Stay at Home, Protect the NHS, Save Lives
During this unprecedented pandemic, many of my constituents have contacted me with concerns about the provision of healthcare in Powys during the COVID-19 outbreak. I am under no illusions that those who have contacted me are the only ones who are worried in Brecon and Radnorshire. Given the unique seriousness of the situation we currently face, these concerns are completely understandable.
I have written to Carol Shillabeer, CEO of Powys Teaching Health Board and asked her to outline the full plan, with the hope that this will mitigate the concerns which have been raised with me. Her update is as follows:
“Our unique geography - covering a quarter of the land mass of Wales but serving less than 5% of the population – therefore requires a unique local solution. We have therefore put in place a model of care to save lives during Coronavirus (COVID-19) with five main elements:
- Stay Home Save Lives - We all share a responsibility to reduce the spread of infection
- Saving Lives through Self Care, Families and Support - We are supporting people to maintain their health and wellbeing
- Saving Lives through the best use of the skills and resources in Primary Care - We are enabling local access to health and care within your local communities, including rapid assessment for Coronavirus (COVID-19)
- Saving Lives through the best use of the skills and resources in Community Care - We are increasing the beds and skills in Powys to provide local care, to reduce the need for acute hospital care, and to support people to return from acute hospital quickly and safely
- Saving Lives through strong partnership with acute and specialist care for those who need it - We have strong relationships with neighbouring hospitals for access to acute and specialist care for the people of Powys
“Each of these elements are vital to our response here in Powys. All five elements will need to work together. And all five will need to adapt and change, as our needs and challenges in relation Coronavirus will also change.
“Stay Home Save Lives
“First and foremost, we must all stay home and save lives.
- Only go outside for food, health reasons or work (but only if you cannot work from home)
- Stay 2 metre (6ft) away from other people
- Wash your hands as soon as you get home
“The most important step in the fight against Coronavirus (COVID-19) is to reduce the spread of infection. By reducing our contact with other people, we reduce the spread of infection. This means that fewer people will be infected. Fewer people will become seriously ill. Fewer people will need to be admitted to hospital, and more lives will be saved.
“This message is important for everyone. We must all adopt social distancing. Social distancing is particularly important for people who may be more vulnerable to serious illness from COVID-19. This includes older people or those with long term conditions.
“Some people have a very high risk of serious illness. They are being advised to stay home for 12 weeks (shielding) – through April, May and June.
“This includes:
- Solid organ transplant recipients.
- People with specific cancers: o people with cancer who are undergoing active chemotherapy or radical radiotherapy for lung cancer o people with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment o people having immunotherapy or other continuing antibody treatments for cancer o people having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors o people who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs
- People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe COPD.
- People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell).
- People on immunosuppression therapies sufficient to significantly increase risk of infection.
- Women who are pregnant with significant heart disease, congenital or acquired.
“The Chief Medical Officer for Wales has written to people who meet these criteria. The letter includes advice on shielding, and on the support available to them. This includes food deliveries, pharmacy deliveries and other support. Welsh Government has shared with GPs a list of patients who have received letters, so that GPs can check to see if any high risk patients have not yet received a letter. Please be patient as these checks may take a few days, but if you are aware of anyone in your community with the conditions listed above please ask them to contact their GP practice to arrange for their letter to be sent.
“Saving Lives through Self Care, Families and Support
“The next step is for all of us to take action to look after ourselves and those around us. This is vital if we want health and care services to be available for those who most need them.
“Steps we can all take include adopting self-isolation if we or our household have symptoms, social distancing for everyone particularly those more vulnerable to infection, and shielding for people at the highest risk of serious illness from coronavirus (COVID-19). People who have been advised to shield for 12 weeks can access additional support, for example help with food and prescription deliveries.
“Hand hygiene is also one of the most powerful tools in everyone’s toolkit. Regular handwashing for 20 seconds using soap and water, or antibacterial handwash, helps prevent the spread of infection.
“Here in Powys we have a powerful tradition of family and community support. Never has this been more important than now, as communities reach out to those who are most vulnerable and isolated. Across the county, community networks are being established by local people – and we are working with Powys Association of Voluntary Organisations to put in extra support and signposting to help these networks.
“Education, skills and training can help all of us with simple ways to maintain our health, to respond to common ailments, and to take action to prevent symptoms from getting worse. Our teams are working hard to put in place a range of additional support.
“We are also providing ever more services through online and telephone access. Internet services such as video consultations can be a great way to provide care for people who cannot leave the home. We recognise that this is not suitable for everyone, so our teams are working hard to keep telephone contact with vulnerable patients and service users – and with processes in place to refer to face-to-face services when this is needed.
“For example:
- Our midwives having been putting on antenatal classes via YouTube and providing advice and support via Bump Talk on Facebook.
- We have a wide range of online resources in place to support emotional and mental health, including the SilverCloud Online CBT service.
- PTHB is rolling out an “my mhealth” App to help some patients with long term conditions such as Diabetes and COPD with self-management, education and rehabilitation remotely.
“A vital part of self care is using the online symptom checker at http://111.wales.nhs.uk/covid19 to check our symptoms, seek advice if our symptoms get worse, and to access a self-isolation note if we need this for our employer.
“Saving Lives through the best use of the skills and resources in Primary Care
“In response to Coronavirus (COVID-19) we are working hard to support primary care to provide local, flexible services that best meet your needs.
“Our local primary care services will need to introduce changes to keep you safe and keep their staff safe. This will include using more telephone and online services, but reducing face-to-face contact to reduce the spread of infection. They will need to reduce the number of people who can visit their premises at one time. They will also need to make changes if they face workforce challenges because their own staff are self-isolating or shielding.
“This includes:
- Providing telephone and online support to reduce the need for face-to-face appointments that may increase the spread of infection. Our multi-disciplinary teams in primary care have a lot of experience in providing remote triage to help assess conditions and decide whether treatment, appointment, referral, or urgent or emergency care is needed.
- Referring you to face-to-face appointments when you need this.
- Providing rapid assessment services when Coronavirus (COVID-19) is suspected, particularly for those people who are most at risk to serious illness. These services aim to help prevent symptoms from getting worse, and help people stay at home or close to home.
- Active monitoring of vulnerable patients, for example through regular phone contact by members of the multi-disciplinary team with patients and family
- Helping people find additional support if they need it – for example, through voluntary prescription delivery schemes, local community networks, Community Connectors and more.
- Making sure that there are referral routes in place during day time hours and evenings and weekends.
- Using the skills in our pharmacy teams to support vulnerable patients, and supporting our patients through pharmacy delivery with support of volunteers.
- Changing the way we delivery optometry and dental service to provide remote triage, and appointments for emergencies and sight-threatening conditions.
“Saving Lives through the best use of the skills and resources in Community Care
“Across Powys we have a strong network of community services. However, these will also face new challenges because of Coronavirus (COVID-19), including workforce gaps when staff are unwell or shielding.
“During Coronavirus (COVID-19) we will need to care for sicker patients in a community hospital setting than is normally the case.
“Our current plans include:
- Increasing beds, and the skills and services (including the provision of oxygen for some COVID19 patients although this will not include non-invasive ventilation or invasive ventilation) in Breconshire War Memorial Hospital, Llandrindod Wells Memorial Hospital and Victoria Memorial Hospital Welshpool. This will allow us to care for more patients in the county with Coronavirus (COVID-19) – reducing the need for them to be admitted to acute hospital, and bringing them closer to home when they are more stable and no longer need acute hospital care.
- Refocusing our community hospitals and health and care centres in Bronllys, Builth Wells, Knighton, Llanidloes, Machynlleth, Newtown and Ystradgynlais to provide an enhanced level of in-county community hospital care for those who need it. This will also include increasing the number of beds, as well as making sure we are able to continue to provide dignified palliative support and end of life care.
- Working in partnership with patients, carers, families, nursing homes, residential homes, Powys County Council, Powys Association of Voluntary Organisations and wider partners in the third sector, local communities, private and independent sector and local businesses to provide as much care as possible in the most appropriate setting.
“This will include creating around 100 additional beds within our hospitals and health and care facilities – effectively we will have a “virtual” field hospital across the county that makes use of existing facilities, working with partners to make best use of the skills and assets across the county. It also includes increasing the scope of practice so that we are able to provide a higher level of care within the county than would normally be possible.
“We also continue to develop plans so that extra local capacity can be put in place if the need for health and care support has peaks that cannot be accommodated within the plans outlined above.
“Saving Lives through strong partnership with acute and specialist care
“The four elements of the model outlined above will mean that as many people as possible continue to receive their care at home or close to home in Powys. Our teams in the NHS, Council, third sector and local partners have excellent skills and experience to enable us to achieve this.
“But, some people with more serious illnesses will need to be admitted for specialist and critical care, with specialist teams and equipment to give them the best chance of recovery – for example, for non-invasive and invasive ventilation.
“We have very well established relationships with our network of neighbouring hospitals who provide acute and specialist inpatient care for the people of Powys. This will continue to be the case, and each of our neighbouring hospitals is increasing their own capacity so that as the impact of Coronavirus (COVID19) increases, they will continue to be able to provide essential care including for our communities – both for Coronavirus (COVID-19) as well as for the other life, limb and sight threatening illnesses and injuries we may experience.
“This includes working with neighbouring hospitals to ensure that access to urgent cancer diagnosis, treatment and care, including emergency and urgent surgery, remains a key priority during challenging times. We are also working with partners to maintain essential renal services in the county and in neighbouring hospitals.
“Having this wealth of partnerships with a network of hospitals will be a real asset to us. If an individual hospital around our borders face particular challenges then we have other partners in the network that we can turn to.
“Our ambition is to save lives by ensuring that patients receive their care in the right place, from the right team, with the right skills, and the right equipment. Wherever possible, acute and specialist care should be provided by those organisations with the specialist skills and expertise to do so. Ventilation is requires more than providing a piece of equipment. It is a complex medical intervention that requires specialist staff with training and expertise in areas such as critical care and respiratory medicine.
“Here in Powys we have pathways of care in place so that patients needing acute and specialist care receive this from our neighbouring hospitals. This continues to be the case during Coronavirus (COVID-19) and we are working across Wales, and with partners in England, to make sure that their plans take account of the needs of all of us in Powys.”
While I hope this plan has provided some reassurance that the appropriate measures are being taken by our health board, the situation is fast moving and these plans are reviewed on a daily basis.
I would encourage all my constituents to regularly check the latest using reputable sources. The daily statement from Public Health Wales is available from https://covid19-phwstatement.nhs.wales. The most up to date information on changes to healthcare services in Powys is available from www.powysthb.wales.nhs.uk/coronavirus.
The overall healthcare response in Wales is coordinated nationally by the Welsh Government working closely with the UK Government. More information about the overall response by Welsh Government is available from their website at https://gov.wales/coronavirus, and more information about the UK Government response can be found at https://www.gov.uk/coronavirus.
As you can imagine, I have been contacted by many worried constituents during this difficult time. My team and I have been working tirelessly to help everyone who has been in touch with us and we will continue to do so. If we can help you at all during this most worrying period, please do not hesitate to contact us
The most important point that I want to stress is this: following Government advice will see this crisis conclude more quickly. Stay at home. Protect the NHS. Save Lives.
I wish you all the best during this difficult time.
Yours sincerely,
Fay Jones MP
Member of Parliament for Brecon and Radnorshire