I’m pleased to able to make a contribution as a member of the Petitions Committee and Plaid Cymru’s spokesperson on health. I’m going to talk about the principles of downgrading and losing emergency services.

This petition, of course, which we’re discussing today, is a reflection, once again, of the concern that arises regularly when we talk of reorganising hospital services, and particularly the recommendations that have been causing concerns in this part of Wales for many years. Concerns are often ignored by politicians who say, 'Well, we have to go through a process of change. We have accept this.' And perhaps we will hear rhetorical references today to the parliamentary review of healthcare in Wales in the future, but before you go and search yourselves, I can tell you that there is no reference in that report to anything that is akin to the reorganisation being recommended here for the Hywel Dda area. Believe you me, it is important that we do listen to the petitioners and the protesters, because I think that people do have a right to crucial services within a reasonable distance of their homes, and an emergency department in a hospital, surely, is essential. 

I’ve called in the past for the development for frameworks within the health service noting which services should be provided at what level, that is, some services within your community or close to your community—your GP, for example, pharmacists, and so on. We should note that there are some specialist services that we have to travel for, and I would include in that—I’ve been convinced of this—the emergency trauma services, specialist trauma services. And I will note here that it reflects very poorly on historical decisions taken that patients in north Wales have to travel to Stoke for some of these trauma services, rather than investment having being made in developing those services to serve north Wales in Wales. But you can’t develop those services easily now.

But, looking at emergency services generally, I looked at a recent report published in Health Services and Delivery Research, which was a study comparing outputs between areas that have seen A&E services centralised and other areas. And that study doesn’t demonstrate any benefit of centralisation. Some good news for you: in centralising, there was no great increase in the number of deaths, but that was because mitigating steps had been taken. And, yes, there was an increase in the risk of death following centralisation, but, generally speaking, things weren’t much worse as a result of centralisation, if you can take some comfort from that. But, there was evidence of pressure on the ambulance service as a result of the centralisation of services, and it’s worth noting too that the areas looked at as part of that study were less rural than this particular part of west Wales.

I also think that it could be useful to look at the findings of the Sheffield University study, which looked in 2007 at 10,500 emergency cases and found that 10 km further in distance from an A&E department corresponded to a 1 per cent increase in mortality. And the figure was worse, then, for people with respiratory conditions. So, distance from A&E does have an impact on outputs and outcomes.

So, there are risk factors inherent in these proposed change, and people, therefore, have a right to be concerned. And, of course, we don’t have the details that we need at the moment to make a full evaluation of what is being proposed. There is no recommendation on out-of-hours care; no significant increase in social care; no plans to invest in the ambulance service, and so on and so forth. Rather, what we have is the bait of a new hospital, and I can tell you that everyone that I’ve spoken to is very suspicious as to whether that can be delivered: £350 million in investment—all of the capital expenditure in a single year in Wales. What we need to do, of course, is to improve those elements of the service that will make a real difference to people: we need to strengthen primary care; we need to invest more in medical training; we need to tackle recruitment problems, and so on, and retain staff in that way.

To conclude, removing crucial services from large areas of Wales is not going to improve our health service, I’m afraid, and I’m very grateful to the petitioners for ensuring one of the highest numbers of signatures on a petition to be considered by our committee, because you represent not only the people of the Hywel Dda area, but people the length and breadth of Wales who treasure their local health service.