Having read in full the Clinical Governance Support and Development Unit Phase II report into the future of local National Health Services (NHS) in the Machynlleth area, the future looks bleak for the local hospital.
Aside from the map, Machynlleth is mentioned on pages 9, 13, 16, 23, 24 & 33 of this report.
Page 9 details that Machynlleth tends to care for acutely ill patients whom are under the supervision of local GP's.
According to this report, "acutely ill patients should be cared for by an NHS trust consultant led team , providing 24 hour medical cover, and supported by a health service infrastructure for acute service".
In general it views that GP's don't have proper accountability towards Powys Local Health Board (LHB) for the service it provides to acutely ill patients. Due to the Service Level Agreements (SLA) between the practices and LHB not being more specific towards this treatment, degrees of involvement vary throughout the area.
Currently Machynlleth is not able to offer this type of care due to the lack of staff not just in the local area but as pointed out in the report, in Powys in general.
The 'Community Hospital Age Care Service Consultant Service' is led by three Age Care Consultants (ACC) whom have access to 105 beds at six sites, including Machynlleth. They are assisted by GP's providing a committed service to the older people and are held in high regard. The downside to this service is the lack of 'out of hours' (OoH) support offered by the consultants who usually provide advice over the telephone. Any direct support during this period relies on the OoH GP service with 'Shropdoc' being its main provider. A service which the report points out can lack experience is a number of areas. The ACC view is that "community hospitals are now meeting much less of patients' medical needs than in the past. They foresee the need for a, Community Geriatrician in the future to work with patients in the community and care homes rather than in hospitals as they do now". A view support by the report.
Regarding the nursing service in the community hospitals the report concludes that "the current situation of 10 nursing workforces [one workforce at each community hospital] is not sustainable, and places nurses in an unacceptable position. There is too little experience for nurses to maintain the wide range of skills expected of them; from acute emergency care to the rehabilitative care of the elderly. In order to develop their skills, nurses providing acute care need to be part of an acute care directorate outreached from an NHS Trust, whilst nurses providing rehabilitative care and nursing care to the elderly need to be based in the community or in care homes".
In general it recommends that Machynlleth Hospital acute services is provided by a NHS Trust near to the local area. Our strong links to Aberystwyth is mentioned. Which (apart from Ystradgynlais Hospital) is a different recommendation for the all the other sites in Powys, whom are advised to be under the control of one NHS Trust. It points out that these recommendations are likely to require the support of the Welsh Assembly.
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A sentence in the report which I found amazing is it estimates that "at least half of the patients in the community hospitals do not need to be in hospital". Suggesting that local support in either the patients own home or admission into a care home would be the better, modern day solution. This waste of bed resources has occurred because of a number of reasons. The lack of transport to attend an out patient clinic was one reason. The use of ambulances to ferry patients to these clinics is a complete waste of time and money when this service can be done locally. I have copied below an area of the report which I think causes the biggest problem in this area.
11.5 The challenge of providing services for elderly citizens and others in rural areas
We appreciate that in rural areas where community services are under developed, and short term care is not always available, the community hospitals have provided a valuable service in the past and have traditionally filled this gap. Furthermore there is great attachment to the buildings themselves, but this attachment may now be holding up the development of modern Rural Health, Rehabilitation, and Social Care Centres, that could benefit both the elderly and the younger residents of rural communities.
The community hospital beds in Powys cost approximately £2000 per week. The Wales average cost for a rehabilitation bed in 2006 in a District General Hospital was approximately £1400. The nursing home that currently provides beds to Powys GPs costs approximately £700 per bed per week. Transferring the care of those patients who need nursing care to a care home setting would provide the patients with a better environment, and release resources to develop extended local health, rehabilitation, and community care services to benefit all members of the community.
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The Minor Injury Service (MIU) in Machynlleth has on average 2 new patients per day and the reports says "not sustainable as a stand alone MIU.Most of the nurses providing this MIU service normally staff the wards and are skilled in the care of the elderly. Asking them to change roles increases the risks to nurses and patients because staff are not able to maintain their skills, which could result in a poor service to the patient.
Currently the LHB are talking to the public about the future of MIUs but Machynlleth is asked to talk to local GPs to provide this service.
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My conclusion
Machynlleth Hospital has a bleak future ahead of it. Its obvious that the LHB wants to move the acute services to the Ceredigion & Mid Wales NHS Trust because of its remoteness from central Powys. The MIU will only stay open at the current site should Aberystwyth decide to keep the acute service wards in Machynlleth. This can only be done with the Welsh Assembly covering the excess cost.
The MIU service does raise one question. What will happen if the local GP's refuse to take it over? I cannot see any MIU service being maintained in Machynlleth unless they do.
So what of the future?
1. The main hospital building being closed and sold for low cost housing or a new care home with acute services being moved to Aberystwyth. The MIU transferred into an extension of the GP Practice, so that the GPs can provide a quick response. The selling of the building to provide the funding for this new MIU.
2. Current hospital building being redeveloped into a GP Practice (includes all the additional services the current building offers) which will enable to retention of the current MIU facilities. This will also allow the facilities to become the centre point of community health services in Machynlleth. Current GP Practice redeveloped. My preferred option.
3. Aberystwyth keeping open the acute services with support from the Welsh Assembly. The MIU staying where it is on the understanding that there will be a wait until the GP arrives.
4. Keeping the current status quo. Not an option in my opinion.
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So what do you think? A big blog (sorry) and not something I talk about but it is one area of my life I have an interest in.
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