A&E in Wales – Not a lot different. Fire the administrators and change the NHS

Throwing money at A&Es ‘will not solve problems’

4 Jun 2013 19:43

Consultants speak out in support of hospital changes as the way hospital services are delivered in South Wales are being consulted on

The Royal Glamorgan Hospital near LlantrisantThe Royal Glamorgan Hospital near Llantrisant

Thowing money at Wales’ beleaguered A&E departments will not solve the problems that surround emergency care in South Wales, a senior consultant has said.

Dr Mark Poulden, a consultant in emergency medicine with ABMU Health Board, said that money alone would not help with the pressures faced by emergency units as there would still not be the doctors there to run the departments.

Dr Poulden, who is also chair of the Welsh National Board of the College of Emergency Medicine, said that many departments could soon collapse if change did not take place.

He was speaking as plans to reform the way hospital services are delivered in South Wales are being consulted on.

Health bosses from the five health boards involved in the South Wales Programme have drawn up four options for consultant-led neonatal and maternity care, inpatient children’s services and top-tier A&E services across South Wales.

These will see at least one hospital from a choice of Bridgend’s Princess of Wales, Llantrisant’s Royal Glamorgan and Merthyr Tydfil’s Prince Charles lose these four services.

The controversial plans have come under fire after health bosses said the “best fit” option, which scored most highly on issues such as safety, quality and access, would be to remove these services from the Royal Glamorgan site.

Dr Poulden’s comments also follow major concerns raised by the College of Emergency Medicine, which warned in March that A&E departments in Wales were on the brink of “meltdown” with patients lives being put at risk.

Critics of the plans for reorganisation have called for greater investment as a solution to the problems, but Dr Poulden said this was not the case.

He said: “Even if you gave me a load of cash, I could not create a perfect system because the doctors are just not there.

“It’s difficult to predict [when departments will be at breaking point] because staffing depends on various types of doctor. But certainly if you look at some of the departments, there is that potential, and already their staffing is heavily dependant on locum staff or pulling in staff who are already overworked.

“There are a number of departments that are facing difficulties but there is the potential for significantly more problems.

“At the moment if you come into A&E at night, chances are you will be seen by a junior doctor without any senior doctor in the emergency department. They may be on call but they will not be in that department at the time. That is unacceptable.”

Dr Ian Bowler, a consultant paediatrician based at the Royal Gwent Hospital, said: “Even if we threw money at it, the doctors are not in the system.

“There are a number of locums who are filling gaps and they are the same people who are on the rotas as you have got to replace an experienced paediatrician with an experienced paediatrician and the only people hospitals can look to is consultants – and they expect to go home sometimes.

“This is a UK problem, not just a Wales problem, but doctors choose where they want to go to train based on what their experience is going to be and their work-life balance and how well-staffed are the rotas. And that is why we have got to where we are.”

Their comments echo arguments from Cardiff University’s postgraduate dean for medical education, Professor Derek Gallen, who said Wales was in a “downward spiral” when it came to the recruitment of new staff in hospitals and that by changing provision of certain services, medics would be more attracted to working here.

He said: “Changing the way we provide some hospital services is essential to help us improve the training experience and to attract doctors to Wales.

“We are in a downward spiral in terms of the recruitment and retention of trainee doctors in a number of specialities. This is a vitally important issue for the NHS because we get many of the doctors, consultants and GPs who work on the frontline from our training grades.

“Providing the same services in so many hospitals means that the medical rotas are spread very thinly across South Wales and the educational experience is not sufficient for the curriculum – this means we are not training the best doctors for the future of healthcare in Wales.”