Pa mor iach yw dyfodol y Gwasanaeth Iechyd yng Nghymru? How healthy is the future of the NHS in Wales?
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Tonight, the biggest change to the NHS for years.
During the summer, two health boards published their plans.
Now, they want to hear the public's views.
A number of people are ready to share their views.
This is not significant change for Prince Philip.
I'm going to answer the question.
CROWD: Don't close the hospital!
If they close the hospital, Blaenau will die.
With an ageing population and a diminishing budget...
..the challenges are huge. For some, change must happen.
Some of the things taking place at Welsh hospitals aren't safe.
Taro Naw reveals details of a confidential health board document..
..which discusses the effect on jobs.
Blaenau Ffestiniog, Gwynedd.
Here, among slate quarries, a new kind of industry is succeeding.
Downhill mountain biking.
Despite the success of the site, one thing worries the scheme's leaders -
Betsi Cadwaladr Health Board's plans to close the local hospital.
It's the worst time to close Blaenau Hospital.
The type of riding and skill levels here...
..means accidents are going to be unavoidable.
Everyone who rides mountain bikes understands what the dangers are.
What we realize is that people pick up nasty cuts.
The terrain we have here, with the slate...
..means wounds have to be cleaned properly.
Change is afoot across Wales, not just in Blaenau.
The health boards are responding to the Welsh Government's policy...
..of a five-year vision for the NHS.
More care at home and centralization of some services.
The plans for Blaenau Ffestiniog are part of the health board's plans...
..to improve the service in North Wales.
I cannot film inside the hospital because I do not have permission.
But I can tell you there are 12 beds for inpatients.
There is also a minor accident unit.
Keeping the doors open costs £800,000 a year.
Under the health board's plans, it would all disappear.
I went to meet one family which insists the hospital is crucial.
Good afternoon. I'm Garry. How are you?
Sharon O'Neill and her mother, Jean Evans, live close to the hospital.
When I visited, Sharon's father, Wil Evans, was in hospital.
He had problems with his kidneys, his heart and dementia.
When you look out of the window and see the hospital, how do you feel?
I feel sad.
I look up and I know my father is there.
I say good morning when I open the curtains every morning.
We don't know how long Dad will be with us.
I want to be close to him.
To see it not as a hospital...
..because I've spent a lot of time there too with illnesses...
They've been wonderful. I can't fault it.
Aren't you being a little emotional, sentimental, perhaps?
Things have moved on now and there are newer services?
No, it's part of Blaenau. That was built for Blaenau people.
The hospital opened in 1925...
..in memory of those who died in World War I.
Local slate workers paid for it.
The name of Sharon O'Neill's uncle, her father's brother...
..is on the memorial.
Another relative helped build the hospital.
They built the hospital for the area.
If they decide to close it, they should hand it back.
The community should then decide what to do with it.
Last week, Wil Evans was moved to a nursing home 12 miles away.
When I visited the family before he was moved...
..the importance of having him nearby was clear.
It means I can see the hospital from the house.
And I know that if... I know he's dying. They told me he's dying.
It's the fact that if they move him from there...
..it will be really difficult to go and visit.
The health board says there have been staffing problems.
Beds have had to be moved...
..and the minor injuries unit temporary closed.
The aim is to relocate the unit and the beds...
..14 miles away to Alltwen Hospital in Tremadog.
Staffing problems are an excuse...
..according to the chairman of the hospital's protection board.
They won't spend on overtime for current members of staff.
They won't spend to bring in extra members of staff.
That problem is a recent one. The health board created it.
Alltwen Hospital was opened three years ago.
The health board emphasises it has modern facilities...
..and can treat more patients.
Looking at the building, it's an old building.
You now have an opportunity to get modern facilities.
Until you've been inside, and heard people's experiences...
..then you would never describe it as old or old fashioned.
The care here is excellent.
Travelling to Alltwen Hospital worries Sharon O'Neill.
Buses are very rare here. They only go once every hour or so.
I'm fortunate because I have a car.
But what about the elderly who want to go to Alltwen?
It will be difficult.
It's a similar story across Wales.
Services are being centralized, some community hospitals will close.
The health boards say this will lead to better patient care.
They say there are too many people are currently in hospital.
It would be better to care for them in the community.
By investing in home care, Betsi Cadwaladr Health Board...
..acknowledges it won't be suitable for everybody.
Those who have to travel further for hospital beds and their families...
..will be given support.
We have looked at the community transport system, buses, taxis...
..and the third sector, such as the Red Cross...
..to make sure we considered these things.
But how do you explain the change to people in Blaenau Ffestiniog?
One reason to close is because the building is no longer appropriate.
There have been changes with nurses, staff...
..and the problems we've had concerning staffing.
We also need to move on with enhanced care at home in the area.
We believe that is something that will bring much more...
..of the care that is needed in that community.
The enhanced care at home scheme...
..has been run as a pilot scheme in Rhyl and Prestatyn.
Three years ago, in-patient wards were closed...
..at Rhyl's Royal Alexandra Hospital.
The money was used to provide care at home.
The aim is to extend the scheme throughout North Wales.
Janet Binns is part of the pilot.
As part of the scheme, a number of agencies co-operate...
..including social workers, nurses, physiotherapists and consultants.
This morning, we shall be visiting a woman.
We shall be taking her blood pressure.
We shall assess her to see how things are developing.
Usually, the patient receives support for a fortnight.
Without this service, the patients would have to go to hospital...
..or they would have to stay there for a longer period.
How are you? Can I come in?
There we go.
Right from the first night, they're absolutely marvellous.
Absolutely marvellous, all of them.
Not just the nurses, but the healthcare workers as well.
A nurse visits the home every day.
Also during the day...
..a healthcare worker will help with the food and cleaning.
They can have as many as four calls in a day.
The agencies work successfully together according to Janet Binns.
Feedback from patients has been very positive.
If they are at home, they already feel better.
They can see their families more easily.
We are in an area where people have moved to other countries or areas.
People can feel lost, especially in hospital without many visitors.
Clarence Health Centre, Rhyl.
The surgery is also part of the pilot scheme.
Dr Gwyn Williams says the scheme has been excellent for some...
..but not for everyone, especially those with mobility problems...
..or those who live alone.
A problem we've had is they've had to go to a community hospital...
..in Holywell, Colwyn Bay or Denbigh.
Because they are older, their friends are older...
..and their partner is also older.
They will have had difficulties when trying to visit.
This adds to the isolation and hampers their recovery.
The GP questions if there will be enough finance to extend the scheme.
My main concern is if they will try and make the best of what's there.
Will they be pushing community nurses into the scheme...
..instead of employing staff for the scheme?
That will add pressure on them.
The health board says...
..it does not intend to get rid of hospital beds entirely.
The board is confident there will be enough money.
We will have to reinvest the savings that we make.
That is the way forward with our consultation plans.
But changes will also take place in other areas.
Back in Blaenau Ffestiniog, about 200 people are protesting...
..outside last month's health board public meeting.
CROWD: Don't close the hospital! Don't close the hospital!
The emotion is clear and similar scenes can be found elsewhere.
Recently, it became clear that every health board is behind...
..when it comes to making savings.
One health economist says savings isn't the only reason for change.
The cost, not just the financial cost...
..of running services at local hospitals is higher.
If they're not secure, the standard won't be there...
..to ensure patients get the required service.
That is why we must change the system.
A whole list of things makes the situation more complicated.
There is less money to spend and more people are living longer.
Health boards admit they don't always reach their targets.
They say some services are in danger of collapsing...
..because of a shortage of doctors.
There's enough evidence and enough research has been done...
..to show the system we have is unaffordable.
People need to understand there are many more risks in the system...
..if we retain the status quo. We also have financial problems.
Llanelli and a Hywel Dda health board public meeting.
The health board wants to change things over the next five years...
..as do other boards in Wales.
They intend to invest £40 million in care in the community.
But those gathered here only want to discuss one thing...
..the emergency service plans for the local Prince Philip Hospital.
Your have to go back to the drawing board. This is a bad idea.
Let me tell you, moving A&E, people will die. No question.
Under the plans, the A&E unit will change its name...
..to the Local Accident Centre and will be led by nurses...
..rather than by the current emergency consultant.
They will be treating minor illnesses and injuries.
This is not significant change, in terms of Prince Philip.
Can I just answer the question?
This is not significant change, in terms of Prince Philip.
I'm going to answer the question, if you let me answer it.
That was the clear message from the board, no significant change.
Despite the unit's current name, it is misleading.
We cannot continue to call it something which it isn't.
Visitors to Llanelli would hope that there would be...
..the whole range of back-up specialities in the hospital...
..because it's says A&E above the door. It means something.
If you have it there and there are not the appropriate specialists...
..that is a recipe for disaster.
There will also be an emergency assessment unit...
..for conditions such as strokes, diabetes and heart problems.
Geraint Hopkins attended the meeting.
He disagrees there are no changes under the plans.
Nothing against the nurses, but this nurse-led unit won't work.
Say you go there with a headache, you're given paracetamol...
..you could be having a brain haemorrhage.
The nurses are not qualified to tell you what is wrong.
The nurses will receive support and training...
..from emergency consultants via video link, say Hywel Dda.
As it is a 24-hour service, it will be better than the current system...
..where GPs provide night time care.
Geraint Hopkins is worried there will be extra pressure...
..on the ambulance service with patients travelling further...
..to Carmarthen or Swansea.
He says the service is already under pressure.
He recently called an ambulance for his wife...
..who suffers from an unusual allergy.
There was no ambulance available. I spoke to the woman on the phone.
She told me, "You can't move her. You must leave her on the floor."
"I have to get her to hospital in ten minutes...
"..so they can give her hydrocortisone...
"..or she'll have a second anaphylaxis
She said, "I can't do anything." Well, she couldn't breathe.
She was changing colour. Luckily, the rapid response turned up.
While arguments remain over the name, one body is warning...
..that a national policy is needed in naming emergency centres.
With so many changes planned, there is the potential for confusion.
We know they're called minor injury units, local accident centres...
..but we also know of units that are called minor injury units...
..that actually provide GP services.
This where the confusion lies.
It's making a decision on what we call them and what is provided...
..so the public are clear what they can expect.
A week ago, the South Wales health boards announced their plans.
Some specialist services will be centralised..
..with fewer hospitals providing full accident and emergency services.
But the changes are not restricted to Wales.
Across the border, changes have already taken place in many areas.
I travelled to Newark, near Nottingham.
In 2010, the A&E unit changed...
..and became a unit which would only treat minor injuries and sickness.
Paul Baggaley is secretary of the committee to safeguard the hospital.
We're constantly told that Newark Hospital never had A&E...
..because it never had all the specialist support services...
..that other major hospitals do.
Newark Hospital dealt with emergency care in Newark...
..and provided a great service.
The arguments presented to close the A&E unit here in Newark...
..are similar to those heard by campaigners in the Llanelli area...
..that there is a shortage of back-up services...
..such as intensive surgery.
Managers also argued that most of the patients coming to the unit...
..only needed treatment for minor injuries and illness.
Campaigners say the community has lost out following the changes...
..with increased pressure on the remaining full A&E units.
Recent figures show the number of people waiting over four hours...
..has more than tripled.
As more and more small hospitals close, more people have to go...
..to these major A&Es and it's creating greater pressure.
Added on to that is the pressure it puts on the ambulance service.
The average transfer times for people being discharged...
..into an alternative A&E is an hour and a half.
That's 15 minutes worse than the average for the East Midlands.
According to the health trust, they are acutely aware...
..of the importance of transferring patients as quickly as possible.
They're working with the ambulance service to provide the best care.
Back in Llanelli, no-one from the health board was available...
In a statement, they said the plans for Prince Philip Hospital...
..do not involve scrapping any emergency services...
..trained emergency nurses will treat most patients...
..while emergencies will go straight to the assessment unit...
..led by consultants, reducing unnecessary delays...
..in receiving emergency treatment...
..so there will be no additional pressure on services.
Most of Hywel Dda's budget is spent on the workforce.
There are no details on how changes may affect the number of jobs.
But Taro Naw has obtained this confidential draft document.
It's the board's draft document.
It notes and shows what some of the changes could mean...
..regarding local staffing levels.
Over the coming years, eight wards and four community hospitals...
..will close with nurses and clinical staff the worst hit.
The reduction in the number of jobs...
..will correspond to 319 full-time jobs.
But around 100 of those will move to the community.
As so many staff are part-time, the changes could affect more people.
But it's not clear, looking at this document...
..how many people will lose their jobs through compulsory redundancy.
The board told Taro Naw that they could not find the document...
..and therefore could not be certain it was authentic...
..despite it containing the director's name.
They added that no final decisions had been made.
The aim is to work with the staff to ensure efficacy.
The changes would improve experiences and work opportunities.
With 46% of their budget going on wages, savings in this field...
..are part of wider plans to ensure the best value for money.
All health boards across Wales will be looking closely at staffing...
..according to Professor Ceri Phillips...
..but that doesn't necessarily mean job losses...
..or that services will be affected.
We have to consider whether or not we need doctors to do everything...
..or whether nurses, pharmacists and physios can do certain things.
What we will see is health boards working with professional groups...
..to try and ensure a different skill mix...
..that maybe has the same effect, but at a lower cost.
According to GP Dr Williams, the effect on the workforce...
..will be significant.
You starting to talk about cuts of 8% per year.
You can't cut that.
It's going to come out of where most of the budget goes...
..and that is staffing.
Betsi Cadwaladr and Hywel Dda's consultation periods...
..come to an end at the end of the month.
In South Wales, the process has just begun.
Those at the centre of change are already raising their voices.
We're the ones who live in the area.
We want them to come here and live in the area for a while...
..and realise how much the hospital is needed.
The challenge for the health boards is to answer those concerns.
When the system changes, hopefully we will see improved services...
..better quality services for people in Wales...
..and the NHS back on its feet.
Subtitles by Red Bee Media Ltd
Wrth i fyrddau iechyd Cymru gyhoeddi newidiadau pellgyrhaeddol i'r gwasanaeth, beth fydd yr oblygiadau i gleifion ac i lefelau staffio? Er gwaetha'r holl brotestio cymunedol, golyga'r wasgfa ariannol fod newid mawr yn anochel. Bydd Taro 9 yn teithio i wahanol rannau o Gymru ac i Loegr i bwyso a mesur y chwyldro mwyaf yn hanes y gwasanaeth ers ei sefydlu ym 1948. As health boards in Wales announce far-reaching changes to the service, what effect will this have on patients and staffing levels? Despite protestations from communities, the financial squeeze means a big change is inevitable. Taro 9 travels to different parts of Wales and to England to assess the effects of the biggest shake-up of the service since it was established in 1948. Transmitted on 02/10/12 at 9pm.