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

I call on Eluned Morgan to ask the second urgent question.

Will the Minister make a statement on the options put forward by Hywel Dda Health Board to temporarily reduce paediatric services at Withybush Hospital? EAQ(5)0077(HWS)

Thank you for the question. At its public board meeting on 24 November, Hywel Dda university health board will consider options for temporary changes to the opening hours of the paediatric ambulatory care unit at Withybush hospital. This is an operational matter for the health board.

Cabinet Secretary, you’ll be acutely aware of the concerns of residents in Pembrokeshire with regard to the changes in the way health services are delivered there. Hywel Dda health board will discuss a series of options this Thursday that seek to reduce the opening of the paediatric ambulatory care unit at Withybush hospital due to recruitment difficulties. Amongst the set of options is the full closure of the paediatric unit, which would be totally unacceptable to me and the people I represent.

Cabinet Secretary, I would like to ask you to ask the health board, as I have, how a single mother who lives in Fishguard with three children, one of them sick, with no transport and on a low income is going to get to and from Glangwili in Camarthen after 6 o’clock at night. Those who arrive by ambulance can expect to pay about £100 in a taxi to get home or face a four-hour journey via public transport. Please could you press the health board on this issue of transport to and from the hospital during this temporary period of closure? Will you ask the health board to ensure that accident and emergency at Withybush continues to assess all patients, regardless of age? Will the Welsh Government commit to support the recruitment of urgently needed posts to the paediatric unit in Haverfordwest? Finally, could you ask the health board to give a categorical assurance that this situation is only temporary?

I thank the Member for the follow-up points. On your first one, which you made earlier, as well, about the possibility of full closure, that’s not the planned option. I’ve seen that the recommended option is, indeed, a temporary reduction in hours, before returning to a 12-hour ambulatory care unit, supported by consultant cover in addition on rota from Glangwili. I’m clear that that’s their preferred option, and I’ll check myself with the health board that that is the option they’re pursuing—a temporary reduction with a plan to return to the previous service.

Indeed, I’m happy to reassure you about the point that I expect every hospital with an A&E to undertake proper assessment of every patient that comes through the door and understand where is the most appropriate point for the next part of care to take place. It may be that they can be seen, treated and discharged at that point, it may be that they need further care in that setting or in a different one, and I expect that to continue to be the case.

I think that the first point, though, is that this is because of recruitment challenges. This is the very real and unavoidable truth—that if you can’t recruit the staff, you can’t run a safe service. So, I’m pleased that they’ve made some recruitment. They’ve got further interviews, and it’s really important that that’s successful. Actually, we all have a job of work to do to support the health board in making it an attractive place to come and work in, with a model of care in which consultants want to work, middle-grade doctors want to work, and where trainees want to be part of the work environment as well, supported by a nurse group of staff who have more skills to do more than nurses could do in the past. Advanced paediatric nurse practitioners will be part of the future of care in this part of Wales and the rest of Wales. And I’m happy to indicate that I expect the health board to properly cover transport issues as well. I understand it’s a very real concern, not just in west Wales, but in other parts of the country, too, that access, physical access to services, has to be there as well. So, I’m pleased to see that you’ve taken this up directly with the health board and I’ll happily contact them afterwards to make sure your questions do get an answer.

Cabinet Secretary, a few weeks ago, you made it clear in this very Chamber that, and I quote,

‘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.’

Well, it looks like that’s not the case in the short term, should these changes go ahead. Once again, the people of Pembrokeshire will see more and more services removed from their local hospital. Cabinet Secretary, you will not be surprised that I believe families in Pembrokeshire deserve a full-time paediatrics unit at their local hospital. Now, you made it clear two weeks ago that it would not be sensible to try to reinstate a 24-hour paediatric ambulatory care service, but surely, Cabinet Secretary, you cannot seriously support any changes that will result in a service that’s only open during office hours. Therefore, can you give us reassurances today that these changes, if they go ahead, will be on a temporary basis only?

Now, as we know, it’s a previous Welsh Government that has approved the reduction of a full-time paediatric service at Withybush hospital in the first place. So, do you agree with me that reducing services at a hospital could affect the sustainability of those remaining services? Therefore, can you provide cast-iron guarantees that there will be no impact on the sustainability of other services, and do you also agree with me that urgent intervention is now needed to protect those other services? And finally, Llywydd, Cabinet Secretary, you’ve made it clear that any decisions taken regarding Withybush hospital have been based on expert advice. As you know, the Royal College of Emergency Medicine, who are also experts, have endorsed an NHS England report that states, and I quote,

‘Hospitals providing emergency care to children must have comprehensive paediatric facilities, 24/7 paediatric cover and paediatric nursing and anaesthetic support.’

In light of those comments, will you now change your Government’s policy and aspire to restore full-time paediatric services at Withybush hospital?

I’m happy to reassure you that local families do not need to change access to care. You’ll have heard me answer Eluned Morgan’s question, and in particular the point about transport and access to care, and, indeed, if there is a need for a child to be transported to a different point to receive their care, then the health board, together with the Welsh ambulance service trust, should make those arrangements available—and have that potential planned in, rather than waiting for a situation to occur that hasn’t been anticipated.

I am happy to reiterate the point that Eluned Morgan made again: that this is a planned temporary change in response to an inability to recruit in the short term, with further recruitment being planned. I don’t accept or recognise your point that urgent intervention is needed to protect other services. To try to expand this out and to spread more mistrust and fear about the future of those services I think is highly irresponsible. When it comes to acting on expert advice, you will of course know that, in many other parts of the United Kingdom, paediatric support is provided by expert nursing staff who are appropriately qualified and provide support for accident and emergency departments to continue; that is not an unusual service model.

Indeed, we come back to the nub of the Royal College of Paediatrics and Child Health’s recommendations about what is an appropriate service and what is the best possible service to provide in this part of Wales. And indeed, those recommendations in that review indicate the previous model is not safe, not sustainable and not the right thing to do for patients. I reiterate: I am being guided by expert advice in this field, by people who understand the need to run these services safely and effectively, by people who have run these services safely and effectively in a variety of different settings across the United Kingdom, including in significantly rural healthcare places, and I will not go back to a system where that expert advice says it would be a worse service delivering worse outcomes for people in Pembrokeshire; I believe they deserve much better than that.

Would the Cabinet Secretary please say which part of the review that he just called in aid says that a reduction to an office hours, closing-at-six-o’clock service would be acceptable, because I don’t recall that in the review at all? Please tell us if that is the case. What assessment have you made of your decision—your Government’s decision—to approve the closure of the 24-hour paediatric service on the now inability of Hywel Dda to recruit to a 12-hour—and declining—paediatric service? Surely, there’s a link, because the best consultants want to work in the 24-hour service, where they will have support, and will see that as part of the support. When this was last raised, I asked you, Cabinet Secretary, whether you would have confidence, as a parent, in the services provided at Withybush under the old regime. With the new proposed closures, I certainly can’t stand and support these, and I ask you to take action.

I thank the Member for the points that he’s made. Now, I go back to the fact that we’re talking about options for a temporary change to the service, and that’s the point. To try and talk about these as if this is a done deal for the long-term future of the service is simply not the case. That is simply not what the health board are proposing to do. And it really is important that Members of any and every political party behave in a responsible manner about really important choices for families in the Pembrokeshire area. And so, that is a temporary change.

The long-term ambition is to have a 12-hour, seven-days-a-week service, properly staffed and supported, both in the community and by consultants, in the way that the rota works—again, following the expert advice provided by the Royal College of Paediatrics and Child Health. Actually, if you read the board papers, and if you read the previous review, then they indicated that, actually, not changing the service model would make it more difficult to recruit, would mean that the service is more fragile and would deliver worse outcomes. And, indeed, not taking these changes means that, actually, the training ability is going to be compromised as well. Part of the complaints trainees at present have is that there isn’t enough work for them to undertake their training appropriately and properly.

So, there really is a point here about high-quality training, but also a service that genuinely delivers the best outcomes, and based on the best evidence and advice. And I will support every health board in Wales in delivering healthcare on that basis, to deliver the right outcomes for people in every single part of the country.

Cabinet Secretary, I don’t—or I would hope that there isn’t anybody in this room who would accept the health board’s decision to take the appropriate action in this case. Because in this case, as things are now existing on the ground, it seems that, sadly, patient safety, which has to be the No. 1 priority, could be put at risk. And that is simply as a consequence of the recruitment problems that several people have mentioned here this afternoon.

So, my question is this: I want to know whether there has been a conversation—I’ve certainly written to Hywel Dda, and spoken to them—about recruiting that paediatric consultant to the paediatric ambulatory care unit. But I think there’s also a wider picture that needs addressing here, and you’ve slightly alluded to it, and that is the care that happens within the community, because an awful lot of the children who are accessing care in Withybush hospital are children who need long-term care. And, very often, it’s about crisis management of their long-term condition that sees them arrive at Withybush hospital in an untimely and unscheduled fashion. I remember, when we were both at the paediatric unit in Withybush, that there was talk about moving forward into delivering that care, very often in the homes of those children, so they don’t need to travel at all. So, I think we need to widen the debate. I think that people are hugely concerned, and mostly it’s the parents of the children who I’ve just described. So, if you have anything further to add to that, I would be most grateful.

Thank you for the points made. And, again, I recognise and recall the same conversation about improving the community service in paediatrics, to make sure that children’s care is properly anticipated and managed. It’s much better for the families and much better for the child to make sure that, wherever that care is being undertaken, it’s undertaken in as planned a manner as possible. And that has to be the direction of travel, not just in Pembrokeshire, but right across the country, in other rural settings, but also in urban and Valleys settings as well. It’s actually the right thing to do for the child in that whole context.

I’m happy to go back to the point about recruitment. This is a planned temporary change, in response to a failure to recruit, and there are interviews being stated for early January to try and fill the particular vacancies. And I think you’re right to remind us all that the worst thing for the health board to do is not to act in the face of a staffing shortage. That would mean running short—it would mean running a service where I do not think individual professionals could or should be assured, or even the health board could be assured, that they’re providing a safe and high-quality service that people in Pembrokeshire really do deserve. So, there is a need to act. I’m pleased the health board are acting, both in terms of their options and their choice about what to do with the service now, but also in the longer-term future, both in the community and in the hospital setting as well.

The Cabinet Secretary will recognise that there is universal concern across the party divide in this Assembly over this regrettable situation. And this arises because it coincides with the retirement of a Pembrokeshire paediatric consultant and the maternity leave of another. The retirement of one paediatric consultant surely is reasonably foreseeable, and there should have been some provision for this situation arising. There are many people in Pembrokeshire who think this is part of a long-term plan to close these services, because, three years ago, the service was downgraded from 24 hours to 12—now it’s been downgraded to eight. This is, apparently, a temporary change, but who knows. The Cabinet Secretary has given us tentative assurances, but on the other hand has said it’s not actually his decision or responsibility—it’s that of the local health board. This is a board that is in targeted intervention. Why doesn’t the health Secretary target his intervention on this very pressing need, which is going to affect, particularly people in north Pembrokeshire and west Pembrokeshire, because Glangwili is a very long way to go, especially late at night?

I thank the Member for the points that he’s made, which largely restate points made by other Members in terms of the questions. I’m happy to indicate again that the health board indicate it’s their option to have a temporary change in the service to reflect the fact that they’re not able to provide all of the consultant cover for the model of care to be provided safely for children and their families. It is important to me, as I expect that it is to everyone else in this Chamber, that the service is provided in a manner that is properly safe, and we do not take risks with children and their families in the manner in which care is provided. I expect the health board to follow through on their commitment to return to a 12-hour service. I expect the health board to follow through on their commitments to make all reasonable efforts to recruit people into this service, and to manage and to try and plan properly for anticipated staff absences and retirements. We know this is a particularly pressed area right across the United Kingdom, but it is a challenge that this health board and others will need to manage.

I thank the Cabinet Secretary.