Health is a devolved matter and is the responsibility of the Welsh Assembly. Any legislation made on NHS Wales matters is decided by the Welsh Government. The 2018/19 budget allocation to the Welsh Government is £15.5bn. Health and social services receives almost 50% of the allocated funding, £7.7m with local government and public services being allocated £4.2m.
Established in 1999, the Welsh Government is the devolved Government for Wales and has responsibility for health and the Welsh NHS. Considerable differences exist between the public health care systems of the devolved nations. In Wales, the close working relationship with local government and NHS Wales has placed greater emphasis on public health.
The British Society for Rheumatology and the National Rheumatoid Arthritis Society (NRAS) partnered in 2016 to produce our joint report on Rheumatology in Wales: The State of Play. Collaboration with NRAS and Versus Arthritis continues, with the campaign for a multidisciplinary paediatric rheumatology service for South Wales and expansion of the current service in North Wales. This campaign led to the Welsh Assembly’s decision to support BSR’s call for a fully dedicated multidisciplinary paediatric rheumatology centre in Wales.
In August 2018, BSR appointed a new Devolved Nations Liaison Officer, the first time in the Society’s history that BSR will have a staff presence outside of London. Lauren Bennie is based at the Royal College of Physicians & Surgeons of Glasgow and has a broad range of responsibilities, including extending our educational programme and exploring how BSR can actively support our members across Wales, Scotland and Northern Ireland.
Geographical area covered:
Wales has a population of 3.17 million over 8023 square miles. The devolved nation of Wales is served by seven Local Health Boards (LHBs). The main hospitals delivering rheumatology services for each Health Board are listed below. In addition, services are delivered at a number of community hospitals and clinics throughout Wales. The University Hospital of Wales in the Heath District of Cardiff is the largest hospital in the county and is a teaching hospital of Cardiff University School of Medicine.
In 2010, the seven LHBs in Wales established the Welsh Health Specialised Services Committee (WHSSC) to establish a Committee to work on behalf of the LHBs to reduce duplication and ensure consistency in service planning and provision.
Where rheumatology services are delivered:
Abertawe Bro Morgannwg University Health Board diagnoses and manages adult rheumatology disorders on four hospital sites: Singleton, Morriston, Neath Port Talbot and Princess of Wales. A Rheumatology Day Unit operates out of the Princess of Wales hospital. The multi-disciplinary team is predominately nurse led.
There are approximately seven consultant rheumatologists and six specialist nurses working out of the Aneurin Bevan University Health Board. Rheumatology in-patient and day case care is provided in Nevill Hall Hospital and outpatient services are provided throughout the region at Royal Gwent, Nevill Hall, Ysbyty Ystrad Fawr, St. Woolos , Chepstow, County, Brecon War Memorial and Ysbyty Aneurin Bevan.
The Betsi Cadwaladr University Health Board combines the North Wales NHS Trust (previously North East Wales NHS Trust and Conwy & Denbighshire NHS Trust), the North West Wales NHS Trust, and the six LHBs of Anglesey, Conwy, Denbighshire, Flintshire, Gwynedd and Wrexham.
At Wrexham Maelor Hospital, the Medical Day Care Unit is used by the rheumatology service for intravenous drug therapy with community rheumatology services at Deeside Hospital. Rheumatology services are also delivered at Glan Clwyd and the Peter Maddison Rheumatology Centre (Llandudno / Bangor), Dolgellau Hospital, Ysbyty Bryn Beryl, Ysbyty Alltwen, Ysbyty Eryri, Ysbyti Penrhos Stanley and Blaenau Ffestiniog Health.
The Cardiff and Vale University Health Board offers both outpatient and inpatient services. The Rheumatology Department is based at the University Hospital of Wales and University Hosptial Llandough.
The Royal Glamorgan, Dewi Sant and Prince Charles hospitals are all part of the Cwm Taf University Health Board. Rheumatology teams operate out of the Royal Glamorgan and Dewi Sant. Specialty clinics include biologic therapy, Lupus and Ankylosing Spondylitis. There is a large emphasis on developing research with the Rheumatology Department at Cwn Taf University Health Board.
Rheumatology services are health board wide in the Hywel Dda University Health Board with bases at the Prince Philip Hospital, West Wales General Hospital and the Prince Philip Hospital Day Unit. The LHB’s Clinical Musculoskeletal Assessment and Treatment Service (CMATS) is a specialist team of advanced physiotherapy and podiatry practitioners running clinics in a range of sites across Carmathenshire, Ceredigion and Pembrokshire. The LHB is also served by Bronglais and Withybush hospitals.
Paediatric rheumatology provision in Wales is a part-time and limited practice. Services at Alder Hay Childrens’ Hospital in Liverpool or Bristol Royal Hospital for Children are utilised. BSR has been jointly campaigning with Arthritis Care Wales, Versus Arthritis and the NRAS for a full multidisciplinary paediatric rheumatology service for South Wales, with expansion of the current service in North Wales.
Specialist training locations
The Welsh Rheumatology Specialist Training Committee (STC) comprises rheumatology consultants from each of the Welsh LHBs and a trainee representative. A chair and training programme director (TPD) oversee the STC. The STC meetings take place during the Annual All Wales meeting with calendar dates in April and October. These meetings are held in Central Wales and discuss issues relating to teaching, training, research and service delivery. An all-Wales audit is presented and reports given by the Chair of the BSR and RCP meetings.
Hospitals participating in rheumatology training:
1. Ysbyty Gwynedd, Bangor
2. Peter Maddison Rheumatology Unit, Llandudno
3. Wrexham Maelor Hospital, Wrexham
4. Prince Charles Hospital, Llantrisant
5. Royal Gwent Hospital, Newport
6. Nevill Hall Hospital, Abergavenny
7. Ysbyty Ystrad Fawr
8. Morriston Hospital Swansea
9. Neath Port Talbot Hospital
10. Princess of Wales, Bridgend
11. University Hospital of Wales, Cardiff
12. Llandough Hospital, Penarth
North and South Wales have a regular teaching programme with teleconference links and have external speakers contributing to their teaching programmes.
There is an active research programme in Wales. Professor Ernest Choy, Head of Rheumatology and Translational Research and Director of the Cardiff Regional Experimental Arthritis Treatment and Evaluation Centre (CREATE) at Cardiff University School of Medicine has a major research interest in experimental medicine and clinical trial design in rheumatic diseases. There are clinical trials at all major centres in Wales.
The All Wales Ultrasound Group aims to deliver standardised rheumatology ultrasound training across Wales and works in close collaboration with the British Society for Rheumatology’s ultrasound Special Interest Group and the Scottish Rheumatology Ultrasound Group (SRUG). There are currently 5 sites (3 in South and 2 in North) recognised for ultrasound training.
The Wales Deanery coordinates postgraduate training for the 9 StRs and one academic StR in Wales, as well as a number of core medical training and foundation posts in Rheumatology. StR training includes monthly supra-regional training days co-hosted with Severn deanery, regular regional updates and access to a variety of sub-speciality training opportunities. There are excellent links between the North Wales Rheumatology units and Manchester & Merseyside.
Dates for the diary
|Paediatric & Adolescent Rheumatology Conference
||British Society for Rheumatology
||17-18 October 2018
|Gwent NRAS Meeting
||Gwent NRAS Group
|10 November 2018
|Bi-monthly WHSSC Joint Committee
|Welsh Health Specialised Services Committee
||13 November 2018
|West Wales NRAS Meeting
|West Wales NRAS Group
|15 November 2018
|Swansea NRAS Dinner with guest speaker
|Swansea NRAS Group
|19 November 2018
|Core Skills Course*
|British Society for Rheumatology
|26-27 November 2018
|Medicine for All: Rheumatology
|Royal College of Physicians & Surgeons of Glasgow
|8 February 2019
|British Society for Rheumatology
|Annual Education Meeting
|Scottish Paediatric & Adolescent Rheumatology Network (SPARN)
|May 2019 with education sessions last week of each month
||Melrose, Scottish Borders
|British Society for Rheumatology
*Significant discounted delegate fees apply to our series of annual conferences and educational events if you are a member of the British Society of Rheumatology
Email our Governance Manager via firstname.lastname@example.org to find out who is your Regional Chairperson
Devolved Nations Liaison Officer
Your Devolved Nations Liaison Officer is Lauren Bennie who can be contacted via LBennie@rheumatology.org.uk or on 0141 465 7289 / 07957 091 588. She is based at the Royal College of Physicians & Surgeons of Glasgow.