Wales faces £466m blow from disability benefit reforms
A SPECIALIST nurse has spoken out as critical care services at Prince Philip Hospital in Llanelli are quietly scaled back ahead of a public consultation — with direct implications for Pembrokeshire patients who rely on Glangwili Hospital for intensive care.
Hywel Dda University Health Board is preparing to launch a consultation on its Clinical Services Plan, which includes a proposal to formally downgrade the Intensive Care Unit (ICU) at Prince Philip Hospital and replace it with an Enhanced Care Unit (ECU).
However, the transition has already begun. The Herald understands that ICU staff are being reassigned, and patients requiring high-level intensive care are being routinely transferred to Glangwili Hospital in Carmarthen — nearly 24 miles away — despite no final decision having been made.
One senior nurse at the hospital told The Herald: 'Staff are being moved off the unit. There are people who need ICU beds but have to wait, as there are none now here. Everyone who needs one has to be transferred to Glangwili.'
The ICU at Glangwili is under significant pressure (Image: File)
She continued: 'They could have bleeds, they are not stable. Not only that, but if they need to be transferred between hospitals, that is done by a specialist NHS service based in Cardiff – the Adult Critical Care Transfer Service (ACCTS), part of EMRTS Cymru. We call them ACCTS. When we sign the paperwork, we can see the Health Board is paying around £6,000 per patient for each transfer. The transport is carried out in a specialist ambulance, including an anaesthetist, doctor, and critical care team, to ensure patient stability during transfer. It's not cheap.'
The nurse also claimed that there are enough skilled staff locally to continue providing intensive care, but the team is being broken up. 'We are a specialised team, and we are being dispersed. The people of Llanelli are being put at risk. For what? To save money.'
She said patients from Llanelli were now overwhelming beds in Carmarthen, leaving Glangwili Hospital with little capacity for new cases. 'Everyone now down at Glangwili are people with Llanelli area postcodes. They should be being treated here near their family, loved ones. And now down in Carmarthen they are chocker – no room to accept new patients, which is going to impact on patients further west into Pembrokeshire.'
This concern is echoed in Pembrokeshire, where Withybush General Hospital still technically retains seven ICU beds. However, ongoing staff shortages and the discovery of unsafe RAAC concrete have meant that many patients requiring critical care from Pembrokeshire are already being transferred to Glangwili. Now, with Llanelli patients added to the demand, access to critical care is under further pressure across the region.
Costly specialist ambulances from Cardiff are used to transport ICU patients between Llanelli and Carmarthen hospitals (Image: NHS)
Hywel Dda University Health Board is expected to launch a 12-week public consultation on its Clinical Services Plan this week, with options that could lead to permanent reconfiguration of hospital services across Carmarthenshire, Pembrokeshire, and Ceredigion. However, documents seen by The Herald confirm that changes such as the ICU downgrade may proceed before consultation results are finalised.
Appendix 7.55 of the Clinical Services Plan states: 'We recognise that the need to respond to service fragility may mean some service change and investment decisions are required ahead of any final reconfiguration, and these will be developed with service, operational and executive leadership.'
Another section of the Plan notes: 'Due to the nature of service provision across Mid and West Wales, it is recognised that a wide range of services have some fragilities. This was a key driver behind the development of the Health Board's strategy which seeks to reduce, if not eliminate, the risks to sustainable service provision.'
Hywel Dda University Health Board's Medical Director: Mark Henwood (Image: Hywel Dda)
Commenting directly, Hywel Dda University Health Board's Medical Director, Mark Henwood, said: 'There has been a temporary change in place for critical care services at Prince Philip Hospital since July 2022. This was approved by the Board because of an inability to safely staff two critical care units with Consultant staff in Carmarthenshire providing care to the most unwell patients. This has meant that the sickest patients have been stabilised and transferred mostly to the Critical Care Unit at Glangwili Hospital.
'The temporary change was needed to improve our ability to safely deliver our critical care services in Carmarthenshire with the staffing available.
'We launched our Clinical Services Plan consultation at our Board Meeting today and Critical Care is one of the services which we will be looking at.
'In the consultation, options A and B propose having fewer intensive care units, and Option C proposes maintaining the current temporary arrangement at Prince Philip Hospital, where the sickest patients are transferred to Glangwili intensive care unit.
'In all options, bringing specialist critical care consultants together onto fewer sites would make the service more sustainable, improve safety, and help meet quality standards for our patients.'
However, critics argue that the Health Board's response amounts to a technocratic justification that fails to meaningfully address community impact, consultation integrity, or patient safety.
Lee Waters MS: 'You can't run a consultation while services are being stripped away'
Lee Waters MS: The people of Llanelli deserve proper, local access to intensive care
Commenting, Llanelli's Member of the Senedd, Lee Waters, told The Herald: 'It looks very much like decisions about critical care at Prince Philip Hospital are being made before the public's had a real say—just like we saw with the overnight closure of the Minor Injuries Unit. That's not how you build trust. The people of Llanelli deserve proper, local access to intensive care, and I'm not convinced the Health Board has a credible plan to deliver that. I've always tried to be reasonable about change, but in this case the case simply hasn't been made. You can't run a meaningful consultation while services are being quietly stripped away.'
Dame Nia Griffith MP: 'This erosion of services by the backdoor has got to stop'
Commenting, Llanelli's MP, Dame Nia Griffith, said: 'I am extremely concerned to hear reports of intensive care services at Prince Philip Hospital being scaled back, because people in Llanelli should be able to access this care here, and not see loved ones taken all the way to Glangwili for services that have hitherto been provided in Llanelli.
'Moreover, the fact that this is happening without there having been any consultation, or even any mention of this, completely undermines trust in the Health Board. I will be seeking an urgent meeting with Hywel Dda health board bosses to seek clarification, and make it absolutely clear to them that they must recognise the need for these services in Llanelli and design their staffing model accordingly, with full teams of appropriately qualified staff based here.
'Everyone knows that they are already struggling for space in Glangwili so it makes no sense to be sending more Llanelli patients up there, and on top of that, there is the cost of transporting patients, the discomfort for the patients and the anxiety and inconvenience for the family. This erosion of services by the backdoor has got to stop.'
Welsh Conservatives: 'Declare a health emergency'
Commenting, a Welsh Conservative spokesperson said: 'The downgrading of ICU services at Prince Philip Hospital before public consultation is unacceptable and undermines trust in the health system.
'The Welsh NHS is in crisis under Labour, with over 10,000 patients waiting more than 12 hours in A&E and two-year waits still unacceptably high, the Welsh Labour Government continues to fail our communities.
'The Welsh Conservatives would declare a health emergency, directing the resources and the entire apparatus of government at the health service, ensuring timely access to care and restoring faith in our Welsh NHS.'
Sam Kurtz, Senedd Member for Carmarthen West and South Pembrokeshire added: 'If any decisions are taken before the consultation has concluded, then both the Health Board and the Welsh Labour Government must be prepared to justify them to a deeply concerned public.
'Recruitment has long been a challenge, one that has only worsened under the shadow cast by ongoing uncertainty over the future of healthcare in West Wales.
'That uncertainty stems from the Welsh Labour Government's continued drive to centralise services, often to the detriment of rural communities.'
Kurtz added: 'Access to critical healthcare should never be a postcode lottery.'
Campaigners: 'Not acceptable – and a shock'
Shocked: Hospital campaigner Cllr Deryk Cundy was not consulted, he said (Image: BBC)
Chair of the SOSPPAN campaign group, Councillor Deryk Cundy, told The Herald that they had raised concerns with Hywel Dda over 'rumours from a separate source' suggesting changes to intensive care were already under way — before any formal decision by the Health Board.
'We have not been directly contacted about these changes,' he said. 'SOSPPAN has been working closely with Hywel Dda trying to find a way forward — recommending a merger of the Minor Injuries Unit and Same Day Emergency Care, operating 16 hours per day, with increased mental health cover available in Llanelli 24/7.'
He said that when combined with the existing 24-hour Acute Medical Assessment Unit, this could improve service delivery in Llanelli and reduce pressure on Glangwili Hospital. However, he described the ICU downgrade as 'a shock' and 'not acceptable'.
'For too long, Hywel Dda management have said departments are unsafe and instead of making them safe, they shut them down — only to reopen them 20 miles away. We will be asking for an early meeting with the Health Board, and if these proposals are confirmed, we will express our determination to prevent any further reductions in service at Prince Philip Hospital.'
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The Herald Scotland
4 days ago
- The Herald Scotland
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The first was that Ms Peggie was carrying out observations on a patient in the resuscitation area when Dr Upton entered the cubicle. Rather than continue, Ms Peggie allegedly "stopped, exited the cubicle and told Beth Upton to complete the observations herself." The second concerned an incident on December 18, when a child left the department without being seen. Dr Upton said they asked Ms Peggie for her "advice and assessment from a triage perspective," but the nurse refused to answer and "chose to speak through a colleague." The third allegation was of misconduct: that Ms Peggie told Dr Upton they "did not have the correct chromosomes to be within a female changing room," and referred to "a recent news story that involved a transgender woman in a female Scottish prison." The fourth was that she misgendered her colleague by referring to Dr Upton as "he/him, including in discussions with colleagues." 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The email, circulated shortly after the Christmas Eve incident, appeared to condemn Ms Peggie outright — before any formal investigation had taken place or Ms Peggie had been asked for her account of events. Dr Searle wrote: "Beth was approached in a very confrontational and aggressive manner by SN Sandie Peggie in the changing room. She stated that she had no right to be in the female changing room, and that Sandie was not the only member of staff who felt this way, and that she found Beth's presence in there intimidating. "She then proceeded to use other offensive terms, including alluding to her presence in the female changing room being akin to the situation of a convicted rapist being housed in a woman's prison earlier this year. "Beth is understandably shaken and distressed by the episode, and indeed felt unsafe and threatened at the time. I have had a long chat with Beth today and ensured she knows we all support her and that we condemn the actions of Sandie." 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READ MORE They took two months off work in March 2024 after learning Ms Peggie was returning to the department. They told the panel they had suffered "daily panic attacks," and that "her wife was concerned about safety at work." "I feel people — especially in this country — can be prejudiced towards trans people," they said. "I was conscious of the potential for this situation to become so much bigger, which it has subsequently done." They said there had "been leaked pre-transition photos of her and harassment of her and her family, all of which has been very distressing." They said journalists had turned up at their door and harassed them and others around them. Personal logs and earlier difficulties Dr Upton kept notes of their interactions with Ms Peggie on their phone. In one entry dated August 2023, they wrote that Ms Peggie had walked into the changing room while they were there and "abruptly walked out" and waited outside. "Can't help but feel slightly off, upset, put off by this. Disappointed it appears that she chose not to enter because of me and didn't think I belonged there. Sad times." A second note, from October 2023, said Ms Peggie again left the changing room when Dr Upton arrived. After the Christmas Eve incident, Dr Upton wrote that they were "distraught." "I feel attacked and cornered. I explained, this is the first time I've experienced anything like this in person." Asked why they kept a log on your phone, Dr Upton said "if you're having difficult interactions with people, that you should keep a track of it." They added that their wife and mother "also advised her to keep a track of difficult interactions and any repeat behaviours." Dr Upton told the panel they were "feeling uncomfortable in the situation and felt it was good to keep track." They also confirmed they "had previous difficulties with a colleague during her FY1 placement, and had kept a log of that." Ms Peggie's legal team sought an order for Dr Upton's phone to be inspected by forensic expert Jim Borwick. However, this was rejected by the tribunal. They wanted to discover the date and time the notes were created and when they were edited. Mr Borwick is due to give evidence on Tuesday. The nurse's response The panel also sent supplementary questions to Ms Peggie. None were about patient safety. The first four were about her general use of pronouns. In a formal reply, Ms Peggie's solicitor, Margaret Gribbon, said a disciplinary hearing should 'proceed on the basis of concrete allegations of clearly specified allegations of misconduct, normally on a specified date. An invitation to an employee to make a general confession is neither usual nor fair." Asked how she refers to Dr Upton, Ms Peggie said: "Beth." She added: "Pronouns are not used to address people, so I do not use pronouns, either preferred pronouns, or correct sex pronouns, to address anybody, patients or colleagues." Asked why she told colleagues before Christmas Eve that she would speak to Dr Upton directly, Ms Peggie said: "No one appeared willing to speak to Beth on behalf of myself or my colleagues. "I hope that by speaking to him personally, he might be able to realise he was making us feel uncomfortable by changing in a female changing area, and the reason why, in the hope he would understand and change elsewhere." She said she entered the changing room to change her trousers, which were soiled due to menstruation, and that the situation made her feel "embarrassed." Asked whether her feelings contributed to the interaction, she said: "Yes." Asked if she had discussed the incident with a supervisor, she replied: "I wasn't upset I was menstruating. "I was upset because my dignity as a woman was being violated because I was being forced to deal with the situation with a male being present in the female changing room at a time when I felt vulnerable and in dire need of privacy and a single-sex space. "I didn't feel comfortable speaking to the staff I was working with, especially as it was a personal and embarrassing matter. I was keen to go home, especially as it's Christmas Day, and discuss my upset with my husband and my family." She said the incident lasted just two minutes and that she hoped the conversation might help Dr Upton understand. Asked why she didn't report the matter, Ms Peggie said: "I was hopeful that Beth would accept my concerns and the reasons why I felt uncomfortable. "I tried to give him an example so he could appreciate the severity of the situation. I told them I had a difficult history with men." 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The National
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The Herald Scotland
6 days ago
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The key points as Sandie Peggie denies racism allegation
Witnesses Dr Espeth Pitt, a consultant in emergency medicine, and Louise Curran, a senior charge nurse - and Ms Peggie's line manager - gave evidence. Dr Pitt was the first person to see Dr Upton after her altercation with Ms Peggie, while Ms Curran gives us insight into Ms Peggie's character. Here are the key points you may have missed from today's session at the Dundee Tribunal Centre, on Friday, July 18. Peggie allegedly made 'racist comment' Ms Curran's begins her evidence by detailing the character of Sandie Peggie. The senior charge nurse told Ms Russell KC that she had heard Ms Peggie had views on "religion, race and politics" through conversations with other staff members. She states that she had heard Ms Peggie was not happy about transgender staff using female facilities, before stating: "I believe there had been a racist comment to one of our junior doctors who is now a consultant." 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Dr Beth Upton was 'crying so much' Dr Pitt, who saw Dr Upton shortly after the altercation reportedly took place, said the medic appeared "very shaken and visibly distressed and upset". The tribunal heard that Dr Upton's demeanour was "different" compared to how the medic had been earlier while on shift. Dr Pitt took Dr Upton into the wellbeing room where Dr Upton gave an account of the incident with Ms Peggie. We heard that Dr Upton believed a "very upsetting interaction" had taken place, with Dr Pitt telling Jane Russell, KC, who represents NHS Fife, that Dr Upton felt "very cornered". Dr Pitt recalled the conversation had something to do with "likening" Dr Upton's use of the female changing room to "the situation with a convicted rapist". The consultant said: "I clearly remember just feeling very, very, very sad because that must have been so hurtful to hear. I felt very sad when I heard that comment. "I had to comfort Dr Upton. She was crying so much." Dr Pitt then walked Dr Upton to their car to ensure that if an encounter happened with Ms Peggie, it could be de-escalated. There was some back and forth in cross examination from Charlotte Elves, who was standing in for Naomi Cunningham. Ms Elves suggested Dr Pitt did not consider the incident so serious, otherwise she would have immediately escalated it. Dr Pitt did not agree with this. She did what she thought was right on Christmas Eve, she said. Peggie's actions 'condemned' in mass email The tribunal heard that Dr Pitt was among 20 consultants to receive an email from Dr Kate Searle, who was also Dr Upton's line manager. In that email, details of the incident on Christmas eve were shared. Dr Pitt defended this email, arguing it was simply sent to notify consultants that Dr Upton's shifts could be changed and that the medic may appear upset at work. However, when it came to cross examination from Ms Elves, we learn Dr Searle "condemned" the actions of Ms Peggie in the mass email. Read more: The barrister asks whether it is fair to take a side in this kind of dispute but Dr Pitt said she did not see it as taking sides. The email specifically said "we support" Dr Upton, suggesting Dr Searle was speaking on behalf of around 20 consultants, Ms Elves said. "That's an email condemning Sandie's actions to 20 of the most senior clinical staff," Ms Elves said. Neil Gray has 'confidence' in NHS Fife It may not be surprising that Neil Gray has confidence in the under fire health board. He has said it before when quizzed on the details of the tribunal. But he was asked by The Courier whether his opinion had changed since Ms Peggie was cleared by the health board of four allegations of gross misconduct, relating to her dispute with Dr Upton and patient care concerns. Mr Gray said "of course" he had "confidence" in the health board's ability to continue to deliver NHS services to Fife residents. 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