At an open meeting recently organised by Tenby Town Council, there was strong backing for the fight to keep the Tenby Cottage Hospital Minor Injuries Unit open.

The main business of the evening centred on the response of the South East Pembrokeshire Community Health Network (SEPCHN) to the Health Board proposals and there was a strong demand to share this viewpoint in an effort to inform the public of the implications of the proposals.

Below, SEPCHN chairman, Mr. Mansel Thomas, gives a detailed response following the meeting, and the main arguments for the rejection of the Board proposals and retention of the present service:

GP participation has not been agreed -

• Saundersfoot GP practice has indicated its opposition to the proposal. They have stated the closure of the TCH MIU would be significantly deleterious to the health needs of the local population and indeed the visiting holiday population. Tenby GP's have also said they share the concerns of the general public over the proposals. How can the Hywel Da Health Board ignore such medical opinions? In any case, the doctors have a nationally agreed contract which would have to be renegotiated before any changes could occur.

A detrimental effect on Minor Injury Unit opening hours which will be insufficient -

• One of the main problems with the proposals is that the opening hours and therefore the available service will be drastically reduced from the 8 am to 10 pm, seven days a week opening that the unit has offered. This would mean a lack of MIU provision for most of the evenings, weekend period and Bank Holidays, which are so busy and important to the local economy.

The Health Board has not researched in sufficient detail the effects of the closure on the community of South East Pembrokeshire -

• The proposed changes would have serious effects on the community.

• The resident population within five miles of Tenby Cottage Hospital is now approaching 20,000 people, according to census estimates. This is probably the largest concentration of rural population within the Hywel Dda Health Board area.

• The summer population increases to over 50,000 people as visitors flock to the area. As ours is a National Health Service, they too require care whilst in Pembrokeshire. The MIU supports the main industry of our community, which is tourism, and the Health Board plans threaten its prosperity.

• For most of the weekend period, the nearest minor injury service will be at Withybush Hospital in Haverfordwest, some 23 miles away, or alternatively at Glangwili Hospital, in Carmarthen, 27 miles away. Of all the Pembrokeshire towns, according to AA figures, this is the furthest to travel for a hospital service and therefore the Health Board is proposing that the largest concentration of rural population in the county travels the furthest for this service. This is ironic considering the Board's aim of bringing 'Care Closer to Home'.

• The nature of the population in SE Pembrokeshire is also important to consider. According to the latest census figures available, 25.65 per cent is over 65 years of age, 10.9 per cent report that they are not in good health, and 22.3 per cent report a limiting long term illness. It is these people who require a service close to home not involving complicated journeys to a hospital for minor injuries treatment.

• The problems are compounded when other factors are considered. Car ownership is low. In the two Tenby County Council wards, 40.5 per cent and 29.6 per cent are without their own car transport.

• The transport system is often poor. The bus service from Tenby to Withybush takes 1.5 hours and from Amroth an additional 30 minutes. From Amroth there are only three summer Sunday services and there are no winter services.

• A single taxi service from Tenby to Withybush costs around £40, with £15 an hour waiting time. It could be possible for a hospital visit to cost nearly a £100.

• In a recent meeting, a Board medical director, Mr. Robertson Steel, when questioned about such problems, advised the people of this area to buy first aids kits and start saving £20 notes for the fare. Is that the level of service the Hywel Dda Health Board plans for this area?

There will be a detrimental effect on this rural population, (by definition fewer than 10,000 inhabitants) which brings into question the role of the Welsh Government Rural Health Plan -

• These are situations that the WG Rural Health Plan highlights in its report, but the problems do not appear to have influenced the thinking of the Hywel Dda Health Board which appears to be creating a situation where the disadvantaged in society are further being penalised. Is there need for a Strategic Needs Assessment?

The use made of the Tenby Cottage Hospital MIU has not been sufficiently considered -

• The Tenby facility has the busiest minor injuries unit in the Health Board area. In the technical paper provided by the Board, are figures for the last full year of operation, 2010/11, in which 5,324 patients were treated.

• During the enforced closure in 2012, 22.8 per cent of admissions to Withybush A and E came from South Pembrokeshire. Not only is this not an insignificant number, but also it illustrates the numbers forced to make a substantial journey to receive minor injury treatment. According to information provided to the SEPCHN, if the nurse-patient ratio be compared in the two bases, then the use of the Tenby MIU is not inconsiderable.

• Figure 14 of the technical paper also illustrates the seasonal nature of use of the Tenby MIU, with very high figures for the summer months, illustrating once again the importance to the local tourist industry. The question arises as to how the surgeries would cope with this seasonal influx and are there sufficient facilities to cater for them?

• Moving the service five yards from state-of-the-art Tenby MIU facilities to a location in the GP surgery that does not have them can only bring a diminished level of service. The proposal beggars belief.

What efforts are being made to train and recruit the large number of Emergency Nurse Practitioners required for this new system -

• At the beginning of 2012, the south county units were closed because of staffing shortages at Withybush A and E. As well as a consultant shortage, there was a shortage of Emergency Nurse Practitioners, who are specially trained nurses who man the unit. The MIU's in the south of the county were closed in order for the units' ENP's to support the A and E. Despite assurances that more nurses were to be trained for these positions, there is very little evidence that this has occurred, as in its plans, the Health Board envisages the nurses to be based at Withybush on a full-time basis. In its plans for GP surgeries to undertake minor injury work, there are statements that all surgeries will have trained nurses for this function. Where is the evidence for the training and appointment of these vitally important personnel and what are its timescales?

The Health Board is wasting its resources by closing the Tenby MIU -

• The Tenby MIU has up-to-date facilities based in modern premises. There appear to be no plans to utilise these superb arrangements. In its plans, the Health Board emphasises, 'the need to make best use of its resources'. The Board is failing in a major way in this regard and is guilty of wasting its resources. At the same time, the Hywel Dda Health Board states that one of the challenges it faces is that, '...Too many people use our emergency and urgent care departments when they could access more appropriate care through other services'. Surely by closing the Tenby MIU this will mean even more people using A and E.

The HDHB has failed to consider public opinion -

• It was only nine months ago that a petition of 2,500 South East Pembrokeshire signatures was presented to the HDHB protesting at the closure of the MIU and demanding its reopening. This has been totally ignored by the Health Board.

There is a total lack of flexibility in the Board's planning -

• Why is the Board attempting to enforce one simple model for the whole area it covers? There are different circumstances throughout which demand a more flexible approach. The South East Pembrokeshire and Tenby area is an unique case, as described earlier, and which warrants a different form of provision. The impression is given that there are individual Board members blindly tearing apart a successful working system without careful investigation of local needs. It is resulting in a 'Lowest Common Denominator' approach which will seriously damage minor injury provision in this part of the county.

The proposed new system will bring additional costs and not bring about savings -

• The need for additional facilities and training of specialist staff in the new locations will mean additional costs. It is also very likely that ambulance expenditure will also increase. It seems unlikely there will be savings.

"For these reasons, the Health Board's proposed plans are being opposed and the retention of the Tenby Cottage Hospital Minor Injury Unit demanded," explained Mr. Thomas, urging anyone who agrees with the views outlined from the SEPCHN meeting, to make every effort to return the Health Board questionnaire stating that they strongly disagree with the proposals.

Anyone who wishes to help by distributing and collecting questionnaires in their organisation or street or road is also asked to please contact the Tenby Town Council offices at the De Valence Pavilion where forms can be collected.

Forms can also be obtained from the Tenby Library.

Alternatively, the questionnaire can be accessed on line at http://www.hywelddahb.wales.nhs.uk/consultation">www.hywelddahb.wales.nhs.uk/consultation

"Please try your best to help, as every questionnaire returned counts, and the fight continues," added Mr. Thomas.