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In April 2013, Hywel Dda University Health Board’s proposals to reconfigure maternity and neonatal services in West Wales were referred to Welsh Ministers by the community health council for formal determination. In January 2014, I made that determination in accordance with established procedures.


Following the advice from an independent expert panel, I confirmed that neonatal services would be concentrated at Glangwili Hospital, in Carmarthen, where a new local neonatal unit would be created; consultant\-led maternity services would also be concentrated at Glangwili Hospital and a new midwife\-led unit would be set up at Withybush Hospital, in Haverfordwest. I required that a set of robust safety net measures were put in place at Withybush Hospital while the midwife\-led unit was being fully established.


These measures included a dedicated ambulance vehicle and crew for emergency transfers to Glangwili Hospital for pregnant women and newborn babies and on\-call consultant cover for obstetric and gynaecology emergencies out of hours. Hywel Dda University Health Board was required to undertake an independent evaluation of the changes after they had been in operation for 12 months.


The new model of care was introduced in August 2014\. Hywel Dda University Health Board subsequently made changes to paediatric services in October 2014 – inpatient children’s services were concentrated at Glangwili Hospital and a new 12\-hour paediatric assessment unit was opened at Withybush Hospital. The paediatric changes were not referred for Ministerial determination.


The Royal College of Paediatrics and Child Health (RCPCH) was commissioned to undertake the evaluation of the changes in June 2015\. A review team, made up of representatives from the RCPCH, the Royal College of Obstetricians and Gynaecologists, the Royal College of Anaesthetists, the Royal College of Midwives and the Royal College of Nursing, evaluated the services, including extensive engagement with staff, the public and people who have used the services over the last 18 months.  

A summary of the RCPCH’s report was today discussed at the Hywel Dda University Health Board’s meeting. It is available at http://www.wales.nhs.uk/sitesplus/862/opendoc/274532


The review concluded there is no evidence of any harm to any patients as a result of the changes and that they are sustainable in the long term. It found the new services are safe, are providing improved outcomes, better compliance with professional standards and more women are being cared for in the Hywel Dda area than under the old arrangements.  


The main conclusions of the report are:


 


* There would be no clinical sense in reversing the major decisions of reconfiguration made last year;
* There is a need to progress the second phase of improvements to estate at Glangwili Hospital without delay. This will improve the physical condition of the labour ward which the report said is currently “too small with insufficient facilities and provides a poor environment for women and staff”;
* The dedicated ambulance vehicle team has provided an excellent service and must remain in place for a further 12 months when it should be reviewed again. It has averaged two trips a day compared to the planned nine. The ambulance crew has spent their downtime supporting other teams in the hospital, including the emergency department and children’s unit, providing staff training in emergency procedures and where appropriate, covering for some non\-emergency transport;
* The on\-call obstetric and gynaecology consultant cover at Withybush Hospital should be phased out as it has not been needed and is hampering the development of other services at the hospital. These resources can then be better deployed to increase services;
* The fears of the public about service safety were largely unfounded but anxiety generated by their experiences and those of others was real and damaged their confidence in services;
* The health board needs to prioritise an active and evidence\-based dialogue with patients, advisory groups and clinical staff to mitigate the “misunderstandings and anxieties” that have arisen in the past.


 


Additionally, the review team has commented:


 


* There has been a gradual increase in the use of the midwife\-led unit at Withybush Hospital, consistent with implementation of units elsewhere in the UK, and women using the facilities are almost universally positive about their experience;
* There is capacity to increase the activity at the midwife\-led unit, enabling more women to give birth locally in Pembrokeshire but their confidence, and the morale of the staff, is being partially damaged by public negative messages about the service based on anecdote and speculation rather than evidence;
* Despite this, survey data collected from 500 women after they gave birth at all three sites during the past year – since the changes were made – have shown overwhelmingly\-positive responses;
* Medical management should consider consolidating on\-call obstetric cover at the Glangwili site with increased daytime activity at Withybush Hospital.


 


     

I welcome the review, which provides further reassurance to people in Pembrokeshire and Carmarthenshire that these services are safe and have led to improved outcomes for mothers and babies. A more detailed report by the RCPCH will be discussed by the health board at its next meeting in November.


Where the review team has made recommendations in relation to elements of the safety net, which I required to be put in place in my determination of January 2014, I accept them. In relation to those recommendations which require improvements to the estate at Glangwili Hospital, the health board will be submitting a capital business case early in the next financial year.


 


 


 







Translation:


 
Ym mis Ebrill 2013, cafodd cynigion Bwrdd Iechyd Prifysgol Hywel Dda i ad\-drefnu gwasanaethau mamolaeth a gwasanaethau newyddenedigol yn y Gorllewin eu cyfeirio at Weinidogion Cymru gan y Cyngor Iechyd Cymuned, i wneud penderfyniad ffurfiol. Ym mis Ionawr 2014, gwnaethpwyd y penderfyniad hwnnw gennyf yn unol â gweithdrefnau sefydledig.

Yn dilyn cyngor gan banel o arbenigwyr annibynnol, cadarnheais y byddai gwasanaethau newyddenedigol yn cael eu canoli yn Ysbyty Glangwili yng Nghaerfyrddin, lle byddai uned newyddenedigol leol newydd yn cael ei chreu; byddai gwasanaethau mamolaeth dan arweiniad ymgynghorwyr hefyd yn cael eu canoli yn Ysbyty Glangwili a byddai uned newydd dan arweiniad bydwragedd yn cael ei sefydlu yn Ysbyty Llwynhelyg, Hwlffordd. Roedd yn ofynnol gennyf bod cyfres o fesurau cadarn yn cael eu rhoi ar waith fel rhwyd ddiogelwch yn Ysbyty Llwynhelyg, tra bod yr uned dan arweiniad bydwragedd yn cael ei sefydlu'n llawn.

Roedd y mesurau hyn yn cynnwys cerbyd a chriw ambiwlans penodedig ar gyfer trosglwyddo menywod beichiog a babanod newydd\-anedig ar frys i Ysbyty Glangwili, ac ymgynghorydd ar alwad ar gyfer achosion obstetreg a gynecoleg brys y tu allan i oriau. Roedd yn ofynnol i Fwrdd Iechyd Prifysgol Hywel Dda gynnal gwerthusiad annibynnol o'r newidiadau ar ôl iddynt fod ar waith am 12 mis.

Cafodd y model gofal newydd ei gyflwyno ym mis Awst 2014\. Gwnaeth Bwrdd Iechyd Prifysgol Hywel Dda newidiadau dilynol i wasanaethau pediatrig ym mis Hydref 2014 \- cafodd gwasanaethau mewnol i blant eu canoli yn Ysbyty Glangwili ac agorwyd uned asesu pediatrig 12 awr newydd yn Ysbyty Llwynhelyg. Ni chafodd y newidiadau pediatrig eu cyfeirio at Weinidogion i wneud penderfyniad yn eu cylch.

Comisiynwyd y Coleg Brenhinol Pediatreg ac Iechyd Plant (RCPCH) i gynnal gwerthusiad o'r newidiadau ym mis Mehefin 2015\. Bu tîm adolygu, yn cynnwys cynrychiolwyr o'r RCPCH, Coleg Brenhinol yr Obstetryddion a'r Gynaecolegwyr, Coleg Brenhinol yr Anesthetyddion, Coleg Brenhinol y Bydwragedd a’r Coleg Nyrsio Brenhinol, yn gwerthuso'r gwasanaethau, drwy ymgysylltu'n helaeth â staff, y cyhoedd a phobl sydd wedi bod yn defnyddio'r gwasanaethau dros y 18 mis diwethaf.  
Trafodwyd crynodeb o adroddiad yr RCPCH yng nghyfarfod Bwrdd Iechyd Prifysgol Hywel Dda heddiw. Mae ar gael yn: http://www.wales.nhs.uk/sitesplus/862/opendoc/274532

Daeth yr adolygiad i'r casgliad nad oes tystiolaeth bod unrhyw niwed wedi'i achosi i unrhyw gleifion o ganlyniad i'r newidiadau, a'u bod yn gynaliadwy yn y tymor hir. Dywedodd bod y gwasanaethau newydd yn ddiogel, eu bod yn darparu canlyniadau gwell, eu bod yn cydymffurfio'n well â safonau proffesiynol a bod mwy o fenywod yn cael gofal yn ardal Hywel Dda o gymharu â'r hen drefn.  

Dyma brif ganfyddiadau'r adroddiad:

* Ni fyddai'n gwneud synnwyr clinigol o gwbl i wrthdroi'r penderfyniadau mawr am ad\-drefnu a wnaed y llynedd.
* Mae angen symud ymlaen ag ail gam y gwelliannau i ystad Ysbyty Glangwili heb oedi. Bydd hyn yn gwella cyflwr ffisegol y ward geni sy’n rhy fach ar hyn o bryd, heb gyfleusterau digonol ac sy’n darparu amgylchedd gwael i fenywod a staff, yn ôl yr adroddiad;
* Mae'r tîm ambiwlans penodedig wedi darparu gwasanaeth gwych a rhaid iddo barhau yn ei le am 12 mis arall, pryd y dylid ei adolygu eto. Ar gyfartaledd, mae wedi gwneud dwy daith y diwrnod o gymharu â'r naw y cynlluniwyd ar eu cyfer. Mae criw yr ambiwlans wedi treulio eu hamser segur yn helpu timau eraill yn yr ysbyty, gan gynnwys yr adran frys ac uned y plant, darparu hyfforddiant i staff ar weithdrefnau brys a lle y bo'n briodol, helpu i gludo cleifion mewn achosion nad ydynt yn rhai brys;
* Dylai gwasanaeth yr ymgynghorydd obstetreg a gynecoleg sydd ar alwad yn Ysbyty Llwynhelyg gael ei leihau’n raddol gan nad oes galw wedi bod amdano a'i fod yn rhwystro datblygiad gwasanaethau eraill yn yr ysbyty. Gall yr adnoddau hyn gael eu defnyddio'n well i gynyddu gwasanaethau;
* Roedd ofnau'r cyhoedd ynghylch diogelwch y gwasanaeth yn ddi\-sail ar y cyfan, ond roedd pryderon go iawn wedi deillio o'u profiadau a phrofiadau pobl eraill, ac effeithiodd hyn ar eu hyder yn y gwasanaethau;
* Mae angen i'r bwrdd iechyd roi blaenoriaeth i gynnal sgwrs weithredol, sy'n seiliedig ar dystiolaeth gyda chleifion, grwpiau cynghori a staff clinigol i leihau'r "camddealltwriaeth a'r pryderon" sydd wedi codi yn y gorffennol.

Yn ogystal â hynny, mae'r tîm adolygu wedi dweud:

* Mae cynnydd graddol wedi bod yn y defnydd sy’n cael ei wneud o'r uned dan arweiniad bydwragedd yn Ysbyty Llwynhelyg, sy'n gyson ag unedau mewn rhannau eraill o'r DU, ac mae'r menywod sy'n defnyddio'r cyfleusterau bron i gyd yn dweud eu bod wedi cael profiadau cadarnhaol;
* Mae lle i gynyddu'r gwaith yn yr uned dan arweiniad bydwragedd, gan alluogi mwy o fenywod i roi genedigaeth yn lleol yn Sir Benfro, ond mae eu hyder, a morâl y staff, yn cael eu niweidio yn rhannol gan negeseuon negyddol am y gwasanaeth ymhlith y cyhoedd yn seiliedig ar straeon a siarad, yn hytrach na thystiolaeth;
* Er gwaetha hyn, mae data a gasglwyd gan 500 o fenywod ar ôl iddynt roi genedigaeth ym mhob un o'r tri safle dros y flwyddyn ddiwethaf ers i’r newidiadau gael eu gwneud, wedi ymateb yn gadarnhaol ar y cyfan;
* Dylai rheolwyr meddygol ystyried cyfuno gwasanaeth meddygon obstetreg sydd ar alw yn Ysbyty Glangwili gyda mwy o waith yn ystod y dydd yn Ysbyty Llwynhelyg.

       
Rwy'n croesawu'r adolygiad, sy'n rhoi sicrwydd pellach i bobl Sir Benfro a Sir Gaerfyrddin bod y gwasanaethau hyn yn ddiogel a'u bod wedi arwain at well canlyniadau i famau a babanod. Bydd y bwrdd iechyd yn trafod adroddiad manylach gan yr RCPCH yn y cyfarfod nesaf ym mis Tachwedd.

Rwy’n derbyn pob un o’r argymhellion gan y tîm adolygu mewn perthynas ag elfennau o'r rhwyd ddiogelwch y gofynnais iddynt gael eu rhoi ar waith ym mis Ionawr 2014\. Mewn perthynas â'r argymhellion hynny sy'n gofyn am welliannau i ystad Ysbyty Glangwili, bydd y bwrdd iechyd yn cyflwyno achos busnes cyfalaf ddechrau'r flwyddyn ariannol nesaf.