Community Hospitals - Ysbytai Cymunedol

Speech by Kirsty Williams AM delivered to The National Assembly for Wales on Wed 5th Feb 2003

Today, I want to divert Members' attention away from prescription charges and draw it instead to community hospitals, an aspect of the national health service that is often overlooked; it is highly regarded by all our constituents, and is a vital component for a modern, efficient NHS. I would even go as far as to suggest that a new strategic vision, and an associated commitment of resources to community hospitals could help us to address some of the problems that have dogged our district general hospitals.

Heddiw, hoffwn droi sylw'r Aelodau oddi wrth ffioedd presgripsiwn at ysbytai cymunedol, agwedd ar y gwasanaeth iechyd gwladol a anwybyddir yn aml; mae gan ein holl etholwyr barch mawr tuag ati, ac mae'n elfen hanfodol ar gyfer GIG modern ac effeithlon. Byddwn hyd yn oed yn mynd mor bell ag awgrymu y gallai gweledigaeth strategol newydd, ac ymrwymiad cysylltiedig o adnoddau i ysbytai cymunedol ein cynorthwyo i fynd i'r afael â rhai o'r problemau a fu'n bla ar ein hysbytai cyffredinol dosbarth.

Living in and representing Brecon and Radnorshire, I know how important community hospitals are from personal and professional experience. The absence of a district general hospital in my constituency and throughout Powys focuses attention on what services can and cannot be delivered in a community setting, it focuses attention on access—many of my constituents live up to an hour away from a district general hospital, literally in another country—and on what untapped potential there is in community hospitals up and down Wales.

Gan fy mod yn cynrychioli Brycheiniog a Sir Faesyfed ac yn byw yno, o brofiad personol a phroffesiynol gwn pa mor bwysig yw ysbytai cymunedol. Mae absenoldeb ysbyty cyffredinol dosbarth yn fy etholaeth i a thrwy Bowys gyfan yn hoelio'r sylw ar ba wasanaethau y gellir eu darparu mewn lleoliad cymunedol a pha rai na ellir eu darparu, yn hoelio sylw ar fynediad—mae nifer o'm hetholwyr yn byw hyd at awr i ffwrdd oddi wrth ysbyty cyffredinol dosbarth, yn llythrennol mewn sir arall—ac ar ba botensial heb ei ddefnyddio sydd mewn ysbytai cymunedol ar hyd a lled Cymru.

In 1996, the Welsh Office produced authoritative guidance entitled 'Community Hospitals: the future', and the Assembly Government has invested heavily in capital programmes, with important announcements of new or replacement community hospitals throughout Wales. I welcome the multi-million-pound refurbishment of many of the hospitals in my constituency, but I believe that we now need a new vision for community hospitals. We must invest in the hospitals and their staff, and acknowledge and support the contribution they make, and expand upon it.

Yn 1996, cynhyrchodd y Swyddfa Gymreig arweiniad awdurdodol yn dwyn yr enw 'Ysbytai Cymunedol: y dyfodol', ac mae Llywodraeth y Cynulliad wedi buddsoddi'n drwm mewn rhaglenni cyfalaf, gyda chyhoeddiadau pwysig am ysbytai cymunedol newydd neu adnewyddu hen ysbytai ledled Cymru. Croesawaf y gwaith adnewyddu gwerth miliynau o bunnoedd a wneir i lawer o'r ysbytai yn fy etholaeth i, ond credaf fod angen gweledigaeth newydd arnom yn awr ar gyfer ysbytai cymunedol. Rhaid inni fuddsoddi yn yr ysbytai a'u staff, a chydnabod a chynorthwyo'r cyfraniad a wnânt, ac ehangu arno.

For the uninitiated, the term 'community hospital' may conjure up images of benign nursing care for elderly patients but the reality is radically different. With their intimate and friendly maternity units, intensive rehabilitation programmes, and cataract and other surgeries, community hospitals across Wales offer a complex range of services to meet their communities' needs.

I'r rhai nad ydynt yn gyfarwydd â'r term, gall 'ysbyty cymunedol' greu delweddau o ofal nyrsio hynaws ar gyfer cleifion hyn ond mae'r realiti yn wahanol iawn. Gyda'u hunedau mamolaeth clòs a chyfeillgar, rhaglenni adsefydlu dwys, a llawdriniaethau cataract a llawdriniaethau eraill, mae ysbytai cymunedol ledled Cymru yn cynnig amrywiaeth cymhleth o wasanaethau er mwyn diwallu anghenion eu cymunedau.

The benefits of delivering care in such a setting are clear. In my constituency, and in many other Members' constituencies, access—and the fact that the hospital is a community facility—make a world of difference. It is simpler for patients and their relatives to access a community hospital, and its environment will be more familiar and reassuring to them at an often stressful and worrying time. Although difficult to quantify and identify, it seems to me that the atmosphere often differs to that of a district general hospital in being more relaxed, and the staff have more time to spend in caring for their patients. I visited my mother this morning in Mynydd Mawr Hospital in Carmarthenshire, a hospital which has often been threatened with closure. My mother also spent some time in the local district general hospital. Although she has no complaints about the district general hospital, on moving to Mynydd Mawr Hospital, she said that it was much nicer there, and that the nurses have more time to talk to her and to attend to her needs.

Mae manteision cyflwyno gofal mewn lleoliad o'r fath yn amlwg. Yn fy etholaeth, ac yn etholaethau nifer o Aelodau eraill, mae mynediad—a'r ffaith bod yr ysbyty yn gyfleuster cymunedol—yn gwneud byd o wahaniaeth. Mae'n haws i gleifion a'u perthnasau gael mynediad i ysbyty cymunedol, a bydd ei amgylchedd yn fwy cyfarwydd ac yn rhoi tawelwch meddwl iddynt ar adeg sy'n aml yn llawn straen a gofid. Er ei fod yn anodd i'w feintioli a'i nodi, ymddengys i mi fod yr awyrgylch yn aml yn wahanol i awyrgylch ysbyty cyffredinol dosbarth oherwydd ei fod yn fwy hamddenol, ac mae gan y staff fwy o amser i dreulio yn gofalu am eu cleifion. Ymwelais â'm mam y bore hwn yn Ysbyty Mynydd Mawr yn Sir Gaerfyrddin, ysbyty y bygythiwyd ei gau ar sawl achlysur. Yn ogystal, treuliodd fy mam beth amser yn yr ysbyty cyffredinol y dosbarth lleol. Er nad oes ganddi gwynion am ysbyty cyffredinol y dosbarth, ar ôl symud i Ysbyty Mynydd Mawr, dywedodd ei bod yn llawer mwy dymunol yno, a bod gan y nyrsys fwy o amser i siarad â hi a diwallu ei hanghenion.

The medical benefits are also clear and community hospitals are cheaper to run. The cost of occupying a bed in a district general hospital can be five times higher than in a community facility and waiting times and lists are often shorter. It is almost embarrassing for me to talk of the waiting times for my constituents that access surgery through Breconshire War Memorial Hospital because they are considerably shorter than they would be if they were receiving such treatments in a district general hospital.

Yn ogystal, mae'r manteision iechyd yn amlwg ac mae ysbytai cymunedol yn rhatach i'w rhedeg. Gall cost gwely mewn ysbyty cyffredinol dosbarth fod bum gwaith yn uwch nag mewn cyfleuster cymunedol ac mae amseroedd a rhestrau aros yn aml yn fyrrach. Yn ogystal, mae'n peri embaras imi siarad am amseroedd aros fy etholwyr sy'n cael mynediad i lawdriniaeth drwy Ysbyty Coffa Brycheiniog oherwydd maent yn llai o dipyn na phe baent yn derbyn triniaethau o'r fath mewn ysbyty cyffredinol dosbarth.

Community hospitals also lend themselves to more appropriate patient care and better use of facilities throughout the NHS as a whole. The 1996 Welsh Office report suggested that some 10 per cent of patients in acute hospitals could be treated in community hospitals. I would go so far as to suggest that, with the development of telemedicine and the progress in medical techniques, even more people currently accessing services via the district general hospital could do so in community hospital settings. Community hospitals can facilitate early discharge of patients for rehabilitation and recovery and can provide those services in a planned way that would help to prevent the revolving-door syndrome, whereby people suffering from acute ailments are constantly readmitted.

Yn ogystal, mae ysbytai cymunedol yn addas i ofal cleifion mwy priodol a gwell defnydd o adnoddau drwy'r GIG yn gyffredinol. Awgrymodd adroddiad 1996 y Swyddfa Gymreig y gallai rhyw 10 y cant o gleifion mewn ysbytai aciwt gael eu trin mewn ysbytai cymunedol. Byddwn yn mynd mor bell ag awgrymu, gyda datblygiad telefeddygaeth a'r cynnydd mewn technegau meddygol, y gallai hyd yn oed mwy o bobl sy'n cael mynediad i wasanaethau drwy ysbyty cyffredinol y dosbarth wneud hynny mewn ysbyty cymunedol. Gall ysbytai cymunedol hwyluso rhyddhau cleifion yn gynnar ar gyfer adsefydlu a gwella a gall ddarparu'r gwasanaethau hynny mewn modd sydd wedi'i gynllunio a fyddai'n helpu i atal y syndrom drws troi, lle bydd pobl sy'n dioddef o anhwylderau difrifol yn mynd yn ôl i'r ysbyty droeon.

A week ago, we saw the publication of Professor Brian Edwards's report into orthopaedic waiting times at the Royal Gwent Hospital. The report pointed to many different measures that should be taken to improve the situation for patients in that area, but there was also a specific recommendation about the use of community facilities. Professor Edwards recommended that facilities be developed at the county hospital, which I believe is in Panteg, to help the Royal Gwent Hospital address some of its problems with orthopaedic waiting lists. It is no surprise that the fact that services that have not been developed at Panteg Hospital or St Woolos Hospital now contributes to some of the worst waiting list problems in that area. It cannot be a coincidence that enhanced community facilities do not exist uniformly through the Royal Gwent Hospital's catchment areas and that it is struggling to meet the demands placed upon it by patients.

Wythnos yn ôl, gwelsom gyhoeddi adroddiad yr Athro Brian Edwards ar amseroedd aros orthopedig yn Ysbyty Brenhinol Gwent. Nododd yr adroddiad nifer o fesurau gwahanol y dylid eu cymryd er mwyn gwella'r sefyllfa ar gyfer cleifion yn y maes hwnnw, ond yr oedd hefyd argymhelliad penodol ynglyn â'r defnydd o gyfleusterau cymunedol. Argymhellodd yr Athro Edwards fod cyfleusterau'n cael eu datblygu yn ysbyty'r sir, sydd ym Mhanteg mi gredaf, er mwyn cynorthwyo Ysbyty Brenhinol Gwent i fynd i'r afael â rhai o'i broblemau â rhestrau aros orthopedig. Nid yw'n syndod bod y ffaith bod gwasanaethau na chawsant eu datblygu yn Ysbyty Panteg neu Ysbyty Eglwys Gwynlliw bellach yn cyfrannu at rai o'r problemau gwaethaf yn ymwneud â rhestrau aros yn y maes hwnnw. Nid cyd-ddigwyddiad yw'r ffaith nad oes cyfleusterau cymunedol gwell yn bodoli yn unffurf drwy ddalgylchoedd Ysbyty Brenhinol Gwent a'i fod yn brwydro i fodloni'r galw gan gleifion.

I regret the fact that my hard work with my local trust to try to develop a partnership with the district general hospitals of Swansea has been to no avail. While the problems of Singleton Hospital and Morriston Hospital may not be as acute as those of the Royal Gwent, they are still under great pressure. Why, then, has it not been possible to develop a relationship between those hospitals and Powys? Why has it not been possible to use capacity in the Ystradgynlais Community Hospital to provide a step-down facility for patients from Singleton and Morriston hospitals? If the capacity in Ystradgynlais hospital could be used for those patients, not only would it mean that they could be treated closer to home, but it would free up essential space in district general hospitals.

Gresynaf at y ffaith i'm gwaith caled gyda'm hymddiriedolaeth leol er mwyn ceisio datblygu partneriaeth ag ysbytai cyffredinol dosbarth Abertawe fod yn ofer. Er nad yw problemau Ysbyty Singleton ac Ysbyty Treforys mor ddifrifol o bosibl â'r rhai yn Ysbyty Brenhinol Gwent, maent o dan bwysau mawr o hyd. Pam, felly, na fu'n bosibl datblygu perthynas rhwng yr ysbytai hynny a Phowys? Pam na fu'n bosibl defnyddio'r capasiti yn Ysbyty Cymunedol Ystradgynlais er mwyn darparu cyfleuster cam i lawr i gleifion o ysbytai Singleton a Threforys? Pe byddai modd defnyddio'r capasiti yn ysbyty Ystradgynlais ar gyfer y cleifion hynny, byddai hynny nid yn unig yn golygu y gellid eu trin yn agosach i'w cartrefi, ond byddai'n rhyddhau lle hanfodol mewn ysbytai cyffredinol dosbarth.

Clinical governance is an issue and it makes delivering services within a community setting perhaps more complex than delivering them in a district general hospital. However, as I said in a meeting in Brecon last week, I make no apology for national service frameworks or clinical standards. As Chair of the Health and Social Services Committee, I have seen too often the results of a lack of clinical standards. One only has to think of the scandals at the Bristol Royal Infirmary and at Alder Hey Hospital, and the adverse incidents experienced in Carmarthenshire. That shows what happens when you do not give due regard to clinical standards. Unlike some Members here, I do not believe that clinical governance is a laudable aim; I believe that it is a must. I do not believe that people living in rural areas should accept lower standards of treatment than their urban counterparts; that is unacceptable. However, working with community hospitals, we can consider ways of delivering a high standard of care in a community setting. That would allow more people to be treated closer to home. Can it be sensible for patients from my constituency, or any Member's constituency, to travel many miles for an out-patient appointment that often lasts between 10 to 15 minutes? Is it sensible for eight patients to travel from Brecon to Abergavenny to see the same consultant? Would it not make more sense for that consultant to travel to Brecon or, even better, to establish telemedicine links between Llandrindod Wells Hospital and Hereford County Hospital? In a local setting, supported by a nurse to help with the consultation exercise, neither patient nor doctor need travel too far. That would increase the number of patients that a consultant can see, as well as being much more convenient for the patients concerned.

Mae rheolaeth glinigol yn ffactor ac mae'n gwneud darparu gwasanaethau o fewn lleoliad cymunedol yn fwy cymhleth efallai na'u darparu mewn ysbyty cyffredinol dosbarth. Fodd bynnag, fel y dywedais mewn cyfarfod yn Aberhonddu yr wythnos diwethaf, nid ymddiheuraf am fframweithiau gwasanaeth cenedlaethol neu safonau clinigol. Fel Cadeirydd y Pwyllgor Iechyd a Gwasanaethau Cymdeithasol, yr wyf wedi gweld canlyniadau diffyg safonau clinigol yn rhy aml. Nid oes ond rhaid ichi feddwl am y sgandal yn Ysbyty Brenhinol Bryste ac yn Ysbyty Alder Hey, a'r digwyddiadau ofnadwy yn Sir Gaerfyrddin. Dengys hynny yr hyn sy'n digwydd pan na roddwch ystyriaeth ddigonol i safonau clinigol. Yn wahanol i rai Aelodau yma, ni chredaf fod rheolaeth glinigol yn nod canmoladwy; nod hanfodol ydyw. Ni chredaf y dylai pobl sy'n byw mewn ardaloedd gwledig dderbyn safonau triniaeth is na phobl sy'n byw mewn trefi; mae hynny'n annerbyniol. Fodd bynnag, gan weithio gydag ysbytai cymunedol, gallwn ystyried ffyrdd o ddarparu gofal o safon uchel mewn lleoliad cymunedol. Byddai hynny'n caniatáu i fwy o bobl gael triniaeth yn agosach i'w cartrefi. A yw'n gwneud synnwyr i gleifion o'm hetholaeth i, neu etholaeth unrhyw Aelod, orfod teithio milltiroedd lawer ar gyfer apwyntiad cleifion allanol sy'n aml yn parhau rhwng 10 a 15 munud? A yw'n synhwyrol i wyth claf deithio o Aberhonddu i'r Fenni i weld yr un ymgynghorydd? Oni fyddai'n gwneud mwy o synnwyr i'r ymgynghorydd hwnnw deithio i Aberhonddu neu, yn well byth, i sefydlu cysylltiadau telefeddygaeth rhwng Ysbyty Llandrindod ac Ysbyty Sirol Henffordd? Mewn amgylchedd lleol, wedi'u cynorthwyo gan nyrs i helpu â'r ymgynghoriad, nid oes yn rhaid i glaf na meddyg deithio yn rhy bell. Byddai hynny'n cynyddu nifer y cleifion y gall ymgynghorydd eu gweld, yn ogystal â bod yn llawer mwy cyfleus i'r cleifion dan sylw.

Several treatments currently delivered in district general hospitals could be delivered in community settings. We must be bold and think outside the box. By working in clinical networks, and by establishing agreed protocols between staff in community settings and those in district general hospitals, we can overcome concerns about clinical standards, without removing services. For instance, why is it not possible for the Brecon War Memorial Hospital to have a dermatology treatment and diagnosis centre? There is nothing to prevent that from happening—no clinical standards exist to say that that cannot happen. The same could be said of many community hospitals throughout Wales.

Gellid darparu nifer o driniaethau a ddarperir ar hyn o bryd mewn ysbytai cyffredinol dosbarth mewn lleoliadau cymunedol. Rhaid inni fod yn ddewr a meddwl yn greadigol. Drwy weithio mewn rhwydweithiau clinigol, a thrwy sefydlu protocolau y cytunir arnynt rhwng staff mewn lleoliadau cymunedol a'r rhai mewn ysbytai cyffredinol dosbarth, gallwn oroesi pryderon am safonau clinigol, heb gael gwared ar wasanaethau. Er enghraifft, pam nad yw'n bosibl i Ysbyty Coffa Brycheiniog gael canolfan trin a chanfod dermatoleg? Nid oes dim i atal hynny rhag digwydd—nid oes safonau clinigol yn bodoli i ddweud na all hynny ddigwydd. Gellir dweud yr un peth am nifer o ysbytai cymunedol ledled Cymru.

I want the Minister to consider these points. I know that she is committed to developing a new strategy for community hospitals and I understand that that work is underway, led by Jan Williams, and will form part of the Wanless review. I trust that Derek Wanless and his team will take time to visit community hospitals throughout Wales so that they can be assured of the quality service that they deliver, and share in this vision of community hospitals delivering more, which would save the NHS money and provide patients with a better service.