Annex A > Chapter 11 - Referrals > Referrals to Bristol from South Wales
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Referrals to Bristol from South Wales
The catchment area
139 Mr Peter Gregory, Director, NHS Wales, explained why referral patterns from Wales differed by area, and thus why it was essentially South Wales that fell within the Bristol catchment area:
`... there are quite significantly different patterns of referral, for reasons which obviously spring from geography. The natural connection, socially and economically and in the NHS for North Wales is to the major conurbations in the north west of England and there has been traditionally a significant dependence on Liverpool for this service and Manchester and Liverpool for a variety of tertiary specialist services. Mid-Wales often drains down into Birmingham, although there are connections to the south; and South Wales, at this time, would be dependent ... on the significant hospitals in the south of [England].' [143]
140 The South Glamorgan Health Authority's Approval in Principle Submission entitled `Regional Cardiac Service for Wales' [144] described the paediatric cardiology clinics available to children resident in Wales in June 1986:
`North Wales is served by cardiologists from Liverpool who carry out 22 clinics per year. Clinics are held in Wrexham, Rhyl and Bangor.
`Mid Wales receives a visit from a cardiologist from Cardiff who performs a clinic in Aberystwyth 4 times a year, seeing mainly adults, but small numbers of older children also.
`South Wales is served principally by one cardiologist from Cardiff who, in addition to holding weekly paediatric clinics in the University Hospital, performs clinics in Newport (12/year), East Glamorgan (3/year), Camarthen (5/year), Swansea (3/year) and Pontypridd (4/year). In addition, a cardiologist from London performs clinics in Bridgend 5 times per year, seeing patients referred from paediatricians in Bridgend, Swansea, Neath and Pontypridd.' [145]
141 The document also identified the patterns of referral to cardiologists in June 1986:
`Gwynedd, Clwyd, Northern Dyfed and Northern Powys: All neonatal and infant emergencies and almost all older children are referred to Liverpool. Small numbers of older children from Northern Dyfed are referred to Cardiff.
`Southern Dyfed: Almost all children are referred to Cardiff.
`West Glamorgan: Almost all neonatal and infant emergencies are referred directly to London, the majority going to the Hammersmith Hospital and the remainder equally divided between the Brompton Hospital, the National Heart Hospital and Great Ormond Street Hospital. Of the 4 paediatricians in West Glamorgan, 2 refer all their older children to a visiting cardiologist from the Hammersmith Hospital at her Bridgend clinic and 2 refer some older children direct to London but most to Cardiff.
`Mid Glamorgan: Most neonatal and infant emergencies are referred directly to London; a small number go to Cardiff. Three of the five paediatricians refer their older children to the Hammersmith cardiologist at Bridgend. The other 2 refer to Cardiff.
`South Glamorgan: Almost all neonatal and infant emergencies and older children are referred to Cardiff.
`Gwent and Southern Powys: Most neonatal and infant emergencies are referred to Cardiff except when the paediatric cardiologist is unavailable, in which case they are referred to Bristol (very small numbers). Most older children also go to Cardiff apart from those living in the Chepstow area who are referred to Bristol.' [146]
Referrals for surgery were described thus:
`All children requiring cardiac surgery seen by cardiologists in England or visiting from England are referred for surgery to their surgical colleagues in England. Of children requiring surgery referred to Cardiff, two thirds are referred to cardiac surgeons in Cardiff, the remaining third being shared between surgeons at the Brompton Hospital, Harefield Hospital, Great Ormond Street Hospital and the National Heart Hospital.' [147]
142 Professor Crompton told the Inquiry that in his view there had been little immediate impact on referral patterns after the designation of NICS as a SRS in 1984. [148]
143 Mr Gregory told the Inquiry [149] that he was not aware that referral patterns changed at all between the 1981 Working Party Report [150] and the time when the Approval in Principle document was submitted.
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Footnotes
[144] South Glamorgan Health Authority's Approval in Principle Submission, `Regional Cardiac Service for Wales', is discussed in detail in Chapter 7
[145] WO 0001 0148; South Glamorgan Health Authority's Approval in Principle Submission: `Regional Cardiac Service for Wales'
[146] WO 0001 0148 - 0149 ; South Glamorgan Health Authority's Approval in Principle Submission: `Regional Cardiac Service for Wales'
[148] WIT 0070 0002 Professor Crompton
[150] The Working Party was set up in 1979 to report on cardiothoracic services in Wales. It reported in 1981. Its report is considered in detail in Chapter 7