > 0:18:34Across the border, changes have already taken place in many areas.
0:18:34 > 0:18:37I travelled to Newark, near Nottingham.
0:18:37 > 0:18:41In 2010, the A&E unit changed...
0:18:42 > 0:18:46..and became a unit which would only treat minor injuries and sickness.
0:18:46 > 0:18:50Paul Baggaley is secretary of the committee to safeguard the hospital.
0:18:50 > 0:18:53We're constantly told that Newark Hospital never had A&E...
0:18:53 > 0:18:58..because it never had all the specialist support services...
0:18:58 > 0:19:02..that other major hospitals do.
0:19:02 > 0:19:06Newark Hospital dealt with emergency care in Newark...
0:19:06 > 0:19:08..and provided a great service.
0:19:09 > 0:19:14The arguments presented to close the A&E unit here in Newark...
0:19:14 > 0:19:19..are similar to those heard by campaigners in the Llanelli area...
0:19:19 > 0:19:22..that there is a shortage of back-up services...
0:19:22 > 0:19:25..such as intensive surgery.
0:19:25 > 0:19:30Managers also argued that most of the patients coming to the unit...
0:19:30 > 0:19:35..only needed treatment for minor injuries and illness.
0:19:36 > 0:19:40Campaigners say the community has lost out following the changes...
0:19:41 > 0:19:44..with increased pressure on the remaining full A&E units.
0:19:45 > 0:19:49Recent figures show the number of people waiting over four hours...
0:19:50 > 0:19:51..has more than tripled.
0:19:52 > 0:19:55As more and more small hospitals close, more people have to go...
0:19:56 > 0:20:00..to these major A&Es and it's creating greater pressure.
0:20:00 > 0:20:04Added on to that is the pressure it puts on the ambulance service.
0:20:04 > 0:20:09The average transfer times for people being discharged...
0:20:09 > 0:20:13..into an alternative A&E is an hour and a half.
0:20:13 > 0:20:18That's 15 minutes worse than the average for the East Midlands.
0:20:18 > 0:20:23According to the health trust, they are acutely aware...
0:20:23 > 0:20:28..of the importance of transferring patients as quickly as possible.
0:20:28 > 0:20:33They're working with the ambulance service to provide the best care.
0:20:33 > 0:20:38Back in Llanelli, no-one from the health board was available...
0:20:38 > 0:20:40..for interview.
0:20:40 > 0:20:44In a statement, they said the plans for Prince Philip Hospital...
0:20:44 > 0:20:47..do not involve scrapping any emergency services...
0:20:47 > 0:20:51..trained emergency nurses will treat most patients...
0:20:51 > 0:20:55..while emergencies will go straight to the assessment unit...
0:20:55 > 0:20:59..led by consultants, reducing unnecessary delays...
0:21:00 > 0:21:02..in receiving emergency treatment...
0:21:02 > 0:21:07..so there will be no additional pressure on services.
0:21:09 > 0:21:15Most of Hywel Dda's budget is spent on the workforce.
0:21:15 > 0:21:21There are no details on how changes may affect the number of jobs.
0:21:22 > 0:21:26But Taro Naw has obtained this confidential draft document.
0:21:26 > 0:21:28It's the board's draft document.
0:21:28 > 0:21:32It notes and shows what some of the changes could mean...
0:21:32 > 0:21:35..regarding local staffing levels.
0:21:35 > 0:21:39Over the coming years, eight wards and four community hospitals...
0:21:40 > 0:21:44..will close with nurses and clinical staff the worst hit.
0:21:45 > 0:21:48The reduction in the number of jobs...
0:21:48 > 0:21:51..will correspond to 319 full-time jobs.
0:21:52 > 0:21:55But around 100 of those will move to the community.
0:21:56 > 0:22:01As so many staff are part-time, the changes could affect more people.
0:22:01 > 0:22:05But it's not clear, looking at this document...
0:22:05 > 0:22:10..how many people will lose their jobs through compulsory redundancy.
0:22:10 > 0:22:15The board told Taro Naw that they could not find the document...
0:22:15 > 0:22:19..and therefore could not be certain it was authentic...
0:22:19 > 0:22:23..despite it containing the director's name.
0:22:23 > 0:22:27They added that no final decisions had been made.
0:22:27 > 0:22:32The aim is to work with the staff to ensure efficacy.
0:22:32 > 0:22:36The changes would improve experiences and work opportunities.
0:22:36 > 0:22:42With 46% of their budget going on wages, savings in this field...
0:22:42 > 0:22:46..are part of wider plans to ensure the best value for money.
0:22:49 > 0:22:53All health boards across Wales will be looking closely at staffing...
0:22:54 > 0:22:57..according to Professor Ceri Phillips...
0:22:57 > 0:23:00..but that doesn't necessarily mean job losses...
0:23:01 > 0:23:03..or that services will be affected.
0:23:03 > 0:23:07We have to consider whether or not we need doctors to do everything...
0:23:07 > 0:23:12..or whether nurses, pharmacists and physios can do certain things.
0:23:13 > 0:23:18What we will see is health boards working with professional groups...
0:23:18 > 0:23:23..to try and ensure a different skill mix...
0:23:23 > 0:23:27..that maybe has the same effect, but at a lower cost.
0:23:28 > 0:23:32According to GP Dr Williams, the effect on the workforce...
0:23:33 > 0:23:35..will be significant.
0:23:35 > 0:23:38You starting to talk about cuts of 8% per year.
0:23:39 > 0:23:41You can't cut that.
0:23:41 > 0:23:46It's going to come out of where most of the budget goes...
0:23:46 > 0:23:47..and that is staffing.
0:23:48 > 0:23:52Betsi Cadwaladr and Hywel Dda's consultation periods...
0:23:52 > 0:23:55..come to an end at the end of the month.
0:23:55 > 0:23:58In South Wales, the process has just begun.
0:23:58 > 0:24:03Those at the centre of change are already raising their voices.
0:24:03 > 0:24:06We're the ones who live in the area.
0:24:06 > 0:24:11We want them to come here and live in the area for a while...
0:24:11 > 0:24:16..and realise how much the hospital is needed.
0:24:16 > 0:24:21The challenge for the health boards is to answer those concerns.
0:24:21 > 0:24:27When the system changes, hopefully we will see improved services...
0:24:27 > 0:24:32..better quality services for people in Wales...
0:24:32 > 0:24:35..and the NHS back on its feet.
0:24:56 > 0:24:59Subtitles by Red Bee Media Ltd
0:24:59 > 0:25:00.