[R] signifies the Member has declared an interest. [W] signifies that the question was tabled in Welsh.

Rydw i’n galw nawr ar Paul Davies i ofyn yr ail gwestiwn brys.

Will the Minister make a statement on the future of paediatric services at Withybush Hospital? EAQ(5)0058(HWS)

Thank you. The Hywel Dda university health board is committed to maintaining the paediatric ambulatory care unit at Withybush hospital. Services are available from 10 a.m. to 10 p.m. seven days a week, and local families are being assured that they can continue to access services as they do now and do not need to make changes in how they access care.

Cabinet Secretary, of course, these latest developments at Withybush hospital of a consultant paediatrician retiring and a consultant paediatrician going on maternity leave are a huge concern to my constituents, who have already seen paediatric services downgraded from a 24-hour service to a 12-hour service, which, quite frankly, has been a disaster for us in Pembrokeshire. But I am pleased that the local health board has restated its commitment in the press release they’ve issued earlier today to maintain the current opening hours, because if this 12-hour service does not continue then that will be catastrophic. There were Members in this Chamber, including me, who warned the previous Welsh Government, when the original changes were made, that the downgrading of paediatric services at the hospital could have a detrimental effect on the sustainability of remaining services. And it now appears that that is the case. So, in the circumstances, what reassurances can the Cabinet Secretary give my constituents today that the Welsh Government will do everything it can to support the local health board to maintain these vital services? And given that downgrading paediatric services has had an effect on these part-time services, because it’s probably even more challenging to recruit clinicians to a place where services have been reduced, will he now commit to reviewing paediatric services at Withybush hospital, with a view of establishing a 24-hour service? And, in the short term, what specific support is the Welsh Government giving to the Hywel Dda university health board in order to overcome some of the recruitment challenges facing the hospital?

Thank you for the follow-up points. I don’t wish to continue to have a row and a series of angry exchanges about the future of paediatric services in west Wales, but it’s hard not to when the Member refuses to acknowledge the factual evidence available and the very best clinical advice about the service model being provided. We have rehearsed time and time again the review by the Royal College of Paediatrics and Child Health, which confirms that the new service model has improved outcomes for women and their babies, and simply denying that that is the case is producing a climate of fear and uncertainty, is wholly unnecessary and does a real discredit to people providing that service and families who need that service.

There is an issue with regard to the recruitment of paediatric consultants right across the UK, and it’s no surprise that we see that here in Wales as well. I’m pleased that there has been some acknowledgement about the press release that the health board have issued, which confirms that they are committed to recruiting to the model that they have. I can confirm that I expect interviews will take place in December and January for new consultant posts, and the challenge here is how you build upon a service model that does make sense as part of a wider whole. And that’s what we’re committed to doing. We’ll support the health board in doing what it needs to, to try and recruit not just consultants, but other grades of staff there as well, to make sure that the whole service model actually delivers on what people need. That’s why I’m delighted to see, for example, that there are more nurses within the service now than before the changes were made as well. In fact, far from saying that the service changes have made things more difficult, I think this particular issue reinforces the need for service change that is designed to deliver a better service—the best evidence, the best available clinical advice and the best outcome and the best service for people that we should be in business to serve and honestly represent.

I thank you, Cabinet Secretary, for what you’ve already said. You did join with me, through the summer recess, to view for yourself, alongside me, and speak to, all those involved in delivering this care in paediatric services, both in Glangwili and also in Withybush. And what we’ve seen, and what we’ve heard, really supports what you’ve just said—that we have a very, very good workforce there, who are delivering a really good service. Nonetheless, you are right to say, and it is the case, that there are challenges recruiting consultants and other staff within Wales and beyond Wales. And what we heard, and the plans that are afoot, seemed to be helping them to rise to that challenge and to meet the needs of the patients—and particularly, here, the paediatric patients—in the very best way. I was also pleased to see that the ambulatory service has been extended now until March 2017, and that was key to that provision in the very first place, when we moved that down to the existing 12-hour service.

But my question, I suppose, to you today is: we do know that there’s going to be turnover of staff—we were informed that then, it’s not new news, and it’s not particularly urgent news. But what I want to know, Cabinet Secretary, is what support you would give to the health board, in helping them, in any way that they might request, to recruit the staff that they need, in west Wales, so that the service that they intend to keep doesn’t have to rely continually on a temporary locum.

Thank you, Joyce Watson. You make an important point about a service that isn’t entirely reliant on temporary or locum-based staff, and, indeed, going back to the conversations that we’ve had on several occasions within this Chamber, about the broader picture on recruitment in areas of challenge specialities, but also about maximising the opportunities to work in Wales. So, when we talk about a recruitment campaign for doctors that recently had a very successful launch at the BMJ careers fair, that’s a part of what we need to do, to make sure that people understand the opportunities that exist in working in west Wales, what it is to live there with your whole family, and what it means to actually join part of the healthcare picture here in Wales.

We want to be positive about the opportunities that do exist, and actually, for doctors who want to move to somewhere, understanding there is a real evidence base to the system we have in Wales, and understanding how clinical best practice will guide the models of care we need to deliver—including what we deliver within the community as well, as well as in a hospital-based setting. So, we will continue to work in a supportive way with the health board to meet the recruitment challenges they have.

But there are real grounds for optimism here, not just because of the recent careers fair. When you look at the nursing end of this, as I said, we’ve recruited, so we’re actually ahead of the British Association of Perinatal Medicine recommendations about nursing numbers, with the new model now. So, we’re in a good position to sell a service that people want to work in. And there’s a recognition that, at the time of initial change, there was real uncertainty and concern from some members of staff about what would happen. But we have more nurses and midwives working in these centres now, better standards of care, and better outcomes—a really good experience. And it does show that people should have confidence about the future, and the commitment that the health board has expressed for the future of the service.

In asking the Cabinet Secretary for further information today, I can say to him that the paediatric service in Withybush, which is valued enormously by the local people, goes beyond maternity and is, in fact, part of the accident and emergency service that is provided there. The Royal College of Emergency Medicine say that you need a 24-hour paediatric service in order to maintain an A&E service. And, in the past, his predecessor has told me that the long-term aim is to restore paediatrics to a 24-hour service in Withybush. Now, he seems content with a 10 in the morning until 10 at night service, which, in fact, is an office-hours service, with a 30-minute on-call for consultants up to 10 o’clock at night. And the statement from Hywel Dda today, which confirms that that will continue, also says that further merging of on-call rotas will take place between Withybush and Glangwili.

What, therefore, can the Cabinet Secretary say to local residents who actually want to see paediatrics return to 24 hours? Can they give up on that previous commitment by Hywel Dda itself, and a previous Government? And, if he thinks that it’s delivering so well at present—and, of course, the staff and those who are working there are doing the very best they can—but is he really content to see a service delivered on this basis, in perpetuity, on the basis of locum recruitment?

Well, you make a fair point about the paediatric service being about more than very young children, and not just about the maternity end—the newborn end. And, in fact, when I visited with Joyce Watson recently, I saw a number of families and younger children who were there. In fact, the ambulatory care service makes sure that the overwhelming majority of people are turned around and don’t need to stay in the hospital—they’re turned around at the time, being provided with the support and treatment that they need.

The future, though, is one that has to be based on the reality of the staff mix that we have, and what we can achieve. It’s important that the health board continues to have a conversation with its local population about the services they can provide, the evidence base for providing them, and what it is actually able to do, as well. It’s really important that we don’t try to oversell the ability to say, ‘We want something, therefore we’ll have it’, regardless of the evidence about the quality of care that can be provided and regardless of the ability to recruit into that model of providing care. So, it is for the health board to set that out in conversation with its local population and in conversation with its local group of clinicians, in all those different grades and professions, who understand what is possible where there is a real commitment to be able to make that happen in reality. The easiest thing to do is to demand a level of service agreement that is simply not achievable, and I don’t want to see that happen. It’s an important step to stabilise what exists there. The health board then need to set up, with their local population, what will happen in the future.

I thank the Cabinet Secretary.