The future of the Royal Glamorgan Hospital's A&E department is hanging in the balance after plans were unveiled last month to completely or partially close it.
Cwm Taf Morgannwg University Health Board has confirmed that it cannot continue to operate the emergency unit safely 24 hours a day due to a severe shortage of doctors.
Since the proposals were first unveiled, there has been fierce opposition from patients, staff and politicians who claim any downgrade would have a hugely detrimental impact on surrounding communities.
Here is our rundown of everything you need to know about the plans...
Why is this being proposed?
In 2014, a consultation known as the South Wales Programme was devised by five health boards.
It was designed to address major challenges faced by many hospitals in recruiting and retaining highly-skilled staff in certain speciality areas.
As part of the consultation, plans were put in place to reduce services at the Royal Glamorgan Hospital including the transfer of consultant-led maternity, inpatient paediatric services and emergency services to other hospitals in the region.
Consultant-led maternity has already been removed from the hospital and has been replaced by a freestanding midwifery-run unit which no longer deals with complex pregnancies or births.
Changes to children's hospital care at the hospital have also been repeatedly postponed.
In its place, the Royal Glamorgan was identified as a "beacon site" for diagnostic services. A new £6m diagnostic hub has already been created, along with a new 50-bed acute medicine unit.
Why are the plans being unveiled now?
Cwm Taf Morgannwg University Health Board claims there are "growing service and staffing pressures" on A&E at the Royal Glamorgan which means the situation is becoming increasingly unsustainable.
It is claimed emergency services have become so stretched that they can no longer be maintained in the without "unacceptable risks to patient safety".
The health board revealed that due to a significant doctor shortage, ambulances were told to divert their seriously ill and injured patients to neighbouring hospitals on Christmas Day and Boxing Day last year.
This is allegedly the first time such a drastic measure has ever been taken at the hospital.
How short-staffed is the A&E department?
It is understood that its one remaining permanent consultant will be retiring at the end of March, meaning the department will be run entirely by locums from April onwards.
According to national guidelines, there should be one consultant for around every 4,000 people in an emergency unit. The UK average is around one consultant for every 7,000 people, but in Cwm Taf there is one consultant https://www.walesonline.co.uk/news/health/royal-glamorgan-hospital-ae-closure-17679564for every 15,000.
If it were to meet national standards, the health should have around 40 consultants. However it currently has eight in the Princess of Wales Hospital, Bridgend, the equivalent of four-and-a-half consultants in Prince Charles Hospital, Merthyr, and one in the Royal Glamorgan Hospital who will soon leave.
Cwm Taf's medical director, Nick Lyons, has admitted that the uncertainty around the Royal Glamorgan site has made it more difficult to convince doctors to work there.
What options is the health board considering?
At a meeting on Thursday, January 30, the health board recommended that two proposals for the future of Royal Glamorgan's A&E department should be considered:
- To turn it into a minor injuries unit (MIU) staffed 24 hours a day;
- To operate A&E only during daytime hours (from 8am-8pm, for example) and provide a nurse-led MIU service overnight.
The health board stated that retaining the status quo was no longer an option.
What does the health board say about the proposals?
Cwm Taf Morgannwg University Health Board has stressed that this decision is not a financial one.
A spokeswoman said: "This is not about saving money, this is about making sure we provide people will safe services and the risk to patient safety is now becoming unacceptable.
"We simply do not have enough doctors to be able to staff our units – if we could recruit to these areas, we would.
"We already spend more money on the current model in the Royal Glamorgan Hospital than in any other unit as we have to pay premium rates for locum and agency doctors."
What impact will this decision have on surrounding communities?
At the health board's meeting in Ynysmeurig House, Abercynon, on Thursday, January 30, there were protests both inside and outside the building.
Some members of the public even claim lives could be lost if the changes go ahead.
Sally Evans, from Pontyclun, said: "I just think the Royal Glamorgan is needed for the whole of the Rhondda and the community.
"It was built only 20 years ago to serve that community which has grown even more, so closing the A&E is only going to put pressure on the other hospitals and lives are going to be lost.
"The health board at the moment are not giving the option to keep 24-hour consultant led A&E open in Royal Glamorgan - and it's crucial."
Labour, Plaid Cymru and Conservative politicians have jointly condemned the plans by the health board, and a number of public meetings have already been held.
Rhondda AM Leanne Wood described the result of these proposals as "grave" for people in her constituency.
She said: "The towns and villages at the top of the Rhondda Fach and Fawr can access Prince Charles Hospital relatively quickly via the Maerdy and Rhigos mountain roads. However, Rhondda residents who regularly use that route know that that's a dangerous assumption to make because in the winter those roads are often closed.
"As far as I and many thousands of others living in the Rhondda are concerned, we are best served by having a 24-hour, consultant-led accident and emergency department operating out of the Royal Glamorgan Hospital."
Labour's Alex Davies-Jones MP and Mick Antoniw AM have called on the Welsh Government to intervene to ensure A&E services are retained at the Royal Glamorgan.
Mr Antoniw said: "Since the South Wales Programme, we've had massive housing development and over the next 10 years there's going to be a further 20,000 homes in the Taff Ely area."
Mrs Davies-Jones added: "I think it's clear that the South Wales Programme, on which this is based, is no longer fit for purpose."
There are also fears that any downgrading of the Royal Glamorgan Hospital will lead to a surge of patients using neighbouring A&E departments at Prince Charles, Princess of Wales and the University Hospital of Wales which are already overstretched.
How do the three A&Es in Cwm Taf compare?
In December 2019, figures show the Royal Glamorgan was the busiest of the three emergency units in Cwm Taf with 5,152 attendances.
This compares to 4,947 in Prince Charles and 4,881 in Princes of Wales during that month.
It was also the best performing unit of the three when looking at getting patients admitted, transferred or discharged in under the Welsh Government's four-hour target.
In the Royal Glamorgan, 72.7% of patients spent four hours or less in the department, compared to 71.8% in Prince Charles and 62.2% in the Princess of Wales.
What has the Welsh Ambulance Service said about the proposals?
At this stage, the Welsh Ambulance Service would not be drawn on their opinions over the plans.
Sonia Thompson, the Welsh Ambulance Service's operations manager for the Cwm Taf Morgannwg University Health Board area, said: "The ambulance service and health board are part of the same system, which is why it’s important we're around the table at discussions about the future of Royal Glamorgan Hospital's emergency department.
"We were fully engaged in the South Wales Programme and are now represented on a number of programme boards and clinical reference groups set up to scope out the options, development and impact of any changes in provision of services in Llantrisant.
"The timely handover of patients at hospitals remains a priority and we'll work closely with our Cwm Taf colleagues to ensure this isn't compromised and that services are safe and sustainable."
Kate Chamerlain, chief executive of Healthcare Inspectorate Wales, explains the governance failings identified at Cwm Taf in November last year...
What has the First Minister said?
First Minister Mark Drakeford said it was for doctors, not politicians, to decide the future of the Royal Glamorgan Hospital's A&E department.
On Monday, February 3, the former Health Minister criticised politicians for not leaving the matter to clinicians.
"It needs to be a clinically-led, not a politically-led decision," said Mr Drakeford.
"I think that's how that debate ought to be grounded rather than by politicians thinking that they are in a better position than doctors."
What happens next?
Following their meeting on January 30, the health board will now enter into a period of consultation where it will gather evidence from a number of sources and decide on the most appropriate action.
A spokeswoman added: "We will be working closely with staff, the public and all key partners to ensure they are fully engaged in developing our future model of care and working through all implications to ensure quality is central and strengthening community-based services at every opportunity."
At a public meeting last week, Chris Bryant MP offered to give health board bosses "the Rhondda test" by driving them around the two Valleys to highlight the dire traffic problems in the area.
*A meeting is being held at Llantrisant Leisure Centre on Friday, February 7 from at 7pm where members of the public will be given the chance to quiz health board bosses about the plans.
The meeting will also be streamed live on Facebook.
