Written Statement: Establishment of the South Wales Trauma Network and ‘go live’ date

I am writing to update Members on the establishment of the South Wales Trauma Network (SWTN) which will cover South Wales, West Wales and South Powys and to advise you that the new arrangements will go live on 14 September 2020. 

Members will be aware that patients in North Wales and North Powys already have access to the Major Trauma arrangements as part of the North West Midlands and North Wales Major Trauma Network. Powys residents also feed into the Birmingham, Black Country, Hereford & Worcester Trauma Network.

Since I issued a written statement in November 2019 updating members on the progress establishing a major trauma network for South Wales, West Wales and South Powys, work has been undertaken to finalise the implementation ready for go live.

The Programme Business Case was considered within relevant health board and trust meetings during November 2019 and was formally approved by the Welsh Health Specialised Services Committee (WHSSC) in January 2020.

The Welsh Government provided £3.717 million capital funding in 2019/20 to support the development of the polytrauma ward, expand resuscitation capacity within the emergency department and provide additional equipment within emergency department/critical care/theatres within the major trauma centre at University Hospital of Wales, Cardiff.

I have now agreed £13.186 million in 2020/21, rising to £13.280m recurrent revenue funding from 2021/22 to meet the costs for the major trauma centre, specialised services, pre-hospital and network elements of the programme business case.

It was originally hoped that the SWTN would go live in Spring 2020, but a decision was taken to delay due to the impact of the coronavirus. In the meantime, the Operational Delivery Network (ODN) has developed a surge plan and guidance, utilising the experience of trauma networks in England during the first wave of coronavirus, to help ensure that the network is prepared and can function during any future waves. The ODN has also worked closely with health boards, ambulance service and Emergency Medical Retrieval and Transport Service Cymru (EMRTS) to ensure they will be operationally ready for the proposed new go live date and consider any impacts on pathways/services in light of the coronavirus.

At the WHSSC Joint Committee on 14 July, health boards/trusts agreed that whilst minor changes in the delivery of some areas were required to mitigate the impacts of coronavirus, the necessary infrastructure and governance arrangements are now in place for the SWTN to go live from 14 September 2020.

The South Wales Trauma Network (SWTN) consists of:

• An Operational Delivery Network (ODN), hosted by Swansea Bay University Health Board, providing the management function for the network and coordinating the operational delivery
• A pre-hospital triage tool to ensure major trauma patients are conveyed directly by Welsh Ambulance Services NHS Trust (WAST) or the Emergency Medical Retrieval and Transport Service Cymru (EMRTS), or other emergency providers, to the Major Trauma Centre (MTC) or Trauma Unit (TUs)
• An adults’ and children’s MTC at University Hospital of Wales (UHW), Cardiff. The MTC will have access to all specialist services relevant to major trauma. It will take responsibility for the acute care of all major trauma patients in the region via an automatic acceptance policy and manage the transition of patients to rehabilitative care. It will collaborate with and support other hospitals in the network
• An adult and paediatric TU, with specialist services, at Morriston Hospital, Swansea. It will provide specialist support to the MTC and provide specialist surgery for patients who do not have multiple injuries, for burns, plastic, spinal and cardiothoracic surgery
• Five adult and paediatric TUs at the following locations:
  • UHW, Cardiff (for its local population)
  • Royal Gwent Hospital, Newport (until the Grange University Hospital is fully operational at which point the Grange University Hospital will become the designated TU for the Aneurin Bevan University Health Board)
  • Prince Charles Hospital, Merthyr Tydfil and Princess of Wales Hospital, Bridgend
  • Glangwilli Hospital, Carmarthen
• The TUs will provide care for injured patients and have systems in place to rapidly move the most severely injured patients to hospitals that can manage their injuries, in most cases the MTC. They will have a role in receiving patients back who require ongoing care in hospital and will have a suitable ‘landing pad’ via an automatic acceptance policy
• Rural trauma facilities at Bronglais General Hospital, Aberystwyth, and Withybush General Hospital, Haverfordwest. Whilst there are no specific quality indicators for a rural trauma facility, Hywel Dda University Health Board is committed to ensuring these hospitals maintain the ability to assess and treat major trauma patients, given their relatively unique geographical locations
• A Local Emergency Hospital (LEH) at Royal Glamorgan Hospital, Llantrisant and Nevill Hall Hospital, Abergavenny. A LEH does not routinely receive major trauma patients. However, it has processes in place to ensure that if this does occur, patients are appropriately managed and transferred to the MTC or nearest TU. These hospitals will continue to receive both moderate trauma and isolated orthopaedic trauma. It has been confirmed that the Royal Glamorgan Hospital will maintain a 24/7 Emergency Department with associated acute services. The Local Emergency Hospital at Nevill Hall Hospital will be maintained until such time the Grange University Hospital is opened.

For the vast majority of patients who suffer major trauma, their first contact with NHS Wales will be with the ambulance service or EMRTS when they receive initial care at scene. The ambulance service also has play a critical role in taking patients either home following care in the secondary care setting or onwards for their specialist rehabilitation. The trauma triage tool and the major trauma desk will help ensure patients are taken directly to the most appropriate hospital.

The trauma unit at Morriston Hospital will also have a role in providing specialist services support to the network (e.g. orthoplastics, spinal surgery, level 1 rehabilitation). In addition the trauma unit in ABUHB will provide a spinal service for some trauma patients.
 
Considerable work has taken place within health boards, the ambulance service, EMRTS, commissioners and the network to ensure the service is ready to go live on 14 September 2020. The fact that we have been able to move forward with this service development at the current time is a significant achievement for NHS Wales and testament to the hard work of all those involved.  I want to thank all those people for the role they have played in bringing this important service to the people of south Wales.  
 
This statement is being issued during recess in order to keep members informed. Should members wish me to make a further statement or to answer questions on this when the Senedd returns I would be happy to do so.