Restarting our Services during the Covid-19 Pandemic

Current status - 30th May 2022

Whilst some adult mental health services have changed the way they deliver care, all services have remained open throughout the pandemic.  All of our inpatient wards are open to admissions. Visiting is allowed subject to Infection Control processes and current Health Board guidance at the time.

There is general rule of no visitors being allowed onto wards at present unless there are exceptional circumstances.

The Crisis Resolution Home Treatment Teams based in St Cadoc’s Hospital, Ysbyty Ystrad Fawr and County Hospital remain open. Patient assessments are carried out face to face and ongoing treatment is delivered either face to face or via telephone, or virtual appointment, dependent on the needs of the patient.

The Out of Hours crisis service remains open with patients being assessed within Kemeys at St Cadocs Hospital.

The Community Mental Health Teams based within each borough remain open and are accepting referrals, with assessments being carried out face to face where possible, or via telephone or virtual appointment. Existing patients are continually reviewed and offered either face to face, telephone or virtual appointments, dependent on the needs of the patient.

All specialist services remain open. Many appointments are delivered via telephone or virtually. Patients are continually reviewed and if required will be seen face to face.

Current status - 30th May 2022

We are continuing to offer online or telephone appointments for Pre-Assessment Clinic and Obstetric Pre-Assessment Clinic patients but hope to be able to offer face-to-face appointments shortly.   Anaesthetic Notes Reviews are also being undertaken online.

Pain Services Outpatient appointments for new and follow up patients will continue to be conducted over the telephone and online and face-to-face consultations have restarted based on clinical priority.

Future Plans

The Pain Service has recommenced some of its injection lists in Nevill Hall and County Hospitals. Unfortunately the service is unable to offer appointments for acupuncture at the current time.

Current status - 30th May 2022

Current status - 30th May 2022

Outpatient clinics are being re-started at Ysbyty Aneurin Bevan and Chepstow Hospital sites.

Future Plans

Plans are progressing to reintegrate staff that are currently supporting District Nursing Teams to return to the Bladder and Bowel Nursing Service, so the service can be delivered at full capacity once again.

Current status - 30th May 2022

All urgent elective inpatient services have relocated to The Grange University Hospital.

Outpatients

The following Cardiology Outpatient Services are taking place as indicated below:

- Consultant Clinics - Telephone and Attend Anywhere (video calling system) clinics continue to take place. Face to face clinics are being held in Royal Gwent Hospital, Nevill Hall Hospital, Ysbyty Aneurin Bevan and County Hospital;

- Heart Failure Clinics - Telephone clinics and Attend Anywhere (video calling system) clinics continue to take place. Face to face clinics are being held in  Chepstow Hospital, County Hospital and the Royal Gwent Hospital;

- Cardiac Rehabilitation Clinics - Telephone clinics and Attend Anywhere clinics continue to take place and patients will also be issued with guidance manuals for remote sessions where appropriate.  Some individual exercise assessments have also been started where appropriate.

The following Cardiology Diagnostic Services are taking place at the sites indicated below:

• Urgent and Routine Echocardiogram appointments - Royal Gwent Hospital, County Hospital, Chepstow Hospital, Nevill Hall Hospital, Ysbyty Aneurin Bevan and Ysbyty Ystrad Fawr.
• Urgent face-to-face Pacing clinics- County Hospital, Ysbyty Aneurin Bevan, Nevill Hall Hospital and Royal Gwent Hospital. Pacing clinics continue to take place as telephone clinics also.
• Urgent Transoeophageal Echocardiogram (TOEs), Dobutatamine Stress Echocardiogram (DSE's) and Physical Stress Echocardiography (PSEs) - The Grange University Hospital
• Exercise Tolerance Tests (ETTs)- Cardiology Unit, Royal Gwent Hospital
• TILT (Tilt Table Tests)- Cardiology Unit, Royal Gwent Hospital.
• Elective Diagnostic Angiograms - The Grange University Hospital
• Elective Pacemakers - The Grange University Hospital
• Ambulatory Monitoring Clinics - Royal Gwent Hospital, County Hospital, Nevill Hall Hospital and Ysbyty Ystrad Fawr
• Implantable loop recorder (ILR) - Commenced at County Hospital. Follow up appointments available for urgent patients experiencing symptoms.

Future Plans

Plans are being worked through for Cardiac Rehabilitation individual face to face assessments.

Current status - 30th May 2022

Face to face clinics are restarting in the next week in the Day Hospital Nevill Hall for the most clinically urgent patients.

The Care Of The Elderly service continues to review and treat patients with the most clinical need.

The service is conducting face to face appointments for clinically urgent patients at both Royal Gwent Hospital and Nevill Hall Hospital. Virtual and Telephone clinic sessions have also been restarted at Ysbyty Ystrad Fawr.

Current status - 30th May 2022

Service is undertaking WLI clinics on Saturdays starting this week to help with some of the backlog of initial appointments.

Status at 21st June 2021

Additional hours via a Waiting List Initiative will support this recovery method with appointments for children and young people currently on the ND waiting list. The timescale of this recovery plan is scheduled from June until August 2021.

Additional Easting Disorder clinics are being arranged to start mid June and run for 6 – 8 weeks to provide brief intervention to those identified as being most suitable. These will run on Saturdays and provide joint dietetic and therapy sessions with the aim of increasing the confidence of the families in managing the changed eating behaviours.
 

Status at 14th June 2021

CAMHS continues to offer a service to children and young people. We are fortunate to be able to continue to meet with our young people and families face to face, however, this must be governed by clinical need with the use of remote platforms of communication, assessment and intervention being fully utilised where appropriate.

Single Point of Access for Neuro-developmental (ND) Referrals

A single point of access mailbox for ND referrals has been developed aligning ND with SPACE Wellbeing processes. From 1st April 2021 professionals are required to email ND Referrals to:
ABB.SPACEWellbeingND@wales.nhs.uk 

 Referrals will be triaged and ensure seamless forwarding to SPACE / (Early Help) Wellbeing, ISCAN Community Embedded team and ND assessment as appropriate. This system should provide less confusion as to which service to refer to or the need to make multiple referrals for children with co morbid presentations and professionals will have better access and communication with partner agencies to work jointly to support families.

Whilst a proportion of our appointments occur as either an Attend Anywhere virtual appointment or a telephone consultation, we have continued to offer a large number of face to face appointments in those cases where there is clinical need.

Clinicians have continued to undertake a number of telephone appointments offering a range of options to patients for clinical work. Our operating procedure is in place with rooms set up to support social distancing for staff and families and we are continuing to use PPE.

CAMHS are continuing to offer a range of remote and face to face appointments , and those young people and families in greatest need will continue to receive a good service. This will continue throughout the lockdown . We are of course adhering to all of the guidance regarding COVID-19, in order to keep families, young people and staff as safe as possible throughout this period and beyond.

We are still receiving higher than normal numbers of referrals for young people experiencing difficulties, and are looking at trends and data in order to continue to ensure that we are meeting the needs of young people. We continue to offer appointments and intervention using a range of approaches and platforms, including face to face when clinically indicated. Our young people and families are given choices regarding how they can access help - this can be via telephone , virtual platforms or face to face meetings. We would like to reassure families and young people who are struggling that we are here for them, and that all our interventions are carried out according to COVID guidelines.

Virtual group work has started and we are actively looking at increasing access to this safely in order to increase the therapeutic choices for young people. For example, alongside DBT groups, we are organising Family Therapy Clinics remotely and carrying out other systemic, family orientated group work.

Future Plans

With the recent COVID-19 localised lockdowns and following an increase in the number of referrals coming into the service, we have begun to re-visit discussions and planning on the provision of virtual therapeutic group work.

Current status - 30th May 2022

Community Pharmacies continue to provide prescription dispensing services for all patients across Gwent. However, because of the need for social distancing, access to pharmacies may be limited. Please allow plenty of time when requesting repeat prescriptions, ideally ordering 7 days before you need your next supply.  My Health Online offers a convenient way to order repeat prescriptions and book appointments with your GP online. Please see more details.

If you are taking regular medication, repeat “batch” dispensing may be suitable for you and provide prescriptions for up to a year’s medication at a time. Please see more details.

Both My Health Online and batch prescribing can help cut down the visits you need to make to your GP and pharmacy and help with social distancing.

The following non-prescription services continue to be available from pharmacy, with consultation being provided in person, over the telephone or video call.

Common Ailments – Providing NHS funded treatment for 28 common conditions without the need to see your GP

Smoking Cessation – A 12 week, one to one programme of support and nicotine replacement therapy to help you quit

Emergency Contraception – Confidential provision of emergency contraception without the need to see your GP

Emergency Supply – Provides an emergency supply of most previously prescribed medication if you run out and your GP isn’t available.

Lateral Flow Test– Provides free rapid lateral flow COVID-19 test kits (LFTs) for people eligible for asymptomatic testing to collect and test themselves at home. Please note, rapid lateral flow tests are only for people who do not have coronavirus symptoms. Please do not go to your community pharmacy for lateral flow test kits if you have symptoms.

Please see the 111 Wales website for more details or contact your local pharmacy.

Current status - 30th May 2022

Current status - 30th May 2022

We have now re-instated Urgent Patch Testing and a telederm session to appoint our routine lesions.

Urgent skin lesion patients are being seen in one stop lesion clinics or via the telederm service.  Services are currently only in place at Newport Hospitals.  Patients attending one stop lesion clinics may be offered treatment on the day if appropriate.  Patients being seen via the telederm service will attend the Clinical Photography department for images of the lesion to be taken.  They will then receive a report from a Consultant Dermatologist and information about any further treatment that may be necessary.

Some telephone clinics and face to face clinic appointments are in place for urgent lesion follow up patients.

Minor procedures using Local Anaesthetic are being undertaken at St Woolos Hospital. 

Urgent general dermatology (e.g. skin rashes) services for both adults and children are being provided via telephone consultations.  Where this is not appropriate urgent patients are being seen face to face in outpatient clinics.  Telephone consultations are also in place for follow up patients and those on the routine waiting list.

The Phototherapy Service restarted as planned in St Woolos Hospital and Ysbyty Ystrad Fawr.

The Patch Testing Service restarted as planned in St Woolos Hospital.

For urgent patients a Phototherapy Service at St Woolos Hospital was reinstated on 3rd August; telederm appointments at Nevill Hall Hospital were reinstated on 10th August.

General dermatology clinics are being held at St Woolos Hospital

Teledermatology sessions for routine lesion patients have commenced as planned.

One stop lesion clinics recommenced as planned in Nevil Hall Hospital.

The Thursday am clinic has recommenced as planned in Nevill Hall Hospital.

Paediatric Dermatology will return to the Maple Centre.

Current status - 30th May 2022

A selection of face-to-face clinics for clinically urgent Diabetes and Endocrine patients have commenced in Nevill Hall Hospital, Ysbyty Aneurin Bevan and Royal Gwent Hospital .

A number of Diabetes and Endocrine Consultant clinics will continue operating via telephone consultations across all sites.

Most of the Diabetes Specialist Nurse clinics will continue to operate via telephone or video consultations. Face to face consultations will be offered to clinically urgent patients.

Future Plans

We are currently working through our plans to evaluate how our Diabetes Education group training can be conducted in an online setting.

Current status - 30th May 2022

Dietetic outpatient services and community clinics are running. We are able to offer telephone or video appointments and groups. In addition, some clinics are running face to face and this will gradually increase as able to. Please discuss with our booking centre at the time of booking and check your clinic letter for details.

Booking Centre:

Adult Dietetics - 01633 431644

Paediatric Dietetics - 01633 431642

Current status - 30th May 2022

The Grange University Hospital is open and our Emergency Department is now based here. If you have a life threatening injury or serious illness you can call 999 or attend the Emergency Department for treatment.

The following services will be available at the Grange University Hospital:

- Emergency admissions for major illnesses or injuries and those in need of resuscitation;

- Emergency surgery and trauma care;

- Major and co-morbidity (more than one serious condition) surgery;

- Emergency Assessment Unit;

- Critical Care;

- Acute Cardiac Unit;

- Cardiology Inpatients;

- Hyper Acute Stroke Unit;

- Acute Medicine;

- Obstetric inpatients and high risk births;

- Childrens Assessment Unit;

- Neonatal Intensive Care and Special Care Baby Unit;

- Paediatric inpatients and Paediatric inpatient surgery;

- Diagnostics;

- Emergency endoscopy.

For a minor injury, our Minor Injury Units are ready to welcome you at Nevill Hall Hospital (24/7), the Royal Gwent Hospital (24/7), Ysbyty Ystrad Fawr (24/7) and Ysbyty Aneurin Bevan (Monday to Friday 9am-7pm). Adults and children over one year old with a wide range of injuries can be treated at our Minor Injury Units. These units are run by an experienced team of highly skilled, specially trained Emergency Nurse Practitioners, Triage Nurses and Healthcare Support Workers. You can visit one of our units for:

- Limb injuries which includes broken bones, fractures and dislocations to fingers and toes;

- Wounds, grazes and minor burns;

- Head injuries (providing there is no loss of consciousness or the patient is taking blood thinning medications);

- Face injuries (providing there is no loss of consciousness);

- Minor back and neck injuries (providing the patient is mobile, there is no pins and needles in arms or legs and has not fallen from a height greater than five stairs or 1metre);

- Eye, ear and nose injuries and foreign bodies;

- Rib injuries;

- Insect , animal or human bites.

The following services can be provided at our Minor Injury Units:

- Access to x-rays for injuries;

- Wound closure including stitching and gluing;

- Application of dressings;

- Application of plaster casts, splints, strappings and slings;

- Reduction of minor joint dislocations;

- Removal of foreign bodies;

- Eye washouts;

- Administration of medication to treat the injury.

Current status - 30th May 2022

In order to ensure we have sufficient capacity and resources to safely care for our patients we have centralised our emergency surgery and trauma services at the Grange University Hospital.

This means if you need to attend an Emergency Department by ambulance with abdominal pain, major broken bones or anything that may require emergency surgery, you will be safely directed to the Grange University Hospital.

Our Minor Injury Units at Ysbyty Ystrad Fawr, Ysbyty Aneurin Bevan, Nevill Hall and Royal Gwent hospitals are functioning as normal and generally the waiting times there are much shorter. Our team of Emergency Nurse Practitioners are waiting to treat you.

We would encourage you to attend your Minor Injury Unit for any minor injuries such as:

• Suspected broken small bones, fractures, dislocations
• Wounds, grazes and minor burns
• Head and face injuries provided there has been no loss of consciousness and not taking blood thinning drugs
• Minor neck and back injuries provided the patient is mobile, has no pins and needles in the arms or legs and has not fallen from a height greater than 5 stairs or 1 metre
• Eye, ear and nose injuries and foreign bodies
• Rib injuries
• Insect, animal and human bites

For minor ailments such as colds, earache, rashes, temperatures please use the symptom checker on the NHS 111 website to Choose Well how best way to access the most suitable healthcare for you. If you are unsure and need advice then phone 111 who will direct you to the most appropriate place for you to attend.

Current status - 30th May 2022

We are offering some weekly face-to-face Hepatology Outpatient appointments and Fibroscan clinics for Urgent patients at County Hospital, and routine/ non-urgent clinics are being conducted via telephone. We will be restarting face to face clinics at The Royal Gwent Hospital at a reduced capacity to comply with social distancing guidance for Dr V Goel, Dr N Balaratnam, Dr A Somasekar and Dr A Yeoman as below;

Dr Goel

Wednesday clinic

Friday Alt clinic 

Dr Somasekar

Tuesday clinic 

Dr Yeoman

Thursday clinic 

Dr Balaratnam

Thursday clinic 

We have restarted a clinic on a Friday afternoon for our IBD patients at Nevill Hall Hospital.

All other standard outpatient appointments are being undertaken either virtually or by telephone, at a reduced capacity.

Fibroscan clinics, Endoscopic Retrograde Cholangiopancreatography (ERCP), Endoscopic ultrasound (EUS), Capsule Endoscopy appointments and Diagnostic Endoscopy services at the Royal Gwent, Nevill Hall and Ysbyty Ystrad Fawr Hospitals are all running daily, but at a reduced capacity. Bowel Screening Wales services have restarted, with reduced activity at Ysbyty Ystrad Fawr Hospital.

An Endoscopy service currently takes place at St Joseph's Hospital. We are also providing some outpatient activity at St Josephs Hospital.

The Gastroenterology and Medical Ambulatory Care Unit has now returned to C4 West at the Royal Gwent Hospital. There is now a larger area to allow for patient safety and for future expansion of the service. The Unit continues to provide nurse led care and follow ups, IBD infusions, blood transfusions and assessment and management of ascites as well as many more interventions helping keep patients well and out of hospital. Any queries please email GAU.abb@wales.nhs.uk   

Personal Protective Equipment (PPE) is being utilised where necessary.

Future Plans

We are reviewing our plans to reinstate our Blood Borne Virus (BBV) service for treatment of Hepatitis, as well as the booking of urgent and routine, repeat and surveillance Endoscopy appointments.

Current status - 30th May 2022

Urgent Suspected Breast Cancer Surgery has continued throughout the Pandemic, with an additional all day Tuesday list commencing at St Josephs Hospital.

We are currently offering reduced clinics for all face-to-face diagnosed Colorectal Cancers. Urgent Paediatric Surgery has now been started once again, and Endocrine Surgery has been re-instated at the Royal Gwent and Nevill Hall Hospitals, with follow up appointments happening over the telephone.

Some Oupatient appointments have restarted for Upper Gastrointestinal at Ysbyty Aneurin Bevan. Consultations have been taking place over the telephone, unless physical examinations are required. Telephone Consultations are also taking place for all Urgent Suspected Cancer, and urgent and routine colorectal referrals (including Hernias, Bleeding Haemorrhoids). In addition to telephone consultations, urgent Upper Gastrointestinal and urgent colorectal face-to-face outpatient appointments have commenced at St Joseph's Hospital.

Telephone consultations for Vascular Surgery are encouraged wherever possible, however face-to-face appointments and hot clinics are available if preferred.

The following treatments have resumed, with reduced lists re-instated:

- Laparoscopic Cholecystectomy for Pancreatitis and other urgent conditions;

- Laparoscopic cholecystectomy following certain illnesses (considered on a case by case basis);

- Rectum Examinations Under Anaesthetic for anal pain/anal mass/ Crohn’s sepsis/ Crohn’s resections;

- Colonoscopy (reduced lists)

We have now introduced a reduced outpatient service at Nevill Hall Hospital, in addition to the outpatient clinics already being undertaken Monday to Friday at St Joseph's Hospital. These are face to face clinics for Upper Gastrointestinal and Lower Gastrointestinal patients. The appointments are booked for patients who have been referred to the service and prioritised as urgent and also for the longest waiting routine patients.

All routine patients will be treated in turn, with those waiting the longest treated first.

Current status - 30th May 2022

Current status - 30th May 2022

We are running outpatient clinics from w/c 07/06/21 in both Nevill Hall and the Royal Gwent Hospital to reduce the waiting times for new referrals.

Treatment lists with local anaesthetic continue to be held in the Women’s Health Ambulatory Care Unit at Nevill Hall Hospital thereby reducing the wait for treatment.

Current status - 7th June 2021

Gynaecology has currently suspended routine services in line with recent Welsh Government advice and Health Board communication.

Urgent Suspected Cancer activity, including Post-Menopausal Bleeding and Colposcopy appointments, will now be delivered from Ysbyty Ystrad Fawr and Ysbyty Aneurin Bevan. Urgent Suspected Cancer diagnostic procedures continue to be delivered at Nevill Hall Hospital.

Cervical Screening services and Fertility Clinics have also recommenced, with face-to-face Fertility consultations available and women age 38+ prioritised.  Insertion of pessary has now restarted.

The service will be utilising capacity at St Joseph's Hospital to increase the number of operations being performed.

Future Plans

We are currently working through our plans to re-start the following treatments:

- Urodynamics diagnostics;

- Any laparoscopic procedure;

- Anterior and posterior repair and urogynaecology procedures including TVT/TOT insertions and other repairs;

- Total Abdominal Hysterectomy (including Bilateral Salpingo-Oophorectomy;

- Oophorectomy (benign conditions);

- Sterilisation;

- Hysteroscopy (benign conditions)