Warning to Health Minister

Senior doctors have written to the Welsh health Minister, Eluned Morgan, warning that pressures on the Welsh Ambulance Service are putting patient safety at risk.

BMACymru Wales Committee Chairs and Local Medical Committee chairs signed the letter, reported in Wales Online https://www.walesonline.co.uk/news/health/doctors-tell-health-minister-patients-21664036

What does the letter say?

In the letter the doctors refer to serious delays in urgent transport of patients to hospital, leading to avoidable harm. In some cases, the Welsh Ambulance Service has refused to attend emergency requests from the public and clinicians. Some patients have had to arrange alternative urgent transport to hospital or receive treatment in inappropriate settings.

Why does this matter to Co-locate Velindre?

Velindre’s stand- alone Cancer centre in Whitchurch frequently calls on the Welsh Ambulance Service to transport very sick patients from Velindre to the University Hospital of Wales. Staff dial 999, just as you would if you had a medical emergency at home. Velindre patients aren’t ‘fast-tracked’ by the ambulance service, as they are deemed to be in a place of relative safety, ie a hospital.

Patient transfers from Velindre

Velindre has 47 in-patient beds. We know that in-patients in Velindre can rapidly become seriously unwell so they can’t be safely looked after on the remote site. Velindre claimed that this was very uncommon, in fact this happens around twice a week. (These figures were confirmed by the Nuffield trust in their advice on the model.)

Even before this latest development, transfers were taking up to six hours: not the ‘minutes’ claimed by Velindre. We can only wonder how long such transfers are taking now, and how these extremely sick patients are getting the care they need while they wait.

We know from the Nuffield Trust report that at night there is only one doctor resident in the hospital- a general practice or internal medicine trainee who may be in their first year of speciality training. Trainees told the Nuffield that they felt exposed to levels of risk that they were worried abut when on-call.

The choice of a stand- alone model for the new Velindre Cancer Centre inevitably leaves acutely unwell patients vulnerable to delays in getting the treatment they so urgently need. Nuffield Trust recognised this, and advised in December 2020 that Velindre ‘should not admit patients at risk of major escalation to inpatient beds at the Velindre Cancer Centre’. Ten months on, has this change been made?

Is this really the best we can offer patients?

Even if Velindre do revise their plans so that fewer patients are admitted to the remote site, the risk of sudden deterioration needing Intensive Care not available there will persist. It simply isn’t possible to predict with accuracy which patients will deteriorate.

Their plan of assuming ambulance transfer can be quickly and safely arranged wasn’t working before this recent crisis. It seems, and very senior doctors agree, that things are only getting worse.