Letter to Welsh Government regarding Betsi Cadwaladr’s plans to centralise vascular services at Glan Clwyd.

Annwyl Vaughan Gething

Further to my oral question to you in the Assembly plenary meeting on Wednesday January 9th, we write to you with urgency regarding BCUHB’s recent announcement of their intention to downgrade the world-renowned Vascular Service at Ysbyty Gwynedd. We hope to impress upon you the need to undertake a comprehensive impact assessment of the effects of centralising services on those patients living in the most rural parts of Ynys Môn and Gwynedd, and indeed North Wales as a whole.

A commitment was given last year to safeguard the well-established in-patient and limb salvage service at Ysbyty Gwynedd – and to secure the capacity for emergency admissions – following considerable opposition from patients, staff and elected representatives to earlier plans to move services to Ysbyty Glan Clwyd. Now the health board has gone back on its word.

BCUHB’s position was explained to me in a letter from the Chief Executive dated 2nd January (a copy of which is attached for your reference). In response to that letter, may we draw the following points to your attention. (This is not an exhaustive list of concerns):

1. The public consultation on which the decision is based is now considerably dated – which raises serious questions, especially since the service has changed since that consultation.

2. Elsewhere in the UK, the Vascular Society’s guidance (ie. not mandated) is implemented in a way which is mindful of the differences in needs of rural and urban areas – these plans do not give such considerations.

3. We do not believe that there is an argument that standards need to be raised within the current service offered. Ysbyty Gwynedd and Wrexham Maelor – which would be downgraded – operate to very high clinical standards, and it is therefore questionable that standards would be higher at a site that does not currently operate any vascular services, but which also has experienced problems with services currently provided there.

4. We recall that in March 2018, the Board recommended emergency admissions would go to both YG and YGC with consultants at both sites, and in agreement with clinicians and executives, also stated that emergencies would also be carried out in Bangor which is contrary to what is stated in this most recent response. We ask what has changed since March 2018, and stress that building on a recognised site of clinical excellence is far more compelling that the current plans, especially as the Vascular Society or the RCS have specifically recommended that the service should be ‘centralised’ at YGC either.

5. At present, we understand that there are a considerable amount of emergency patients admitted to YG and YWM weekly, but that patient transfer numbers between sites are low because the present system of having two sites works well – and provides the best access for the overall population of North Wales. The proposed plans would also affect the patients’ families.

6. Decision-making appears to be rushed, and ever-changing plans give the impression of further uncertainty which is demoralising for staff and worrying for patients.

7. We understand that the Vascular department at YG can remain attractive to new consultants due to its reputation and believe strongly that the Health Board should strive for such excellence, particularly in rural provision given inherent problems with recruitment, and that it is therefore sensible to build on existing foundations in this field of medicine in North Wales. Furthermore, it has been drawn to our attention that there have been three rounds of advertising posts which also raises concerns about the quality of appointments. This is at best very worrying given that the standard of any future provision at YGC is currently unknown compared to YG’s highly regarded reputation.

8. We are also concerned about the overall impact of this change on the status of Ysbyty Gwynedd, especially in the context of the introduction of a medicine course at Bangor University.

We strongly believe that no decision should be taken until there has been an urgent and transparent review that fully considers the effects of downgrading the service will have on patients living in the farthest corners of Ynys Môn and Gwynedd, who would face added challenges in accessing emergency care provision. Furthermore, we have serious concerns that this persistent agenda of shifting vital services eastwards only puts patients living not only in our constituencies, but throughout North Wales, at further risk – especially when dealing with medical emergencies.

This service change will have a real impact on emergency admissions, and we look forward to your early response in anticipation that you will now accept that this decision must be looked at again for the reasons outlined above.

Yn gywir,

Rhun ap Iorwerth
Sian Gwenllian
Hywel Williams
Liz Saville Roberts