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16 October 2014
me and my health

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What's happening to our hospitals?

by Kevin Sullivan, Policy and Public Affairs Manager, Welsh NHS Confederation

They are where our loved ones were born, cared for, and sometimes where they died. They were built by our forefathers, and they are part of the fabric of our communities. So it's no surprise that people are so attached to hospitals.

But there's no getting away from it: if we want the best possible care for our patients, we need to change the way our hospitals work.

Wales has around 130 hospitals. Many of them were built in the 1960s, or even earlier. But the world is changing fast, and hospitals need to keep up.

The population is ageing. And as people live longer, more of the NHS's work is treating long-term conditions such as diabetes and heart disease.

Technology has moved on - for example, doctors in one hospital can see patients elsewhere by video link.

Many more treatments are becoming available. Medicine - and the job of a hospital doctor - is becoming much more specialised.

Quality standards are rising - and new laws mean that hospitals can no longer rely on junior doctors working excessive hours.

Many services which have traditionally been provided in hospital can now be provided in the community.

Technology has moved on - for example, doctors in one hospital can see patients elsewhere by video link.

Faced with changes like these, we need to make sure our hospitals can provide twenty-first century care for patients in Wales.

The three main changes to our hospitals are:

  • Taking 'hospital' care out of the hospital building: much of the care that has traditionally been provided in hospitals can now be provided closer to patients' homes.

  • Focussing on specialist care: increasingly, hospitals will be where you go for specialist care which can only be provided in a hospital. Currently, many people who are in hospital could be treated elsewhere - and remain in their own homes - if support were available.

  • Doing different things, working together: so many new treatments are now available that we simply do not have enough doctors to provide them all everywhere, to modern standards of safety. Even if we did, some very specialist services would still need to be concentrated in certain places - doctors need to see enough patients to keep up their skills, and they also often need to be near other experts, or highly-specialist equipment. But what's happening is that different hospitals are working more closely together, as parts of a network.

What does it all mean for patients?

Taking the hospital to the patient
You will no longer have to go to hospital for many of the treatments that have traditionally been provided in hospitals. For example, in Pembrokeshire, patients who need urgent care when the GP surgery is closed can be visited at home by a paramedic practitioner. She can treat many patients on the spot, saving them a trip to the hospital. Or she can refer them to the hospital if needed.

In for a day not for a stay
If you do go to hospital, in many cases you will be in for a day, not for a stay. In Swansea, patients can now have cataracts removed, orthopaedic keyhole surgery and even minor plastic surgery, without having to stay overnight in hospital. Senior sister Susan Williams says, "The theatres are right here and patients can just walk in. Many of the procedures can take just 30 minutes. But the difference it makes to patients' lives is remarkable."

Specialist care, most of it close to home
If you need specialist care, you will have it in the best place. Some patients might need to travel for the procedure itself, so that it can be provided by the experts in that field. But preparation and follow-up care can often be provided locally.

For instance, patients from Aberystwyth who need complex cancer surgery sometimes have it carried out at the specialist centre in Swansea. However, most of the care - before and after the surgery itself - is provided locally.

Dr Alan Axford, Lead Clinician for Cancer Services in Aberystwyth explains: "We can carry out the diagnosis locally, and video and internet links mean the team in Aberystwyth can discuss the case with specialists in Swansea. If the best place for the surgery is Swansea, the patient only has to go there once. After surgery, once the patient is stable, they are transferred back to the local hospital. Any further treatment they need, such as chemotherapy and on-going care, can be provided locally. It means patients get the best of both worlds - they go to the best possible place for their surgery, but still get most of their care closer to home".


Anon Bronglais
If prepatation and after care can be providied in local hospitals, how much more practical would it be for the surgeons to do the travelling, thus providing total care locally?

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