Emergency Surgery and The South Wales Plan TJ Havard MD FRCS(Eng) FRCS(Ed) Director of Professional Affairs for Wales Royal College of Surgeons of England

South Wales Plan Consultant led Maternity care Neonatal care Inpatient Paediatrics Emergency Medicine (A&E)

Emergency Surgery Considerable number of Emergency admissions ‘Permissive’ role A+E Unfiltered General Medical Admissions Level III Critical Care Full Range of Elective Surgery Therapeutic Endoscopy

Emergency Surgery Considerable number of Emergency admissions ‘Permissive’ role A+E Unfiltered General Medical Admissions Level III Critical Care Full Range of Elective Surgery Therapeutic Endoscopy

Key Drivers for Change QUALITY & SAFETY Meeting core standards Improving patient outcomes (NELA) SUSTAINABILITY – Medical Workforce Compliant rotas (all levels – v difficult at Core trainee) Acceptable training standards (Deanery & GMC) Recruitment and retention

Surgical Clinical Reference Group Tertiary Services not included 3 Sub-groups Head & Neck General Surgery, Vascular, Gynae and Urology T&O GIRFT Project supplementing T&O sub-group

March 2014

Population 3,063,000 13 Acute Surgical Intakes 2014

Emergency Surgery (FCEs)

General Surgery (FCEs)

Emergency General Surgery (FCEs) (By Age Group)

Emergency Surgery – 4 levels of hospital

Example – General Surgery

Example – General Surgery

Sustainability - Workforce Recruitment and retention difficult at all levels Core Trainees (SHO) most difficult 157 CT in surgery in Wales reduced to 94 in 2012 Fill rates currently 100% but Of 37 appointed 2016 34 started 25% dropout 20 posts in North Wales, 17 currently vacant Possible reduction to 70 in the future Higher training Shape of Training imminent SCP/ANP development required

Sustainability How many acute sites for Emergency surgery in South Wales?

Sustainability How many acute sites for Emergency surgery in South Wales? 3 or 4

Healthier Together – Manchester

Clinical conferences (All Nations Church) South Wales Health Collaborative Surgery Steering Group General Surgery/Urology/Gynaecology/Vascular Surgery Clinical Reference Group Acute Medicine/Surgery – Joint Clinical Reference Group South Wales Health Collaborative Board South Central Wales Acute Care Alliance Cwm Taf Clinical Conference USW Cwm Taf Strategic Planning Group Cwm Taf Surgical Workshops Also – Ad Hoc meetings with Alun Tompkinson, Geoff Clarke, Richard Johnson, Hamish Laing, CEO’s Also also – Directorate/consultant meetings, “corridor meetings”

How far have we got?

Population 3,063,000 13 Acute Surgical Intakes 2016