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‘Once in a lifetime bid’ for health and care investment in mid and west Wales

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HYWEL DDA University Health Board will discuss and agree the submission of an ambitious plan to improve health outcomes and well-being of our population.

A Programme Business Case (PBC) for the Welsh Government, will be discussed at the Health Board meeting at 9.30am on Thursday 27 January 2022, available to watch live here.

It’s a milestone in the Board’s journey to achieve its long-term strategy and improvement in population health – A Healthier Mid and West Wales, which followed extensive engagement and consultation in 2018.

It is also the means by which the Board will address long standing challenges, including fragile services, unsustainable workforce and financial challenges, and an aging hospital estate (some of the oldest hospital buildings in Wales).

The PBC offers hope following the pandemic, that health and care can shift from an illness service with a focus on hospital buildings and intervention, to a service that works across boundaries to prevent ill health or deterioration of health, providing help earlier, and wherever possible closer to home.

Steve Moore, Chief Executive of Hywel Dda UHB, said: “This is the first but important stage of producing a business case to Welsh Government to try to secure a scale of investment never seen before in this area of Wales.

“The COVID-19 pandemic has re-enforced the need for change, and we believe this is our once in a lifetime opportunity to improve the health outcomes and wellbeing of our population and create a healthier mid and west Wales and hope for the future.”

The PBC is the first stage of business planning to secure support from Welsh Government in order to proceed to far more detailed planning, analysis and recommendations on the detail of how to proceed.

Included at this stage is a prospectus of investment opportunities, which could be realised over the next decade, to fundamentally improve the way in which health and care services are provided, as well as the environments they are provided from. If supported, investment could exceed £1.3billion, which is a level never seen before in west Wales. This is a significant bid but reflects the enormity of the change and improvement being sought for the benefit of our communities.

Proposals within the plan include;

  • the enablement of closer integration and joint working between health and social care, spanning community, primary care (such as GPs, community pharmacists) and hospital services
  • investment in existing or new community hubs (such as integrated care centres) across Carmarthenshire, Ceredigion and Pembrokeshire to bring more care closer to home
  • a new Urgent and Planned Care Hospital, somewhere between Narberth and St Clears, providing a design separation between planned and urgent care that will protect the ability to deliver both types of care and reduce waiting times; and inclusive of mental health services
  • re-purposing or re-build of Withybush Hospital, Haverfordwest; and Glangwili Hospital, Carmarthen, inclusive of GP-led minor injury units, the ability to provide same-day care, and beds for patients who do not need to be in an acute setting but need support
  • improvements and modernisation of Bronglais Hospital, in Aberystwyth, and Prince Philip Hospital, in Llanelli. Bronglais Hospital will continue to provide acute emergency and planned care and Prince Philip Hospital will continue to provide a GP-led minor injuries unit as well as acute adult medical care, consultant-led overnight beds and diagnostic support

Changing the way services are delivered and improving the environments will improve patient outcomes, quality of care and patient experience. By bringing together some services onto fewer sites, such as trauma, emergency surgery and A&E, the health board will also be able to improve standards.

To properly appraise all options, as required by Welsh Government business case process, the next stage would look in more detail at how we re-purpose Glangwili and Withybush Hospitals. This would include options to use the current buildings and location, but also potential to re-build them on site.

Another fundamental aspect of the PBC is a focus on providing better conditions and opportunities for staff, to retain and attract the workforce needed. One of the board’s biggest challenges has been workforce shortages and over-reliance, and cost of, temporary staff.

The health board also wants to maximise the social benefit from the way it works and anticipates the proposed investment would bring significant economic benefits for our communities. For example, the procurement (purchasing) strategy is to increase the proportion of spending with local suppliers or providers that support job opportunities for more vulnerable citizens or local employment, training and apprenticeship opportunities.

The PBC recognises the need to create a digital infrastructure that will enable the health board to connect with patients and service users in all settings, creating a health system ‘without walls’. This would include innovations, such as wearables, more advanced electronic health records, and greater use of technology to simplify processes including admission and discharge.

It is through this transformation that the health board believes its buildings and infrastructure can support NHS Wales decarbonisation strategy.

Mr Moore added: “I understand the strength of feeling and passion for our NHS that our staff and public have and we want to continue to harness that and keep engaging with our communities as we build more detail around these plans.

“To enable a generational shift to a wellness system we need the whole package of prevention and early intervention, at all stages of life. That includes the backbone of strong and sustainable primary and community services; proper provision of rehabilitation and therapies; acute hospital services that are able to provide the standard of provision our communities deserve; and a supported workforce.”

Following a formal endorsement from the Welsh Government, the health board will then move to the next stage of individual outline and final business cases for elements of the programme. There will be a need for regular engagement, and possibly consultation on parts of the programme, with patients, public, staff, and partners.

In the meantime, the health board will continue with the process around site selection and preparation for the new urgent and planned care hospital. We are working with the Consultation Institute to ensure public involvement in the criteria and final scoring of options. We will share progress on this as more information is available. It is hoped a preferred site will be identified in the summer.

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Health

Childhood hepatitis outbreak – four more cases in Wales under investigation

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PUBLIC HEALTH WALES is investigating four more cases of acute hepatitis among children.

Health officials have identified 17 cases in Wales, an increase of four cases since the last update on 6 May.

UK Health Security Agency launched an investigation in April after hospitals reported a rise in cases of acute childhood hepatitis with no known cause.

Typically, UK hospitals see about 20 cases a year that are not caused by common hepatitis viruses, but cases this year are nearly 10 times higher.

A number of hypotheses are being investigated and the information gathered so far increasingly suggests that the rise in these cases may be linked to adenovirus infection, with other factors likely to be playing a role.

Dr Ardiana Gjini, Consultant in Communicable Disease Control for Public Health Wales, said:

“Hepatitis can cause jaundice and inflammation of the liver, so parents and carers should be aware of the symptoms of jaundice – including skin with a yellow tinge which is most easily seen in the whites of the eyes.

“We are reminding the public to familiarise themselves with this and other symptoms of hepatitis in light of these UK cases.

“In addition, the importance of maintaining normal hygiene routines, especially ensuring that children wash their hands properly, help to reduce the spread of many common infections.

“Parents and carers are reminded that they should keep their children away from school and seek advice from a GP or an appropriate specialist if their child experiences any symptoms linked with hepatitis.”

Hepatitis symptoms include:

  • dark urine
  • pale, grey-coloured poo
  • itchy skin
  • yellowing of the eyes and skin (jaundice)
  • muscle and joint pain
  • a high temperature
  • feeling and being sick
  • feeling unusually tired all the time
  • loss of appetite
  • tummy pain

Regular updates on the ongoing investigation into the cases in the UK can be found on the UKHSA website.

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Health

Monkeypox Q&A: how do you catch it and what are the risks? An expert explains

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THE LATEST outbreak of monkeypox has, at the time of writing, reached 17 countries with 110 confirmed cases and a further 205 suspected cases. It’s a fast-moving story, so if you need to catch up on the latest, here are answers to some of the most pressing questions.

How is monkeypox spreading?

The first patient in the current outbreak had returned to the UK from travels to Nigeria where monkeypox is endemic. However, cases are now spreading among people who have not travelled to west or central Africa, suggesting local transmission is occurring.

Monkeypox usually spreads by close contact and respiratory droplets. However, sexual transmission (via semen and/or vaginal fluid) has been posited as an additional possible route. The World Health Organization (WHO) says: “Studies are needed to better understand this risk.”

Most cases in the current outbreak have been in youngish men, but the virus can spread to anyone.

There are no confirmed cases in Pembrokeshire at the present time.

What are the symptoms?

Early symptoms are flu-like, such as a fever, headaches, aching muscles and swollen lymph nodes.

Once the fever breaks, a rash can develop, often beginning on the face and then spreading to other parts of the body – most commonly the palms of the hands and soles of the feet.

Monkeypox lesions.
Evolution of monkeypox lesions. UK government/Wikimedia

How deadly is monkeypox?

Monkeypox is mostly a mild, self-limiting disease lasting two-to-three weeks. However, in some cases, it can cause death. According to the WHO, the fatality rate “in recent times” has been around 3% to 6%. The west African monkeypox virus is considered to be milder than the central African one.

Monkeypox tends to cause more serious disease in people who are immunocompromised – such as those undergoing chemotherapy – and children. There have been no deaths from monkeypox in the current worldwide outbreak, but, according to the Daily Telegraph, one child in the UK is in intensive care with the disease.

Why is it called monkeypox?

Monkeypox was first identified in laboratory monkeys (macaques) in Denmark in 1958, hence the name. However, monkeys don’t seem to be the natural hosts of the virus. It is more commonly found in rats, mice and squirrels. The first case in humans was seen in the 1970s in the Democratic Republic of the Congo.

Is monkeypox related to smallpox and chickenpox?

Monkeypox is related to smallpox – they are both orthopoxviruses – but it is not related to chickenpox. Despite the name, chickenpox is a herpes virus, not a poxvirus. (How “chicken” got in the name is not entirely clear. In his dictionary of 1755, Samuel Johnson surmised that it is so named because it is “of no very great danger”.) Nevertheless, the vesicles (little pus-filled blisters) caused by monkeypox are similar in appearance to those of chickenpox.

Are cases likely to continue rising?

Cases are likely to continue to rise significantly over the next two-to-three weeks, but this is not another pandemic in the making. Monkeypox doesn’t spread anywhere near as easily as the airborne virus SARS-CoV-2 that causes COVID-19.

Has monkeypox evolved to be more virulent?

RNA viruses, such as SARS-CoV-2, don’t have the ability to check their genetic code for mistakes each time they replicate, so they tend to evolve faster. Monkeypox is a DNA virus, which does have the ability to check itself for genetic mistakes each time it replicates, so it tends to mutate a lot slower.

The first genome sequence of the current outbreak (from a patient in Portugal) suggests that the virus is very similar to the monkeypox strain that was circulating in 2018 and 2019 in the UK, Singapore and Israel. So it is unlikely that the current outbreak is the result of a mutated virus that is better at spreading.

How is monkeypox diagnosed?

In the UK, swab samples taken from the patient are sent to a specialist laboratory that handles rare pathogens, where a PCR test is run to confirm monkeypox. The UK Health Security Agency has only one rare and imported pathogens laboratory.

Is there a vaccine for it?

Vaccines for smallpox, which contain the lab-made vaccinia virus, can protect against monkeypox. However, the vaccine that was used to eradicate smallpox can have severe side-effects, killing around one in a million people vaccinated.

The only vaccine specifically approved for monkeypox, Imvanex, is made by a company called Bavarian Nordic. It uses a nonreplicating form of vaccinia, which causes fewer side-effects. It was approved by the US Food and Drug Administration and the European Medicines Agency in 2019 – but only for use in people 18 years of age or older.

UK health secretary Sajid Javid said that the UK government will be stocking up on vaccines that are effective against monkeypox. The UK currently has about 5,000 doses of smallpox vaccine, which has an efficacy of around 85% against monkeypox.

Are there drugs to treat it?

There are no specific drugs to treat monkeypox. However, antivirals such as cidofovir and brincidofovir have been proven to be effective against poxviruses in animals and may also be effective against monkeypox infections in humans.

By Ed Feil, Professor of Microbial Evolution at The Milner Centre for Evolution, University of Bath

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Health

No monkeypox cases identified in Wales say public health officials

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THE UK Health Security Agency (UKHSA) has detected 11 additional cases of monkeypox in England.

The latest cases bring the total number of monkeypox cases confirmed since May 6 to 20.

The new cases come on top of the nine already identified in the country.

There are currently no cases of monkeypox identified in Wales, public health in Wales have said.

Public Health Wales said it is working with the UK Health Security Agency (UKHSA), Public Health Scotland, and Northern Ireland HSC Health Protection Agency to respond to UK cases of monkeypox.

Richard Firth, Consultant in Health Protection for Public Health Wales, said: “We are working closely with our UK partners to monitor and respond to cases of monkeypox in the UK. Monkeypox is a rare disease that has been reported mainly in central and West African countries. No cases have so far been identified in Wales.”

“Monkeypox does not spread easily between people and the overall risk to the general public is very low. It is usually a mild self-limiting illness, and most people recover within a few weeks. However, severe illness can occur in some individuals.”

The first case in the current outbreak was confirmed on May 6.

It is not the first time monkeypox has been reported in the UK.

Three cases were also reported in 2021, two of them in Wales.

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