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'We're very busy' - inside Wales' newest hospital
ByOwain ClarkeWales health correspondent and Michela RivaBBC Wales
Updated 3 hours ago
It is the £350m "super hospital" that has been slammed as "dangerous" and a "disgrace" on social media.
At just six years old, the Grange University Hospital in Cwmbran has already come under fire for long delays, overcrowding, staff shortages and the quality of its care.
But senior staff insist it's one of the safest in Wales on patient safety and survival rates.
BBC Wales spent the day on the frontline at the hospital as 999 calls came in.
Image source, Aneurin Bevan University Health Board
Image caption,The Grange has arguably the best view of any hospital in Wales
The PA announcement in A&E is clear, somebody's life is in danger and they'll soon be arriving by ambulance.
But all eight beds at the Emergency Department's (ED) resuscitation unit, where the sickest patients go, are already full.
Staff have to decide quickly which patient to move.
But two similar "crash calls" have already come in by ambulance, as well as someone who walked into an already-full reception having a suspected heart attack.
Overall there are more than 90 patients in the department with the longest wait about 18 hours.
Image caption,Medical staff in resus swarm a patient supported by an Air Ambulance crew
"We're currently over capacity," says Dr Zoe Morgan-Pittard, who is so busy that she's placed stickers on her arms to remind her who she's been assessing.
"We've had to move three patients already who probably aren't well enough.
"But the sickest patients have to take priority, we're having to make fluid decisions.
"We're putting patients in any extra space we can find... but there's a lot of block and very little flow.
"Everybody is working hard, but unfortunately the hospital isn't big enough."
Image caption,Margaret Giles slipped while helping her granddaughter, whose husband had suffered a serious medical emergency
One of those extra spaces is located behind some cubicles at the back of A&E.
Margaret Giles, 84, from nearby Croesyceiliog, has spent the past nine hours on a trolley after slipping and injuring her hip.
"It's not satisfactory, but needs must," she says.
But Alan, Margaret's husband, is angry.
"I went to see the lady at the desk [during the night] because she wanted to go to the toilet… and [the lady] said, 'can't she walk to the toilet?' I said 'no, it's a suspected broken hip'."
There is relief when X-rays show Margaret's hip isn't broken, and soon she'll be able to go home.
Staff tell us there are strict criteria, meaning only the least sick patients can be kept in these open spaces, but it's an experience both Margaret and Alan don't want to repeat.
"We've never been in here before," Alan gestures, "it's the first time for me, and hope it's the last.
"I don't think it's the staff, it's the system."
Image caption,Margaret Giles spent the night in a corridor with her husband Alan by her side
One reason people are treated in open spaces is to free up ambulances arriving outside. We counted at least eight waiting outside during our visit.
But, previously, crews could expect to spend an entire 12-hour shift waiting to hand over patients. Now, the target is to release them within 45 minutes.
On the day of our visit, because of the pressures, 33% of the ambulances were released within 45 minutes, but it was 67% for the previous 30 days - a huge improvement compared to before.
"We've seen a vast improvement," Darren Panniers of the Welsh Ambulance Service says.
"We are responding to patients quicker in the community, particularly around calls which involve stroke and heart attacks."
Image caption,Ambulances could be seen queuing outside the hospital's A&E but handover times have improved
But the efforts to release ambulances also involves improving the flow of patients through and out of the entire hospital.
Surgical teams now go to A&E to spot the patients they can treat more quickly, while urgent patients needing same-day care can go to different departments.
But, for years, the biggest logjam has been delays in releasing patients who have completed treatment.
So, the Grange has built a portable cabin with 10 beds and 15 chairs where patients can prepare to go home or move to another hospital and staff can wash, feed and care for them, as if on a ward.
Image caption,The Transfer Lounge hosts patients waiting to go home or those who need ongoing care in the community or other hospital settings
They also liaise with families and social services to try to speed up discharge.
"It allows us to free up beds quickly and it's somewhere quieter more comfortable for patients to wait," senior nurse Sian Williams tells us.
"I always say even one bed makes all the difference to the ambulances outside."
Yet, despite these and other efforts, the Grange, since it opened early because of Covid in September 2020, has been under intense scrutiny.
It was based on a model where lots of specialist care including intensive, surgery and A&E were centralised from existing hospitals in Newport and Abergavenny.
The assumption was that community services would be strong enough to take up the slack.
Image source, BBC Wales
Image caption,Chief operating officer Leanne Watkins says it's her "firm belief" centralising services in the Grange was right
One of the health board's top bosses, chief operating officer Leanne Watkins, says: "Bringing our teams together, for example, in paediatrics and obs and gynae, we had very fragile services spread across the system, and when you think of the risk that are contained in maternity services, for example, in paediatrics, that's enormous.
"So, I think we would have really struggled without [the Grange].
"I think we could have benefited from some additional beds."
Despite this, the health board remains in level four measures, the second highest level of Welsh government oversight, because of worries linked to urgent and emergency care.
'Unfair criticism'And social media posts go further, dubbing the Grange as "dangerous", "awful" and "a disgrace".
"I don't believe that [those criticisms] are fair," Watkins says.
"We have amongst the best mortality rates in Wales, and, in fact, for some procedures, things like fractured neck or femur (hip) and emergency surgery, we rate right up there with the best in the UK.
"If you're unwell, critically unwell, it is a great place to be."
She said the criticisms were driven by a small number of complaints, and has reduced public confidence.
"For our staff, it is devastating to read what's been said.
"We know we need to do better, we know delays are unacceptable, but the teams work incredibly hard, and I'm for one proud of them.
"It absolutely is a safe hospital."
Image caption,By late afternoon, the A&E waiting room has fewer patients waiting to be seen
The health board's own data suggests death rates at the hospital are lower than in similar hospitals in Wales, taking into account the nature of the population and the severity of cases.
Figures also suggest the proportion of patients who die in the Grange's emergency department remains below the Welsh average and has shown sustained improvement.
"I just encourage people to look at the facts. I know sometimes it's really hard, especially on social media that people can get messages that can make them feel low in confidence [but] please come and talk to us," Dr Seema Srivastava says.
"It makes me sad," deputy head of nursing Lorna Lear says.
"Obviously, sometimes there are instances where the care is less than what we expect.
"But we always listen to the feedback... and we always want to improve our services and give our patients the best possible care."
"So when we do see those negative headlines, it can be quite upsetting."
"If you have been waiting excessive hours to be seen, you're going to be frustrated and that's okay. It's understandable," consultant and director of urgent care Owain Chandler adds.
Image caption,A&E nurse Sam Taylor-Harley has to be aware of every patient coming and going
After a seven-hour tour of the hospital, we're back at A&E where staff have seen 274 patients during the course of the day.
The nurse in charge, Sam Taylor-Harley, says: "We've had some more heart attacks, myocardial infarctions, we've had a couple of trauma calls, we've had a couple of admissions to the ITU upstairs, and we've also had some infection prevention control issues coming in as well."
Image caption,Air ambulance teams escort a patient involved in a serious incident through the emergency department
As we prepare to leave the hospital, a patient with life-threatening wounds is flown in by air ambulance.
More than a dozen staff from across the hospital are ready and waiting.
If you're as seriously ill as this, you'll never have to wait to be seen, but that means less serious cases are likely to wait even longer.
The Welsh government said NHS staff were "working incredibly hard" to give patients compassionate care, and early plans are in place to help with a challenging winter.
It said Aneurin Bevan health board, which runs the Grange hospital, still needed to improve, adding it "must show clear improvement plans, better unscheduled care performance, a stronger grip on urgent and emergency care concerns, and clearer information for patients on how to access care".