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Last Updated: Friday, 13 October 2006, 07:02 GMT 08:02 UK
Shifting NHS focus from buildings
Hywel Griffith
Health correspondent

Young campaigners
Protests against hospital reforms have drawn young and old
Wherever you live in Wales, plans to re-organise hospital services are likely to affect you.

Over the last six months protests have been held in every corner of the country - leading to several of the key proposals being shelved.

But the whole premise of the reforms is to build a better health service that is easier for patients to access.

So what has gone wrong? Why have the plans become so unpopular? The answer may be in the way we think of our NHS.

From Blaenau Ffestiniog to Bronllys, Llandudno to Llanelli, the proposals to centralise care away from smaller hospitals have failed to convince campaigners.

Opposition has lead to re-organisation in Aberystwyth, Haverfordwest and Carmarthen being stalled, along with a decision over the future of Llandudno General Hospital.

'Bricks and mortar'

According to Mike Ponton, director of the Welsh NHS Confederation, the message that services can be delivered differently has yet to get through.

He said: "We need to challenge the fixation with bricks and mortar, and show how the future is about services not just buildings."

According to Mr Ponton, staying with the current set-up is not an option.

We have to face the realities of a changing world, and we want to exploit the opportunities we have to improve the care we provide
Mike Ponton, Welsh NHS Confederation

"We have to face the realities of a changing world, and we want to exploit the opportunities we have to improve the care we provide," he added.

This includes making greater use of technology such as tele-medicine - where a patient can receive a consultation through a video-link, meaning they can be seen at their local hospital.

Distance is a key issue in the whole debate, with patients concerned at the prospect of travelling further for specialist treatment, especially in an emergency.

In Aberystwyth, the prospect of withdrawing a consultant from Bronglais Hospital and creating a midwife-led maternity unit drew the greatest concern.

Local Plaid Cymru Assembly Member Elin Jones said lives would be put at risk

"We cannot have a service which would mean that mothers requiring emergency caesarean sections and patients needing emergency night-time theatre would need to undertake a three-hour emergency ambulance transfer," she said.

Review of services

While attention has so far focused largely on services for rural areas, the next six months are likely to see further details emerge of changes in larger towns and cities.

The proposed super-hospital for Swansea will mean Morriston and Singleton hospitals - two of the largest in Wales - being merged. It will come at a cost of 500m.

A review of services at Prince Charles Hospital in Merthyr Tydfil and the Royal Glamorgan in Llantrisant has pointed towards the two having to work together.

That will mean avoiding duplication, and potentially withdrawing services from both sites.

Hospitals in south-east Wales are also under review.

New units are being built in Caerphilly and Blaenau Gwent, but three hospitals in Newport could be shut to make way for one new hospital in the city.

Judging from the experience of health authorities in rural areas, it will not be plain sailing.

While many agree on the need to modernise the NHS, deciding how it should be done is far more difficult.

A programme examining the challenges facing the NHS is being recorded in Caerleon, near Newport this month.

Me and My Health - A Debate is broadcast on 25 October, at 2230, on BBC One Wales.

If you would like to take part in the programme or have any questions for the debate, email or call 08703 500 700.

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