Will the Cabinet Secretary make a statement on the fact that there has been a 20 per cent increase in the number of patients being directed from Llandudno MIU to district general hospitals since removing doctors in 10/2017, and explain whether provision might be available to ensure that a doctor is present daily?
It should be noted that all Minor Injury Units (MIUs), whether staffed by Emergency Nurse Practitioners (ENPs) or by medical staff, will need to advise some patients to go to a District General Hospital (DGH) when their injury is too serious to be managed within the MIU eg a serious fracture or an injury which needs more complex imaging such as a CT scan.
The Minor Injury Unit in Llandudno is operational for 12 hours each day, 7 days a week. Until October 2017, just under half of these hours had medical cover, the majority of which was undertaken by an agency locum. The Unit also employs an Associate Specialist from Ysbyty Gwynedd for one day each week. This doctor is still in post and works in the Unit providing medical cover. He is also responsible for the further development of the Emergency Nurse Practitioner (ENP) competencies and overseeing the clinical governance of the MIUs in Llandudno, Denbigh and Holywell.
The health board’s decision to reduce medical cover in October brought the Llandudno MIU in line with the health board’s service model in the other MIUs in north Wales, all of which are staffed by Emergency Nurse Practitioners. These nurses are very skilled, able to assess, diagnose and treat a wide range of injuries.
In the seven months, from November 2017 to May 2018, 993 patients were directed to a DGH, compared to 826 patients in the same period in 2016/17. This is an additional 5-6 patients per week on average.
The health board is currently undertaking more detailed analysis of the reasons patients are being directed to a DGH, to determine the reasons for the change, which are likely to be multi-factorial. The health board will then use this further analysis to determine what action can be taken to reduce the numbers, where it is clinically appropriate, for example, by further developing the competencies of the ENPs.
Officials will continue to monitor local delivery closely as part of ongoing assurance mechanisms.