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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.

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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.

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

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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.

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.

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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.

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

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“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.

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

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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.

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

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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.

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

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“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.

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).

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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.

“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.

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“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.

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.

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“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.”

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.

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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.”

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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Dance

Doctors prescribe dance classes to keep patients on their feet

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Over 65s in Swansea Bay are being encouraged to attend dance classes in a bid to keep them on their feet.

Five of the health board’s clusters – groups of GP surgeries working together within a geographical area – are backing the scheme as the exercise to music is proven to aid falls prevention.

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Each class is led by a trained dance teacher with participants encouraged to follow a range of routines, designed to develop their strength and balance, with the option of using a chair for support if their mobility is limited.

The Dance for Health programme is a collaboration between the health board, clusters, local authorities, and Aesop, an arts focused charity.

Alyson Pugh, Programme Manager at Aesop, said: “We are delighted to be working with our partners in the health sector to improve the health and wellbeing of people aged over 65 through the medium of dance.

“During each class participants will move to a variety of music from all around the world. The classes are fun and vibrant, increasing fitness, mobility and strength.

“Afterwards, participants will have a good chance to get to know one another over a cup of tea or coffee. No previous experience is needed, everybody is welcome.”

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So far classes are held in Pontardawe, Morriston, Seven Sisters, Cwmavon and Briton Ferry, Upper Killay, Reynoldston, Mumbles and the Waterfront Museum.

Alyson said: “The health board asked for 12 classes across Swansea Bay and funded the management side while the GP clusters are funding the delivery of the classes. They wanted it to be grass roots up.

“Anyone can walk in but they wanted the main referrals to come from the virtual wards and local area coordinators and social prescribers, a whole community approach.”

Lizzie MacMillan (Image: Swansea Bay HNS)

Dance artist Lizzie MacMillan (left), a development officer for Dance for Health, said: “It’s for older people and people who are struggling a little bit with perhaps balance issues, mobility issues as well, so we are not expecting them to foxtrot along the floor on the first class or anything like that. It builds up over the weeks.

“We start off quite gently, just seeing where everyone is in the class – I like to gauge the class first of all to see if people are having problems with balance or perhaps giddiness or joint problems. I like to get to know each person in the class so that I can look after them and know their capacity for movement.

“We use the chairs quite a lot if someone is unsteady on their feet. They can still do a variation using the chair for support. We also do a standing variation if people are a little fitter or a little bit more able to push themselves further in the class.”

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Over 65s in Swansea Bay are being encouraged to attend dance classes in a bid to keep them on their feet. (Image: Swansea Bay NHS)

Mike Garner, Cwmtawe Cluster lead, said: “We are delighted to be participating in this programme as it fits in perfectly with our goal of improving well-being and helping people remain fit and healthy.”

One participant, Pauline Anderson, said: “I’ve been to four or five classes. I thought I would try it to see what it’s like and it’s been very good.

“As you get older you become more immobile. I’ve been struggling with my knees and joints, so I have found it helpful.

“I would advise anyone thinking about it to just come along.”

Another participant, Betty Didcock, said: “I try to keep active as much as I can. I used to enjoy dancing when I was younger. I’ve made friends here. If you’re a bit shy, it’s a wonderful place to come to get used to talking to people. I’m a quiet one. I don’t always do it right but I have a go.”

While Amber Davies said: “I thought I’d come along to see what it was like. It’s important to keep busy and remain active. It’s also a good way of meeting new people.”

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(Lead image: Swansea Bay NHS)

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Swansea

Swansea’s popular land train is back – and you can even take your dog for a ride!

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Taking your family for a day out along Swansea prom? Now your four-legged friend can join in the fun too by hitching a ride on the land train!

Officially known as the Swansea Bay Rider, the 72-seater land train runs along Swansea’s prom from Blackpill Lido to Southend Gardens in Mumbles giving passengers an incredible view of Swansea Bay as they travel along.

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Run by Swansea Council, the land train has been a feature of summer holiday trips for many years – whether it’s to soak up the sights in style, or hop on for a relaxing journey after a day of fun in the sun.

But did you know that dogs are allowed on board too?

The council has highlighted the little known fact that four-legged friends are welcome to ride the land train with their owners, as long as they are wearing a lead and are under control.

With more people than ever taking their dog on holiday or on days out, the land train is another fun activity that all the family can enjoy.

The Swansea Bay Rider is also fully accessible to wheelchair users.

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The land train runs every weekend from 23 April to 4 September, and daily during the school holidays between 30 May and 3 June, and again between Friday 15 July and Sunday 4 September.

The 30 minute ride from Blackpill to Southend runs 7 times a day at 10.30am, 11.30am, 1pm, 2pm, 3pm, 4pm and 5pm from Blackpill.

Return journeys from Southend are at 11am, 12pm, 1.30pm, 2.30pm, 3.30pm, 4.30pm and 5.30pm.

Can’t get enough of riding the land-train? How about becoming its driver!

Swansea Council are recruiting a land train driver on a zero hours contract for £19,264 per annum (pro-rata). Applications are open until 24 May on the council’s website.

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(Lead image: Swansea Council)

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Books & Literature

Author uncovers the lost tale of Swansea fairground legend

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From Swansea Bliz survivor to fairground strongman – an author discovers his grandfather’s fascinating story as The Welsh Hercules.

In the early half of the 20th Century, Jack Lemm was a household name in Wales. As the Strongman star of fairgrounds and Music Hall, he was famed for his feats of strength, wrestling and his dangerous headlining act, The Whirl of Death.

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Times and entertainment trends change, however, and now the once-famous showman is almost forgotten.

For one man, however, the story of the strongman had special meaning. Glaswegian Steven Blockley had always thought that his Great Grandfather deserved to be better known.

“I never actually met Jack,” he says. “I grew up listening to my uncles and aunts telling fascinating stories about all his incredible achievements around the Swansea area and I always knew I wanted to write a book to bring them to a wider audience. As I dug further into his past, however, even I was surprised by what I found.”

Looking into the background of Jack, Steven and co-author David J Thacker uncovered a rich life story and the perfect antidote to our troubled times.

Steven continues, “Jack lived through some harsh years – he was on HMS Lion at the Battle of Jutland in World War 1 and was a survivor of the Swansea Blitz in the Second World War – but his focus was always to put family first and to provide for everyone at home, even if doing so took him away from them.”

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David takes up the story. “Jack came from a Greek family and his given surname was actually Lamnea, but his exploits on stage and at fairs all over the UK, including at Neath, were not always popular, especially with his authoritarian father.

“A lot of the tension in our book comes from that relationship, of a son trying to live up to the ideals of his father.”

The resulting book, The Welsh Hercules, took over a year to research and write but in doing it Steven found a kind of resolution.

“While we were writing the book, I turned 60. At that age, Jack was still doing 40 shows a day at the fairgrounds and even after he retired, he was helping roadworkers outside his house to fix the roads!

“Age really was just a number for him and I think that’s a great attitude to have.”

The Welsh Hercules tells the story of Jack, from his humble beginnings on Swansea Docks through to becoming a renowned boxing coach and fairground star. It takes him through two World Wars, as a survivor of the Battle of Jutland and the Swansea Blitz, and introduces a whole new world of showmen, acrobats and colourful characters.

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But at its heart, Jack’s story is one of family – of the challenges met, the hearts won and the enduring romance of a Showman and his wife.

The Welsh Hercules is available in paperback on Amazon priced at £11.99

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