Helpless and ignored in west Wales
Outside a part-closed minor injuries unit, a small cluster of tents line a grassy strip. For three weeks, people have slept out in all weathers to make a point about the downgrading of their hospital
As health bosses around Wales grapple with sums that don’t add up, vacancies they can’t fill and crumbling buildings, their choice often seems to be to centralise services in the most populous areas. Today we share a despatch from Llanelli by reporter Rob Harries which captures the strong emotions among a group of people who feel they’re unfairly paying the price.
People in Llanelli once took healthcare on their doorstep for granted. The historic town on the Loughor Estuary is the largest in the county of Carmarthenshire and the most populous in Wales west of Swansea. Yet the accident and emergency (A&E) department at the town’s Prince Philip Hospital closed several years ago and in a couple of weeks it will no longer have a 24-hour minor injuries unit (MIU) either - something that was promised when the A&E bit the dust.
Instead, the unit will only be open from 8am to 8pm. The blame, as is often the case, lies with cost and recruitment. Hywel Dda University Health Board - which is responsible for healthcare across Carmarthenshire - cannot or will not employ enough doctors to keep the MIU fully open at Prince Philip Hospital. The change is only for six months, the health board insists. A report discussed by health chiefs last month showed that sickness levels among staff at the hospital’s MIU are on the up, with stress-related conditions being a factor, while medical staff have also left permanently.
Andrew Carruthers, the health board’s chief operating officer, said: “It’s unacceptable to continue to expose our nursing staff to the critical risk presented without a doctor present. Failure to take action will lead to more staff leaving and could leave the daytime service fragile.”
Despite explanations given in an attempt to pacify anger in Llanelli, people in this town feel afraid. It’s 24 miles to Carmarthen’s Glangwili Hospital; it’s 11 miles to Swansea’s Morriston Hospital. But if you’re ever faced with a serious medical problem and are unsure what to do or where to go, those hospitals can feel like a million miles away. During the 12 months up to the end of September, approximately 31,000 people used the MIU in Llanelli - around 6,000 of them between 8pm and 8am.
For three weeks now (since September 28), locals have camped outside Prince Philip Hospital in protest at the health board’s “outrageous” decision. For 24 hours a day, every day, there is someone here. There are tents on the grass outside the main entrance; people are sleeping here in all weathers, making a stand and waving to motorists who beep in solidarity as they drive past. The protest is important, even though organisers know it will not reverse a change which is coming on November 1. In a letter seen by WalesOnline, a health board official confirms that it “will not revisit this decision”.
This refusal to even entertain the idea of a U-turn flies in the face of petitions calling for one which have already garnered more than 10,000 signatures - almost the equivalent of the population of the county’s second biggest town, Carmarthen. To put that into context, Llanelli has a population of more than 40,000, and the parliamentary constituency of Llanelli had an electorate of over 70,000 at this year’s general election.
Earlier this year, Rachel Beckett from Llanelli and her fiancé Dwain Jones found out first-hand just how vital the MIU at Prince Philip Hospital is. Dwain suffered an accident when he fell through a glass greenhouse. A huge shard of glass pierced his skin (pictured below) and he was losing blood. “When he fell through the greenhouse there was only a bit of the glass protruding out,” explained Rachel. “I thought it was only a little bit so I pulled it out to dress the wound and discovered this eight-inch piece of glass that was as sharp as a knife. I tried unsuccessfully to stem the flow but it quickly became obvious that I would have to get Dwain to hospital by car or he was going to die.”
Rachel took her partner straight to the MIU in Llanelli. The unit saved his life. A few months on from that ordeal, Rachel is adamant that her hometown is once again being left behind by health bosses. “If the unit had not been open Dwain would have lost too much blood and he would not be alive today. The A&E department shouldn’t have been taken away. If anything that should be brought back due to the bottlenecks at Glangwili and Morriston. People are having to wait hours for ambulances and a journey of that distance isn’t always possible. What about people who haven’t got cars? The decision that they’re now going to cut the MIU’s hours for six months is just crazy.”
Dwain is lucky to be alive. His accident occurred at a time when the MIU would still be open under the new plans. But come the summer months when people are outside later into the evening and the next person to endure such an incident might not be as lucky as he was. As Rachel points out: “Accidents don’t stop at 8pm.”
It’s accepted here by those camping and protesting in the rain and wind outside the hospital that their vociferousness and dedication will ultimately be in vain. They will not be able to stop the health board’s controversial plan. But still they turn up. Every day. Every night. They’re keeping the same hours as those kept by the MIU.......until November at least.
“The main purpose of the protest is to not let them get away with it,” said Suzy Curry, pictured above. She is a Llanelli resident, local councillor and vice chair of the Sosppan group - ‘Save Our Services Prince Philip Action Network’. "With changes like this, we are supposed to have a consultation. We all know that if the unit shuts for six months, the chances of it reopening are slim. They are saying there are no doctors on site but there is an Acute Medical Assessment Unit at the hospital which is staffed by doctors who are called upon in an emergency, so to simply say there are no doctors is not true.”
A chief worry among the protesters is the inconvenience and at times impossibility of getting to Glangwili Hospital at short notice. Patients needing emergency medical attention are asked to head to Carmarthen instead of Swansea’s Morriston Hospital (managed by a different health board) even though it is more than twice as far. According to Ms Curry, it was promised that an agreement would be struck between Hywel Dda and Morriston Hospital meaning A&E patients can head there in an emergency - something that is yet to materialise. Regardless of the advice given, patients in need will seek the nearest possible medical attention, and there are already concerns that the overnight closure of the MIU at Prince Philip will lead to worsening A&E performances in both Carmarthen and Swansea. Anyone who has been to Glangwili Hospital’s A&E department at night knows full well that the last thing it needs is more patients.
“The health board say they are concerned about patient safety but what about the safety of the general public at large who won’t have an MIU to attend overnight?” asked Ms Curry during a shift at the protest site. “When they shut the A&E here they said we would have an MIU open 24 hours a day. This is a broken promise from the health board. They’ll tell you they can’t get the doctors but when was the last time they advertised vacancies for doctors? Two doctors have left because they heard the unit was shutting overnight. The whole management (of the health board) is not fit for purpose. They have managed us into this crisis.”
While no consultation has been held prior to the decision being made, Hywel Dda bosses have announced that a drop-in event will take place at the Antioch Centre in the town’s Copperworks Road on Wednesday (October 23) between the hours of 2pm and 7pm. People with concerns, according to the health board, “will be able to learn more about why the temporary change is needed, how to access care in different circumstances, and what the next steps will be for further engagement with the community”. However, calls for a public meeting have fallen on deaf ears. “I’m guessing they just don’t want one,” said Ms Curry. “I feel they don’t really want to be answerable to the people of Llanelli.”
Despite the immediate fears of not being able to see a medical profession during the night, there are also concerns that the reputation of the healthcare provision on offer in Llanelli could discourage people from living and investing in the town for years to come. “Llanelli is the biggest town in the health board region and we should have an A&E department, not just an MIU,” said Ms Curry. “One woman told us that a key reason she moved to Llanelli was because the local hospital had a 24-hour MIU. And the fear of course is that the six-month night-time closure will be a permanent one. They are not recruiting doctors. Have they thrown the towel in?”
Llanelli MP Nia Griffith has also been visible at the protest site outside the hospital. She believes the decision by Hywel Dda and the way it has been announced is “unacceptable”. She said: “The MIU needs to remain a 24-hour service permanently, not just a daytime one. The call to reduce the opening hours temporarily was made by the health board at short notice and without public consultation. The decision was one created by the health board’s inability to recruit appropriate personnel and inadequate management of staff absence. Serious questions need to be asked as to why they have left this situation to fester for so long and why this much valued local service is now under threat.
“Scant regard seems to have been given to those who will need the support and treatment that the MIU provides and the suggestion that the people of Llanelli can just as easily travel to Glangwili or Morriston is ludicrous. No thought has been given to those who don’t have access to their own transport nor to the extra pressure that would be placed on those two hospitals who are struggling to cope with the existing demands upon them as it is.
"The manner in which this decision was made has only served to damage confidence in the health board, its processes and the ability for it to be held to account for their delivery of healthcare in Llanelli. They (Hywel Dda board members) really need to listen and carefully consider their next steps on this. It is such an important decision for our town. They have the responsibility of providing the level of NHS care that Llanelli needs and deserves. It is now time for them to step up and show that they are capable of doing exactly that. For a town the size of Llanelli, with the largest centre of population within the Hywel Dda area, to be left without MIU cover at night is unacceptable.”
The concerns raised by protesters have been put to Hywel Dda University Health Board, which has stressed that the unit will revert back to running a 24-hour operation from next May. It also wants to reassure the public that people with the most serious conditions will still be seen and treated at Prince Philip Hospital, once they have been conveyed there by an emergency ambulance or referred there by their GP.
Jon Morris, the hospital's Minor Injury Unit clinical lead, said: “We want to assure people that the Minor Injury Unit is not closing and if you have a minor injury, you can continue to walk into the unit between 8am and 8pm from 1 November 2024. Outside of these hours, and if the minor injury is urgent and cannot wait for attention until the unit re-opens at 8am, then the advice to patients is to visit NHS Direct Wales symptom checker online or call NHS Direct Wales on 111 for advice (choose option 2 for mental health). This service can also connect you to the Out-of-Hours service when GP surgeries are closed. In a life-threatening emergency, always call 999.
“The temporary change to MIU opening hours is being put in place to protect patient and staff safety due to not having the appropriate MIU GPs in place during evenings and overnight. We have had a number of GPs working in the MIU in recent years but have had an issue finding GPs who are willing to cover night shifts. While this temporary change is in place, it is important to stress that Prince Philip Hospital continues to provide acute medical care for the local population from the adult Acute Medical Assessment Unit, for example, stroke or heart attack. These cases come into the unit via ambulance or via GP referral.
“We will work closely with GPs and the Welsh Ambulance Services University NHS Trust to ensure these patients continue to be seen in Prince Philip Hospital, as their closest hospital, during this temporary change to the Minor Injury Unit. This means we continue to care for medical emergencies at Prince Philip Hospital and in typical circumstances, these will not be diverted to either Glangwili or Morriston Hospitals."
In the short-term, the people of Llanelli will have to wait and see how things work under the unit's new 12-hour system and whether - as promised - it reverts back to being a 24-hour unit next May. In the long-term, however, things could get worse if you live in this part of the world. Plans have been in place since 2018 to totally overhaul healthcare in the Hywel Dda region, which includes the sprawling west Wales counties of Pembrokeshire and Ceredigion as well as Carmarthenshire. The flagship development of that proposed overhaul is a huge new hospital in the St Clears or Whitland area in west Carmarthenshire - further still from Llanelli. That new hospital, should it finally be built, will cost over a billion pounds and boast a shiny, state-of-the-art A&E department - around 35 miles from Llanelli. The A&E department in Glangwili Hospital - already 24 miles away from Prince Philip Hospital - would be no more.
“From the health board’s point of view, they have such a vast area to cover that they are trying to put a pin in the middle and hope that will work,” said Ms Curry. “But the vast majority of people are in Llanelli and to make them travel so far for care is outrageous."