Minor injury unit to slash opening hours over safety fears

Richard Youle, local democracy reporter

A hospital’s minor injury unit (MIU) will close at night for six months due to concerns about patient safety and the well-being of staff, health chiefs have decided.

Hywel Dda University Health Board members heard more about the contentious proposal for Llanelli’s Prince Philip Hospital at a meeting on September 26, with chairman Dr Neil Wooding saying he knew the decision would disappoint the community but that he was “anxious and concerned about the pressure on staff”.

The 24-hour MIU will shut from 8pm to 8am for six months from November, allowing the health board to bolster the day-time service and develop a new model of care which would try to ensure patients were seen in the right place.

Qualified doctors

A report before the board said it had become increasingly difficult to cover the MIU rota due to a lack of suitably qualified doctors, particular overnight, meaning it was frequently led by emergency nurse practitioners who, while skilled, weren’t able to deal with many of the acutely unwell patients who came through the doors. Between February and July this year, it said, there were 42 “slots” which didn’t have a duty doctor.

The report said around a quarter of attendances at the MIU were for “major” clinical conditions including strokes, broken legs, appendicitis, children with acute abdominal problems, and women with pregnancy complications. The proportion was higher overnight.

Andrew Carruthers, the health board’s chief operating officer, said: “It’s unacceptable to continue to expose our nursing staff to the critical risk presented without a doctor present.”

Mr Carruthers said that despite the best efforts of the health board to recruit, the MIU had two GPs covering seven nights a month, with locums and other GPs filling in. “As we approach winter it’s really important that we have a clinical model that is safe,” he said. “Failure to take action will lead to more staff leaving and could leave the day-time service fragile.”

Sickness levels

The report said MIU staff sickness levels had been 22% on average over the last six months – half of which were attributable to stress-related conditions.

Dr Jon Morris, clinical lead at the MIU, said patients were presenting with more complex conditions nowadays, and that he often received messages from staff worried about the risks staff felt they were facing.

“The main concern we have is the risk to patient safety within the department because of a lack of medical cover,” he said. “Staff at the minor injury unit are desperate to provide a solid service for the people in Llanelli. We want to have a safe and reliable service.”

Sam Dentten, of patient watchdog Llais, said it was just as disappointed about the proposed reduction of the MIU service as the rest of Llanelli.

He said: “If the eighth most populous town in Wales does not have a full emergency department, if a 24-hour GP-led minor injury unit can’t be reliably staffed, what is the future of urgent care in the town?” He looked forward to a “full and committed” discussion with the public about the issue.

Opportunity

Prince Philip Hospital director Dr Robin Ghosal said there was an opportunity to develop a better model of care for people in Llanelli, for example by better directing unwell patients to the hospital’s acute medical assessment unit. “This is not about something being taken away – it’s about making it better than what it is,” he said.

Dr Ghosal described Prince Philip Hospital was “a massive cog” in Hywel Dda which focused on acute medical care, elective surgery and breast surgery, and that it had attracted some very high-quality staff. He also said it was vital that reducing the MIU service for six months did not increase pressure on emergency departments at Glangwili and Morriston hospitals in Carmarthen and Swansea.

The board will explore alternative care options in the coming weeks and months, fully engage with the public, and discuss any concerns with neighbouring Swansea Bay University Health Board that it might have.

After approving the proposal set out in the report, chairman Dr Wooding said: “This is another example of a difficult decision we have to make. We know that it will disappoint the community, and it’s not to disregard how the community feels about this, but it’s to prioritise the importance of clinical safety and care over this period, and we will come back with a more optimised model in the future.”