South Wales Evening Post - 28 January 2009
The future of neurosurgery at Morriston is again under the spotlight. Dai Lloyd, Plaid AM for South Wales West, sets out the case for keeping the service in Swansea.
Neurosurgery is staying in Morriston Hospital, Swansea. Yet recent deliberations, and a powerful lobby from Cardiff, still question the minister's decision.
Edwina Hart, the Assembly's Health Minister, announced her decision in response to reviews last September. The neurosurgery decision she announced was one service on two sites — Cardiff and Swansea — working together as one neurosurgical unit.
The minister made it plain that the decision was final.
Following the verdict, she has instructed the interim medical director, Alan Axford, of the Hywel Dda Trust, and his expert consultant team to finalise the details of this new arrangement.
Today, we have two neurosurgical units, Swansea and Cardiff, operating independently of one another.
The change means that these two units, previously separate and stand alone, will now operate as one service, sharing the one cohort of specialised staff across the two sites.
This will mean a better service for both patients and specialised staff, combining the geographical accessibility and one of the UK's best burns and plastics units (in Swansea), with the paediatric neurosurgery and research expertise of Cardiff.
Evening Post readers will doubtless recall the huge campaigns fought over the past six to seven years to keep first of all, paediatric neurosurgery — which then went to Cardiff — and then adult neurosurgery in Morriston Hospital.
The largest petitions ever received by the Assembly have both been 100,000-strong petitions organised by the Evening Post. They more than adequately reflect the strength of feeling, not only in Swansea, but in Ceredigion, Pembrokeshire and Carmarthenshire — often from patients with direct experience of the service, understanding what losing neurosurgery to Cardiff would mean.
Recent "noises-off" by the Conservative health spokesman Jonathan Morgan have concentrated on reports about the neurosurgical service prepared for the minister. The reports suggested a one-site solution to neurosurgery in South Wales, and that the one site should be Cardiff.
However, in making a ministerial decision, there are wider considerations than purely the neurosurgical considerations. The ambulance service, for example, and ambulance response times, which are short of their targets at the moment.
Centralising the service in Cardiff means putting additional stress on already overstretched ambulances, which was a recurring fear with people in Swansea and South West Wales.
Another ministerial consideration would have been Swansea's designation as Wales's only level one major trauma centre — achieved because neurosurgery, burns, plastics and a major trauma centre are all on the same site.
Taking neurosurgery away from Swansea to Cardiff will mean Swansea will lose its designation as a level one centre, and, because Cardiff has no burns and plastics unit, Cardiff will not gain that designation — so Wales would be left with no level one major trauma centre.
Doubtless, a further consideration for the minister in reaching her decision is the presence of Bristol's excellent neurosurgery unit less than 40 minutes from Cardiff.
Many people in Gwent and the south east of Wales have a propensity to look to Bristol, and quite properly, that avenue will remain open to them.
Yet the impact of Bristol's neurosurgery unit on the neurosurgical themes in the aforementioned ministerial briefs appears understated or absent.
We could be faced with two neurosurgical units close together — Cardiff and Bristol — and any subsequent professional-led UK reviews could suggest further consolidation, meaning the Cardiff unit goes to Bristol.
To those who say centralising neurosurgery in Cardiff is the only way to save the service for Wales, I would disagree. Swansea has to be part of the answer if we are to keep the service in Wales.
And finally, much has been made in this neurosurgical debate about the research excellence of Cardiff. Medical research in Cardiff is excellent indeed, but it is unfair to totally discount Swansea's status in modern day medical research.
Certainly, we need to push the research agenda further — with both Cardiff, and less so Swansea, being moderate hitters on the UK stage in terms of the size of institutions and population hinterland.
A significant advance in medical research status could be attained by Cardiff and Swansea working together — two magnificent medical and university institutions with a two million population hinterland would be a significant presence on the UK research scene.
Instead of competition between Swansea and Cardiff, how about combining resources and batting together for Wales?
It can be done — the successful research bid for a £10 million burns injury research project announced a couple of years ago was the result of close co-operation between Cardiff University and the burns unit in Morriston Hospital — and we need more of it.
Cardiff and Swansea should work together — not against one another — for better research and improved neurosurgical care for the people of Wales.
