The under-threat A&E at the Royal Glamorgan Hospital has nearly been closed two or three times in 2020 because of staff shortages, bosses say.
Management are looking at changes because patient safety has been left in a “precarious” position.
Meanwhile, senior doctors may support an emergency unit night-time closure – but only as a temporary solution.
They are worried about the impact on the entire hospital if A&E is downgraded permanently.
Cwm Taf Morgannwg health board will meet again on Thursday to discuss its options but there has been local opposition from residents and politicians.
How severe are the staff shortages?
- The Royal Glamorgan’s only full-time A&E consultant is set to leave in April
- It is supposed to have 10 consultants but will soon have none
- Staff are being drafted in to cover from the Princess of Wales Hospital, Bridgend
- As well as consultant shortages, only 12% of its middle grade shifts can be covered by permanent staff
- Consultant numbers at Prince Charles Hospital in Merthyr Tydfil are “significantly lower” than they want, and even in the best staffed departments at the Princess of Wales, they were not up to ideal numbers.
What are the options?
The health board in an ideal world wants to keep A&E open 24 hours a day but cannot deliver this safely as things stand.
The options are for the Royal Glamorgan to be a round-the-clock minor injuries unit but for its A&E to close. The other scenario is for the department to close overnight.
Dr Nick Lyons, its medical director, said there was an “increasingly small” emergency doctor workforce at the hospital near Llantrisant, which meant the team was not able to provide safe care on occasions and there was an increased risk.
Twice already over Christmas, A&E at the Royal Glamorgan had to close to the sickest patients, who were diverted to Prince Charles because of a lack of doctors.
Dr Lyons said they came close again “two or three times” to shutting since then, because of doctor shortages.
“If you have your own staff you’re able to ring and say we’ve got sickness or absence, come in,” he said.
“But if there is sickness or absence among locum doctors, the other locums have no obligation to come in at all – indeed they’re probably working in another hospital in Wales or elsewhere in the UK.”
He said there was a risk using staff not used to working together in the same team – and of an unplanned closure when there were too many patients to cope with.
“It’s far more fragile than I’m confident with to provide the assurance that this department is consistently safe and will remain so,” he added.
One patient had already died because of an over-dependence on agency or locum staff – and the health board was aware of other cases when patients were put in danger.
The NHS faces a nationwide shortage of A&E consultants, with the bigger trauma centres finding it easier to attract staff.
Dr Lyons said they were still not able to judge which was the best option until they had been explored in more detail, heard from clinicians and also from the public. But he was adamant it was “not a done deal”.
Could other services at the hospital be affected?
He said he wanted to provide a 24-hour service but only if staff could be provided to give a service safely on a consistent basis.
Consultant urlogist Tim Appanna, chairman of the hospital’s senior staff committee, recognises something has to change.
He said in an ideal world there would be a 24-hour A&E but he recognises that in the short term – perhaps for a year – they might have to move to an option when the Royal Glamorgan’s consultant-led A&E closed at night.
But he would want this to only be a temporary solution, in the hope recruitment can be addressed.
He is worried if it was permanent there could be a “domino effect” on other departments and services, including anaesthetics.
“It wouldn’t be the sort of hospital it is now,” he said. “It’s a very efficient service, we deal with a lot of patients.
“This hospital has always done very well with surgery and medicine and if we start to lose those services it would a problem, not for us, for the population we serve – and bear in mind in this health board, the biggest concentration of population is sitting on our doorstep.”
What will the health board discuss?
It will look at the options again and its own efforts to bring in new staff, although recognising recruiting emergency doctors is “very challenging”.
It will hear concerns already expressed about the changes:
- Transport and accessibility, including the “unique topography” of the valleys
- Criticism about “inadequate efforts” to recruit and retain staff, with hospital managers admitting uncertainty over the Royal Glamorgan’s future has not helped
- Worries over the impact on other hospital services
- “Confusion” over the scope of what minor injuries services do – and the need to improve existing units in the Cynon Valley and Rhondda
- “Lack of trust and confidence” in the health board, with it widely believed that the decision has already been made.
Numbers of patients using A&E
By hospital, by year
How many use A&E?
Slightly more patients use the emergency unit at the Royal Glamorgan Hospital each month than use Prince Charles – but together they have seen nearly 125,300 patients over the last year, an average of 10,440 a month.
Increasing numbers are using both hospitals each year – but the health board wants to gauge the likely impact on neighbouring hospitals, including Cardiff, on any changes it makes.
Less than 1,000 patients a month also use two minor injuries units.
Mr Appanna said: “We need a line drawn in the sand..all this talk about downgrading the Royal Glamorgan needs to stop. We need to talk about how to bolster services. It’s a fantastic hospital and the passion you see from the people and population is mirrored by the staff.”