We move on now to item 7, a debate on petition P-06-1277, 'Save A&E. Withybush General Hospital must retain 24 hour, 7 days a week, Consultant Led urgent care'. I call on the Chair of the committee to move the motion. Jack Sargeant.

Motion NDM8040 Jack Sargeant

To propose that the Senedd:

Notes the petition, P-06-1277, 'Save A&E. Withybush General Hospital must retain 24 hour, 7 days a week, Consultant Led urgent care', which received 11,168 signatures.

Motion moved.

Diolch yn fawr, Deputy Presiding Officer. I’m grateful to the Business Committee in the Senedd for allowing us to debate the petition this afternoon.

The petition P-06-1277, ‘Save A&E. Withybush General Hospital must retain 24 hour, 7 days a week, Consultant Led urgent care’ was created by Jacqueline Doig and received 10,678 signatures. The petition itself states, and I quote, Deputy Presiding Officer:

'Moving care out of county puts adults & children at risk of poor outcomes or even death. It wastes crucial time, when time is not on our side.

'We have 125,000 residents & millions of tourists. By implementing the downgrades, HDUHB, will be knowingly putting their lives at risk. We re-iterate, we are a rural, widespread county, with poor roads and public transport network. Refinery, gas plant, ferry ports, firing range, extreme sports, plus one of the most dangerous professions: farming.'

'HDUHB may infer that the “Golden Hour” is no longer relevant, with better equipped ambulances & higher trained staff, but that is dependent on an ambulance being available to help & give that immediate care. That is increasingly not the case, as ambulances fail to attend, as they are being sent out of county, unable to offload and unable to return to county, to give the help needed.'

The petition goes on, Deputy Presiding Officer, to explain more events and situations that the petitioner and others have experienced.

But one of the innovations that the Petitions Committee has introduced this past year into our petitions process in the Senedd has been heat maps, and I know that may sound dull to plenty, but, actually, it's a really important point that I want to make this afternoon, Deputy Presiding Officer, because the maps actually show very clearly where petitions have been signed across Wales and the United Kingdom. This particular petition has one of the most clear-cut maps we’ve ever seen as a committee, with over 85 per cent of the signatures coming from the two Pembrokeshire constituencies. Clearly, this is an issue that provokes strong—extremely strong—local passion, and I’m sure that Members representing the constituencies this afternoon will explore those issues in greater detail.

But, I should say that that local passion for our health services in general isn’t restricted to Pembrokeshire: it exists everywhere, in every corner of Wales. And all of us in this Chamber are extremely passionate about the areas we represent, and we are equally passionate about our health services and the services they provide us. We all represent areas where our constituents are passionate about their services and the services that they receive, and the way that they are provided.

So, I'm very much looking forward to today's debate. I had the pleasure of welcoming today's debate to the Chamber, and I do look forward to hearing more about the concerns of people, in particular in Pembrokeshire, where this petition was so heavily signed, and the wider Hywel Dda health board area. But, I also look forward to hearing from Members across the Chamber of related issues and concerns in other parts of Wales. And, of course, we all look forward to the Minister’s response.

Deputy Presiding Officer, while this petition is about a hospital in Haverfordwest and the services that are provided there, the issue is one that resonates across the nation. So, I’m pleased to be able to open today's debate. I'm pleased to give the 10,678 people who signed this petition, in particular, a chance to raise their voice in their Parliament, the home of Welsh democracy, and I'm grateful that their concerns will be heard by the Welsh Government, and I very much look forward to hearing the rest of the debate. Diolch yn fawr.

I'm pleased to take part in this debate and speak in support of the petition to ensure that Withybush hospital retains its A&E department. This petition is not the first to call on the Welsh Government to protect services at Withybush hospital, and ensure that they are not moved further afield. And yet, despite Welsh Government Ministers and the local health board saying that Withybush plays an important role in the delivery of health services in west Wales, the reality is that we've seen more and more services relocated elsewhere over the years, and the proposal now to move A&E is indeed the final straw.

Now, as Members will be aware, Pembrokeshire is home to an oil refinery, two liquefied natural gas terminals, ferry ports, firing ranges and a large number of workers in higher risk industries, like energy and farming, as the Chair of the Petitions Committee has just said. Pembrokeshire also welcomes thousands of visitors to the county every year, something, incidentally, the consultation documents to build a new hospital do not take into consideration when talking of moving A&E services eastwards.

Surely, the arrival of thousands and thousands of visitors to Pembrokeshire must also be a factor when deciding to downgrade A&E facilities. Removing A&E facilities from Withybush hospital would undoubtedly deter people from visiting the area if emergency facilities were not available at the local hospital. Quite clearly, we need these essential services at Withybush hospital in order to support local people, who should continue to have access to first-class emergency services, and to support the tens of thousands of visitors who visit us on a regular basis.

Members will know that outcomes improve significantly if people receive the right care and the right treatment within the first golden hour of falling ill or being injured. And in a recent letter issued by the local health board, it acknowledges that for some of the communities I represent, travel times to access emergency care at a new hospital site will now be longer. Therefore, if Withybush hospital's A&E department is transferred further afield, then it's highly unlikely that some of my constituents will receive the right care and treatment within the first golden hour of falling ill or being injured.

In Pembrokeshire, we accept that we already have to travel further afield for specialist treatment, but forcing us to travel further afield for life-saving treatment and emergency services is totally unacceptable, and could put lives at risk. By the health board's own admission, Pembrokeshire desperately needs upgrades to its transport infrastructure, and that means that people living in areas like St David's or Fishguard, for example, will take much more than an hour to reach A&E facilities if they do not remain at Withybush hospital. 

From time to time, we see the A40 closed due to accidents, and getting further eastwards within the golden hour from places like Fishguard, St David's and Dale, under those circumstances, would be impossible. As I've rehearsed in this Chamber on several occasions recently, the ambulance service in Pembrokeshire is already so stretched that it's been struggling to cope, and so, if A&E services are moved further afield, that will have a huge impact on response rates and the ability to get people to A&E as quickly as possible.

As some of you will be aware, Hywel Dda University Health Board has now identified five potential sites as locations to build this new hospital and those sites are now under consultation. Nevertheless, I cannot be any clearer—none of these sites are acceptable. And I'll tell you why: in the consultation document, it is made quite clear that Withybush hospital was not identified as a site because, quite rightly, it would not be appropriate for Carmarthenshire residents to travel this distance for this type of care. Surely, therefore, it's not appropriate for the people I represent in Pembrokeshire to travel further eastwards for this type of care either. I therefore implore the Minister and the Welsh Government to intervene in this matter and make sure that A&E services stay at Withybush hospital—no ifs, no buts.

In fact, what the people I represent want to see is the Welsh Government and the local health board develop and modernise Withybush hospital’s infrastructure and ensure that it can continue to provide first-class health services in Pembrokeshire. The constant erosion of services at Withybush hospital has to stop. The paediatric ambulatory care unit must be returned, the A&E department must be safeguarded, and the Welsh Government must stop waving through proposals that take vital services away from the people who need it.

Dirprwy Lywydd, the protection of services at Withybush hospital is the No. 1 priority of the people I represent, and so I urge the Minister to intervene now and develop a new approach for the delivery of health services in Pembrokeshire—an approach based on listening to the people of Pembrokeshire and providing them with a guarantee that services will be safeguarded and invested in for the future.

I’m very grateful for this opportunity to respond to this petition. Much of what I had intended to say has already been said. But certainly, during last year's election campaign, concern about the future of Withybush hospital, specifically the future of the accident and emergency department, was something that was frequently raised on the doorstep when I was canvassing in Pembrokeshire. Unfortunately, in several parts of the county, the uncertainty, the recent reorganisation, as we've already heard, and the loss of services, such as the paediatric service a few years ago, have led to a loss of faith and confidence in general in Hywel Dda health board and in the Welsh Government.

In the meantime, residents, including the vulnerable and older people, are concerned about the possibility of losing the accident and emergency provision, which has literally been a life-saving service for many of them, and for their families and neighbours. Since I was elected to this place, this strength of feeling towards safeguarding the future of Withybush hospital has become even more pronounced. Earlier this year, I was very pleased to attend a rally on the hospital site to support the retention of emergency services at Withybush hospital. In the meantime, the concerns about the hospital’s future have increased.

Plaid Cymru has long argued that people should have the right to essential services, which clearly includes A&E departments, within a reasonable distance of their homes in all parts of Wales. The potential for healthcare reform in the area by building, potentially, a new hospital is creating more uncertainty in Pembrokeshire. Whilst I recognise the opportunities that opening a brand new hospital would bring to west Wales in terms of recruiting specialist staff, providing improved clinical facilities and research opportunities, there is no doubt that, despite the health board's efforts, very real and pressing concerns remain that this could see vulnerable residents living on the far peripheries of west Pembrokeshire being put at risk should emergency health services be called for.

This strength of feeling is evident, as we've heard from Jack Sargeant already. The loss of A&E provision from Withybush to some of the proposed hospital sites that were announced last week could see distances for residents living in St David's more than double, from 16 to 36 miles. A similar doubling of journey lengths would also be seen for areas such as Milford Haven, Fishguard and Angle. I know that many residents are extremely concerned about the impact of this increase in journey times to A&E, particularly when considering the significant influx in the population in Pembrokeshire, as we have heard again already, during the height of the tourist season, as well as the concentration of industrial activity found on the Milford Haven waterway.

It's also important to note, Dirprwy Lywydd, that the concerns about the impact of the loss of accident and emergency provision aren't just anecdotal. Evidence exists that supports wider concerns, not to mention the importance of the golden hour response, as the public in general are aware of. A previous study by the University of Sheffield, which investigated 10,500 emergency cases, found that an increase of 10 km in a straight line distance travelled from an A&E department is linked to an absolute increase of approximately 1 per cent in mortality, particularly for those with respiratory conditions. With some proposals seeing areas such as Milford Haven and Pembroke Dock facing an increase of over 30 km to the nearest A&E, it's understandable why so many people are concerned about the future of local healthcare provision.

I acknowledge the challenges that the Hywel Dda health board faces all too often, especially bearing in mind the chronic lack of capital investment that there has been in the health board in west Wales, as compared to other health boards in Wales. However, as the discussions regarding the new potential hospital continue, it's vital that the health board and the Welsh Government pay careful attention to the genuine concerns expressed by the residents of Pembrokeshire, and that they take decisive action to ensure that access to emergency services, and residents' right to access these services, isn't undermined by any proposed reforms to the area's health system.

Can I thank the Petitions Committee as well for bringing this forward? I do echo your points, if I may, Chair, around that fact that any hospital closure, any transition, any change or new location does produce anxiety and challenges. I present a balance here. I’ll be honest and say that I haven’t heard loud calls, in terms of people who have contacted me, in favour of us keeping Withybush, but it has been a balance. Many people have said that they want Withybush to stay, but there are also others who have accepted the need for change. They understand the challenge of the geography of the area, the sparsity of services, the profile of the residents, and the seasonal churn, as we’ve heard, in population, which does require a change in approach. I do echo many of the comments that have been made to date.

People are really concerned about the distance that residents, particularly in the west of Pembrokeshire, would have to undertake, and those new services and the transition to those services. As an absolute minimum, residents need certainty and a commitment that the emergency care centre at Withybush will not be downgraded until any planned new hospital is fully functional and has been tried and tested with a period of clear review and engagement with patients and their families, and that the new integrated health and well-being centres are also fully functioning. As we’ve heard, ambulance response times have repeatedly made headlines for all the wrong reasons, so it’s very understandable that people are raising concerns around the distance for patients to any new hospital site and A&E.

In conclusion to my very brief contribution to this debate, I would be interested to hear from the Minister about any reassurances that she can give about any new model being proposed by Hywel Dda, and the potential locations as well, ensuring that patients will be able to get the right care at the right time, particularly those patients who need that emergency care. Thank you. Diolch yn fawr iawn.

I'm pleased that we have another opportunity to raise the issue of keeping a 24-hour, seven-day-a-week accident and emergency department at Withybush hospital in Haverfordwest. I'm grateful to the Chair and the Petitions Committee for bringing this forward.

May I begin my contribution by paying tribute to the efforts of local Pembrokeshire people, who have co-ordinated and organised this latest petition, which has brought this subject yet again to the floor of the Senedd? Under several guises, the local campaign has been running for a number of years and has managed to co-ordinate support to maintain services at Withybush. We've seen petitions signed, rallies taking place outside of this Chamber, and marches through Pembrokeshire towns, all of which I've attended and all to draw attention to the threats to local health services. I'm pleased to see several campaigners in the public gallery this afternoon. I also want to pay tribute to the staff, who, despite the decade-long threat of downgrading and removal of services, continue to fulfil their roles with consummate professionalism. And it would be remiss of me not to thank Paul Davies, my constituency neighbour and good friend, for everything he has done on this matter. The Member is a true champion for this hospital.

I have to say that in my near 14 months as a Member of this place, not a week goes by without me being contacted by a constituent regarding their concerns over the removal of A&E from their local hospital. Whilst Withybush is not housed in my constituency, many of my constituents are patients there and rightly hold it in very high esteem. But despite all the platitudes and campaigns, we are still in the position that we have been in for the last decade, with the future of A&E services at Withybush and Glangwili under threat. Withybush, let's not forget, has lost a number of services over the years, thanks to decisions taken by this Labour Government. But, for the sake of clarity, it is worth me reiterating again that today's debate is focused solely on the retention of A&E at Withybush. I urge the Minister, in her response, not to fall into the trap of talking about wider plans for reorganisation, as that does nothing to diminish the anxiety of local people specifically relating to A&E provision.

I'm not going to repeat all of the arguments as to the importance of vital services in west Wales, especially to the local people who rely on a good-quality, fully operational A&E service at both Withybush and Glangwili, but we must also consider the influx of visitors who see the population of west Wales swell over the summer months, enjoying all the excellent attractions and beautiful countryside and coastline that the county has to offer. Some Pembrokeshire communities are already at least 45 minutes away from Withybush, and with potential sites for a new hospital finally being announced, there is no prospect of these services getting closer. But let me take you back to the tactics that those who want to see the removal of A&E are using.

Organisations will often send me a briefing paper before debates. Imagine my surprise when Hywel Dda's arrived in my inbox earlier this week. I had to read it a few times to ensure that the information that they were giving was relevant to this debate, as it ignored the petition title and skirted over the issue of A&E closures in a way that, no wonder, causes local people to be concerned and anxious over the future of their A&E department. Instead, the brief focused on the wider health board reorganisation, selling the dream of a new superhospital for west Wales—the same dream that they've been selling for the last decade and that will not be, in their words, 'realised' until the end of this decade at the earliest.

Minister, I absolutely appreciate that the way healthcare provision is provided needs to change, but we are always going to need an A&E department. There will always be patients needing emergency care close to home, from heart attacks and strokes through to broken legs and head injuries. To move that service further away from communities is foolhardy to say the least, and callous at worst. If promises are upheld and the hospital remains on the Withybush site once the new hospital is built, then why can't it house an A&E department? Why can't the new hospital and the retention of A&E services at Withybush coexist? The five preferred sites of the new hospital exist along a 12-mile stretch of the A40, a road that is often a single carriageway, suffering from heavy traffic and many accidents, and I've not even touched on the pressures our ambulance services are currently under.

Minister, I could go on, but for too long and too often, west Wales is forgotten in the policies of your Government. Local people deserve better and they feel their voices are not being heard. I run a poll on my website and social media giving local people a voice, a way to air their views on where they would like to see a new hospital located. Whilst not hugely scientific, less so than the heat map that the Chair of the Petitions Committee mentioned earlier, it is overwhelming: 82 per cent have voted to maintain A&E services on the current site.

The Member must conclude now, please.

Minister, these aren’t just my constituents or Paul’s constituents, these are your constituents too. They do not back the proposals to remove A&E services. Please offer some certainty to the constituents of mine, Paul, Joyce, Jayne, Cefin, and yours, that lives will not be put at risk should A&E services move further away from where they're currently situated, because nothing I’ve heard up until now from the Government or the health board gives me any confidence that a change of policy or direction is forthcoming. Diolch.

I call on the Minister for Health and Social Services, Eluned Morgan.

Diolch yn fawr, Dirprwy Lywydd. The people of Wales deserve health services that deliver the best possible outcomes for patients. We will be guided by the best and most up-to-date clinical evidence to deliver that high-quality care. Today’s debate is a subject that we’ve discussed on numerous occasions and I therefore make no apologies to Members that they will hear again why services must change. We need improvements if we are to provide health services that the people of Wales deserve. That was the conclusion of the Parliamentary review of health and social care. The review clearly advocated the need for a revolution in our health and care system to meet future demands, and I’d like to remind the Conservatives about the previous debate, the one before this, where they were asking for radical transformation: the parties in this Senedd signed up to those recommendations, and let me tell you that west Wales has not been forgotten. If plans to develop a new hospital were to proceed, this would represent the largest public sector investment ever to happen in west Wales, delivering a brand-new, cleaner, greener facility, and massive opportunities for local people, and I know on which side of that debate I would want to be. Hywel Dda University Health Board is responsible for the provision of safe, sustainable, high-quality healthcare for its local population, including acute and emergency services. It’s been consulting on a range of proposals as part of its 20-year health strategy. The Welsh Government is currently scrutinising their programme business case and no decisions have yet been made.

The health board continues to make it absolutely clear that duplication of services across its sites leads to fragility. Multiple sites cannot sustain the necessary expertise nor the scale needed to provide optimum 24/7 care. And as someone who is based in St David's with a 90-year-old mother, I know that I would rather travel an extra few miles to see an expert quicker than spending hours on end in A&E, as is currently the case. The health board’s programme for transformation has been designed by clinicians specifically to ensure proposals are safe for patients. The health board reached this current proposal after what was regarded as an exemplar engagement process with many communities over many months. Now, the proposal to build a new hospital that will have state-of-the-art emergency-care facilities is intended to improve standards of care. The proposal means that it will be possible to have timely access to decision makers at a senior level who can assess patients, and it’ll also lead to an improvement in terms of training opportunities for our professional staff, and attracting staff, when we’ve got an ageing workforce, is going to be difficult. And let’s just be honest about how difficult it is at the moment to attract people.

In accordance with our expectations, and the policy for all health boards, Hywel Dda University Health Board is developing their six-point plan for emergency care, and this includes the whole accident and emergency care, from primary care to health services, and social care in the community, which is at the heart of our communities. The priority of the health board is to maintain safe services. The health board continues to work through the details of its plans. It's engaging with stakeholders, patients, carers, citizens and partners to help to shape these proposals, and I encourage anyone who has an interest to continue to participate in that process. 

Of course, I understand the concerns that people have on a local level in Pembrokeshire about Withybush hospital, so I want to be entirely clear that the hospital will continue to play an important role in the future of healthcare services in that area. We can't keep everything as it is and also secure the change required. It is misleading to suggest that that is a possibility.

Every day, I am told where the greatest pressures on the NHS in Wales are, and Hywel Dda appears on that list regularly. Every day, despite the heroic efforts of staff, people are waiting longer than they would wish to because it's difficult to recruit to Withybush hospital. For the large number of people in west Wales who are awaiting surgery, the ability to separate emergency cases from planned care would be a positive step forward. And once again, may I remind the Conservatives that they ask us to do more of this continually? You're constantly asking us to do this, and this would allow us to do it. It means that there isn't so much disruption on planned surgery. 

So, those people who are waiting for hip operations in places like Pembrokeshire need to understand that having A&E and planned care in the same place, you're constantly being thrown out. And we've got an expert amongst us, who's an orthopaedic surgeon, who knows that that is the situation. You keep on asking us to separate things; this is an opportunity to do that—

Minister, you need to conclude now, please.

for us to really tackle those waiting lists. Let me just be clear, there has been no decision on the hospital yet. I'm sitting next to the finance Minister here, and she'd have to find a hell of a lot of money. This is not straightforward at all. And, of course, as somebody who represents the area, I would not be allowed to make a decision, but let me tell you, as the person responsible for health in Wales, I cannot be in a situation where we are not organising and planning for what the future will look like, and we have to plan something that is sustainable. Let me make it absolutely clear that A&E will remain in Withybush until a new hospital is built. We've got a long, long way to go and lots of hoops to jump through before we get to that point, and, of course, there will consistently be a doctor-led minor injury unit that would continue under the plans proposed by the health board.

I call on Jack Sargeant to reply to the debate.

Diolch yn fawr, Deputy Presiding Officer. On behalf of the Petitions Committee, can I thank all the Members who have spoken in this debate this afternoon, and all the Members that actually represent constituents there and who use the services at Withybush, including the Minister, as she rightly said? This has enabled today an important issue to be raised. We've heard already that this is not the first time it's been raised in the Chamber; I'm sure it probably won't be the last time it's raised in the Chamber.

I think Paul Davies mentioned in his contribution that this is the No. 1 priority for his constituents. That resonates, doesn't it, with the 85 per cent shown signatories on the heat maps? And in his powerful contribution, Sam Kurtz raised that Paul Davies is a true champion of the hospital, and Sam's own powerful contribution, and his 82 per cent from social media polling, shows this is clearly a topic of interest for those in Pembrokeshire. Cefin Campbell also referenced the importance of this on the doorstep and how many times the services and the need for safeguarding of the services came up with him. He noted the efforts and challenges of the health board of Hywel Dda, but also that the uncertainty remained, and called for clarity on that. My colleague Jane Dodds provided balance to the debate this afternoon, understanding again that there needs to be a change in approach, but did note the concerns raised by other Members, and you've had some of them yourself. And I think you called for a commitment not to downgrade services, if I'm right in saying, until a new fully functioning location and hospital was in place, and then after a review of that particular hospital. And the Minister, in response, made it very clear, I think, that the A&E services will remain in place until a new hospital is in place, and we are some way away from that. And if that was to go ahead, it would be the largest public sector investment in Wales, one that would be designed by clinicians based on clinical evidence.

But as I said, Deputy Presiding Officer, in closing today, I do want to thank the petitioner in particular, who, over the last decade, has been putting this on our agenda, and it was another opportunity again, and I'm sure, again, that it won't be the last. I thank all of those who supported the process. But can I end, Deputy Presiding Officer, if you'll allow me, by just taking a little bit of time here to say thanks to all those staff and those who support Withybush hospital, and all those staff in the NHS across Wales, because we do need to thank them—they do go above and beyond for us, our families and our constituents every single day, and I think we need to remind ourselves of that and praise them at every opportunity? Diolch yn fawr.

The proposal is to note the petition. Does any Member object? No objection, therefore the motion is agreed in accordance with Standing Order 12.36.

Motion agreed in accordance with Standing Order 12.36.