1. WHAT IS RURAL? Mid Wales Healthcare Collaborative
Dr Sue Fish
Clinical Programme Director
WHAT IS RURAL? Mid Wales Healthcare Collaborative

2. WHAT IS THE DEFINITION OF RURAL?
Welsh Government Guidance states:
‘There are many sensible ways to consider rurality. There is no single definition that applies for all purposes. There are many options, which may be more or less appropriate in different circumstances.’

3. Sparsity of the population Land use Access to services Settlement size
THE CHARACTERISTICS OF A RURAL AREA
Sparsity of the population
Land use
Access to services
Settlement size

4. POPULATION DENSITY

5. LAND USE

6. WELSH GOVERNMENT STATISTICS

7. RURAL WALES – ACUTE HOSPITALS

8. WHAT IS RURAL?

9. MEDICAL SERVICES - MID WALES

10. BRONGLAIS GENERAL HOSPITAL
GENERAL SURGERY
ACCIDENT AND EMERGENCY
GENERAL MEDICINE
ANAESTHETICS
PAEDIATRICS
OBSTETRICS
GYNAECOLOGY
PATHOLOGY
TRAUMA AND ORTHOAEDICS
DIAGNOSTICS
GENERALISM VS SPECIALISM?

11. TELEMEDICINE Bronglais Aberaeron Aberteifi Llwynhelyg Glangwilli
Tywysog Phillip
Singleton &
Treforys
Ysbyty Prifysgol Cymru

12. GOOD OUTCOMES
Ysbyty Gwynedd – Improved diabetic foot care reducing amputation rates
Bronglais Hospital – Performed well in the National Emergency Lapartotomy Audit

13. RURAL HEALTH PLAN
2009
The ageing population is increasing faster in rural than in urban areas, compounded by the outward migration of young people and inward migration of older people. This will have a significant impact on local service needs and support systems across health and social care.
Two features distinguish the rural from the urban scene in Wales and both have an impact on health conditions. They are:
The problem of access to services for those living in the remoter communities
Difficulties with integrating services provided for the individual when some are NHS based with others coming from local government and the voluntary sector.

14. MID WALES HEALTHCARE STUDY
2014
People in Mid Wales want a health service that delivers high quality, safe and accessible services that are sustainable. In this respect, they are no different from their fellow citizens elsewhere. They appreciate that it is not practicable to have every conceivable specialised service on their doorstep, but two expectations come across loud and clear in this study: that core health services in Mid Wales should be just as good as those elsewhere; and that their needs should be just as important to the NHS as those in the more populous parts of the country.

15. ACUTE CARE IN REMOTE SETTINGS
2016
There are a number of areas, some with relatively sizeable populations, which have difficulties creating safe and viable hospital services
There are a number of solutions available for the problems facing rural and remote hospitals, but some of them require some change in approach, new models, the deployment of technology, and different approaches to creating and running networks.

16. THE CHALLENGES FOR HEALTH SERVICES IN A RURAL AREA
Age profile of the population
Staffing models – subspecialisation and recruitment
Training, education, skills
Standards, inspection and regulation
Costs
Time sensitive care
Transport

17. AGE PROFILE OF RURAL AREAS COMPARED TO URBAN AREAS

18. SKILLS
Rural areas often require a mix of skills that cut across current speciality or sub-speciality boundaries

19. STANDARDS
Standards based on minimum numbers of patients or numbers of consultants may not be achievable because the population to sustain the service does not exist – Standards linked to inputs need to be replaced with outcome measures

20. COSTS
Rural and remote services suffer from the dual problem of high costs from sub-scale operations and higher transport costs for staff and patients

21. TRAVEL TIMES TO HOSPITALS

22. WHAT ARE THE SOME OF THE ISSUES FACED BY THE PUBLIC?
Long travel times on narrow roads are draining for patients and their families particularly the elderly
Measures of safety should consider an assessment of the wider patient experience and wellbeing

23. MID WALES HEALTHCARE COLLABORATIVE
The Mid Wales Healthcare Collaborative works with providers and communities to plan and deliver safe, sustainable, high quality and accessible healthcare services for the population of Mid Wales

24. MID WALES HEALTHCARE
COLLABORATIVE

25. BRONGLAIS GENERAL HOSPITAL
REFERRAL AREA
BRONGLAIS GENERAL HOSPITAL

26. BRONGLAIS GENERAL HOSPITAL
Catchment population – 130,000
Travel times to other hospitals
Glangwili, Carmarthen – 90 minutes
Withybush Hospital, Haverford West – 110 minutes
Royal Shrewsbury Hospital minutes
Ysbyty Gwynedd, Bangor – 140 minutes
Unselected presentations to A+E
Interdependencies between specialties

27. RECOMMENDATION 5
Hywel Dda University Health Board, supported by the other two Boards, should confirm publicly its vision of the future strategic role of Bronglais General Hospital and the strategic direction that it intends to pursue. The vision will require subsequent detailed consideration of pathway and service options, but should be sufficiently specific to reassure potential and current staff and the public that the hospital will remain an acute centre, and that urgent and non-urgent provision will address the challenges of remoteness. It should state explicitly the criteria that must be met, based on the Six Key Service Criteria set out in this report

28. RECOMMENDATION 6
A further examination of the options for providing surgical services in Bronglais General Hospital should now be started which takes into full account of the broad range of presenting conditions at the hospital and evaluates alternative ways of constructing the sort of clinical network support that is needed.

29. SERVICE CRITERIA TO SHAPE THE FUTURE OF BRONGLAIS HOSPITAL
Senior staff should not be expected to work in relative professional isolation
There should always be sufficient, appropriate staff readily available
Cover must be provided for key staff when they are away
Good quality facilities must be available to deal with the unpredictable
Staff should not be expected to work outside their area of expertise
It must be possible to sustain the service into the foreseeable future

30. RECOMMENDATION TO COLLEGES
Review current standards in light of the issues in rural and remote but also smaller acute hospitals and ensure they are fit for purpose
Be clear where there is flexibility and demonstrate that the interdependencies are properly taken into account
Consider the idea of combining the ‘front door’ emergency specialities

31. ANY QUESTIONS?