Health board receives withering feedback after decision to close minor injury unit overnight

Richard Youle, local democracy reporter

The anger and disappointment felt by people in Llanelli at the overnight closure of the town’s minor injury unit (MIU) this winter have been made clear in a health board report.

The unit at Prince Philip Hospital operated 24/7 before Hywel Dda University Health Board decided in September to close it between 8pm and 8am for a period of six months, starting from November 1, in response to concerns about patient safety and staff well-being.

A report updating health board members on the latest developments, which included some strongly-worded feedback at a public event, was presented at a meeting on November 28. More than 100 people had attended the event at Llanelli’s Antioch Centre with many feeling their local health service had been downgraded again following the previous loss of Prince Philip Hospital’s accident and emergency service.

There was scepticism about whether the MIU would ever re-open at night again and fears that lives might be lost as a result of the temporary overnight closure. The feedback included someone asking who was “going to take accountability when people die”.

GP shortages

Other people wondered if the persistent shortage of GPs to lead the unit could be addressed in six months. Another said: “We were promised when we lost our A&E that MIU would be 24/7. We feel betrayed.” Someone else said Llanelli was larger than Carmarthen but that everything was located there, while another person said: “It would be better off if we moved to Swansea.”

However, there was also praise for the work carried out at the MIU, acknowledgement that some people attending it should have gone elsewhere for treatment, and acceptance that recruiting medics to West Wales wasn’t easy. “I know these decisions are difficult,” said one person.

Health board members didn’t discuss the feedback but were told that a shortlist of options about a way forward would be drawn up ahead of a board meeting in March next year. Vice-chairwoman Eleanor Marks said: “We said it would be a temporary closure. Restoring it is one of the options that will be on the table.”

This was reinforced by chief operating officer Andrew Carruthers, who said: “That absolutely has to be the situation. We are still seeking to recruit GPs into that service.”

Steering group

A steering group and project group have been set up to evaluate longer-term options for the MIU. Factors being considered include what is essential, what needs improvement, what can be learned from the temporary overnight closure, and the risks involved.

Mr Carruthers said a higher proportion of patients were being seen at the MIU within four hours since November 1 than previously, but also that fewer day-time patients attended in November to date compared to October and September. “I’m interested to see where they are going,” he said.

Sharon Daniel, interim director of nursing, said the drop in attendances hadn’t led to “an obvious impact” on Carmarthen’s Glangwili Hospital or services at neighbouring Swansea Bay University Health Board. “Redirection protocol (signposting patients to other services) is working well,” she said. “Feedback from the staff is positive.”

Donna Coleman, of patient watchdog organisation Llais, said it had not been approached by dissatisfied patients since November 1. But independent board member Delyth Raynsford said she was concerned there might an indirect impact on GP surgeries.

Pressures

The pressures facing the MIU service were laid out at the September board meeting, chief among them a persistent shortage of doctors available at night and a notable proportion of patients turning up with serious clinical conditions. “It’s unacceptable to continue to expose our nursing staff to the critical risk presented without a doctor present,” said Mr Carruthers at the September meeting. “Failure to take action will lead to more staff leaving and could leave the daytime service fragile.”

Alongside the controversial decision to approve the temporary overnight closure was a stated intention to bolster the MIU’s day-time service and develop a new model of care to try to ensure patients were seen in the right place.

A campaign group in Llanelli called Save Our Services Prince Philip Action Network (SOSPPAN) has presented a petition this month to the Senedd’s petitions committee which called for an immediate re-opening of the overnight MIU service. SOSSPAN chairman Deryk Cundy, who is also a Carmarthenshire councillor, said he had been reassured that the committee would consider the petition. He also wants the matter to be debated by the Senedd.

The November 28 meeting also heard that it would be 10 years or more before a much-anticipated new hospital in West Wales was built. The comment was from chief executive Philip Kloer during a long discussion about a strategy to help create a healthier Mid and West Wales.