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Friday, August 10, 2007

Adult neurosurgery

It was inevitable that the Health Minister's compromise to keep Adult neurosurgery in Swansea would start to unravel at some point and today is as good a time as any.

The BBC report that there is growing concern among AMs and MPs about proposals to send patients from north Wales to Swansea or Cardiff for brain operations. So much so that some Labour AMs and MPs are in open revolt.

The problem that the Minister had to overcome was one of sustainable volume. There needs to be a certain population for a neurosurgery unit to be viable and safe. Health Commision Wales otherwise known as Help Cardiff Win in some parts of Swansea, had wanted to merge the two neurosurgery units in Swansea and Cardiff so as to meet this requirement.

However, their option of locating the new unit in the capital city did not win favour in most of South Wales because of very understandable geographical arguments based on keeping journey times below two hours for emergencies. Cardiff is also very close to the unit in Bristol leaving the people of South East Wales spoilt for choice, whilst those of us to the west would face a life-threatening journey.

The obvious solution was to merge the two services on the Swansea site so that the vast majority of people in South and Mid Wales would have a journey of less than two hours to a neurosurgical unit. Instead the Minister kept both Swansea and Cardiff open and announced a review so as to construct an all-Wales solution. This would mean people travelling from North Wales to the south coast for scheduled operations together with all the logistical problems of accomodating relatives and ensuring proper post-operative support.

The outcome of all this is a certain amount of back-tracking on the part of the government. On 4th July for example the Minister told Plenary that "I have given you categorical assurances that the Swansea and Cardiff neurosurgery units will remain open. The purpose of my task and finish group is to look at issues of how this will work and how we will draw in the other work. This solution will work, and that is the end of the matter as far as I am concerned. On my watch as Minister, this will work because we wish it to work, and we will find ways to make it work. It is important that we recognise my clear commitment today to the services." However, on Radio Wales this morning the Chief Executive of the NHS in Wales told viewers on three separate occasions that no decisions have been taken. She implied that the future of Cardiff and Swansea was dependent on the outcome of the review.

I have now written to the Minister to ask her what the government’s position is on this and to confirm that if the review concludes that patients in North Wales should continue to go to Walton then this will have no impact on the decision to keep both Swansea and Cardiff open as part of a managed network? I will be watching developments intently.
Mrs Hart's recent description of her “overriding aim [of] secure[ing] as many services as can be safely provided within Wales’s boundaries” suggests, worryingly, that the new government's health policy inclines more to satisfying a political agenda of self-sufficency (autarky), than the actual needs of patients. Most of the proceedures presently carried out at the Walton for North Walian patients are for example done as 'day surgery' cases. This is simply not going to be possible if these people are going to be compelled to travel down from Shotton to Swansea, or Mold to Morriston. How long did the journey to the Eisteddfod take you earlier this week?

As you rightly point out, there is a critical mass required to sustain services such as neurosurgery on both a clinical and cost effective basis. Surely the solution is to have more interdependence with England, with most South Walians treated in Swansea, but those from the East having the option of Bristol and those from the North remaining with the Walton.

Next thing North Walians expect will be to be forced to travel with their sick children to Cardiff as the contacts with Alder Hey are withdrawn to help cover the costs of this white elephant children's hospital 200 miles (and 4 hours drive assuming clear roads) away. It is actually quicker to get to Great Ormond St from North Wales than to UHW!

Tertiary health services are a classic example of where Wales needs to focus on interdependence, not independence in our policy planning and delivery.
While the worries are perfectly valid it's intersting that the Labour politicians complaining are the usual anti-coalition suspects. A bit like Chris Bryant and his railway announcements, they seem determined to undermine the agreement in all ways possible. It's a pretty dangerous position for Labour.
I really think we need to move on from attributing every policy difference or initiative by a Labour politician to an attempt to split the coalition. In the case of neurosurgery the Labour AMs and MPs have genuine constituency concerns that they are representing. Believe it or not Labour MPs also take up constituency matters which put them at odds with the UK Labour government. We should concentrate on the issues and take pronouncements by politicians at face value unless we know differently.

Edwina is trying to provoke a response from the civil service that recognises the political reality of the situation in Swansea. Do not fool yourself - there is no clinical case for neuro surgery in Swansea. It is too small, there are too few cases, the Royal Colleges will not wear it and have the power to stop it whatever the politicians say. Edwina can only meet the political commitment by diverting more demand to Swansea and it has to come from somewhere. It is only volume of cases that can neutralise the Royal College veto.

I suspect this will resolve around a compromise shift of patients from Mid Wales. I equally suspect implicating the North is a means of concentrating the minds of rather conservative, intrinsically inflexible policy makers.
Actually there is a very good clinical case for a single adult neurosurgery unit based in Swansea serving the whole of South Wales. It would serve the right size population and it would have the blessing of the Royal College.
Perceptive comments.

Peter is correct. All the North Wales AMs are opposed to this, the more so the further east they go, whether they are presently expressing these doubts publicly or through private channels.

Activist may however be correct in that Edwina may have launched this kite in order to have it shot down in flames. There are wheels within wheels in Edwina's machinations. Perhaps she is using this issue to educate Plaid Cymru members to the realities of government as she considers how to take forward the thorny issue of acute hospital modernisation more generally, without any private financing. Equally she may be intent on blackmailing the North Wales vote into supporting a single site in Swansea solution for South Wales, thus winning a majority over the Cardiffians and the Royal College. Edwina, we may be certain, has her own agenda.
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