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State-of-the-art stroke unit proposed for Morriston Hospital

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A state-of-the-art stroke unit offering 24-7 emergency care could be developed at Swansea’s Morriston Hospital.

The health board is developing a proposal for what’s known as a hyper-acute stroke unit, expanding on the existing facility based in Ward F.

It would bring together experts and equipment under one roof to provide world-class treatment whenever patients need it.

Another proposal is the creation of an Acute Hub for patients requiring urgent unplanned medical care but who will not need to stay there for more than 72 hours.

These form part of wider proposals to reconfigure services across Swansea Bay, creating a series of different Centres of Excellence in each main hospital to avoid delays and rapidly work through sometimes lengthy waiting lists.

If the proposals – contained in a document called Changing for the Future, which is currently out to engagement until Friday 1st October – are approved, all urgent and emergency medical and surgical cases would be brought to Morriston.

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The hospital would then become Swansea Bay’s Centre of Excellence for urgent and emergency care.

As part of these proposals, acute medical wards at Singleton would transfer to Morriston, with the space created allowing Singleton to become the centre of excellence for planned care (operations/treatments by appointment.)

An important part of the Morriston proposals is the development of the Acute Hub, which would be centred on Enfys Ward.

This is the former outpatient waiting area that was temporarily converted into an additional intensive care facility during the pandemic. The proposal is to continue to use it for clinical care in the future.

The Acute Hub would bring together existing services from several sites, and some new ones.

It would ease the pressure on the hospital’s ED by diverting many urgent, but not 999, patients its way. For many people it would provide alternatives to hospital admission.

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Developing the Morriston Acute Hub would ensure staff with the right expertise could work together in one place, rather than be spread across various sites. The service would be more joined up and effective.

It would also mean patients who need to be seen urgently, but don’t have life-threatening illnesses, would no longer have to wait behind very sick people in the ED for diagnosis and treatment.

Instead, they would be seen on the same day by new or expanded multidisciplinary clinical teams and receive diagnostic tests and treatments.

One of the services proposed to relocate there is the very successful Acute GP Unit (AGPU), currently based in Singleton.

Dr Stephen Greenfield

AGPU is staffed by experienced GPs and other healthcare professionals. Dr Stephen Greenfield, who leads the service, explained: “Any GP wanting to admit a patient into hospital comes through us.

“We have a discussion with the GP. The outcome could be advice and discharge, so the patient does not come anywhere near a hospital, or referral to a community team.

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“Some patients will come to AGPU and have ambulatory care – tests and investigation but they are not admitted. Others may have to be admitted.

“Currently, between 50 and 60 percent of the patients we deal with do not end up coming into hospital.

“Some are advised or referred to community services, some are seen in AGPU and then discharged.

“This is better for the patients because there are unintended consequences of coming into hospital such as the risk of picking up infection or losing muscle strength through inactivity.”

AGPU also works with the Welsh Ambulance Service, redirecting some patients who have not yet had a paramedic review to more appropriate services rather than be brought into Morriston ED by ambulance.

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The unit will move to Morriston on a temporary basis as part of the health board’s ongoing response to the pandemic.

This has been agreed with patient watchdog Swansea Bay Community Health Council, ahead of the conclusion of the engagement which proposes making these and other changes permanent.

The Acute Hub would also bring together other services, some of which are well-established while others are new.

For example, GP Out of Hours, which was temporarily moved during the pandemic, has now relocated back to Morriston, into Enfys.

The hub would also incorporate Morriston’s existing Older Person’s Assessment Service, which assesses clinically appropriate elderly patients who might otherwise have gone to ED.

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In a new development, the hub will support the all-Wales 111 First initiative, due to launch in Swansea Bay later this year.

An expansion of the existing 111 service, it will use expertise within the hub to offer alternatives to patients who might otherwise end up in ED.

These alternatives could include appointment slots in the Minor Injury Unit at Neath Port Talbot Hospital or a direct referral to one of a range of services, such as respiratory or mental health.

Morriston is also home to a new, Welsh Government-funded Urgent Primary Care Centre (UPCC) which is strictly by referral from ED only.

“It is not a walk-in service and there is no direct public access,” said Dr Greenfield. “People cannot just turn up if, for example, they cannot get an appointment in their own GP practice.

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“Instead they are triaged and, if it is felt they need to be seen on the same day, they are referred to the UPCC.

“If it is not urgent and they can be seen by their own GP another time, that can be facilitated for them.”

Bringing these key services together, as outlined in the Changing for the Better proposals, would help take pressure off ED.

But, just as importantly, the new hub is intended to ensure all patients get the best care for their needs, in the best place to receive it, and without delay.

“It’s about ensuring that, whatever patients present with and wherever they have come from, they are going to the right place and are treated by the right person,” said Dr Greenfield.

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Another part of the proposals to centralise all urgent care and emergency services at Morriston involves the creation of a hyper acute stroke Unit (HASU).

There is evidence that having a single specialist centre is the best way to provide excellent care and deliver best outcomes for patients.

HASUs have been developed in parts of England, resulting in fewer deaths, improved recoveries and greater cost-effectiveness.

Swansea Bay’s Deputy Chief Operating Officer, Craige Wilson, said: “We are doing reasonably and consistently well, compared to other health boards, against the performance indicators in Wales.

“However, like all of the health boards in Wales, we are not hitting the UK standards and our aspiration is to do that.

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“We already have a stroke unit based on Ward F in Morriston so it would not be about moving services from different locations to create a hyper-acute stroke unit.

“Our major limitation is staffing. We don’t have the medical or nursing staff we need to provide a 24-7 service so a hyper-acute unit would involve a considerable investment in staff.”

People with suspected strokes should have a brain scan, ideally within one hour, so doctors can decide on the right treatment.

Most strokes – around 85 per cent – are known as ischaemic strokes, caused by a blockage in the artery leading to the brain.

The treatment for this is thrombolysis, using medication to break up the clot blocking the blood supply. This should be given within four-and-a-half hours of the stroke symptoms starting.

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It’s essential that the CT scan is carried out beforehand as these clot-busting drugs can exacerbate the other, less common, type of stroke, haemorrhagic stroke, which is bleeding in or around the brain.

Mr Wilson said: “The vision for the future is to have the hyper-acute stroke unit with rapid access to CT and sufficient medical and nursing workforce to thrombolyse patients, where appropriate, in a timely manner, 24 hours a day, 7 days a week.

“That’s the crux of the matter because the quicker we can do that, the better the outcomes are for the patients.

“The issue is, the level of investment that is required to actually achieve that, and a realistic timescale to recruit all the required staff.

“It’s not something that can happen overnight. So we have put together a proposal to do this in three phases over a couple of years.

“This will allow us to incrementally increase our staffing numbers to get us to where we want to be.”

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As part of Changing for the Future, the health board is proposing a rehabilitation centre of excellence at Neath Port Talbot Hospital, which would support patients who have received urgent care in the Hyper Acute Stroke Unit.

This rehabilitation centre of excellence would include specialist rehab services such as neuro-rehabilitation and stroke rehabilitation – instead of the current service which is split between both Neath Port Talbot and Singleton hospitals.

In early 2020, Swansea Bay introduced an early supported discharge team for patients who are medically ready to leave hospital following a stroke but still require rehabilitation.

Mr Wilson said this had led to a reduction in the number of patients having stroke rehabilitation in the two hospitals.

“If we have the opportunity to bring all the rehabilitation staff into one location, we would have better outcomes for patients. That’s also part of our overall stroke pathway.”

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Lead image: Dr Steve Greenfield in Enfys ward with Dr Helen Dean, who works in the GP Out of Hours and Urgent Primary Care centres (Image: Swansea Bay NHS)

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Education

Pupils create lasting legacy ahead of move to new school

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Pupils counting down the weeks until they can move into their new school building have created a lasting legacy to let children in the future know what school life is like today.

The children at Ysgol Gymraeg Tan-y-lan have worked with staff to gather items for a time capsule that has been buried on the site of the new £9.9m build in Clase.

The development is nearing completion and they are due to move from their existing site at Tan-y-lan Terrace in Morriston to their new home in Clase after the Christmas holiday break.

Pupils joined Swansea Council Leader Rob Stewart, Cabinet member for Education Improvement Robert Smith and other senior councillors at the new site to bury the time capsule.

It includes photos and recordings of performances along with items of news and information that will give a flavour of school life in 2021.

The new build is jointly funded by Swansea Council and the Welsh Government under the 21st Century Schools and Colleges Programme and is part of a £170m investment in new and improved schools in Swansea which is the largest such investment in the city’s history.

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Cllr Smith said: “The new school building and facilities are absolutely first class and I can see how excited the staff and children are about moving into their new home.

“This will give them the very best surroundings in which to work and is very different to the old outdated accommodation of their current buildings.

“The contractors Kier have done an amazing job in building this school while working safely during the pandemic and I can’t wait to see the pupils settle in. I’m really looking forward to visiting them again when it opens.”

The new build at Hill View Crescent has an increased capacity and a nursery that will help meet additional demand for Welsh medium education in the future.

YGG Tan-y-lan headteacher Berian Jones said pupils and staff were very excited about the move and said they had all worked together to create the time capsule.

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He added: “Pupils from each year group were involved in preparing USB’s filled with examples of activities, photos and performances that have been placed in the capsule.

“We have also collected items that represent the school and our ‘cynefin’ habitat – we also included items and information from current time that explain our current situation and current events in history.”

(Lead image: Swansea Council)

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Health

Health board warning flu cases leading to hospital admissions in Swansea Bay

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woman lying on bed while blowing her nose

The flu virus is already circulating and has led to people being hospitalised according to Swansea Bay University Health Board’s Director of Public Health, Dr Keith Reid.

Dr Reid said the cases, although small in number, should be a timely reminder that everyone eligible for a free flu vaccination should take up the offer.

Dr Keith Reid

“Flu was non-existent in autumn and winter 2020 as lockdowns, mask wearing and increased hand hygiene stopped it and other winter bugs from spreading from person to person,” he said.

“But we have been expecting to see flu come back this year and potentially at levels up to twice as high as a normal flu season.

“People were simply not exposed to flu and other seasonal viruses last year, so the level of immunity in the community is likely to have dropped and people will be susceptible.

“Plus we are all mixing far more now and, with the bad weather coming, we are all going to be heading indoors which will give flu and other bugs the ideal opportunity to spread.”

Flu can be fatal and research has shown that those infected with both flu and Covid are more than twice as likely to die as someone with Covid alone.

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Dr Reid said: “This will be the first winter when we will have significant levels of flu and Covid circulating at the same time, so I must urge everyone, if they are eligible for a free flu vaccination, to take up the offer as soon as possible.

“While no vaccine can offer 100% protection, the flu vaccine remains our best defence against this nasty virus.

“And remember, if you haven’t yet had your first Covid vaccination you can still do so.”

(Lead image: Andrea Piacquadio / Pexels.com)

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Swansea

Installation of gold-coloured panels nears completion at arena

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Installation of all gold-coloured panels surrounding Swansea Arena is now just about complete.

Over 1,600 of the panels have been installed – each equipped with LED lights to enable the hosting of displays around the attraction.

It’s another milestone for the £135m Copr Bay phase one district, which is being developed by Swansea Council and advised by development managers RivingtonHark.

Construction of the district – led by Buckingham Group Contracting Ltd – will be complete this year, with the arena opening its doors in early 2022.

Cllr Rob Stewart, Swansea Council Leader, said: “This is another great milestone for our Copr Bay phase one district, which will be worth hundreds of jobs and £17.1m a year to Swansea’s economy.

“Significant progress is being made every day. This includes the planting of trees and other greenery in the 1.1-acre coastal park next to the arena and major construction progress on the new restaurant in the park that will be run by a Swansea business.

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“Our arena tenants and operators – Ambassador Theatre Group – have also started announcing arena acts, helping build excitement towards the announcement of a headline opening music act.

“People walking, cycling or driving along Oystermouth Road may also have seen more greenery being introduced recently along the roadside, with a living wall soon being introduced nearby too.

“The arena is creating a stunning new landmark on Swansea’s transformed cityscape. It will combine with many other projects to ensure our city quickly bounces back from the economic impact of the pandemic.

“Copr Bay phase one has been and continues to be delivered despite the challenge of Covid, while also paving the way for phase two that will be progressed with Urban Splash – our preferred development partner for the regeneration of several key sites in Swansea.”

Other features of Copr Bay phase one include the new bridge over Oystermouth Road, which will soon benefit from a permanent lighting scheme. Apartments are also being constructed, along with spaces for more businesses in the hospitality and leisure sectors.

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The arena feature of Copr Bay phase one is being part-funded by the Swansea Bay City Deal as part of the Swansea City and Waterfront Digital District project that also includes the new office development soon being constructed at 71/72 The Kingsway.

The bridge over Oystermouth Road is part-funded by the Welsh Government’s Active Travel fund.

(Lead image: Swansea Council)

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