NHS local community hubs

I appreciate that Casdon and your working knowledge of the service.

However the Labour administration have had over two decades to improve, not worsen, things in our area and if that had happened under the Tories they’d have been crucified!

I take no pleasure in any of this plummeting of service as my DH is politically opposed to my father and both in dire need of prompt healthcare- I count myself fortunate in my good health .

That’s not a Wales wide issue Pantglas. One of the challenges of the NHS is that every service is only as efficient as the people providing it at every level. I know you have the misfortune of living in a poorly served area from an NHS acute services perspective, and if results are not read and acted on it is very likely down to a local failed pathway, not the service model.

“That's what happened with me. The locum referred me immediately and I was given an appointment within days at a local hub. The photo was sent to a doctor at the hospital and I was told on the same day that it looked very much like cancer and I was given an appointment for a biopsy, followed by the actual excision. I can't remember exactly how long it all took but it was less than a month from contacting the GP via econsult to the final op.” Growstuff

Sounds marvellous but here in Wales things don’t run as brilliantly under a long time Labour administration. Latterly where DH photo of problem took more than 3 months in a meandering process whereby it grew exponentially to the point a major procedure was necessary where a previous episode was excised under GP appointment.

Not everything is improved by change.

woodenspoon

I’ve just seen this on the BBC. It seems a really good move going forward. Will it work? Is the money there to do it? On the face of it, care will be more localised which can only be beneficial.

Here is the complete 10 year NHS health planhttps://email.change.nhs.uk/c/eJwcyzuS4yAQANDTiAwX3XwVEGyia7ha0FjsYORisFVz-62d8AUvtXvmVj88fu41xxQUGHZehkIsDVOWVDRKIlAKYQWAIlK7T-7U5_9hMGhYiaVPu5NGrU4SBi29xhV2sM4FI3IsaC0KjuAtOGs9WHFEDR6wpMyemPMazKpYJTaEbgevtKjRBRfQosZQdLiDttkaUNbZsi9GQdodKnarM-r2pNpEi8ecr-9F_1lwW3C7ruv2OD-399eC2-P88OhP7nPB7fXeW00069m_F9xAyR-mIQ-mNg_5atRlOYfk_mjUsyx1_noeLMt7vgeLEa_ae-Wvv8RjMWqftU8enectnU_xifgvAAD__2faayk

Casdon

One of the services local hubs can provide is clinical photography, which is extremely useful for dermatology patients, because it enables the consultant to remotely view a larger number of moles and lesions and decide who needs what treatments. I’m guessing, but I would think this would be an area where AI could be useful in diagnosis in the future too.

That's what happened with me. The locum referred me immediately and I was given an appointment within days at a local hub. The photo was sent to a doctor at the hospital and I was told on the same day that it looked very much like cancer and I was given an appointment for a biopsy, followed by the actual excision. I can't remember exactly how long it all took but it was less than a month from contacting the GP via econsult to the final op.

Allira

growstuff

ronib

I always thought that surgery was a completely different kettle of fish to more minor non surgical procedures. The waiting lists will be completely separate. So I am questioning whether in reality space will be freed up as suggested?

Not necessarily. There are minor surgical procedures which, even now, can be done in GP surgeries. Not all surgery requires high-tech operating theatres.

When I had a skin cancer removed, it was done in a room with no equipment apart from an operating bed. It did take place in hospital, but could quite easily have been done in a cheaper hub somewhere.

25 years ago our GPs would have done this but certainly not any longer. A nurse at the practice completely missed DH's melanoma and said it was fine, wait and see.
I persisted with the GPs and when he saw the Consultant Dermatologist she was horrified.

A GP originally missed my melanoma a couple of years ago. It was on my back during Covid lockdown. After reluctantly giving me a face-to-face appointment, the GP dismissed it. It was only because I eventually managed to get somebody to take a photo of it and then compared it with a photo two years later that I went back to the GP. Fortunately, a locum put me on the two-week fast track pathway. A regular GP also dismissed my breast cancer symptoms. Sorry to say, but some GPs are better than others.

One of the services local hubs can provide is clinical photography, which is extremely useful for dermatology patients, because it enables the consultant to remotely view a larger number of moles and lesions and decide who needs what treatments. I’m guessing, but I would think this would be an area where AI could be useful in diagnosis in the future too.

growstuff

ronib

I always thought that surgery was a completely different kettle of fish to more minor non surgical procedures. The waiting lists will be completely separate. So I am questioning whether in reality space will be freed up as suggested?

Not necessarily. There are minor surgical procedures which, even now, can be done in GP surgeries. Not all surgery requires high-tech operating theatres.

When I had a skin cancer removed, it was done in a room with no equipment apart from an operating bed. It did take place in hospital, but could quite easily have been done in a cheaper hub somewhere.

25 years ago our GPs would have done this but certainly not any longer. A nurse at the practice completely missed DH's melanoma and said it was fine, wait and see.
I persisted with the GPs and when he saw the Consultant Dermatologist she was horrified.

Thanks Elusivebutterfly. Obviously some people have always had further to go than others but distance and lack of suitable transport, now and in the future, is a problem.

There are people who volunteer but this doesn't always work and I think they would need many more volunteers to cover regular local visits.

I think it's a problem as there simply isn't enough frequent public transport. That area (transport) is devolving to the Combined Authority Mayors so we will have to look to our own locality, but I think it will take some time.

PoliticsNerd

^The problem is that you have to go there now for things GPs used to do.^

In what way is that a problem Elusivebutterfly? Is it difficult to get to?

Politics Nerd: The GP is a few minutes walk away. To get to the bigger centre, you walk past the GP surgery to the bus stop, wait for the bus, then 20/25 minutes on the bus. This is not good if you are feeling unwell or have to go regularly for dressings etc. Also you have to wait a couple of hours there. I live in a city so traditionally have had services near me.

Our GP surgery used to offer minor ops like mole removal but that stopped ages ago, and patients are now referred to dermatology. Surely it must be cheaper to do it in the surgery?

I've had a couple of moles removed by a GP. One in the initial appointment ('Oh, I don't like the look of that. Shall we get it sent for testing?' and off it came), and the other needed a separate appointment on a dedicated minor surgery day as the system changed. Neither needed treatment, but it does seem as though things take longer and get less convenient as time goes by, and having several appointments must also increase costs?

We are also providing advanced care that would have been unbelievable when the NHS was born in 1948. I have a friend who could never have expected to survive until now but 3 kidney transplants have ensured they could be part of the family and see his children grow up.

When I was born, small for gestational age, not many under 3lb 5oz survived. Now babies who are "extremely low birthrate" - under 2lb 3oz often survive.

My twin whoo was born with spina bifida and hydrocephalus sadly died soon after birth. If they had survived there was only primitive surgery and the likelihood of being sent to a home. Now such children can have full lives. Progress has got to the stage of surgery in the womb.

With all this progress we have also moved forward with minor illnesses and conditions. Some can be treated by ready available over the counter medicines, by nurses or those trained in specialist areas.

Change has happened and changes in the system are needed to take account of that.

Exactly GrannyGravy. I had a raised mole removed at the GP surgery years ago. It was sent off for testing, but came back negative. I only had this mole removed in hospital because it was a confirmed melanoma. The initial assessment was done at a hub. It didn't need a general anaesthetic, so the actual op could also have been done at a hub.

woodenspoon

Yes, I go to one of those myself. I expect it’s different depending on which hospital you have your surgery. Mine was on a ward specifically for the purpose.

Yes, I expect all hospitals organise their wards differently. I was only on the ward for a couple of hours and didn't need anything specific for breast cancer.

growstuff

ronib

I always thought that surgery was a completely different kettle of fish to more minor non surgical procedures. The waiting lists will be completely separate. So I am questioning whether in reality space will be freed up as suggested?

Not necessarily. There are minor surgical procedures which, even now, can be done in GP surgeries. Not all surgery requires high-tech operating theatres.

When I had a skin cancer removed, it was done in a room with no equipment apart from an operating bed. It did take place in hospital, but could quite easily have been done in a cheaper hub somewhere.

I have had three suspect moles removed by my own GP in his room at our GP practice.

So much easier, quicker and fitted it in around work and school pick-ups.

ronib

I always thought that surgery was a completely different kettle of fish to more minor non surgical procedures. The waiting lists will be completely separate. So I am questioning whether in reality space will be freed up as suggested?

Not necessarily. There are minor surgical procedures which, even now, can be done in GP surgeries. Not all surgery requires high-tech operating theatres.

When I had a skin cancer removed, it was done in a room with no equipment apart from an operating bed. It did take place in hospital, but could quite easily have been done in a cheaper hub somewhere.

Sorry, that was in reply to growstuff.

Yes, I go to one of those myself. I expect it’s different depending on which hospital you have your surgery. Mine was on a ward specifically for the purpose.

Our minor injuries department were nothing but fantastic when I had my accident in February.

I checked before if my injuries were within their remit, they confirmed, so DH drove me there.

I had multiple X rays, one knee stitched (inside and out) put in a thigh to ankle splint, the opposite foot was fractured so I had a surgical boot, I declined crutches as I knew I had some at home.

Antibiotics and painkillers given to me, in and out and back home on the sofa with a nice cup of tea a couple of hours.

If I had gone to one of the teaching hospitals I would have been there for a minimum of 8-10 hours.

growstuff

Casdon

Pippa000

I have just looked the Neighbourhood Care Centres up. They are only in one Health Board in Wales.

See my response to your previous post, they are called different names in different places in Wales, but they exist everywhere, all operate to the same Welsh Government guidance.

I did a quick Google and I also found some in different parts of Wales. I don't think they're the same as the proposed hubs anyway.

I think they are the same thing fundamentally, although the physical hubs for the networks to do not exist everywhere in Wales yet, ultimately it is planned that they will. It can’t be a rigid model, because the needs of populations vary, and geography plays a big part in how best to deliver services at local level, which will be the same in England, hence the varied pilots.

woodenspoon

ronib

Oh did I misunderstand Politics Nerd … what we once needed hospitals for ….. etc?
So if we still need hospitals Casdon let’s make sure that they are funded and fit for purpose?

Nobody is suggesting otherwise are they. What is being proposed is that minor things are treated in the community at the new hubs and, as a result, it will free up space so urgent ops will get done faster in the main hospital. I don’t understand why anybody would be against this happening.
Breast surgery is major. I know. This will take place in a cancer ward for breast surgery.

My breast surgery didn't actually take place in a cancer ward or one for breast surgery.

The ward was a general ward for people having day surgery. I don't think the operating theatre was specifically for breast surgery either. Obviously, the surgeon was a specialist oncoplastic breast surgeon.

However, the place I visit most often most definitely is a specialist breast clinic. I visited before the procedure and have regular follow-up. Usually, I see a specialist nurse but if there are any issues, a doctor can be called or I can have scans, the equipment for which is onsite and can be accessed quickly. It's designed to be "one stop".

growstuff

I agree with you Doodledog. I think they need to be looked at because they would surely offer a cost-effective solution to some social care issues. The issues aren't going to go away.

Also, if elderly patients knew there was this option they might be that much keener to be discharged.

I always thought that surgery was a completely different kettle of fish to more minor non surgical procedures. The waiting lists will be completely separate. So I am questioning whether in reality space will be freed up as suggested?

Next thing you know, they will have G.Ps and midwives makinng house-calls!

ronib I don’t know how the position can be explained to you any more clearly. Do you understand that there is a separate programme for acute hospitals, as discussed above? Your local acute hospital has not been prioritised in the programme, if I remember the previous threads about it correctly. That is a government decision, and I’m afraid that although you disagree with it, the reality cannot be changed by you trying to cloud discussions about other elements of service by repeatedly bringing the issue of your local hospital up on Gransnet. Sorry to be so blunt, but I don’t know how else to convey it after all the previous attempts have failed.