I know from many thousands of conversations with the people of Pembrokeshire the importance of the return of overnight paediatric services to Withybush General Hospital. That is why, for the last 6 months or more, I have been working hard to seek their return. It’s not an easy task and I’m not going to pretend I know everything there is to know about delivering paediatric care (as you can imagine, far from it) but I know just how important it is and I’ve made it my business over the last few months to get to know all I can.
The first thing I needed to do was to make sure I had access to the key information, from people who really knew what was happening on the ground. I’m really grateful to my clinical advisory group (a team of 12 local doctors, nurses and other current and former healthcare professionals) for providing that detail and developing the plan for the return of overnight paediatric services to Withybush. Since devising the basics of that plan I’ve met three times with Steve Moore (the new Chief Executive of Hywel Dda) and those conversations have been detailed, in depth and on the whole very positive.
Set out below is an update on those discussions, where we are with the plan and the next steps to ensuring the return of overnight services to Withybush.
The current paediatric cover at Withybush
08:00 – 17:00: Consultant Paediatrician, Middle Grade Paediatrician(Both on Site)
17:00 – 22:00: Consultant Paediatrician (On-Call), Middle Grade Paediatrician (On Site)
22:00 – 08:00: Consultant Paediatrician Only (On-Call)
The basics of the proposal
The proposal would see no change to the day service but would increase the medical cover overnight in order to allow for the majority of Pembrokeshire children, who need to stay in hospital, to stay in Withybush without the need to travel to Glangwili.
In very basic terms, the paediatricians I’m working with are telling me that in order to provide a safe overnight service they require the following;
– Middle Grade Paediatric cover (on site) overnight
– Junior Paediatric Cover and/or an Advanced Nurse Practitioner, again on site, overnight.
The above is required in addition to the on-call Consultant Paediatrician overnight (The rota for which is already in place).
Where we are now
The Paediatric Rota is shared across Glangwili and Withybush and at the key middle grade level the rota is designed for a full complement of 14 doctors. Currently Hywel Dda have 12 employed and the Health Board were very clear, Steve Moore in particular, that they were absolutely committed to recruiting a further 2 to get to the full complement of 14.
Now according to the Health Board, in order to support a 24 hour service at a hospital, middle grade doctors need to be working a 1 in 8 rota at the minimum. That means 8 doctors for a single 24/7 hospital site. On that basis, returning an overnight paediatric service to Withybush will require a 16 middle grade doctor rota (8 for Glangwili and 8 for Withybush).
Clearly that requires the recruitment of a further 2 middle grade paediatricians (on top of recruiting to the existing 2 vacancies) to provide 16 across Glangwili and Withybush.
In terms of the junior doctor / advanced nurse practitioner cover this would again require recruitment (most likely to Advanced Nurse Practitioner Posts – given the deanery position on junior doctors) and we need to push the Health Board to make this a reality.
Well for the first time we have a real plan. It’s a plan that allows for the safe delivery of an overnight paediatric service, that allows Pembrokeshire children to stay in Withybush overnight and that requires only a modest increase in medical cover and resource.
Where next? Well there are two key obstacles to overcome from here;
1) Getting the Health Board to approve recruitment to these positions (and making sure they actually get the people in position)
I’m trying to get the Health Board to commit a) to funding these posts and b) to interviewing any candidates who come forward within 2 weeks of their application. I want to get stuck into selling Pembrokeshire to anyone even thinking that these jobs might be for them and I’m absolutely convinced we can get the people if we work hard enough.
The Health Boards message to date has been that recruitment is the issue – people simply do not wish to work at Withybush. Now personally I find that difficult to believe. There may be specific challenges in certain areas and there is undoubtedly a tendency for doctors to want to work in larger specialist teams across the UK but, Pembrokeshire is a unique place with a fantastic way of life and amazing communities that are a pleasure to be part of.
The problem for me, is Hywel Dda are not selling these communities properly and we need to help them / make sure they do.
As a starter we need to organise a Pembrokeshire Health recruitment event. Invite people from across the UK and further afield to come to Pembrokeshire for the weekend, absolutely free. They can stay here and experience everything Pembrokeshire has to offer. Take them coasteering, Kayaking, coast path walking – sell Pembrokeshire to them properly. Get the new Chief Executive to talk to them too – about the future for Health in Pembrokeshire and at the end let’s compile a list of anyone who commits to apply.
Once we have enough people on that list (and I’m absolutely convinced we’ll get them) then any excuse around recruitment disappears and at that point the Health Board either need a new excuse – or they need to get on with returning the overnight service to Withybush Hospital.
2) Making the case that returning overnight paediatric services to Withybush is the best use of the money this will cost.
Let me be crystal clear from the outset, I think that returning overnight paediatric care to Withybush is the best use of this additional resource and I will do whatever it takes to make the case that this is what needs to happen.
But we can’t ignore that Hywel Dda’s performance in dealing with children as outpatients is simply not good enough in some key areas.
We need to improve waiting times and outcomes for those children and so a key part of my meeting with Phil Kloer will be to push the case for some more innovative solutions.
To kick off some ideas of what these innovative solutions might be, if the health board are so concerned that the middle grade paediatrician (we are proposing be based overnight in Withybush) would be being taken away from providing clinics and the Health Board are concerned the evening shifts in Withybush will be quiet (as they insist they will be) what about looking at running out of hours clinics from Withybush? Perhaps not universally popular – but if an out of hours appointment gets you seen months earlier or fits in with your working shift, it could well be of interest.
I’m not saying that’s the solution or even part of the solution (maybe it is maybe it isn’t) but the key point is that we need to challenge the decision makers in Hywel Dda to really test themselves and come up with innovative models that work for rural Pembrokeshire.
How we're going to get there
I’m going to be meeting in the coming week with Phil Kloer (Interim Medical Director) and the specific aim of that meeting will be to tackle the challenges identified above head on. I will of course keep you all up to date on progress.
Looking to the future
There’s no doubt that modern healthcare has moved on and we cannot just stay the same and hope we will get better outcomes. There are new drugs, technologies and techniques that mean we can look after people better for longer.
However, we need to adapt and change the systems in order to make this happen. I want Pembrokeshire to be somewhere that encourages that sort of innovative thinking as long as we’re keeping our vital emergency services fully intact. We need to take the lead in developing a rural health care model that works for Pembrokeshire and I’m going to make it my business to keep pushing and challenging those at the top within Hywel Dda to make sure they are.