Health bosses have been pushed to answer how recruitment got so bad at a Welsh A&E during a grilling by AMs.
The Accident and Emergency department of the Royal Glamorgan faces being downgraded and even closed and bosses of Cwm Taf health board have said:
- The last consultant will soon leave the Royal Glamorgan hospital’s A&E department and will be the last to leave
- The level of doctors in the department has fallen to 1.6 full-time equivalents
- One inquest has already linked the provision at the hospital to the death of a patient, and admitted more are coming through the system
- The chief executive admitted: “We cannot say it will remain safe for the foreseeable future. It’s reached the point there’s significant risk”
One of the reasons being given for the proposed closure is the lack of staff, and failure to recruit staff to fill vacancies.
But during evidence to the Assembly’s health committee, when Dr Nick Lyons, the medical director, was asked what steps had been taken to try and recruit staff at the Royal Glamorgan, he couldn’t answer.
“I have to be completely honest I have only been in post since October last year so some of that detail, I don’t have,” he told the Plaid AM.
But, he said there are recruitment issues across the UK and he had personally spoken to other medical directors who were also struggling to fill the 1,200 vacancies UK-wide.
Dr Lyons said that the recent resignation of the final A&E consultant will mean there will be “no substantive, no employed emergency department consultant”.
“Emergency medical consultants like to work in exciting trauma centres and that environment, they like the buzz of that.”
He said that the “backbone” of work therefore falls to middle grade doctors – of which there are only 1.6 full-time equivalent.
Plaid Cymru AM Rhun ap Iorwerth repeatedly asked the trio how the recruitment issue had got so bad.
He said he had been told there had been no “concerted effort” to recruit for five years.
Dr Lyons told him “that may well be the case”.
Mr ap Iorwerth asked the bosses to provide details of occasions in the last five years where they had made attempts to recruit.
And in response to a further question, said the South Wales Programme [which proposed the unit being converted into a minor injuries unit] “paralysed” recruitment.
“If I was a consultant emergency medicine doctor would I come and work, move house, move my family and come and work in a department where there was a matter of public record that there was an intention to convert it into a minor injuries unit”.
He admitted recruitment was a “potentially solvable” problem but said there is a “reality check” is that 17 consultants and 20 middle-grade doctors are needed but there is a low response to any adverts.
Dr Lyons said meetings were taking place with the 50 locum doctors working at the unit to see what they can offer to try get them to stay on as a consultant. One offer is to pay for their remaining training.
Chief executive Sharon Hopkins told the committee she couldn’t “turn the clock back” on decisions made before her time, but was challenged by Mr ap Iorwerth about “what has been done, what has been attempted as a means to resolve problems”.
Labour’s Lynne Neagle said the health board signed up in 2014 but only one of the agreed positions was implemented.
“Why didn’t the health board implement the programme six years ago?”
Mr Hopkins said: “When you look back, in order to facilitate a minor injuries unit, all those pathways need to be put in place. The start point was the acute medical serivce. The board spent a lot of time putting that in to accommodate those pathways, and community care.
“It seems the definitive programme about how we would move from 2014 to what was then envisaged, that wasn’t as clear as it could have been.”
“We can see there has been work done, but not sufficient”.
Angela Burns, Conservative AM, said: “You may be frustrated but trust me, we are so frustrated. Where’s the corporate responsibility?
“It’s a new team and a new ball game and we’ve nothing to do with the past.
Somebody somewhere there is a chain of continuity, this health board didn’t just suddenly reinvent itself when you turned up. There has to be corporate responsibility.
“I haven’t run a health board, but I’ve run other smaller businesses, one of the first things you do is survey the canvas you have to work with. You find out what’s happening, what’s going wrong and what’s going well.
“I struggle with the notion that you don’t really know what went on in the past. I appreciate you may want to say it for political reasons or because you don’t want to diss the previous incumbents but nonetheless I am horrified that you are really going to sit here and say you don’t know what went wrong over the last few years”.
She said it was “important” for AMs to push them on what had gone wrong because “this isn’t just about Cwm Taf”.
“This is happening in other health boards all over Wales. Hospitals are allowed to wither on the vine for whatever reason and we need to understand if it’s deliberate, or whether its’ accidental or workforce and cultural pressures. We have lessons to learn here.”
David Rees, Labour AM, urged them to speak to board members who were in post over the period of decline to find out what happened.