Argyfwng y Gwasanaeth Iechyd Taro Naw


Argyfwng y Gwasanaeth Iechyd

Pa mor iach yw dyfodol y Gwasanaeth Iechyd yng Nghymru? How healthy is the future of the NHS in Wales?


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Transcript


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Tonight, the biggest change to the NHS for years.

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During the summer, two health boards published their plans.

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Now, they want to hear the public's views.

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A number of people are ready to share their views.

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This is not significant change for Prince Philip.

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I'm going to answer the question.

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CROWD: Don't close the hospital!

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If they close the hospital, Blaenau will die.

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With an ageing population and a diminishing budget...

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..the challenges are huge. For some, change must happen.

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Some of the things taking place at Welsh hospitals aren't safe.

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Taro Naw reveals details of a confidential health board document..

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..which discusses the effect on jobs.

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Blaenau Ffestiniog, Gwynedd.

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Here, among slate quarries, a new kind of industry is succeeding.

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Downhill mountain biking.

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Despite the success of the site, one thing worries the scheme's leaders -

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Betsi Cadwaladr Health Board's plans to close the local hospital.

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It's the worst time to close Blaenau Hospital.

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The type of riding and skill levels here...

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..means accidents are going to be unavoidable.

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Everyone who rides mountain bikes understands what the dangers are.

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What we realize is that people pick up nasty cuts.

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The terrain we have here, with the slate...

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..means wounds have to be cleaned properly.

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Change is afoot across Wales, not just in Blaenau.

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The health boards are responding to the Welsh Government's policy...

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..of a five-year vision for the NHS.

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More care at home and centralization of some services.

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The plans for Blaenau Ffestiniog are part of the health board's plans...

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..to improve the service in North Wales.

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I cannot film inside the hospital because I do not have permission.

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But I can tell you there are 12 beds for inpatients.

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There is also a minor accident unit.

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Keeping the doors open costs £800,000 a year.

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Under the health board's plans, it would all disappear.

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I went to meet one family which insists the hospital is crucial.

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Good afternoon. I'm Garry. How are you?

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Sharon O'Neill and her mother, Jean Evans, live close to the hospital.

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When I visited, Sharon's father, Wil Evans, was in hospital.

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He had problems with his kidneys, his heart and dementia.

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When you look out of the window and see the hospital, how do you feel?

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I feel sad.

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I look up and I know my father is there.

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I say good morning when I open the curtains every morning.

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We don't know how long Dad will be with us.

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I want to be close to him.

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To see it not as a hospital...

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..because I've spent a lot of time there too with illnesses...

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They've been wonderful. I can't fault it.

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Aren't you being a little emotional, sentimental, perhaps?

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Things have moved on now and there are newer services?

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No, it's part of Blaenau. That was built for Blaenau people.

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The hospital opened in 1925...

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..in memory of those who died in World War I.

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Local slate workers paid for it.

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The name of Sharon O'Neill's uncle, her father's brother...

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..is on the memorial.

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Another relative helped build the hospital.

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They built the hospital for the area.

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If they decide to close it, they should hand it back.

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The community should then decide what to do with it.

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Last week, Wil Evans was moved to a nursing home 12 miles away.

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When I visited the family before he was moved...

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..the importance of having him nearby was clear.

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It means I can see the hospital from the house.

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And I know that if... I know he's dying. They told me he's dying.

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Yes.

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I'm sorry.

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It's the fact that if they move him from there...

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..it will be really difficult to go and visit.

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The health board says there have been staffing problems.

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Beds have had to be moved...

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..and the minor injuries unit temporary closed.

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The aim is to relocate the unit and the beds...

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..14 miles away to Alltwen Hospital in Tremadog.

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Staffing problems are an excuse...

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..according to the chairman of the hospital's protection board.

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They won't spend on overtime for current members of staff.

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They won't spend to bring in extra members of staff.

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That problem is a recent one. The health board created it.

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Alltwen Hospital was opened three years ago.

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The health board emphasises it has modern facilities...

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..and can treat more patients.

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Looking at the building, it's an old building.

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You now have an opportunity to get modern facilities.

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Until you've been inside, and heard people's experiences...

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..then you would never describe it as old or old fashioned.

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The care here is excellent.

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Travelling to Alltwen Hospital worries Sharon O'Neill.

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Buses are very rare here. They only go once every hour or so.

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I'm fortunate because I have a car.

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But what about the elderly who want to go to Alltwen?

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It will be difficult.

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It's a similar story across Wales.

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Services are being centralized, some community hospitals will close.

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The health boards say this will lead to better patient care.

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They say there are too many people are currently in hospital.

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It would be better to care for them in the community.

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By investing in home care, Betsi Cadwaladr Health Board...

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..acknowledges it won't be suitable for everybody.

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Those who have to travel further for hospital beds and their families...

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..will be given support.

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We have looked at the community transport system, buses, taxis...

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..and the third sector, such as the Red Cross...

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..to make sure we considered these things.

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But how do you explain the change to people in Blaenau Ffestiniog?

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One reason to close is because the building is no longer appropriate.

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There have been changes with nurses, staff...

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..and the problems we've had concerning staffing.

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We also need to move on with enhanced care at home in the area.

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We believe that is something that will bring much more...

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..of the care that is needed in that community.

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The enhanced care at home scheme...

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..has been run as a pilot scheme in Rhyl and Prestatyn.

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Three years ago, in-patient wards were closed...

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..at Rhyl's Royal Alexandra Hospital.

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The money was used to provide care at home.

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The aim is to extend the scheme throughout North Wales.

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Janet Binns is part of the pilot.

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As part of the scheme, a number of agencies co-operate...

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..including social workers, nurses, physiotherapists and consultants.

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This morning, we shall be visiting a woman.

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We shall be taking her blood pressure.

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We shall assess her to see how things are developing.

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Usually, the patient receives support for a fortnight.

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Without this service, the patients would have to go to hospital...

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..or they would have to stay there for a longer period.

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How are you? Can I come in?

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There we go.

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Right from the first night, they're absolutely marvellous.

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Absolutely marvellous, all of them.

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Not just the nurses, but the healthcare workers as well.

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A nurse visits the home every day.

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Also during the day...

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..a healthcare worker will help with the food and cleaning.

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They can have as many as four calls in a day.

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The agencies work successfully together according to Janet Binns.

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Feedback from patients has been very positive.

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If they are at home, they already feel better.

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They can see their families more easily.

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We are in an area where people have moved to other countries or areas.

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People can feel lost, especially in hospital without many visitors.

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Clarence Health Centre, Rhyl.

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The surgery is also part of the pilot scheme.

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Dr Gwyn Williams says the scheme has been excellent for some...

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..but not for everyone, especially those with mobility problems...

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..or those who live alone.

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A problem we've had is they've had to go to a community hospital...

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..in Holywell, Colwyn Bay or Denbigh.

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Because they are older, their friends are older...

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..and their partner is also older.

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They will have had difficulties when trying to visit.

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This adds to the isolation and hampers their recovery.

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The GP questions if there will be enough finance to extend the scheme.

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My main concern is if they will try and make the best of what's there.

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Will they be pushing community nurses into the scheme...

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..instead of employing staff for the scheme?

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That will add pressure on them.

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The health board says...

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..it does not intend to get rid of hospital beds entirely.

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The board is confident there will be enough money.

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We will have to reinvest the savings that we make.

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That is the way forward with our consultation plans.

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But changes will also take place in other areas.

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Back in Blaenau Ffestiniog, about 200 people are protesting...

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..outside last month's health board public meeting.

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CROWD: Don't close the hospital! Don't close the hospital!

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The emotion is clear and similar scenes can be found elsewhere.

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Recently, it became clear that every health board is behind...

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..when it comes to making savings.

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One health economist says savings isn't the only reason for change.

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The cost, not just the financial cost...

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..of running services at local hospitals is higher.

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If they're not secure, the standard won't be there...

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..to ensure patients get the required service.

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That is why we must change the system.

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A whole list of things makes the situation more complicated.

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There is less money to spend and more people are living longer.

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Health boards admit they don't always reach their targets.

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They say some services are in danger of collapsing...

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..because of a shortage of doctors.

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There's enough evidence and enough research has been done...

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..to show the system we have is unaffordable.

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People need to understand there are many more risks in the system...

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..if we retain the status quo. We also have financial problems.

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Llanelli and a Hywel Dda health board public meeting.

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The health board wants to change things over the next five years...

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..as do other boards in Wales.

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They intend to invest £40 million in care in the community.

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But those gathered here only want to discuss one thing...

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..the emergency service plans for the local Prince Philip Hospital.

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Your have to go back to the drawing board. This is a bad idea.

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Let me tell you, moving A&E, people will die. No question.

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Under the plans, the A&E unit will change its name...

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..to the Local Accident Centre and will be led by nurses...

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..rather than by the current emergency consultant.

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They will be treating minor illnesses and injuries.

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This is not significant change, in terms of Prince Philip.

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Can I just answer the question?

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This is not significant change, in terms of Prince Philip.

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I'm going to answer the question, if you let me answer it.

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That was the clear message from the board, no significant change.

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Despite the unit's current name, it is misleading.

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We cannot continue to call it something which it isn't.

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Visitors to Llanelli would hope that there would be...

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..the whole range of back-up specialities in the hospital...

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..because it's says A&E above the door. It means something.

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If you have it there and there are not the appropriate specialists...

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..that is a recipe for disaster.

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There will also be an emergency assessment unit...

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..for conditions such as strokes, diabetes and heart problems.

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Geraint Hopkins attended the meeting.

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He disagrees there are no changes under the plans.

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Nothing against the nurses, but this nurse-led unit won't work.

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Say you go there with a headache, you're given paracetamol...

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..you could be having a brain haemorrhage.

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The nurses are not qualified to tell you what is wrong.

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The nurses will receive support and training...

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..from emergency consultants via video link, say Hywel Dda.

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As it is a 24-hour service, it will be better than the current system...

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..where GPs provide night time care.

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Geraint Hopkins is worried there will be extra pressure...

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..on the ambulance service with patients travelling further...

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..to Carmarthen or Swansea.

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He says the service is already under pressure.

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He recently called an ambulance for his wife...

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..who suffers from an unusual allergy.

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There was no ambulance available. I spoke to the woman on the phone.

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She told me, "You can't move her. You must leave her on the floor."

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"I have to get her to hospital in ten minutes...

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"..so they can give her hydrocortisone...

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"..or she'll have a second anaphylaxis

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She said, "I can't do anything." Well, she couldn't breathe.

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She was changing colour. Luckily, the rapid response turned up.

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While arguments remain over the name, one body is warning...

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..that a national policy is needed in naming emergency centres.

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With so many changes planned, there is the potential for confusion.

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We know they're called minor injury units, local accident centres...

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..but we also know of units that are called minor injury units...

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..that actually provide GP services.

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This where the confusion lies.

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It's making a decision on what we call them and what is provided...

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..so the public are clear what they can expect.

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A week ago, the South Wales health boards announced their plans.

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Some specialist services will be centralised..

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..with fewer hospitals providing full accident and emergency services.

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But the changes are not restricted to Wales.

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Across the border, changes have already taken place in many areas.

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I travelled to Newark, near Nottingham.

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In 2010, the A&E unit changed...

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..and became a unit which would only treat minor injuries and sickness.

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Paul Baggaley is secretary of the committee to safeguard the hospital.

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We're constantly told that Newark Hospital never had A&E...

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..because it never had all the specialist support services...

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..that other major hospitals do.

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Newark Hospital dealt with emergency care in Newark...

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..and provided a great service.

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The arguments presented to close the A&E unit here in Newark...

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..are similar to those heard by campaigners in the Llanelli area...

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..that there is a shortage of back-up services...

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..such as intensive surgery.

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Managers also argued that most of the patients coming to the unit...

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..only needed treatment for minor injuries and illness.

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Campaigners say the community has lost out following the changes...

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..with increased pressure on the remaining full A&E units.

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Recent figures show the number of people waiting over four hours...

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..has more than tripled.

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As more and more small hospitals close, more people have to go...

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..to these major A&Es and it's creating greater pressure.

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Added on to that is the pressure it puts on the ambulance service.

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The average transfer times for people being discharged...

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..into an alternative A&E is an hour and a half.

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That's 15 minutes worse than the average for the East Midlands.

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According to the health trust, they are acutely aware...

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..of the importance of transferring patients as quickly as possible.

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They're working with the ambulance service to provide the best care.

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Back in Llanelli, no-one from the health board was available...

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..for interview.

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In a statement, they said the plans for Prince Philip Hospital...

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..do not involve scrapping any emergency services...

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..trained emergency nurses will treat most patients...

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..while emergencies will go straight to the assessment unit...

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..led by consultants, reducing unnecessary delays...

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..in receiving emergency treatment...

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..so there will be no additional pressure on services.

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Most of Hywel Dda's budget is spent on the workforce.

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There are no details on how changes may affect the number of jobs.

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But Taro Naw has obtained this confidential draft document.

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It's the board's draft document.

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It notes and shows what some of the changes could mean...

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..regarding local staffing levels.

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Over the coming years, eight wards and four community hospitals...

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..will close with nurses and clinical staff the worst hit.

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The reduction in the number of jobs...

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..will correspond to 319 full-time jobs.

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But around 100 of those will move to the community.

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As so many staff are part-time, the changes could affect more people.

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But it's not clear, looking at this document...

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..how many people will lose their jobs through compulsory redundancy.

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The board told Taro Naw that they could not find the document...

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..and therefore could not be certain it was authentic...

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..despite it containing the director's name.

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They added that no final decisions had been made.

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The aim is to work with the staff to ensure efficacy.

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The changes would improve experiences and work opportunities.

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With 46% of their budget going on wages, savings in this field...

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..are part of wider plans to ensure the best value for money.

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All health boards across Wales will be looking closely at staffing...

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..according to Professor Ceri Phillips...

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..but that doesn't necessarily mean job losses...

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..or that services will be affected.

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We have to consider whether or not we need doctors to do everything...

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..or whether nurses, pharmacists and physios can do certain things.

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What we will see is health boards working with professional groups...

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..to try and ensure a different skill mix...

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..that maybe has the same effect, but at a lower cost.

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According to GP Dr Williams, the effect on the workforce...

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..will be significant.

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You starting to talk about cuts of 8% per year.

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You can't cut that.

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It's going to come out of where most of the budget goes...

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..and that is staffing.

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Betsi Cadwaladr and Hywel Dda's consultation periods...

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..come to an end at the end of the month.

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In South Wales, the process has just begun.

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Those at the centre of change are already raising their voices.

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We're the ones who live in the area.

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We want them to come here and live in the area for a while...

0:24:060:24:11

..and realise how much the hospital is needed.

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The challenge for the health boards is to answer those concerns.

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When the system changes, hopefully we will see improved services...

0:24:210:24:27

..better quality services for people in Wales...

0:24:270:24:32

..and the NHS back on its feet.

0:24:320:24:35

Subtitles by Red Bee Media Ltd

0:24:560:24:59

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0:24:590:25:00

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.


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