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On 29 March 2018, the 6 health boards covering the south Wales region – Abertawe Bro Morgannwg; Aneurin Bevan; Cardiff and Vale; Cwm Taf; Hywel Dda; and Powys – considered recommendations in relation to the establishment of a major trauma network for south Wales, west Wales and south Powys. This statement is to update Members on the decisions which were taken by the health boards.


### Major trauma


Major trauma refers to multiple or serious injuries that may result in disability or death. Injuries can include serious head injuries, multiple injuries caused by road traffic accidents, industrial accidents, falls, mass casualty events and knife and gunshot wounds. Less than 0\.2% of people (two out of 1,000\) attending their local emergency department will have suffered a major trauma. Each individual emergency department will therefore see only one or two major trauma cases a week.


There is a significant amount of evidence to show that patients who suffer a major trauma have a greater chance of survival and recover better if they are treated within a major trauma network.


### Establishment of a major trauma network for south Wales


Proposals to establish a major trauma network for south wales have been in development for some time. It is currently the only region in England and Wales that is not currently part of such a network. North Wales and north Powys is part of west Midlands major trauma network that supports the major trauma centre in north Staffordshire, and the people in those areas benefit from improved outcomes as a result.


The work to coordinate the establishment of the south Wales network has been led by the NHS Wales Collaborative. This was done in collaboration with the six health boards; the Welsh Ambulance Service NHS Trust; the Emergency Medical Retrieval and Transfer Service; and also involved the third sector and community health councils.


In 2015, a workshop led by clinicians looked at the options available to develop a network in south Wales and agreed this should be done through the establishment of a major trauma centre on a single site (either Morriston Hospital in Swansea or University Hospital of Wales in Cardiff), supported by a number of trauma units. Local emergency hospitals would continue to see people with serious illness and injuries.


### Independent panel


An independent panel of expert clinicians working in major trauma looked at the evidence and provided advice on the best hospital site for the major trauma centre. In doing so, they identified 3 main factors: clinical interdependencies; critical mass; and travel times. After detailed consideration, the panel recommended:


* A major trauma network for South Wales with a clinical governance infrastructure should be quickly developed. The aim of a clinical governance infrastructure is to make sure a service is high quality, focuses on the patients, and has strong clinical leadership.
* The adults’ and children’s’ major trauma centres should be on the same site.
* The major trauma centre should be at University Hospital of Wales, Cardiff.
* Morriston Hospital, Swansea should become a large trauma unit and should have a lead role for the major trauma network.
* A clear and realistic timetable for putting the trauma network in place should be set.


The panel did not believe that either Morriston Hospital or University Hospital of Wales as a major trauma centre would have any significant advantage over the other in terms of geography. Rather, the panel decided that providing specific highly specialist services such as neurosurgery and paediatric neurosurgery on the same site as the major trauma centre was the main factor in deciding where to base the major trauma centre.


Full details of the reasoning behind the recommendations can be found on the Public Health Wales website at: publichealthwales.org/majortraumaconsultation


### Public consultation


The independent panel’s recommendations were included as part of the formal public consultation which ran between 13 November 2017 and 5 February 2018\. Local meetings were held across the region, with each health board holding a public meeting in each of their districts.


There were over 1,000 consultation responses received from across the region, with a further several hundred people engaging through social media. 242 people attended the 17 public meetings.  I would like to thank everyone who took the time to respond to the consultation and value their views on helping to shape this important new service.


All of the views expressed through the many channels open to the public were treated on an equal footing and were considered by the NHS Wales Health Collaborative Leadership Forum, which is made up of chairs and chief executives of health boards and trusts in Wales.


A range of opinions were expressed, analysed and considered as part of the consultation exercise. After considering the conduct of the consultation and the analysis of the responses received, the Forum was content that the consultation has been conducted in an appropriate manner and in a way that met the requirements of applicable guidance.


Whilst issues were raised which will need to be further considered, addressed or mitigated as part of the implementation of the major trauma network, the Forum concluded that nothing had been raised which would affect the recommendations of the Independent Panel. It therefore recommended to health boards that they approve the establishment of a major trauma network for south and west Wales and south Powys, in line with the recommendations of the Independent Panel.


### Board meetings on 29 March 2018


Each of the 6 health boards met on 29 March to consider the recommendations of the NHS Wales Health Collaborative Leadership Forum. All approved the establishment of a major trauma network for the region and that a new major trauma centre should be located at the University Hospital of Wales in Cardiff.


None of the Accident \& Emergency Departments at any of the District General Hospitals will be downgraded on the basis of these decisions and will continue to see and treat the vast majority of patients, as they do currently.


Morriston Hospital will play a significant role in the major trauma network. It has been agreed that the hospital will become a large trauma unit and have the lead role for the network. I have stated on a number of occasions that there are also no plans to relocate the well established burns and plastics unit from Morriston Hospital and take this opportunity to again confirm that this remains the case. Our commitment to the future of the hospital is clear, as demonstrated by the announcement in January 2018 that the thoracic surgery service in South Wales will be based there. This illustrates the continuing importance we place on the hospital as a centre of excellence.


### Next steps


The health boards are now working together to establish an implementation programme, which will continue to involve all community health councils and stakeholders. Work is progressing to establish a Trauma Network Board for South Wales, which is anticipated to have its inaugural meeting in late spring/early Summer. The Network Board will oversee the establishment of the network for the region, ensuring the provision of high quality, safe and effective services for the population.


The Board will be responsible for developing policies and protocols to support the successful implementation of the network. It will facilitate joint working including developing links between pre\-hospital services, trauma units and the trauma centre. Work is also progressing with the appointment of a clinical lead, who will provide leadership and management in order to create, shape and embed an effective, patient focussed trauma service in south and west Wales and south Powys.


There will be additional capital and revenue costs associated with establishing the major trauma network across the region, including business cases which will be required for the infrastructure at the University Hospital of Wales and Morriston Hospital. These will be considered in the context of the phased implementation programme, the wider site development plans, interdependencies that exist between trauma services and other clinical services and will be subject to formal business case approval by Welsh Government.







Translation:


 
Ar 29 Mawrth 2018, ystyriodd y chwe bwrdd iechyd sy'n rhan o ardal De Cymru – sef Abertawe Bro Morgannwg; Aneurin Bevan; Caerdydd a'r Fro; Cwm Taf; Hywel Dda; a Phowys – argymhellion mewn perthynas â  sefydlu rhwydwaith trawma mawr ar gyfer De a Gorllewin Cymru a De Powys. Diben y datganiad hwn yw rhoi'r wybodaeth ddiweddaraf i'r Aelodau am y penderfyniadau a wnaed gan y byrddau iechyd.  
  
Trawma mawr  
  
Mae trawma mawr yn cyfeirio at anafiadau niferus neu ddifrifol a allai arwain at anabledd neu farwolaeth.  Mae’r anafiadau’n gallu cynnwys anafiadau difrifol i’r pen, anafiadau niferus ar ôl damweiniau ar y ffyrdd, damweiniau diwydiannol, cwympiadau, anafiadau i lawer o bobl ar ôl digwyddiad mawr a chlwyfau sy’n cael eu hachosi gan gyllyll a drylliau.  Bydd llai na 0\.2% o bobl (dau o bob  1,000\) sy'n mynychu eu hadran argyfwng leol wedi dioddef trawma mawr. Felly ni fydd pob adran argyfwng unigol yn gweld ond un neu ddau o achosion o drawma mawr bob wythnos.  
  
Ceir cryn dystiolaeth i ddangos bod gan gleifion sy'n dioddef trawma mawr well siawns o oroesi a'u bod yn gwella'n gynt os cânt eu trin o fewn rhwydwaith trawma mawr.   
  
Sefydlu rhwydwaith trawma mawr i Dde Cymru  
  
Bu cynigion i sefydlu rhwydwaith trawma mawr i Dde Cymru ar y gweill ers tro. Ar hyn o bryd y De yw'r unig ranbarth yng Nghymru a Lloegr nad yw'n rhan o rwydwaith o'r fath. Mae Gogledd Cymru a Gogledd Powys yn rhan o rwydwaith trawma mawr yng Ngorllewin Canolbarth Lloegr sy'n cefnogi'r rhwydwaith trawma mawr yng Ngogledd Swydd Stafford, ac mae'r canlyniadau i'r bobl yn yr ardaloedd hynny wedi gwella o ganlyniad.  
  
Mae'r gwaith i gydgysylltu rhwydwaith De Cymru wedi cael ei arwain gan Gydweithrediad GIG Cymru.  Gwnaed hyn mewn cydweithrediad â'r chwe bwrdd iechyd; Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru; y Gwasanaeth Casglu a Throsglwyddo Meddygol Brys; ac roedd hefyd yn  cynnwys y trydydd sector a'r cynghorau iechyd cymuned.  
  
Yn 2015, edrychodd gweithdy a gafodd ei arwain gan glinigwyr ar y dewisiadau sydd ar gael i ddatblygu rhwydwaith yn Ne Cymru a chytuno y dylid gwneud hyn trwy sefydlu canolfan trawma mawr ar un safle (naill ai Ysbyty Treforys yn Abertawe neu Ysbyty Athrofaol Cymru yng Nghaerdydd), gyda chymorth nifer o unedau trawma. Byddai ysbytai argyfwng lleol yn parhau i weld pobl â salwch ac anafiadau difrifol.  
  
Panel annibynnol  
  
Edrychodd panel annibynnol o glinigwyr arbenigol ym maes trawma mawr ar y dystiolaeth a rhoi cyngor ar ba ysbyty fyddai'r safle gorau i'r ganolfan trawma mawr. Wrth wneud hynny, nodwyd tri phrif ffactor: rhyngddibyniaethau; màs critigol; ac amseroedd teithio. Wedi ystyriaeth fanwl, argymhellodd y panel y canlynol:   
  
• Dylid mynd ati’n gyflym i sefydlu rhwydwaith trawma mawr i Dde Cymru â seilwaith llywodraethu clinigol. Nod seilwaith llywodraethu clinigol yw sicrhau bod gwasanaeth yn wasanaeth o safon uchel sy'n canolbwyntio ar y cleifion, ac sydd ag arweinyddiaeth glinigol gref.  
  
• Dylai’r ganolfan trawma mawr i oedolion a’r ganolfan i blant fod ar yr un safle.  
  
• Dylai’r ganolfan trawma mawr fod yn Ysbyty Athrofaol Cymru yng Nghaerdydd.  
  
• Dylai Ysbyty Treforys yn Abertawe droi’n uned drawma fawr a dylai gael rôl arweiniol yn y rhwydwaith trawma mawr.  
  
• Dylid pennu amserlen glir a realistig ar gyfer y gwaith o greu’r rhwydwaith trawma.  
  
Nid oedd y panel yn credu y byddai gan Ysbyty Treforys nac Ysbyty Athrofaol Cymru fel canolfan trawma mawr unrhyw fantais sylweddol dros y llall o safbwynt daearyddiaeth. Yn hytrach, penderfynodd y panel mai darparu gwasanaethau arbenigol iawn megis niwrolawdriniaeth a niwrolawdriniaeth bediatrig ar yr un safle â'r ganolfan trawma mawr oedd y prif ffactor wrth benderfynu ble i leoli'r ganolfan trawma mawr.  
  
Mae manylion llawn y rhesymau dros yr argymhellion i'w cael ar wefan Iechyd Cyhoeddus Cymru yn: www.publichealthwales.org/majortraumaconsultation  
  
Ymgynghoriad cyhoeddus  
  
Cafodd argymhellion y panel annibynnol eu cynnwys fel rhan o'r ymgynghoriad cyhoeddus ffurfiol a barodd rhwng 13 Tachwedd 2017 a 5 Chwefror 2018\. Cynhaliwyd cyfarfodydd lleol ar draws y rhanbarth, gyda phob bwrdd iechyd yn cynnal cyfarfod cyhoeddus ym mhob un o'i ranbarthau.  
  
Daeth dros 1,000 o ymatebion i'r ymgynghoriad i law o bob cwr o'r rhanbarth, gyda channoedd o bobl eraill yn cymryd rhan drwy'r cyfryngau cymdeithasol. Daeth 242 o bobl i'r 17 o gyfarfodydd cyhoeddus.   Hoffwn ddiolch i bawb a roddodd o'u hamser i ymateb i'r ymgynghoriad ac rwyf yn gwerthfawrogi eu sylwadau ar helpu i lywio'r gwasanaeth pwysig newydd hwn.   
  
Cafodd yr holl sylwadau a fynegwyd trwy'r llu o sianeli sydd ar agor i'r cyhoedd eu trin yn gyfartal ac fe'u hystyriwyd gan Fforwm Arweinyddiaeth Cydweithrediad Iechyd GIG Cymru, sy'n cynnwys cadeiryddion a phrif weithredwyr byrddau iechyd ac ymddiriedolaethau yng Nghymru.   
  
Cafodd ystod o safbwyntiau eu mynegi, eu dadansoddi a'u hystyried fel rhan o'r ymarfer ymgynghori. Ar ôl ystyried y ffordd y cafodd yr ymgynghoriad ei gynnal a'r dadansoddiad o'r ymatebion a ddaeth i law, roedd y Fforwm yn fodlon bod yr ymgynghoriad wedi'i gynnal yn briodol ac mewn ffordd sydd wedi bodloni gofynion canllawiau cymwys.   
  
Er y cafodd materion eu codi y bydd angen eu hystyried ymhellach, delio â hwy neu eu lliniaru fel rhan o roi'r rhwydwaith trawma mawr ar waith, casglodd y Fforwm nad oedd dim wedi cael ei godi a fyddai'n effeithio ar argymhellion y Panel Annibynnol. Argymhellodd felly i’r byrddau iechyd eu bod yn cymeradwyo sefydlu rhwydwaith trawma mawr i Dde a Gorllewin Cymru a De Powys, yn unol ag argymhellion y Panel Annibynnol.  
  
Cyfarfodydd byrddau ar 29 Mawrth 2018  
  
Cyfarfu pob un o'r chwe bwrdd iechyd ar 29 Mawrth i ystyried argymhellion Fforwm Arweinyddiaeth  Cydweithrediad Iechyd GIG Cymru. Cymeradwyodd pob un sefydlu rhwydwaith trawma mawr i'r rhanbarth a chytuno y dylai canolfan trawma mawr gael ei lleoli yn Ysbyty Athrofaol Cymru yng Nghaerdydd.  
   
Ni chaiff unrhyw rai o'r Adrannau Damweiniau ac Achosion Brys yn unrhyw rai o'r Ysbytai Cyffredinol Dosbarth ei hisraddio ar sail y penderfyniadau hyn a byddant yn dal i weld a thrin y mwyafrif helaeth o gleifion, fel ar hyn o bryd.   
  
Bydd gan Ysbyty Treforys ran o bwys yn y rhwydwaith trawma mawr. Cytunwyd y daw'r ysbyty'n uned drawma fawr ac y bydd yn arwain ar ran y rhwydwaith. Rwyf wedi dweud ar nifer o adegau nad oes unrhyw gynlluniau i adleoli'r uned llosgiadau a llawfeddygaeth blastig o Ysbyty Treforys a hoffwn achub y cyfle i gadarnhau eto fod hyn yn dal yn wir. Mae ein hymrwymiad i ddyfodol yr ysbyty'n glir, fel y dangosir gan y cyhoeddiad yn Ionawr 2018 y bydd y gwasanaeth llawdriniaeth thorasig yn Ne Cymru yn cael ei leoli yno. Mae hyn yn dangos y pwysigrwydd parhaus yr ydym yn ei roi ar yr ysbyty fel canolfan ragoriaeth.   
  
Y camau nesaf  
  
Mae’r byrddau iechyd bellach yn cydweithio i sefydlu rhaglen weithredu, a fydd yn parhau i gynnwys pob cyngor iechyd cymuned a phob rhanddeiliad. Mae gwaith yn mynd rhagddo i sefydlu Bwrdd y Rhwydwaith Trawma i Dde Cymru, ac fe ragwelir y bydd yn cyfarfod am y tro cyntaf ar ddiwedd y gwanwyn/dechrau'r haf. Bydd Bwrdd y Rhwydwaith yn goruchwylio sefydlu'r rhwydwaith i'r rhanbarth, gan sicrhau bod gwasanaethau safon uchel, diogel ac effeithiol yn cael eu darparu ar gyfer y boblogaeth.   
  
Bydd y Bwrdd yn gyfrifol am ddatblygu polisïau a phrotocolau i gefnogi'r gwaith o roi'r rhwydwaith ar waith yn  llwyddiannus. Bydd yn hwyluso cydweithio gan gynnwys meithrin cysylltiadau rhwng gwasanaethau cyn\-ysbyty, unedau trawma a'r ganolfan drawma. Mae gwaith yn mynd rhagddo i benodi Arweinydd Clinigol, a fydd yn darparu arweinyddiaeth a rheolaeth er mwyn creu, llywio a sefydlu gwasanaeth trawma effeithiol, sy'n canolbwyntio ar y claf yn Ne a Gorllewin Cymru a De Powys.  
  
Bydd costau refeniw a chyfalaf ychwanegol yn gysylltiedig â sefydlu'r rhwydwaith trawma mawr ar draws y rhanbarth, gan gynnwys achosion busnes y bydd eu hangen ar gyfer y seilwaith yn Ysbyty Athrofaol Cymru ac Ysbyty Treforys. Caiff y rhain eu hystyried yng nghyd\-destun y rhaglen weithredu raddedig, y cynlluniau i ddatblygu'r safle ehangach, rhyngddibyniaethau sy'n bodoli rhwng gwasanaethau trawma a gwasanaethau clinigol eraill a bydd Llywodraeth Cymru'n gorfod cymeradwyo achos busnes ffurfiol ar eu cyfer.