Future Hospital update from Wales

It has been a busy few months here in Wales, both for RCP officers and service quality advisers, and for those of us working in the NHS. The new chief executive of NHS Wales, Dr Andrew Goodall, has started in post; the Welsh Government published a wide-ranging independent review into the way the NHS collects and uses mortality data in Welsh hospitals; and a major report into the complaints system in Wales led to calls for a new independent regulator to handle patient complaints. Furthermore, the independent Andrews report, Trusted to care,¹ outlined highly publicised failings in elderly care at Neath Port Talbot and Princess of Wales hospitals in south Wales.

With the publication of the final plans for reconfiguration in south Wales, the political row has recently died down as the hard work of implementing the reform takes over. The South Wales Collaborative, a clinically-led programme made up of five health boards, has announced three new acute care alliances, which will require clinicians to work in networks across hospitals to improve patient care, training and medical education. Traditional, isolated hospital models are no longer sustainable, and it's vital that we plan ahead to avoid the collapse of services.

But none of this has been easy. In west Wales, campaigners recently failed in a High Court challenge to overturn changes being implemented by Hywel Dda University Health Board, and there is still widespread opposition to changes to accident and emergency and neonatal services in Llanelli and Haverfordwest. The Welsh Government health minister, Professor Mark Drakeford AM, has even announced a review into the reconfiguration process, which is being led by Ann Lloyd, a former director general of the health and social care department at the Welsh Government.

This is why the RCP in Wales is keen to ensure this service change is clinically led and evidence-based, and it's why we’re proud that Welsh health boards have been among the most keen of participants in the future hospital programme so far. The RCP vice president for Wales, Dr Alan Rees, has now had briefing meetings with most of the NHS Wales chairs and chief executives, and all have expressed their support for the principles and vision of the project.

Yet one health board has gone even further. Earlier this year, the RCP team in Wales was delighted to hear that Betsi Cadwaladr University Health Board in north Wales had been chosen as one of the inaugural future hospital development sites. Their project, CARTREF (Welsh for ‘home’) aims to improve access to care for frail elderly patients in rural Wales. They hope to respond to chronic health needs (including end-of-life care) by using tele-health to bring specialist care closer to those living at considerable distance from secondary (or tertiary) care centres.

The Betsi Cadwaladr team of clinicians, patients, academics and service improvement specialists, led by Professor Matt Makin, the health board's medical director, and Dr Olwen Williams, the chief of medicine, will establish video clinics for patients in primary care and community hospitals to facilitate communication and assessment with and between patients, care of the elderly physicians, social services, nursing homes and palliative care practitioners.

The project aims to allow patients to have follow-up reviews closer to their own home, especially for those with chronic illnesses, which fits perfectly with the recommendations of the future hospital report, Future hospital: caring for medical patients.² It also aims to drastically reduce hospital admissions and bed days in community hospitals over the coming year. Crucially, the team will work with patients and carers to design a final service model that has the best chance of success.

The future hospital Wales working group is looking forward to working with Betsi Cadwaladr University Health Board and the future hospital programme board in London over the coming months as this work develops. The group, chaired by the vice president for Wales, is taking a whole-Wales approach by working with local health boards, the Welsh Government, other professional bodies, patients, and RCP fellows and members to support the implementation of the future hospital recommendations in Wales.

So far this year, as part of our local conversations programme, members of the RCP team in Wales have visited Prince Philip Hospital in Llanelli, as well as Bronglais Hospital in Aberystwyth, to meet physicians who are constantly adapting to changing patient needs. Later this year, we will visit north Wales to meet fellows, members and trainees working at Glan Clwyd Hospital near Rhyl, where they will show us how they are using future hospital recommendations to improve patient care.

The future hospital Wales group will also be launching a new report looking at the delivery of safe, sustainable acute medicine in Wales in November. Through all of this work, the RCP in Wales will aim to ensure that as the programme of NHS Wales service change moves forward, our fellows and members retain a strong voice at the centre of that debate, and as ever, we will report our progress to fellows and members through the Future Hospital Journal.