Closing Withybush hospital will be a death sentence for thousands

Chris Paul

When I was 17 my grand-dad was playing on the beach with his great-grandchildren, at Freshwater West. He suffered a massive coronary, and the team at Withybush Hospital saved his life.

When I was 34 my then partner had a sky-high temperature and began coughing up blood. The GP agreed to a home visit, and demanded we drive straight to the hospital, 10 mins away, it would be quicker than an ambulance and time was of the essence.

Upon arrival, the doctor said, “nurse, get this lady on a DRIP now, she is the priority here until that is done.” It saved her life. A few more minutes and it would have been curtains.

Similarly, my friend Jane was driven by her mum from Solfa to Withybush Hospital, as a teenager. She had acute meningitis. If she’d arrived 20 mins later it would have been too late to save here they said. No more Jane.

These are all examples of the so-called Golden Hour. The emergency hour in which a patient must receive treatment, or face dire outcomes.

While modern medicine and technology mean paramedics can do more, certain heart conditions, strokes, acute infections like Sepsis, and problems during pregnancy, can all require pretty immediate intervention.

Fatalities increase if not. Clinical evidence, qualitative research, has proven this to be the case.

For every extra 10KM in an ambulance, fatalities increase by 1%.

This is why Pembrokeshire is angry. It is why 40,000 people (around 40% of the adult population of Pembrokeshire in sheer numbers- higher than turnout at local and assembly elections in many areas) signed the petition to Save Withybush Hospital.

The residents of this beautiful rural county know, in their bones, that closing the A&E will prove a literal death sentence for thousands.

Emergency

To provide context for those of you not very familiar with the  latest intricacies of the Welsh NHS’s decision making:

The Labour Welsh Government, and the quasi-independent Hywel Dda health board who are answerable to them, have just recommended downgrading both Withybush Hospital, Pembrokeshire, and the next nearest A&E at Gwangwili, in Carmarthenshire.

The spin put out by the health board, and lapped up by most of the supplicant Welsh media is that this is about a new hospital in the area which will eventually be constructed.

But as Plaid Cymru Health Spokesperson Rhun Ap Iorwerth stated in the Senedd debate prompted by the Save Withybush petition, “the new hospital is being used as bait to approve the downgrading…”

No money has been assigned, no site identified, and business case for any new hospital has as of yet been approved.

As is stands both Withybush and Gwangwili could be downgraded under the Health Board plans before any new hospital is built to replace them, with no cast-iron guarantees from either health board or Government to the contrary.

In the initial documents from the health board (now no longer available online) just one bullet point buried on page 54 mentioned the ‘inconvenience of receiving planned and emergency care in the area until a new hospital is built’.

Talk of death sentences may seem like hyperbole. But examine the evidence. Research states:

“The mean distance from hospital to home for an emergency admission was 8.7 km (5.4 miles), with a median of 5.5 km (3.4 miles), based on five million emergency admissions in 2011/12.

“Seventy per cent of emergency admissions occurred within 10 km of a person’s home, and very few people (3 per cent) were admitted to a hospital over 30 km (18.6 miles) away from their home.”

The distance between the Pembrokeshire city of St Davids and Swansea, where the nearest A and E would be if as seems plausible no new hospital is built first to replace Withybush, is 67 miles (107 KM).

That’s 12 times further than the average emergency distance admission in England.

So based on the 10KM extra distance in an ambulance leading to 1% increase in emergency fatalities, there could be up to a 9% increase emergency admission fatalities from some areas of Pembrokeshire as a result of these proposed hospital downgrades.

Many patients could be travelling in an ambulance awaiting emergency care for up easily over two hours.

Yet Hywel Dda Health board say, with no sense of irony or shame, they are committed to “community-based healthcare”.

Reality

The Welsh Government can, and does, try to shift the blame, and claim all downgrade decisions are based on the clinician-led recommendations from Hywel Dda Health board.

But Steve Moore, CEO, of the Health Board, allegedly claimed on BBC news yesterday (I did not see the interview in person), that “Pembrokeshire is little more than a retirement village”.

Explain that to my 18-month-old daughter. Or Pembrokeshire council, who say just 23% of Pembrokeshire is aged over 65 years.

If the CEO of the health-board proposing downgrading recommendations is basing his justifications on perceptions of such unfounded bias, then one really must question his competence for the post in the first place, let alone blithely follow his recommendations into a potential health disaster over an unspecified period for over 100,000 people.

In conclusion, imagine, if you will, the population of a London Borough, being told to travel two hours, to Bristol perhaps, for emergency care, for an unspecified interim, before a replacement hospital was built.

Imagine the outrage and the headlines in the national papers.

And now consider that just that scenario is being proposed in Pembrokeshire, with so little media scrutiny.

This is the reality of modern Wales.

Public services cut to the bone to third world standards, but because it is done in Wales (and the the West of Wales in a rural county at that), and because a Labour government are doing it, the indifference is deafening.