Written - Hospital Provision in Merthyr Tydfil

In October 2007, I asked Professor Mansel Aylward CB, chair of the Wales Centre for Health, to undertake a review and provide me with advice and recommendations about the current plans for the development of health services in Merthyr Tydfil.

I wanted to be sure that those plans would deliver a set of strong, fully aligned services for the population of Merthyr.

Professor Aylward’s remit covered making recommendations in regard to the proposed new town centre health facility, the future services to be provided at Prince Charles Hospital, the possible role for a Walk-in Centre, and the provision of new health services, such as occupational health, for the people in the Merthyr Tydfil area.

I asked Professor Aylward to engage all key stakeholders in undertaking this review, including the public in Merthyr Tydfil.

The review has been published this morning. I am, most grateful to Professor Aylward, and also to Professor Ceri Phillips, the Head of the Institute for Health Research at Swansea University, for the work that they have undertaken.

Professor Aylward and colleagues have consulted widely with local people and produced a comprehensive report, with clear recommendations.

The first recommendation is to develop rapidly a Health Park for and in Merthyr, which would bring together a range of health and social services services, to provide a broad range of support to the people of Merthyr.

The authors believe such a health park would help achieve the bold aim in the new Merthyr Tydfil Health, Social Care and Well-being Strategy - “to improve the health and wellbeing of the population of Merthyr Tydfil through targeted and co-ordinated activity, developed in partnership, and based on evidenced good practice; and in particular reduce the numbers of people whose health and wellbeing is being affected both directly and indirectly by mental illness, stroke, alcohol misuse, lifestyle and worklessness.”

The Park would provide an environment for delivering early assessment and treatment to help prevent short term sickness absence from work, and for a multi-disciplinary approach to address the challenge of long term incapacity and benefit dependency. These problems are particularly acute in the Merthyr area and require urgent resolution.

The Park might accommodate not only what I might call traditional health and social care services, but also Job Centre Plus and occupational health services. The report mentions 23 different elements of service that might be located there. This is potentially an exciting and ground-breaking approach.

In coming to these conclusions, the team considered the arguments for creating a walk-in centre or a polyclinic or a community hospital and found these inadequate or inappropriate in themselves to meet the needs of Merthyr. They favoured the Health Park and recommend early action by all agencies concerned to put their proposal into practice. A possible site for the health park will be the plateau site and I will be asking the health bodies to make early moves toward identifying a definitive site for the proposed development.

Secondly, they recommend strengthening primary care, based on the existing model of universal registration with a single practitioner, rather than a polyclinic approach.

The third group of recommendations relate to hospital services. The authors of the report consider it premature to make major changes in the relocation of hospital specialists into community services, preferring limited action at this stage to explore the possible benefits of doing so. They oppose delay in taking forward the major capital programmes for Prince Charles Hospital and urge support for its important strategic role across the heads of the valleys and south Powys. I do not want any artificial boundaries to get in the way of developing services at Prince Charles Hospital. They make some important observations about the benefits of maintaining obstetrics and paediatric services at both Royal Glamorgan Hospital and Prince Charles Hospital, and about reducing inappropriate use of the accident and emergency services at the latter. They also recommend a further study into the suitability of road access to Prince Charles Hospital.

My commitment to redeveloping Prince Charles Hospital as the base for hospital services for the area is demonstrated by the decisions we have already made. More than £2m has recently been spent on providing the first MRI scanner at PCH and in replacing a CT scanner. I have approved a further £47 m expenditure on phase 1 of the ward refurbishment programme and essential infrastructure works including lift replacements and expect to agree the final business case for the £18m redevelopment of unscheduled care facilities at PCH, including significant development to the Accident and Emergency department.

Finally, they recommend seizing the opportunity created by new planning and funding arrangements to strengthen the responsiveness of all the service providers to work together to meet the needs of the population they serve.

I believe that together these recommendations offer a firm basis for moving forward.

In response I propose:

• to ask the service redesign group of the new Cwm Taf NHS Trust area to act on the proposals for scoping the Health Park and produce a report within 6 months
• to ask the Merthyr LHB to act on the recommendation regarding primary care
• to ask them also, in conjunction with the Cwm Taf Trust, to act on the recommendations on the relocation of specialists to the community, the major capital programmes for Prince Charles Hospital, the reduction in inappropriate use of the accident and emergency services at the latter, and the need for a report into the suitability of road access to Prince Charles Hospital.
• to ask the Cwm Taf Trust with the Merthyr and neighbouring LHBs and the SE Wales Regional Office of my Department for Health and Social services to consider carefully the issues the report has raised in relation to the future of obstetrics and paediatric services at both Royal Glamorgan Hospital and Prince Charles Hospital, and also the strategic role of Prince Charles Hospital for the heads of the valleys and south Powys, and the North West area of Gwent within the context of the general development of services in south east Wales and produce a joint report for me within 6 months.

Any substantial service changes proposed by these studies will need to be tested through public consultation in the normal way.

Finally, I will be considering the recommendation to seize the opportunity created by new planning and funding arrangements to strengthen the responsiveness of all the service providers who can help meet the needs of the population they serve within the context of assessing the results of the consultation on reforming NHS structures in Wales.