Oral - Alan Axford’s Review of Services in Ceredigion

Members will recall the announcement by the Welsh Assembly Government last year of a moratorium on service change within district general hospitals and community hospitals in Wales until a number of key reviews on the development of primary and community care services had been undertaken.

In response to significant concerns being expressed in the Ceredigion area by community leaders and the local population, concerning plans to change their community hospital services, I asked Dr Alan Axford, medical director of the then Ceredigion and Mid Wales NHS Trust, to undertake a review of the alignment of services between the proposals for the development of new community health facilities at Aberaeron, Cardigan and Tregaron and services provided from Bronglais Hospital, Aberystwyth.

These proposals for change were developed in the context of the wider plan for service reconfiguration across mid and west Wales, which had also raised considerable concern across communities.

I have today received a copy of Dr Axford’s final report, which provides an informative insight into the considerations that need to be addressed in consistently delivering good-quality services to the population of Ceredigion, and also the important relationships that exist with neighbouring areas. Dr Axford’s report describes a model of health service delivery that will enhance the care that all people might receive in that area, pointing to a real potential for increasing the care that could be delivered more locally and in people’s homes.

Dr Axford’s recommendations are in line with our strategic goal of rebalancing the healthcare system to maximise the care that can be delivered locally and within our developing thinking about the more effective management of chronic conditions in Wales.

The existence of robust clinical governance arrangements is central to the concerns regarding the sustainability of local services. The steps that I have recently taken to create the new Hywel Dda NHS Trust will ensure that the new service models for Ceredigion are capable of being delivered in a clinically effective way, and that the new services are fully integrated with the clinical networks across central and west Wales.

On the specific conclusions of Dr Axford’s report, for the Aberaeron area, he endorses the proposals that have already been advanced by the local authority and the local health board, namely for an integrated facility providing general practice services in new accommodation, nurse and consultant clinics, and enhanced screening and diagnostic services, with improved physiotherapy, occupational therapy, audiology, podiatry and social care services.

In the Tregaron area, Dr Axford has taken into consideration the concerns expressed locally about the future plans for services in the area. Many of the health and social care facilities currently available are in need of replacement. However, Dr Axford recognises the important role undertaken by the good-quality patient care services for rehabilitation that exist for the local community, and the potential to strengthen further the strong clinical links that currently exist between Tregaron Hospital and Bronglais Hospital.

The report also details the steps that can be taken by health and social services to support and develop earlier discharge from hospital, when appropriate.

For the planned development in the Cardigan area, Dr Axford endorses the health and social care service model contained in the business case for the redevelopment of Cardigan Hospital. However, he has expressed his concerns to me about the availability of the proposed site for the new service, particularly as there would seem to be no suitable alternative site for a new facility in Cardigan, which would serve so well the populations of south Ceredigion, west Carmarthenshire and particularly north Pembrokeshire. If a suitable site with planning permission cannot be secured, his view is that serious thought would have to be given to relocating the services to the Lampeter and Felinfach area, but this would be a definite disadvantage to people in north Pembrokeshire. I shall discuss the pressing issue of a site for this important development, as I would be unhappy if we had to adopt a poorer solution due to the absence of an appropriate site.

Although outside the terms of reference for this review, Dr Axford has drawn attention to the strategic importance of the services at Tywyn and Machynlleth, and the potential development opportunities for enhanced services to be provided to those areas through their association with Bronglais Hospital. I have asked Dr Axford to investigate these opportunities further, in consultation with neighbouring organisations and stakeholders.

I have been much reassured by the work undertaken by Dr Axford, and I am most grateful to him for his efforts. He details clearly in his report the ways in which high-quality sustainable care might be delivered for the Ceredigion community, building on the opportunities via telemedicine links to Bronglais Hospital to increase the clinical supervision of the good-quality staff in these communities, to allow them to expand their skills and to develop their services further.

Looking further at the wider implications of this review, Dr Axford’s report confirms to me the important role that Bronglais Hospital will continue to play within the network of larger hospitals in Wales, acting as the clinical hub for more specialised care in this part of Wales, and as the first line of support for smaller hospitals and community-based services. The planned capital investments that we are making to improve services at Bronglais will further support that role.

Dr Axford has emphasised the need for us to think more creatively about the role that traditional community hospitals have played, and to recognise that we cannot take a simplistic view that a single model or view about size and the number of beds will be applicable in different communities. He highlights a number of other developments in Wales, such as in south Pembrokeshire, and Tenby particularly, Monmouthshire and Builth Wells, where new models either in place or being developed are changing the way in which we provide local health services in Wales. I concur wholeheartedly with his views that the services that we provide in future must be delivered in premises that are fit for the purpose intended.

Finally, Dr Axford’s report provides valuable practical evidence for my rural health strategy. The steering group, chaired by Lord Elystan-Morgan, has already considered several of the other reviews that I have commissioned, and I have forwarded a copy of Dr Axford’s report to Lord Elystan-Morgan for consideration by his group. I have no doubt that the steering group will wish to meet with Dr Axford to discuss his conclusions more fully.

Earlier today, I made the report available in full to Assembly Members, and I have asked the local health boards and the NHS trusts in Wales serving rural communities to pay due regard to its conclusions and recommendations in planning their future community and primary care services.