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askthe EXPERT; Betsi Cadwaladr University Health Board executive medical director Matt Makin.

WITH massive changes being made to the health service in North Wales, Professor Matthew Makin, the executive medical director of Betsi Cadwaladr University Health Board, answered Daily Post readers' questions in a webchat yesterday.

Here's what happened: Q Can you confirm that as stated in the Health Board meeting minutes in February 2015 you have now secured a written guarantee from The Welsh Ambulance Service Trust (WAST) for a dedicated 24 hour, seven days a week standby ambulance to be available for emergency maternity patients or are you still as expected "in negotiation"? A The Welsh Ambulance Service Trust (WAST) are part of our Implementation Group, we also have as part of this group a dedicated team looking at transport.

As part of the "safety gateway" process we are still working with WAST to confirm and assure us that the arrangements we put in place are as safe as possible.

We are looking at one to two patients per week having to go west or east from the midwifery led unit at Ysbyty Glan Clwyd, most of those will be planned moves because of failures to progress. We would only anticipate one or two patients every couple of months need to be moved as an emergency.

Q Following the budget cut of 8% imposed by the Assembly, and a clear move to transfer critical service eastwards, away from North West Wales, is there not now going to be a geographical line between life and death for patients in Gwynedd and Anglesey compared to those in North East Wales. Do you agree that this is a major failure of the Betsi Cadwaladr Trust and the Welsh Assembly? A There is no strategic plan to move services away from North West Wales, we have responsibility for the whole population's health in North Wales.

There are some services that we have moved to North West Wales like gynaecological cancer services. We will continue to have strong strategic links with centres in the North West like Clatterbridge, Christie and the Walton Centre though.

We work closely with the Welsh Government on the strategic planning of clinical services.

Q Many people are worried that the Trust will renege on its promise of a sub-regional special care baby unit. They could reassure people by announcing when they will advertise for the next batch of neonatologists. When will this be? A We are absolutely 100%, unequivocally committed to the subregional neonatal intensive care unit coming to Glan Clwyd. We are working closely with Welsh Government on the business case for the Sub Regional Neonatal Intensive Care Centre (SURNIC) and anticipate the SURNIC opening 2017.

We will be recruiting the necessary neonatologists leading up to this and will of course be explicit on the location at Ysbyty Glan Clwyd. This will be a very attractive proposition for specialist nursing and medical staff.

Q What about the breast cancer unit move? A As far as breast cancer services, it is necessary to do the temporary change for the surgical procedure (the unit is not moving). This will free up the surgical beds and theatre space to manage the temporary gynae surgery change which is going east and west as part of stabilising the obstetric services over next 12 months. Most of the breast service will stay local.

Q Will patients at Glan Clwyd who need emergency caesarean section be transferred to Bangor or Wrexham or can this still be performed at Ysbyty Glan Clwyd? A Yes they will have to be transferred and the choice of Wrexham or Bangor will depend on a variety of factors.

This is based on the evidence from the care delivered at other freestanding midwifery led units (eg in South Wales). We need to ensure there is a stable and experienced consultant led team to receive the patient.

Q What was the outcome of your meeting with AMs to work out alternative proposals? A We had a really useful meeting and the consultants at Ysbyty Glan Clwyd had some ideas about medical staffing.

We had considered these issues previously and welcome the opportunity to re-look at them. They have not developed a formal proposal yet but we are supporting them in doing this.

Q At the board meeting last Tuesday, questions were raised by members of the public concerning the moving of maternity care to Maelor and Bangor and the knock on effect of moving breast cancer surgery to Glan Clywd. How I can find the answers to these questions which were promised within 48 hours? Also at this meeting concern was raised about funding for services currently undertaken in England and that the amount spent needed to be reduced but by continuing strong links with the North West, these costs are just going to increase.

A We have got a frequently asked questions document on our website that is constantly updated with questions from members of the public and our responses to them, this addresses the majority of the questions. There are still one or two outstanding where we need more data.

We have natural clinical links and collaborations across Wales but also with the North West we have a duty to ensure the very specialist services we commission from centres like Alder Hey, Stoke, Walton and the Christie for example provide quality services to the patients of North Wales and we continually monitor our contracts and commissioning relationships.

We have to be honest and accept we can't do everything within the geographical boundaries of North Wales.

Q You said it was an attractive proposition for specialist nurses but you are breaking up existing well established teams. What are you doing to stop the loss of current specialist midwifery and neonatal nursing staff during the interim period? A We are holding a series of one to one meetings with nursing staff and midwifery staff to identify their individual personal and professional needs, there are weekly meetings to raise issues.

This is an opportunity for midwives to lead the development of a freestanding midwifery led unit, in promoting normality in birth. It's an opportunity for neonatal staff to be involved in the development of their new SURNIC unit.

Q Do you acknowledge that these changes will expose mums to the possibility of being traumatised by their labour, thus putting them at risk of developing the very serious illness of birth trauma or birth related Post-traumatic Stress Disorder, which can turn into postnatal depression. Do you acknowledge that birth trauma wrecks lives? That women who experience trauma during childbirth can suffer from flashbacks, nightmares, depression, anxiety, fears, phobias, difficulty eating, sleeping, concentrating, bonding with their baby and maybe even intrusive thoughts or potentially become a suicide risk? Do you acknowledge that making women transfer many miles during a life threatening emergency situation by ambulance is adding to the risks to her mental health and is compromising her bond with her baby? A We have to consider the balance of risks if we do not address the crucial issues of medical staffing (and the Royal College of Obstetricians and Gynaecologists have been clear we will not have sufficient medical staff to run X3 rotas into this year) we may expose the risk of not having appropriate access to suitably quali-fied medical staff on site and thereby expose mothers to other risks that maybe traumatic.

As I said earlier we would expect one to two transfers per week from the midwifery led unit with one or two emergency transfers every couple of months.

Every woman will be able to go through their Birthplace Choices with their community midwife to make their individual decision.

Can I challenge the premise though there is more chance of post traumatic stress in making this decision. We have made the decision to improve safety looking forward and hence in implementing this as safely as possible we could in fact reduce the incidence of trauma Q I'm due to be induced due to medical reasons three weeks on Friday, and I still cannot be told for definite where I will be having my baby. This whole situation has left myself and family extremely stressed and worried.

A Can I apologise to you and your family for any additional stress you are going through at an already anxious time.

Women booked for induction at Ysbyty Glan Clwyd will be contacted next week as the implementation board has not confirmed the go live date of April 6 (we are working to this date). We can take your information through your community midwife and we will ensure we clarify this with you as soon as possible you can also ring the helpline 01248 385011.

We have to ensure the "safety gateways" have been passed through and any alternatives given due consideration before we "go live" on April 6.


Major changes are being made affecting services at North Wales's three major hospitals: Ysbyty Glan Clwyd, Ysbyty Gwynedd and Wrexham Maelor hospitals |
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Publication:Daily Post (Conwy, Wales)
Geographic Code:4EUUK
Date:Mar 18, 2015
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