Home » Swansea Bay’s health care under pressure: What’s being done to ease burden?

Swansea Bay’s health care under pressure: What’s being done to ease burden?

Morriston Hospital, Swansea (Pic: Swansea Bay University Health Board)

THERE are days when even a large hospital like Morriston in Swansea can really struggle and it’s at times like this that alerts called business continuity incidents (BCIs) can result.

Swansea Bay University Health Board declared five business continuity incidents (BCIs) in 2024, mainly relating to pressures at Morriston.

BCIs often make the news. It’s a serious level of escalation and they can involve the public being encouraged not to attend accident and emergency departments unless they are seriously ill or badly injured.

The Local Democracy Reporting Service asked Swansea Bay University Health Board questions about BCIs, such as the factors that lay behind them, what steps were taken to avoid them, whether planned operations got postponed and medically fit patients stuck in wards got discharged faster than normal, what evidence there was that the public heeded them, and what back-up plans there were in a case of a major incident like a multi-casualty road collision.

The health board said declaring a BCI triggered additional support, for example the Welsh Ambulance Service would redirect some ambulances to hospitals which were under less pressure. Other health boards could offer to take some of its patients, as it said it would for them in such circumstances.

It said declaring a BCI was not done lightly and that before it happened a minimum number of nationally-agreed thresholds must be met, such as how seriously ill patients in ambulances outside the hospital were, and critical care and resuscitation availability. The health board said a wide range of actions were taken to manage severe pressures before a BCI was considered.

It added: “Although it is possible to postpone planned operations when in BCI this is always as a last resort, and in Swansea Bay we have separated unscheduled and elective care as much as possible to avoid this where we can.

“By this we mean that Neath Port Talbot and Singleton hospitals have been increasingly used for planned care so these procedures are sheltered from emergency pressures. However there may be times when we have to postpone some planned surgery or outpatients appointments. During a BCI we may also need to cancel staff annual leave or study days so they are available to help.”

While declaring a BCI might involve communicating with the public, the health board said the main element was the action it, the ambulance service and neighbouring health boards took. It added that it regularly reviewed major incident plans.

Speaking in the Senedd in April 2024, Plaid Cymru MS Sioned Williams raised concerns about the number of BCIs declared by Swansea Bay University Health Board – nine in the previous year, she said. Speaking afterwards, she said the frequency of BCIs and the pressure being faced by health board staff were, in her view, “unacceptable”.

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While its services remain extremely busy, the health board has not declared a formal BCI since October 2024. “But it is difficult to predict when we may need to call the next one,” it said.

What the health board is doing to manage demand

Things can be done away from the emergency department to alleviate pressures.

There can be 250 patients in hospital wards in Swansea Bay who no longer need acute hospital care but are not able to leave for reasons including no suitable onward package of care. This means fewer beds are available for incoming patients.

Key to this work, said the health board, was treating as many patients as possible at home, and enabling those who attended hospital to leave promptly after being cared for.

Within Morriston Hospital there are services to support this, such as:

  • Urgent primary care centre/same day emergency care. Here the aim is to see and treat patients rapidly and get them home without being admitted to a ward.
  • Acute medical unit. Also aimed at avoiding patients being admitted into a ward if they don’t need to be, but they may stay for a little while as they undergo tests/treatments. Some may then need a bed on a ward, but others will go home.
  • Surgical assessment unit – similar to the acute medical unit but with surgical rather than medical patients.

The community services which can also reduce hospital demand

Last summer the health board launched a new patient discharge hub consisting of the NHS and council and voluntary sectors.

The West Glamorgan Integrated Discharge Hub, as it’s called, is actually based at Morriston Hospital, and health bosses said it was having a big impact, saving an average of 460 bed days per week. This was because the length of time between a referral being accepted by the hub and the patient being discharged from hospital was now 3.3 days on average – a reduction of eight days.  It’s also expected to save around £6 million per year.

The aim of the hub is to get patients the correct community service for their needs. These include so-called virtual wards, the acute clinical team and a home first service.

There are eight virtual wards covering Swansea and Neath Port Talbot, equating to 240 beds in the community. These wards have medics and therapists assigned to them who help frail patients, for example, after a fall.

“If we didn’t have the virtual wards, many of these patients would be in hospital, when they could be at home,” the health board said.

The acute clinical team, meanwhile, provides urgent medical assessments, diagnosis and treatments for patients aged 18 and over in the community, including in care homes. Patients with acute infections, for instance, benefit from it.

The home first service provides care for people who need short-term support, including re-ablement care after an operation, and domiciliary care such as help washing and dressing.

What the public can do to help

The health board encouraged people to choose wisely when they needed unscheduled care. It said the 111 healthcare line, pharmacies, and the minor injury unit at Neath Port Talbot Hospital were often more appropriate.

It was also very helpful, it said, when families, carers and friends could support a patient being discharged from hospital.  “Offering temporary support over a weekend or a few days while a formal package of care is set up can make the word of difference,” said the health board.

Evidence showed that delayed stays in hospital beds could increase the risk of  patients picking up infections and rapidly losing strength and mobility.

“It has been estimated that for an elderly person, 10 days in bed will amount to their muscles ageing by 10 years,” said the health board.

“There are times when patients come into hospital fully mobile but then face having to learn to walk again if they are immobile for too long.”

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