Behind the Headlines: The long road to approval for Gwent's Specialist and Critical Care Centre

Test of time

Health secretary Vaughan Gething at the Gwent Fraily Servic Clinic in Cwmbran.

THE Specialist and Critical Care Centre for Gwent is an idea that "has stood the test of time" according to Aneurin Bevan University Health Board chief executive Judith Paget.

It has certainly had to withstand a lot of tests over a considerable period of time.

This is a project that has survived a protracted row over its location, the financial hardships of economic downturn and recession - which at its height forced planning to be suspended for almost two years - a root-and-branch redesign, and several reviews, the latest as recent as last summer.

A key part - perhaps the key part - of the Clinical Futures strategy to modernise health services in Gwent, the Specialist and Critical Care Centre (SCCC) was unveiled as part of that ambitious blueprint in 2004.

But the concept of such a centre, supported by a network of Local General Hospitals around Gwent, was being talked of the previous year at board meetings of the area's NHS bodies.

The announcement by health secretary Vaughan Gething that the Welsh Government will invest around £350 million in the hospital, is perhaps the ultimate vote of confidence in the SCCC as a means towards realising the aims of Clinical Futures.

A hospital to treat the area's sickest patients, the SCCC was seen as, and remains, a means of separating emergency care from routine care, and will also enable specialist acute services to be made more sustainable amid increasing difficulties with recruitment and retention of staff.

For a project with such potentially radical consequences for healthcare, Clinical Futures and within it the idea of creating an SCCC had a relatively smooth ride through the public consultation process.

By the end of 2006, that consultation had been completed and all seemed set fair. Two Local General Hospital projects, for Ebbw Vale (Ysbyty Aneurin Bevan) and Ystrad Mynach (Ysbyty Ystrad Fawr) were signed off relatively quickly.

A row about where the SCCC should be located - Newport or the Llanfrechfa Grange site - threatened to hold up the preparations, though this was concluded after an in-depth study into travel times

But then choppy economic waters quickly became churning seas and in late 2008, in the midst of global uncertainty over the financial future, the then health minister Edwina Hart ordered Gwent Healthcare Trust to suspend planning work on the SCCC.

It was to be late in 2010 before that process restarted, during time NHS restructuring saw the trust replaced by Aneurin Bevan University Health Board.

In 2011, Ms Hart reaffirmed the project's future, though bed numbers had been slashed by a quarter and its scope was to be reduced.

There then followed the development of a regional plan, known as the South Wales Programme, designed to strengthen four key hospital services - A&E, obstetrics, neo-natal and paediatrics.

This resulted in proposals to reduce the number of hospitals providing these services across the region.

An SCCC for Gwent was approved as one of three key sites for housing these services, but the process of approving the South Wales Programme effectively held up progress on the SCCC for another two years, as it had been considered inappropriate to make a decision on it before the former was settled.

The South Wales Programme process did however, confirm the concept of an SCCC as sound, though it was to take until last autumn before a final business case was submitted to the Welsh Government by the health board.

Estimated opening dates for the SCCC have been set and revised many times, and the health board hoped it might receive approval early this year, to enable a summer 2019 opening.

A decision was not forthcoming however, and after the Assembly election, yet another review of the project was ordered.

That took place during the summer, and following further work by the health board on some of its recommendations, Mr Gething finally felt able to give the go ahead.

Yesterday Mr Gething said he understood the frustrations voiced over delays to the project, but stressed that such acute scrutiny is required, given the proposed investment of more than a third of a billion pounds.

"We needed to be assured that the plan makes sense in a Gwent and South Wales context, but we have got to the point where the choice could be made," he said.

"We had to be sure this really is the right decision at the right time, and it is about delivering the right care in the right place."

Mrs Paget said the aim will be to make a start on site next March. Building could be completed in 2021, with the hospital opened by that autumn.

"I think the whole (Clinical Futures) strategy - investing in primary care and community services, providing new hospitals, working with local authorities and the third sector - has proven to be right, and so has this development," she said.

"The idea of the SCCC has stood the test of time, and all credit to staff and clinical teams who have invested time and ideas in it."

Facilities

Llanfrechfa Grange Hospital.

THE SCCC will be built on land on and around the existing Llanfrechfa Grange Hospital site, near Cwmbran.

The hospital, which will have around 460 beds, will deal with all major emergencies, and will treat and care for those needing complex specialist or critical care.

It will include a 24-hour assessment unit, dealing with emergencies and resuscitation cases, and will have a broad range of diagnostic services, operating theatres, and a consultant-led obstetric unit.

The hospital will have a dedicated paediatric assessment unit which will manage all paediatric emergencies, and it will be a base for neonatal intensive care.

Pathology, pharmacy, and radiology, including MRI and CT scanners, will be available.

There will also be a helipad on the site, to enable emergency cases to be transferred quickly.

The SCCC will serve a population of around 600,000 across Gwent and south Powys.

New roles

Health secretary Vaughan Gething at the Gwent Fraily Servic Clinic in Cwmbran with Bob Wellington and Lynne Neagle.

THE completion of the SCCC will trigger new roles for the Royal Gwent and Nevill Hall Hospitals.

The aim is that these will join Ysbyty Ystrad Fawr, Ysbyty Aneurin Bevan, and Chepstow and County Hospitals in providing the majority of care for patients who require routine and non-urgent treatments, and they will continue to offer diagnostics, therapy and inpatient care.

"I can assure everybody that the Royal Gwent and Nevill Hall will continue to be very important hospitals, providing the majority of the health services that their communities need," said health board chairman David Jenkins.

Currently, many of the specialist acute services that will be concentrated at the SCCC are provided at both the Royal Gwent and Nevill Hall, but these are becoming increasingly fragile - difficult to maintain on two sites, largely due to staffing issues.

Children's inpatient services are currently being considered for a move to one site in order to try to address these problems, though the health board has stressed that no decision has been made about this, and that it will endeavour to maintain a two-site model wherever it is safe and practical to do so.

"We will be trying to maintain these services as best we can for the next couple of years," said Mr Jenkins.

"Staff have been fantastic as the situation has become increasingly difficult.

"I am confident the SCCC will act as a magnet to attract high quality staff to our hospitals."