ONE year after they were introduced, a report has looked at the impact of changes to maternity, neonatal and paediatric services in Pembrokeshire and Carmarthenshire, and the effect on patients and their families.

In compiling the report for the Royal College of Paediatrics and Child Health ahead of its review of the changes, patient watchdog Hywel Dda Community Health Council (CHC) talked to staff and patients about their experiences over the last 12 months.

Overall, the report found that public fear around the safety of the new arrangements ‘had not been realised’, but there remained a ‘sense of loss’ among Pembrokeshire communities.

“While patients report stress, inconvenience or ‘near misses,’ to date there is limited evidence of harm,” reads the report.

While this did not equate to a ‘perfect picture’ of patient care, there was ‘clear evidence’ that the service had matured, and that arrangements were working better now than in the first few months.

But, it added, there was a ‘continued lack of public confidence in the centralised model’ and the health board had a responsibility to improve communications with patients and the public about services, and how well they are being delivered.

While staff were praised overall, many patients felt extra pressures – particularly during the initial ‘bedding-in period’ – meant staff were unable to be as attentive and supportive as they could have been.

Emphasising the ‘desperate need’ to continue with the planned second phase of development at Glangwili, the report said many of patients’ negative stories had ‘some root in the pressured and makeshift units, which will be improved by more-modern and spacious clinical areas’.

While most wards appeared to have stabilised after the original changes, staff on the Special Care Baby Unit (SCBU) seemed ‘less settled’, and nurses confirmed that covering shifts remained problematic, creating problems in releasing staff for important training.

The CHC was left with the clear view that the second phase was ‘crucial for babies, parents and staff,’ and also recommends that ‘outdated’ facilities on the Dinefwr ward be included in the development.

The report also called on the health board to ‘tackle wider NHS pressures’ so that it is in a better position to respond to busy periods.

It said that the introduction of a dedicated ambulance had played a key role in the ‘safety net arrangements’ required by the health minister, but that arrangements after March 2016 were unclear, and immediate action was needed to ensure the ongoing availability of emergency transport.

Transport in general was raised, and in two interviews it appeared distance to travel may also have influenced clinical decision making, raising the question of whether clinicians felt under pressure to reduce inconvenience for patients.

Ensuring ‘clinical outcomes were matched by positive patient experience’ was fundamental if parents were to feel their services were safe, and in minimising inconvenience and anxiety, added the report. Small changes to arrangements for partners and family who do not live locally could also substantially improve the support available for mothers and children.