Written Statement: Establishment of a Major Trauma Network for South Wales, West Wales and South Powys

I am writing to update Members on the progress made in establishing a Major Trauma Network for South Wales, West Wales and South Powys. 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 April 2018 updating members on the health boards’ decision to establish a major trauma network for south Wales, west Wales and south Powys, significant work has been undertaken.

The aim of the major trauma network is to enhance patient outcomes and experience, across the entire patient pathway from the point of wounding to recovery. The network will improve patient outcomes by saving lives and preventing avoidable disability, returning more patients to their families, to work and to education. The network will be a partnership between participating organisations, working collaboratively to achieve this common goal and purpose. The aim is to develop an inclusive, collaborative, world leading trauma network, with quality improvement, informed through evidence-based medicine and lessons learnt from others.

The major trauma programme was established, following an independent expert panel report, public consultation and full endorsement by all 6 health boards in the region.

The major trauma network programme board has overseen the development of the structure of the South Wales Trauma Network, which will comprise:

• An Operational Delivery Network (ODN), to be hosted by Swansea Bay University Health Board, which will provide the management function for the network, and coordinate operational delivery
• A pre-hospital triage tool will 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
• 6 adult and paediatric TUs at the following locations:
  • UHW, Cardiff (for its local population)
  • Royal Gwent Hospital, Newport and Nevill Hall Hospital, Abergavenny (until the Grange University Hospital is fully operational, planned for April 2021, at which point the Grange University Hospital will become the site of a single 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 at Royal Glamorgan Hospital, Llantrisant. This hospital will not routinely receive acute trauma patients but, should this occur, it will ensure appropriate initial management and transfer to the MTC or nearest TU.

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 will also play a critical role in taking patients either home following care in the secondary care setting or onwards for their specialist rehabilitation. The development of 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.

As a consequence of opening the MTC, there will be changes in patient flow which will impact on all providing organisations across the health system. In order to plan for and manage these changes in flow, detailed modelling work has been undertaken to inform the programme business case and to ensure that the network plans to meet this new configuration.

Detailed work has also been undertaken in relation to a number of specialised services which will be required to support the implementation of the MTC. In particular in relation to thoracic surgery, current provision is split across Morriston Hospital and UHW. Following an independent panel review and public consultation in relation to the future provision of thoracic surgery across the region, it was concluded that Morriston Hospital should be a single site for thoracic surgery for Mid and South Wales. An interim solution has been agreed to ensure adequate thoracic surgical presence at the MTC for emergency cases, as the MTC is likely to be operational prior to the wider reorganisation of thoracic surgery. This arrangement will be kept under review while discussions continue on the finer details of the single site model.

The Programme Business Case will be considered within relevant health board and trust meetings during November and will be considered for formal approval at special meetings of the Welsh Health Specialised Services and Emergency Ambulance Service Committees.

Implementation work has already commenced within health boards and the ambulance service and we anticipate the service will commence in spring 2020. The final Go Live date is still to be confirmed as it will be dependent on a number of key infrastructure and staffing issues.

I will of course provide Assembly Members will a further update in the New Year once full consideration/approval of the Programme Business Case has been completed.