Services in Carmarthenshire Dr. Michael Thomas Consultant in Public - - PowerPoint PPT Presentation

Review of General Surgical Services in Carmarthenshire

• Dr. Michael Thomas

Consultant in Public Health Medicine

Statement of the Problem

Need to reconfigure services in Carmarthenshire identified in previous reports:

• Report on the Future Provision of Elective/Emergency

General Surgery at the Carmarthenshire N.H.S. Trust by the Royal College of Surgeons, 2005.

• Recovery Planning Report by Teamwork Management

Services, 2004.

• Joint Committee on Higher Surgical Training (J.C.H.S.T.)

Specialist Advisory Committee (S.A.C.) in General Surgery Regional Visit Report to West Wales General Hospital, 2004.

• The findings of the Mid and West Wales Acute Services

Review will need to be considered.

The Task

• Surgical Services Working Group established to advise

Carmarthenshire L.H.B. on future organisation of surgical services.

• Surgical Services Working Group is multi-disciplinary.
• Integrated working of key stakeholders resulted in

recommendations for future delivery of surgical services.

• Literature review and health care needs assessment.
• Information on activity obtained using epidemiological

and comparative needs assessment approaches.

• Information on treatment and care gained using

corporate and comparative approaches.

• Identification of problems that need to be addressed and

provide information for planning service improvement.

Background

• Trust Organisation

– Two District General Hospitals, Prince Philip Hospital in Llanelli, and West Wales General Hospital in Carmarthen. – Main providers of surgical services for Carmarthenshire. – Carmarthenshire N.H.S. Trust also provides a service for some residents of Ceredigion, Pembrokeshire, Powys and West Glamorgan. – Some Carmarthenshire residents access surgical services at Swansea N.H.S. Trust.

• Primary Care Organisation

– 26 General Practices providing primary care services for the population.

Background

• Surgical Services

– Current arrangement for surgical services in Carmarthenshire involves both emergency and elective surgery at West Wales General Hospital and at Prince Philip Hospital. – No general surgery emergency admissions to Prince Philip Hospital between 5 pm and 9 am during the week or at weekends. – Emergency admissions during these times transferred to West Wales General Hospital. – Elective surgical work is performed at both hospitals.

Aims and Objectives

• Aims

– To review the existing organisation and delivery of surgical services for Carmarthenshire residents and develop recommendations in order to drive improvement.

• Objectives

– To conduct a critical literature review to identify evidence of best practice. – To conduct a health care needs assessment for surgical services, drawing on epidemiological, corporate and comparative information. – To use the information to identify problems and produce a strategy for surgical services aimed at delivering change. – To act as a source of advice to current local planning.

Literature Review

• Aim of Literature Review

– Identify evidence of best practice in the delivery of surgical services.

• Methods for Literature Review

– Search Strategy involved searching multiple databases in order to capture all relevant information.

• Literature Appraisal

– Literature appraised giving consideration to the hierarchy of evidence.

Literature Review

• Audit Commission, 2003. Waiting for Elective Admission: Review of the National
• Findings. London: Audit Commission.
• Audit Commission, 1998. Audit Commission Update. Day Surgery Follow-up:

Progress against indicators from a shortcut to better services. London: Audit Commission.

• Senate of Surgery of Great Britain and Ireland, 2003. Reconfiguration of Surgical,

Accident and Emergency Services in the UK. Glasgow: Senate of Surgery Secretariat.

• The Royal College of Surgeons of England, 2000. The Provision of Elective

Surgical Services. London: The Royal College of Surgeons of England.

• The Royal College of Surgeons of England, 2005. Developing a Modern Surgical
• Workforce. London: The Royal College of Surgeons of England.
• Audit Commission, 2003. Operating Theatres: Review of National Findings.

London: Audit Commission.

• Audit Commission, 2003. Acute Hospital Portfolio Reviews, 2003. London: Audit

Commission.

• Department of Health, 2004. Day Surgery: Operational Guide. Waiting, Booking

and Choice. London: Department of Health.

Key Findings of Literature Review

• The Royal College of Surgeons of England and the specialist

associations exist to set and improve standards of surgical care to patients.

• Modern surgical care must be delivered by Consultant Surgeons within a

multi-professional team.

• There must be a sufficient number of Consultants to meet the increasing

need for service, education, training and professional development of surgeons.

• Consultant Surgeons must be grouped in clinical networks of sufficient

size to provide safe emergency and elective care, and appropriate local services.

• Consultant Surgeons must be employed under conditions that will attract

the widest range of doctors to the permanent surgical workforce.

• Academic Surgeons have a key role to play in enhancing scientific

standards and research, but at present the recruitment and resources are deficient.

Key Findings of Literature Review

• Staff and associate specialists are, at present, essential to maintain a

service and require an appropriate career structure.

• The productivity of surgical teams can be improved by extending the

roles of other professionals within the team.

• Surgeons in training should not undertake unsupervised service work to

the detriment of their training opportunities. They should not be relied upon to support surgical rotas, particularly at night.

• There must be a recognition of the time commitment required of

Consultant Surgeons to provide increased workplace training and subsequent effects on service delivery.

• Improved facilities and better methods of working will be required to

provide an efficient and cost effective service to patients.

• The surgical profession must engage with Government and the

Department of Health to develop new ways of training and service

• provision. The rapid development of surgical knowledge and technology

requires a more responsive and versatile training process. A whole systems approach to training is needed in order that the talents of all members of the surgical team are effectively deployed.

Healthcare Needs Assessment

• Epidemiological Needs Assessment

– Epidemiological approaches required to develop more accurate estimate of burden on surgical services in Carmarthenshire and to provide more information about surgical services. – P.E.D.W. provides information on individuals who require admission to hospital to access surgical services.

Surgical Services Information from Carmarthenshire N.H.S. Trust

West Wales General Hospital

General surgery admissions to West Wales General Hospital by method of admission and year of admission

Data source: Admitted Patient Care dataset, Health Solutions Wales

200 400 600 800 1000 1200 1400 1600 1800 2000 2200 2400 2600 2000/1 2001/2 2002/3 2003/4 2004/5 Date of admission (financial year) Number of general surgery admissions Elective inpatients Day cases Emergency Other

Prince Philip Hospital

General surgery admissions to Prince Philip Hospital by method of admission and year of admission

Data source: Admitted Patient Care dataset, Health Solutions Wales

200 400 600 800 1000 1200 1400 1600 1800 2000 2200 2400 2600 2000/1 2001/2 2002/3 2003/4 2004/5 Date of admission (financial year) Number of general surgery admissions Elective inpatients Day cases Emergency Other

West Wales General Hospital

Emergency general surgery admissions to West Wales General Hospital by area of residence and year of admission

Data source: Admitted Patient Care dataset, Health Solutions Wales

200 400 600 800 1000 1200 1400 1600 1800 2000 2000/1 2001/2 2002/3 2003/4 2004/5 Date of admission (financial year) Number of emergency general surgery admissions Carmarthenshire Ceredigion Pembrokeshire All other areas

Prince Philip Hospital

Emergency general surgery admissions to Prince Philip Hospital by area of residence and year of admission

Data source: Admitted Patient Care dataset, Health Solutions Wales

200 400 600 800 1000 1200 1400 1600 1800 2000 2000/1 2001/2 2002/3 2003/4 2004/5 Date of admission (financial year) Number of emergency general surgery admissions Carmarthenshire Swansea Neath Port Talbot All other areas

Emergency Surgery Admissions for Carmarthenshire Residents

Emergency general surgery admissions for Carmarthenshire residents by hospital site: 2004/5

Data source: Admitted Patient Care dataset, Health Solutions Wales

1,841 773 127 45 82

200 400 600 800 1000 1200 1400 1600 1800 2000 West Wales General Hospital Prince Philip Hospital Morriston Hospital Singleton Hospital Other hospitals Number of emergency general surgery admissions

Emergency General Surgery Admissions

Emergency general surgery admissions of Carmarthenshire residents to West Wales General Hospital by financial year

Data source: Admitted Patient Care dataset, Health Solutions Wales 1,841 1,631 1,654 1,446 1,412

200 400 600 800 1000 1200 1400 1600 1800 2000 2000/1 2001/2 2002/3 2003/4 2004/5 Date of admission (financial year) Number of emergency general surgery admissions

Emergency general surgery admissions of Carmarthenshire residents to Prince Philip Hospital by financial year

Data source: Admitted Patient Care dataset, Health Solutions Wales 773 1,068 1,157 1,590 1,462

200 400 600 800 1000 1200 1400 1600 1800 2000 2000/1 2001/2 2002/3 2003/4 2004/5 Date of admission (financial year) Number of emergency general surgery admissions

Emergency general surgery admissions of Carmarthenshire residents to Morriston Hospital by financial year

Data source: Admitted Patient Care dataset, Health Solutions Wales 74 94 94 132 127

200 400 600 800 1000 1200 1400 1600 1800 2000 2000/1 2001/2 2002/3 2003/4 2004/5 Date of admission (financial year) Number of emergency general surgery admissions

Emergency general surgery admissions of Carmarthenshire residents to Singleton Hospital by financial year

Data source: Admitted Patient Care dataset, Health Solutions Wales 43 42 48 49 45

200 400 600 800 1000 1200 1400 1600 1800 2000 2000/1 2001/2 2002/3 2003/4 2004/5 Date of admission (financial year) Number of emergency general surgery admissions

Carmarthenshire N.H.S. Trust

Proportion of general surgery emergency admissions requiring surgical operation and/or procedure(s) during first episode of care by hospital site and financial year

Data source: Admitted Patient Care dataset, Health Solutions Wales

5 10 15 20 25 30 35 40 45 50 2000/1 2001/2 2002/3 2003/4 2004/5 Date of admission (financial year) Percentage (%) West Wales General Prince Philip Hosptial

Number of General Surgery Emergency Admissions by Hospital Site and Week of Admission: 2004/05

Financial Year General Surgery Emergency Admissions per Week West Wales General Number of Admissions Prince Philip Hospital Number of Admissions 2000/1 Maximum 52 43 Minimum 21 17 2001/2 Maximum 56 46 Minimum 21 18 2002/3 Maximum 59 38 Minimum 25 12 2003/4 Maximum 56 34 Minimum 27 10 2004/5 Maximum 63 29 Minimum 32 7

Carmarthenshire N.H.S. Trust

Number of general surgery emergency admissions by hospital site and week of admission: 2004/05

Data source: Admitted Patient Care dataset, Health Solutions Wales

10 20 30 40 50 60 70 Week 01 Week 02 Week 03 Week 04 Week 05 Week 06 Week 07 Week 08 Week 09 Week 10 Week 11 Week 12 Week 13 Week 14 Week 15 Week 16 Week 17 Week 18 Week 19 Week 20 Week 21 Week 22 Week 23 Week 24 Week 25 Week 26 Week 27 Week 28 Week 29 Week 30 Week 31 Week 32 Week 33 Week 34 Week 35 Week 36 Week 37 Week 38 Week 39 Week 40 Week 41 Week 42 Week 43 Week 44 Week 45 Week 46 Week 47 Week 48 Week 49 Week 50 Week 51 Week 52 Number of admissions West Wales General Hospital Prince Philip Hospital l Apr l May l Jun l Jul l Aug l Sep l Oct l Nov l Dec l Jan l Feb l Mar l

Carmarthenshire N.H.S. Trust

Numbers of patients waiting for General Surgery inpatient care

Data source: Business Service Centre, Mid and West Wales

100 200 300 400 500 600 700 800 900

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Number waiting WWG PPH WWG + PPH* Trust total** l 2000/01 l 2001/02 l 2002/03 l 2003/04 l 2004/05 l

Carmarthenshire N.H.S. Trust

Numbers of patients waiting for General Surgery day case care

Data source: Business Service Centre, Mid and West Wales

100 200 300 400 500 600 700 800 900

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Number waiting PPH WWG Trust total* Trust total** l 2000/01 l 2001/02 l 2002/03 l 2003/04 l 2004/05 l

Carmarthenshire N.H.S. Trust

Patients on General Surgical In-Patient Waiting Lists as at 30th September 2005

248 109 66 43 50 100 150 200 250 300 <3 months 3-5 months 6-8 months 9-11 months Prince Philip Hospital West Wales General Hospital

Carmarthenshire N.H.S. Trust

Patients on General Surgical Day Case Waiting Lists as at 30th September 2005

17 82 115 296 50 100 150 200 250 300 <3 months 3-5 months 6-8 months 9-11 months Prince Philip Hospital West Wales General Hospital

Carmarthenshire N.H.S. Trust

Patients on General Surgical Out-Patient Waiting Lists as at 30th September 2005

974 273 126 99 57 46 100 200 300 400 500 600 700 800 900 1000 <3 months 3-5 months 6-8 months 9-11 months 12-15mths 15-18 mths Prince Philip Hospital West Wales General Hospital

Emergency Surgical Activity

Emergency General Surgical Theatre Activity West Wales General Hospital (CEPOD theatre): 2004/5

10 20 30 40 50 60 April May June July August September October November December January February March Emergency admissions that went to theatre 9am-5pm 5pm-9pm 9pm-9am Weekend /Bank Holiday

Emergency Surgical Activity

Emergency General Surgical Theatre Activity Prince Philip Hospital (elective theatre): 2004/5

10 20 30 40 50 60 April May June July August September October November December January February March Emergency admissions that went to theatre 9am-5pm 5pm-9pm 9pm-9am Weekend /Bank Holiday

Surgical Services Information from Welsh Ambulance Services N.H.S. Trust

West Wales General Hospital

Abdominal Admissions into West Wales General Hospital Between 0900 -1700 for the Period April 2003 - September 2005

5 10 15 20 25 30

09:00-09:59 10:00-10:59 11:00-11:59 12:00-12:59 13:00-13:59 14:00-14:59 15:00-15:59 16:00-16:59

Hour Logged Number of Admissions

West Wales General Hospital

Abdominal Admissions into West Wales General Hospital Between 1700 - 0900 for the Period April 2003 to September 2005

10 20 30 40 50 60

17:00-17:59 18:00-18:59 19:00-19:59 20:00-20:59 21:00-21:59 22:00-22:59 23:00-23:59 00:00-00:59 01:00-01:59 02:00-02:59 03:00-03:59 04:00-04:59 05:00-05:59 06:00-06:59 07:00-07:59 08:00-08:59 Hour Logged Number of Admissions

Prince Philip Hospital

Abdominal Admissions into Prince Philip Hospital 0900-1700 Between April 2003 - September 2005

5 10 15 20 25 30 35

09:00-09:59 10:00-10:59 11:00-11:59 12:00-12:59 13:00-13:59 14:00-14:59 15:00-15:59 16:00-16:59

Hour Logged Number of Admissions

Prince Philip Hospital

Abdominal Admissions into Prince Philip Hospital Between 1700 - 0900 For the Period April 2003 to September 2005

5 10 15 20 25 30 35

17:00-17:59 18:00-18:59 19:00-19:59 20:00-20:59 21:00-21:59 22:00-22:59 23:00-23:59 00:00-00:59 01:00-01:59 02:00-02:59 03:00-03:59 04:00-04:59 05:00-05:59 06:00-06:59 07:00-07:59 08:00-08:59

Hour Logged Number of Admissions

Surgical Services Information from Swansea N.H.S. Trust

Swansea N.H.S. Trust

Patients on General Surgical In-patient Waiting Lists as at 30th September 2005

50 100 150 200 250 300 <3 months 3-5 months 6-8 months 9-12 months

Morriston Hospital Singleton Hospital

Swansea N.H.S. Trust

Patients on General Surgical Day Case Waiting Lists as at 30th September 2005

50 100 150 200 250 300 <3 months 3-5 months 6-8 months 9-12 months Morriston Hospital Singleton Hospital

Swansea N.H.S. Trust

Patients on General Surgical Out-patient Waiting Lists as at 30th September 2005

52 26 11 13 9 2

100 200 300 400 500 600 700 800 900 1000 <3 months 3-5 months 6-8 months 9-12 months 12-15mths 15-18 mths Morriston Hospital Singleton Hospital

Number of General Surgical Emergency Admissions to Swansea Major Acute Hospitals by Electoral Division of Residence

Wards included: 1. Quarter Bach (NURY) 2. Garnant (NUQN) 3. Glanamman (NUQP) 4. Llandybie (NURC) 5. Betws (NUPY) 6. Pontamman (NURW) 7. Ammanford (NUPX) 8. Saron (NUSB) 9. Hendy (NUQT) 10. Tycroes (NUSF) 11. Llangennech (NURJ) 12. Bynea (NUQB) 13. Dafen (NUQK) 14. Llwynhendy (NURR) 15. Bigyn (NUPZ) 16. Tyisha (NUSG) 17. Glanymor (NUQQ) 18. Hengoed (NUQU) Number of general surgery emergency admissions from these wards to Prince Philip Hospital: 2004/5 450 admissions

Healthcare Needs Assessment

• Comparative Approach

– Comparative approach to needs assessment contrasts services received by population in

• ne area with those received elsewhere.

– Information obtained from other regions relating to delivery of surgical services.

Surgical Services Comparative Data

Comparative Data

General surgery admissions to Royal Glamorgan Hospital by method of admission and year of admission

Data source: Admitted Patient Care dataset, Health Solutions Wales

200 400 600 800 1000 1200 1400 1600 1800 2000 2200 2400 2600 2800 3000 2000/1 2001/2 2002/3 2003/4 2004/5 Date of admission (financial year) Number of general surgery admissions Elective Emergency Other

Comparative Data

General surgery elective inpatient admissions by hospital site and year of admission

Data source: Admitted Patient Care dataset, Health Solutions Wales

200 400 600 800 1000 1200 1400 1600 1800 2000 2200 2400 2600 2000/1 2001/2 2002/3 2003/4 2004/5 Date of admission (financial year) Number of general surgery admissions Royal Glamorgan Prince Philip West Wales General Carmarthenshire NHS Trust

Comparative Data

General surgery day case admissions by hospital site and year of admission

Data source: Admitted Patient Care dataset, Health Solutions Wales

200 400 600 800 1000 1200 1400 1600 1800 2000 2200 2400 2600 2000/1 2001/2 2002/3 2003/4 2004/5 Date of admission (financial year) Number of general surgery admissions Royal Glamorgan Prince Philip West Wales General Carmarthenshire NHS Trust

Comparative Data

General surgery emergency inpatient admissions by hospital site and year of admission

Data source: Admitted Patient Care dataset, Health Solutions Wales

200 400 600 800 1000 1200 1400 1600 1800 2000 2200 2400 2600 2800 3000 3200 3400 3600 3800 4000 2000/1 2001/2 2002/3 2003/4 2004/5 Date of admission (financial year) Number of general surgery admissions Royal Glamorgan Prince Philip West Wales General Carmarthenshire NHS Trust

Information from Neighbouring Areas

• Bro Morgannwg N.H.S. Trust

– All emergency general surgical activity is directed to Princess of Wales Hospital in Bridgend, with elective general surgical work at the Princess of Wales Hospital and at Neath and Port Talbot Hospital.

• Cardiff and Vale N.H.S. Trust

– All emergency general surgical activity is directed to the University Hospital of Wales, Cardiff, with elective general surgical work at the University Hospital of Wales and at Llandough Hospital.

Healthcare Needs Assessment

• Corporate Approach

– Corporate approach is essential for a strategy to be sensitive to local circumstances. – This approach involves the systematic collection of knowledge and the views of informers in health care services and needs.

Surgical Services Working Group

• Public Health Director, Carmarthenshire

L.H.B. (Chair)

• Head of Modernisation, Carmarthenshire

L.H.B.

• Non-Executive Board Member of

Carmarthenshire L.H.B.

• Non-Executive Board Member of

Carmarthenshire N.H.S. Trust

• General Manager, Surgical Directorate,

Carmarthenshire N.H.S. Trust

• General Manager, Surgical Directorate,

Swansea N.H.S. Trust

• Clinical Director for Surgical Services,

Carmarthenshire N.H.S. Trust

• General Surgeon, W.W.G.H.
• General Surgeon, P.P.H.
• Anaesthetist, Carmarthenshire N.H.S. Trust
• Physician, Carmarthenshire N.H.S. Trust
• Directorate Nurse, Surgical Services,

Carmarthenshire N.H.S. Trust

• Representative from Professions Allied to

Medicine, Carmarthenshire N.H.S. Trust

• Two General Practitioner Representatives
• Deputy Chief Executive, Carmarthenshire

County Council

• Non-Executive Member, Carmarthenshire

County Council

• Representative from Welsh Ambulance

Services N.H.S. Trust

• Health Commission Wales
• Health Information Analysis Team, N.P.H.S.
• Public and Patient Involvement

Representative, Carmarthenshire L.H.B./N.H.S. Trust

• Representative, Community Health Council
• Representative, Voluntary Sector
• Representative from the Committee for the

Improvement of Hospital Services

• Users of the service
• Observer Member, Mid and West Wales

Regional Office, W.A.G.

• Other co-opted members

as required

Prince Philip Hospital

Mr H J R Evans Senior SHO Vascular FP1 (HO) Trust Doctor (HO) Mr S D Holt Trust Specialist (Part time) Breast Disease (Breast Screening) Staff Grade FP1(HO) Trust Doctor (HO) Mr S Rowley Trust Registrar (LAS) Colorectal FP1(HO) Trust Doctor (HO) Mr D Shanahan Trust Registrar Colorectal FP1(HO) Trust Doctor (HO) Mr Y Sharaiha Sharing junior staff Locum Consultant (Breast) with Mr Holt

West Wales General Hospital

Mr A Locker Staff Grade Vascular HO FP1 SHO BST Mr M Nutt Staff Grade Upper GI HO Trust HO Mr W G Sheridan Specialist Registrar Colorectal Trust HO HO Mr O’Riordan Specialist Registrar Upper GI HO Trust HO + 1 Senior SHO (floating doctor)

Prince Philip Hospital

Surgery Ward 5 Ward 6 Ward 7 Total Beds 23 29 13 65 Main Theatre Day Theatre Total Weekly Theatre Sessions 14 3.5 17.5

Emergency surgical admissions 9am-5pm, no dedicated CEPOD theatre

West Wales General Hospital

Surgery Preseli Cleddau Total Beds 16 28 44 Main Theatre Day Theatre Total Weekly Theatre Sessions Elective 8 4 12 Emergency 5 (dedicated weekday CEPOD theatre for all emergencies, excluding trauma which has separate theatre dedicated during the week for emergencies)

Information for Planning

• Planning Process

– As result of the literature review and the needs assessment this allowed the identification of the problems that needed to be addressed and thus plan the service appropriately.

Planning Process for the Future Delivery of General Surgical Services in Carmarthenshire

• Options Considered

– Maintaining the Status Quo. – All Emergency General Surgery Directed to Prince Philip Hospital. – All Emergency General Surgery Directed to West Wales General Hospital.

• Options Dismissed

– All Emergency General Surgery Directed to Morriston Hospital. – New Hospital Build.

Maintaining the Status Quo

• Benefits

– No change in service delivery.

• Risks

– Not sustainable. – Clinical governance agenda. – Impact on training posts.

All Emergency General Surgery Directed to Prince Philip Hospital

• Benefits

– 24 hour service geared towards Llanelli.

• Risks

– No C.E.P.O.D. Theatre. – No emergency surgical activity between Bronglais and Llanelli. – Increased Ambulance activity.

All Emergency General Surgery Directed to West Wales General Hospital

• Benefits

– All other surgical specialties located at W.W.G.H. – Dedicated C.E.P.O.D. Theatre at W.W.G.H. – Main A.&E. Department located at W.W.G.H. – Increased elective work at P.P.H. – Increased training posts.

• Risks

– Increased numbers of Llanelli patients to Swansea N.H.S. Trust. – Increased Ambulance activity.

Options Appraisal

Criteria Options Maintain the Status Quo All emergency general surgery directed to Prince Philip Hospital All emergency general surgery directed to West Wales General Hospital       Acceptability to stakeholders Users of the service GPs Consultants x x  Evidence of safety of these units    Are measures to ensure clinical governance in place or being implemented?    Accessibility  x  Equitable  x  General surgical staffing and availability x x  Informed choice    Continuity of care    Quality of care  x  Cost ± ± ±

Key to the table  = positive point X = negative point ± = equivocal

Surgical Services

Drivetime Analysis of Available Hospitals to Carmarthenshire Residents for General Surgical Admissions

Drivetime Analysis

Scenario 1 – Status Quo Available hospitals for emergency admission for Carmarthenshire residents: Prince Philip Hospital West Wales General Hospital Singleton Hospital Morriston Hospital Withybush General Hospital Bronglais General Hospital Scenario 2 – No General Surgical Emergency Admissions at West Wales General Hospital Available hospitals for emergency admission for Carmarthenshire residents: Prince Philip Hospital Singleton Hospital Morriston Hospital Withybush General Hospital Bronglais General Hospital Scenario 3 - No General Surgical Emergency Admissions at Prince Philip Hospital Available hospitals for emergency admission for Carmarthenshire residents: West Wales General Hospital Singleton Hospital Morriston Hospital Withybush General Hospital Bronglais General Hospital

Drivetime Analysis

Proportion of residents aged 16+ (cumulative)

Time (minutes) Scenario 1 Scenario 2 Scenario 3 Less than 10 minutes 34% 24% 9% Less than 20 minutes 67% 47% 49% Less than 30 minutes 91% 69% 90%

Drivetime Analysis – Scenario 1

Travel time (minutes) Hospitals

Greater than 30 20 to 30 10 to 20 Less than 10

Drivetime Analysis – Scenario 2

Travel time (minutes) Hospitals

Greater than 30 20 to 30 10 to 20 Less than 10

Drivetime Analysis – Scenario 3

Travel time (minutes) Hospitals

Greater than 30 20 to 30 10 to 20 Less than 10

Recommendation from Options Appraisal

• Reconfiguration of general surgical

services within Carmarthenshire, with all general surgical emergencies being admitted to West Wales General Hospital, with increased elective general surgical capacity at Prince Philip Hospital.

Increased Elective Work at Prince Philip Hospital

• Currently 77% of elective general surgery carried out at

P.P.H.

• Working towards P.P.H. carrying out 100% of elective

general surgery to be achieved over a 1-2 year period.

• Phased transfer of elective work.
• Increased elective work in sub-specialties in surgery i.e.

breast, colorectal, upper gastro-intestinal, vascular, but additional percentage of work transferred in first instance would be in relation to upper gastro-intestinal surgery where all laparoscopic work could be centralised at P.P.H.

Engaging the Public

• Establish Health Panels.
• Carmarthenshire L.H.B. Engagement

Framework to ensure that local communities have opportunities to inform the work.

Carmarthenshire L.H.B. Engagement Framework

Carmarthenshire Local Health Board

Communities First Meetings a Town & Community Councils a Voluntary Sector Forum a User/ Patient Groups a Citizens Panel a Specific Interest Groups/Groups not represented through mechanisms above

Surgical Services Working Group

a Health Panel Aman a Health Panel Tywi Gwili Health Panel Gwendraeth a Health Panel Teifi a Health Panel Llanelli a Health Panel Taf Myrddin Staff Panel a a Community Network Meetings a

Health Panels

• Health Panels launched.
• 80 individuals attended.
• Preferred Scenario

– All emergency general surgical activity conducted at West Wales General Hospital, with only elective general surgical work undertaken at Prince Philip Hospital.

Recommendations of Surgical Services Working Group

• All emergency general surgical activity is conducted at

West Wales General Hospital.

– All other surgical specialties such as orthopaedics, gynaecology,

• phthalmology and E.N.T. are located at W.W.G.H.

– The main Accident and Emergency Department for Carmarthenshire is located at W.W.G.H. which would admit trauma cases which could require general surgical input. – W.W.G.H. has a dedicated C.E.P.O.D. operating theatre.

• Elective general surgical work only would be undertaken

at Prince Philip Hospital.

– Increased elective work at P.P.H. with reduced waiting times, increased productivity and fewer cancellations of planned surgery. – Assist the development of centres of excellence and potentially result in increased training posts in general surgery.

Surgical Services

• Delivering surgical services that are

evidence based is a necessary activity.

• Multi-disciplinary collaboration is important

indicator of successful practice.

• The major impact will be the delivery of

fast, responsive and effective surgical services in order to improve the health of the population.

Surgical Services

• Eighteen Public Consultation Events.
• Emergency/Elective Split Implemented in

February 2007.

• Independent Inquiry into the Processes on

Consultation and Implementation of the Reconfiguration of General Surgical Services in Carmarthenshire.

Cancelled Operations

The elective capacity at PPH has been ringfenced since 3rd February 2007 to ensure that no

• perations are cancelled due to non-availability of

beds Between 3rd February 2007 and 8th September 2008 no operations have been cancelled at Prince Philip Hospital due to non-availability of beds

Trends in Elective General Surgical Activity

Months WWGH % PPH % TOTAL Apr04 – Mar05 426 26% 1182 74% 1608 Apr05 – Mar06 342 23% 1162 77% 1504 Apr06 – Mar07 324 20% 1269 80% 1593 Apr07- March08 297 18% 1285 82% 1582

Elective Activity WWGH & PPH Since 2004/05 there has been an increasing trend in the percentage

• f elective surgery carried out at PPH.

Major Projects at Prince Philip Hospital

• Short Stay Surgical Unit Development

Project.

• Breast Care Phase II Development

Project.

• Engineering Infrastructure Project.

The Way Forward

The Breast Care Phase II Development Project Project Aims and Primary Drivers

• To expand the existing facilities
• To create a ‘one stop facility’ for Breast Care Services
• To provide new facilities which fully accord with current

national guidelines and is at the fore front of national prescribed standards

• To allow and assist the current facility to modernise and

develop into one of the best and most up to date Breast Care facilities in Europe

• To improve the patient experience
• To provide a state of the art facility for staff to work
• To maximise the operational efficiency of the facilities

The Way Forward

PROPOSED EXTERIOR VIEWS 3 & 4

The Way Forward

Minister Opens the New Extended Breast Care Centre

Review of General Surgical Services in Carmarthenshire

• Dr. Michael Thomas

Consultant in Public Health Medicine