Public Consultation about the future of Gellinudd Hospital

Transcription

1 Public Consultation about the future of Gellinudd Hospital March

2 1. INTRODUCTION Abertawe Bro Morgannwg University Health Board (ABMU) continually reviews the way we provide services to our patients, to ensure we offer the highest quality and safest care we can, within the resources we have available. This public consultation document follows the engagement which took place at the end of 2012 about Changing for the Better our strategy for improving health care in the Swansea, Bridgend and Neath Port Talbot area. A key element of Changing for the Better is the development of more services based in local communities, delivering advice and care for people in their own homes and neighbourhoods; with more resources being pumped directly into the community and less into hospital beds. During our engagement about Changing for the Better we heard concerns about what this meant for the future use of our community hospitals, and this included Gellinudd Hospital, in Pontardawe. This consultation document considers the issues which were raised, and explains the reasons behind the Health Board s proposal to close Gellinudd Hospital. 2. BACKGROUND This document looks at the current use of Gellinudd Hospital in Pontardawe, the services it provides to patients, and outlines how the Health Board believes these services could be delivered better in future. In May 2012 we published Why Your Local NHS needs to change which explained the challenges facing us and our services now and in the future. In September 2012 we published Changing for the Better Our Ideas for your Local NHS.Have Your Say! in which we set out our proposals for meeting these challenges and asking people to engage with us about helping us to create a health service that is safe, sustainable and is as good as the very best. We undertook a three month period of engagement from 26 th September to 19th December One part of this engagement was an eight-hour information drop-in event in Pontardawe Arts Centre on 16 th November Over 60 people called in to talk to our clinicians and managers about our ideas for Gellinudd Hospital and its services. The majority of people who attended the day, be they members of the public, the Gellinudd League of Friends, the local Community Council or staff from Gellinudd Hospital, did so to voice their concerns over what they feared might happen to Gellinudd Hospital and the patients who are cared for there. 2 P age

3 The main issues raised at the event, and from other engagement feedback were: Concerns about the adequacy of community services to care for people at home if Gellinudd was closed. Concerns about round the clock (24/7) cover if patients were not in a hospital bed. Concerns that people being discharged from our acute hospitals would not have Gellinudd as a bridge before going home. Inadequate care for patients discharged from an acute hospital might mean that they have to be re-admitted. Questions about the future of Gellinudd staff and concerns about the loss of their skills to the local community Would losing Gellinudd beds result in older patients bed blocking in acute hospitals? Families could face transport problems travelling to other hospitals for visiting. Loss of a valued local resource if Gellinudd closed Concerns about how patients with more serious medical needs, including patients with dementia, would be cared for if Gellinudd closed. If Gellinudd closed, replacement services should be put in place first. We understand these concerns, and have considered these points very carefully as we were developing our proposals, which are explained in this document. 3. CONTEXT The NHS is facing large and complex changes in the way it delivers care. People s needs and expectations are changing, and new medical technologies and ways of delivering care are developing. Advances in clinical tests and treatments for illnesses like cardiac disease and cancer mean that more of us are now living much longer than our parents and grandparents generations. But this also means that a substantial number of older people are also frail, and living with chronic illnesses which need a great deal of care. Already more than 70% of unscheduled and emergency admissions to our acute (main) hospitals are frail, older, people. It is forecast that over the next 20 years, the number of people aged over 75 will increase by 75%. 3 P age

4 The average amount spent by the health board on caring for older patients who are years-old in ABMU is 1,990 per person each year. For those over the age of 80 it jumps to 3,358. (To put this in context, the cost per year of caring for adults under 60, ranges from 465 to 662.) Like everyone else, the NHS is facing huge financial challenges. The NHS also has challenging workforce issues, including an ongoing UK-wide shortage of some doctors. To meet these challenges, we have to continually review how we provide care and to consider whether we have the right services, in the right place, and are providing the best care we can. The system the NHS works to at the moment is based largely on the 1962 Hospital Plan launched by the then UK Minister for Health. This clearly was designed around hospitals and not to meet the changing demography and diverse challenges facing today s NHS. This means that the way we provide care must be radically over-hauled, if we are to meet the challenge of caring for our patients, particularly older people. Evidence from elsewhere in Wales and across the UK shows that patients, particularly the frail elderly, are more likely to be able to remain in their own homes if they receive care there than if admitted to hospital and that the cost to the NHS and social services is reduced if admission can be avoided. A key part of developing NHS care is investing more in community services; providing much more care to people in their own homes or close by, and relying less on hospital beds. 4. OUR PLEDGE ABM University Health Board (ABMU) is committed to providing the best services possible, within our resources, for our patients, their carers, and families. We are determined to offer good quality treatment in accessible, comfortable, modern and safe environments, and ensure patients and their families are treated with honesty, dignity and respect. We are confident that this can be achieved, and there are two important principles driving this: Quality and Safety: Providing the best quality services and facilities for our patients, their carers and families. Rebalancing care: Too many patients receive treatment in hospital or stay in hospital longer than necessary when it is more appropriate to offer them care in community settings or in their 4 P age

5 own homes. Given the choice, most patients tell us they would prefer not to go into hospital, and evidence shows that people recover more quickly, and do better, when they are in familiar surroundings. 5. HOW NHS SERVICES ARE MODERNISING Our strategic plans for NHS services, as set out in Changing for the Better, are based on making the best use of our acute (main) hospitals, our other facilities and our primary care and community-based services as well as taking the opportunities of working more closely with voluntary sector services. Neath Port Talbot Hospital s role in delivering hospital-based care is evolving, with care for older people, and people needing rehabilitation care increasing. The hospital is also set to play a wider role in caring for patients from across Swansea, Neath Port Talbot and Bridgend, and in some cases, from even further afield. For example, the new IVF and fertility service for South Wales opens in 2013 at Neath Port Talbot Hospital; and the hospital is playing an ABMU-wide role for short-stay orthopaedic surgery. The Minor Injuries Unit (MIU) is an important part of our network of provision for emergency care. Major challenges facing the NHS are also playing a part in the changing role of Neath Port Talbot Hospital. The ongoing shortage of doctors meant it was unsafe to continue the Acute Medicine service in the hospital, and the service was forced to stop in August 2012 on safety grounds. Acute medicine covers conditions like acute chest infections or sudden, serious illnesses. Instead, these patients are now taken to Morriston, Singleton or the Princess of Wales hospitals. However, Neath Port Talbot Hospital continues to play an evolving and central role in delivering healthcare. We are also continuing to work with the independent sector to meet respite, nursing and ongoing long term and continuing healthcare needs of our patients in appropriate community settings. There are a number of developments taking place to improve the care provided to older people and other patients within Neath Port Talbot and Swansea and which move us closer to our vision: Elderly Day Unit (EDU) - is based in Neath Port Talbot Hospital. Its ethos is to provide a holistic assessment to the older person. There are speciality clinics for falls prevention, Stroke and for the frail older person. In addition Neath Port Talbot locality has recently 5 P age

6 appointed a specialist nurse in Parkinson s disease who will be based in the EDU. The unit also provides urgent assessments for patients who have become unwell in the community but who do not need the services of an acute hospital. The unit is staffed by nurses experienced in looking after the older person and has easy access to specialist medical opinion, Physiotherapists, Occupational therapists, specialist nurses for skin, wound care and diabetes. In addition the unit can easily access all the investigations available in Neath Port Talbot hospital. The unit also provides treatments like blood transfusions as a day case, thereby preventing an unnecessary hospital admission. The above resources make it an ideal place to form a bridge between community and hospital care. The development of the Community Resource Teams (CRT) in both Swansea and Neath Port Talbot areas. In Neath Port Talbot the CRT is expanding the work of the Community Integrated Intermediate Care Service, and now consists of 80 staff, some parttime, who look after a case load of approximately 100 to 120 patients at any one time in the community, across the locality. The CRT is a multi-disciplinary team of NHS and Local Authority staff that provides a community service to patients whose needs require the specialist skills and knowledge available within the team. The majority of patients are frail older people with complex health and social care needs. In Swansea the CRT is developing in a similar way to Neath Port Talbot, from the previous Intermediate Care Team, and including some palliative care and dementia care services within it. The improvement of facilities at Morriston Hospital which benefit patients from across the ABMU area, including Neath Port Talbot, and the Acute Medicine patients from Neath Port Talbot who now receive care at Morriston Hospital. These include a major 80m development currently underway providing new outpatient facilities, an increased number of operating theatres, new and more endoscopy suites, upgrading of wards, new MRI and CT scanners, an expansion in renal dialysis, an integrated education centre for medical students and replacing 1940s buildings on the Morriston site. The re-provision of mental health facilities in Neath Port Talbot - further development with the local authority of the Local Primary Mental Health Support Service has been put in place to provide assessment and short term support for people of all ages with common mental health problems such as depression. Integrated community teams have also been developed with the local authority to improve the way we work together to support people with dementia. 6 P age

7 In the long term we will provide purpose built adult acute Mental Health assessment inpatient facilities for the whole of the Health Board 1. This will be on a single site and supported by locally based Crisis Resolution Home Treatment teams to provide treatment at home whenever possible. 6. GELLINUDD HOSPITAL The original Hospital on the Gellinudd site was opened in 1910, and was used as an isolation hospital. However the current facility was rebuilt in 1994 to provide largely single room accommodation. Gellinudd now provides care to patients from a wide geographical area, largely around Swansea and Neath Port Talbot. While around 34% of patients live within a five km radius of Gellinudd Hospital, the remaining patients come from a wide range of more distant areas scattered across Neath Port Talbot and Swansea. See graph below for more details. Graph 1: Gellinudd admissions, by postcode 1 The location of these facilities has not been decided or confirmed to date. 7 P age

8 The services Gellinudd Hospital provides consist of the following: There are 30 inpatient beds under the management of a Consultant Geriatrician based at Singleton Hospital. The hospital caters for the ongoing recovery of older people (male and female) who have previously had health problems such as chest and/or heart problems. There are very limited rehabilitation facilities in Gellinudd. Patients requiring intensive physiotherapy and/or occupational therapy cannot be admitted to Gellinudd. Patients are only admitted if they are medically stable, don t require medical attention out of hours and are fit enough to be transferred. Patients with advanced dementia or mental health problems requiring specialist psychiatric care are unsuitable. Also, patients needing intravenous therapy cannot be accepted. Patients generally require nursing care to help them meet the activity of daily living. 7. WHY SERVICES SHOULD BE DELIVERED DIFFERENTLY (i) Improved services in future: The development of community services and the reconfiguration of services within the Neath Port Talbot area will release beds at Neath Port Talbot Hospital, where it is proposed that some of the Neath Port Talbot patients currently cared for in Gellinudd will be treated. Where patients from Swansea have traditionally been transferred to Gellinudd, in future they would either receive support at or near their own home from the Swansea Community Resource Team, or if required in a bed in one of the other hospitals in Swansea. These hospitals have modern and high-quality equipment, environment and rehabilitation services designed to care for older, frail patients. All patients who need to be in a hospital bed will then have access to comprehensive medical cover, along with diagnostic and rehabilitation facilities onsite, enabling them to begin their rehabilitation promptly, without having to move between hospitals. This will assist quicker recovery, discharge from hospital and improve patient health outcomes. Closing Gellinudd would release approximately 340,000 to re-invest in additional community-based staff; to reflect the spread of patients 8 P age

9 currently using Gellinudd. These would include nursing, physiotherapy, occupational therapy staff and healthcare support workers. They would strengthen the community services we could offer in the area, helping people to live as independently as possible in their communities. Given the choice, most people do not wish to go into hospital, and prefer to stay in their own homes or communities. We want to do as much as possible to support this. We have already been investing in community-based care, and we want to do far more of this in future, to assist people to stay at home as much as possible. If the proposals in this consultation document are supported, the Health Board will invest in community services prior to any beds being closed at Gellinudd Hospital. Here are three examples of the community-based care already being delivered in the Neath Port Talbot locality; which we want to expand and do more of. There are similar services in the Swansea area which will also be expanded to meet theseneeds: Case study A A 78-year-old lady, who lived alone. She was supported by her two daughters, both of whom worked full time. This patient was sadly coming to the end of her life. She had malignant cancer and chronic heart failure, and was at the end stages of palliative care. She was referred to three community-based teams: Continuing Healthcare; the Marie Curie Managed Care Service and the District Nursing service. An individualised package of care was designed to meet her needs. The district nurses and Continuing Healthcare team provided support for medication and general nursing care. The Marie Curie team provided respite during afternoons and nights, throughout the week. This package of care enabled the daughters to continue to work, safe in the knowledge that their mum was being cared for in familiar surroundings, in her own home. The patient passed away peacefully at home, surrounded by her family. Without this package of care, the family told us they would not have been able to care for their mum at home, and she would have had to spend her last days in a hospital or nursing home. 9 P age

10 Case study B A 59-year-old lady who had two strokes in quick succession, resulting in left-sided weakness. Before the strokes, she was living independently at home. She was admitted to hospital following the strokes, and given a period of rehabilitation before being discharged. The Community Integrated Intermediate Care (CIIS) team supported her discharge arrangements and set up an intensive package of care to continue rehabilitation at her own home. When she left hospital, the patient needed two people to support her when she walked, and she had four visits a day from two members of the team to deal with her care, meal preparation and domestic task needs. This patient needed a multi-disciplinary approach to ensure all her needs were met, maximise her potential and restore as much of her independence as possible. She received input from an occupational therapist, a physiotherapist and a nurse practitioner. In addition, daily support was given by healthcare support workers and technical instructors. During the early days progress was slow, and there was a setback when the patient fell trying to get out of bed on her own. However as the weeks progressed, she began to regain skills and confidence. As her independence grew, support was gradually decreased. The patient reached her full potential, and was able to remain at home with the help of three visits a day from a member of staff from a domiciliary care agency. In addition, she was referred to the voluntary sector to receive leisure activity support and meet new friends. Case study C A 73-year-old lady, who underwent major bowel surgery. She lives alone. This patient was referred to the CIIS team by a ward occupational therapist, following her operation. The patient was having difficulty dressing, reduced mobility and could not bend down easily. She was assessed by the CIIS team at her own home. They could see the potential for improving her independence, general mobility and personal care. She underwent specialist occupational therapy and physiotherapy assessments and a therapy plan was put in place to increase her mobility 10 P age

11 and strength. Additional equipment was also provided, including a perching stool which offers practical physical support for patients in areas like their kitchens where they have to stand at worktops or sinks to carry out food preparation or wash dishes, etc. The patient received two visits a day, five days a week, to support her reablement needs. Eventually the calls reduced to one a day, and then stopped once her goals were met. At the end of the reablement package she was washing and dressing independently; was mobile indoors without help; her strength had improved and she was able to get in and out of bed, or on and off a chair, etc, safely by herself. These are just a few examples of community-based care already underway, and we hope they illustrate the benefits which drive our ambition to expand it further. (ii) There are a number of issues with the Gellinudd Hospital site: There are 24 single occupancy rooms within Gellinudd, but with no ensuite facilities, plus a 6 bedded bay. Whilst this does support privacy and dignity, it can be challenging to maintain patient safety. Gellinudd Hospital is a relatively small site and facility which is not very accessible from areas outside Pontardawe, limiting the range of services which could be centred there. The beds at Gellinudd Hospital are used for the assessment and rehabilitation of older patients. However there are no doctors based on site, and a full range of physiotherapy services are not available. There is also no dedicated Occupational Therapy assessment area and the hospital does not have any diagnostic equipment - which means patients need to be transferred to Neath Port Talbot or Morriston Hospitals for X-ray and other diagnostic tests. The 30 beds at Gellinudd are well used (see graph 2) but we believe the resources could be used better to support more effective and sustainable services in other ways. The Hospital is not on a main bus route and has limited access due to the frequency of current services. The location of the hospital is also somewhat remote, because the site was chosen on the basis of being an isolation hospital originally. 11 P age

12 Graph 2: Bed use at Gellinudd Hospital 2011 and 2012 (iii) Workforce issues and consolidating services on fewer sites: There are no doctors based in Gellinudd, and onsite medical cover in Gellinudd is limited to a Consultant undertaking a ward round twice a week with daily cover (Monday Friday) provided by a GP practice in Pontardawe. Out of hours cover is provided by the Medical Registrar based in Morriston Hospital who provides telephone advice. If a patient s condition deteriorates or urgent medical treatment is required, patients have to be transferred urgently to either Singleton or Morriston Hospital. This is clearly not ideal as it is disruptive and unsettling for patients and their families and also takes valuable nurse and ambulance resources to make the transfer. We need to maintain a skilled and flexible workforce capable of meeting changing health care needs, both within the hospital setting and increasingly in the community, with care closer to, or in, people s own homes. All these factors mean we have to target resources and make the best use of our staff, to ensure we deliver safe, high quality care in the most appropriate environment. The focus of the care of patients using Gellinudd has also changed and many may be treated more appropriately at home with packages of care, or in the nursing/residential environment. By consolidating our services onto fewer sites we can offer patients better access to doctors, therapists, and diagnostic tests. This will avoid transferring patients between hospital sites. 12 P age

13 8. OUR PROPOSALS As outlined, closing Gellinudd Hospital will enable the Health Board to provide safer, more effective care on fewer hospital sites and in people s own homes. There are 30 beds at Gellinudd Hospital. Closure of the hospital will enable us to transfer the resources associated with these beds to where patients will be cared for in future. We have considered carefully the mix of patients who use Gellinudd Hospital, and identified how many can have care provided for them at home and how many will still need to be admitted. As a result we believe most of the patients are suitable for home care packages, and will not need a hospital bed. To support this, around 12 new full-time equivalent posts will be recruited to, such as healthcare support workers and nursing, physiotherapy and occupational therapy staff. This expansion of the community team means an additional 20 patients will be able to have care delivered to them, in their own homes, at any one time. This will be funded from 340,000 of the monies currently used to provide Gellinudd Hospital services. Some of the patients currently looked after in these beds will in future be cared for in our other hospitals in Neath Port Talbot and Swansea. Because we want to make sure that our services are the best they can be, we will carefully monitor any changes we make to services by checking with our patients and their families through surveys / questionnaires that they are receiving the services they need in a timely manner which results in a positive outcome for them. 9. WHAT WILL HAPPEN TO STAFF EMPLOYED AT GELLINUDD HOSPITAL? We greatly value the skills and experience of the staff at the hospital, and all 33 staff employed at the hospital will be redeployed across ABMU or to community services. There will be no redundancies. Individual discussions will be held with each member of staff to look at their options and to identify any training needs they may have. Appropriate training and support will be provided as required. All staff members will be updated throughout this process and full support will be given to staff during this period. 10. CAN GELLINUDD HOSPITAL BE GIVEN AN ALTERNATIVE USE? Gellinudd Hospital is a good quality site, but it is not a large facility or site, and this limits options for future NHS use. The Health Board has 13 P age

14 carefully looked at its need for facilities across the area, but considers that the services currently provided at Gellinudd Hospital could be provided better, as outlined in this document, and therefore the site will no longer be required to deliver NHS services. Other potential options for the future use of the site include the possibility of whether Gellinudd could have an alternative public sector use. If, following public consultation, it is agreed that services currently provided at Gellinudd Hospital could be provided differently in future and so the Hospital will no longer be required to provide NHS services; the Health Board will declare the site as surplus to our requirements. While it would be impossible to make any firm commitments at this stage, potential possible uses for the site in partnership with other sectors / organisations would certainly be pursued. Recently, when some ABMU sites have closed, there has been success in redeveloping them for community use. For example, the Hill House Hospital site in Swansea is shortly to be redeveloped by Gower College; and Clydach War Memorial Hospital is being redeveloped into flats and a day care centre for war veterans by Gwalia (a provider of housing and care services). 11. FINANCIAL IMPACT The changes to Gellinudd Hospital are being proposed in line with Changing for the Better and in order to improve services locally, and support the overall development of health care in the Neath Port Talbot Locality, and to a lesser extent in the Swansea area. This is not a proposal which will result in large savings for the Health Board, and there will be no job losses. The cost of running Gellinudd is approximately 1.2m a year. The closure of the hospital would provide a small financial saving in terms of heating, rates, cleaning and maintenance. However, staffing and direct costs (such as medicines and dressings) account for the majority of the current service costs. As indicated earlier, if the hospital services transfer, members of staff will be transferred along with the services, and 340,000 would be ploughed into community services. 12. WHAT OTHERS SAY: Dr Firdaus Adenwalla, Clinical Director for Integrated Medicine, Neath Port Talbot Locality: 14 P age

15 Community hospitals have always played a role in looking after the older person. Along with living longer, people are becoming more frail, and developing multiple medical problems. It is becoming increasingly difficult to look after these patients in a community hospital which by its very nature is isolated. This makes it difficult to manage the unwell patient, or obtain certain investigations. We are working with our partners to try and provide better and more comprehensive care at or closer to home. The resources released from closing Gellinudd will go a long way in achieving this Comments from patients who have used Neath Port Talbot community CIIS services: I can t fault them in any way; they watched me and were behind me, they have been a wonderful lot of girls. I was worried about coming out of hospital, but I didn t know such a wonderful service existed. They didn t rush me they took their time and helped me with my confidence building. I am back home after receiving help from the CIIS team who came in twice a day for the following four weeks. I am nearly back to normal and doing my own thing. Aren t we lucky to have such a lot of people that still care for others. Comments from patients and carers using the Continuing Healthcare and Marie Curie Managed care Service: We would like to thank you all for kindness and fantastic support not only to Mum but to ourselves. You have made caring for Mum much easier and could not have done so without your support. Couldn t manage without it. Prevented my mum from admission to hospital. Enormous support, family could not have coped. 15 P age

16 13. CONCLUSION We know that Gellinudd hospital has played an important role in the care of patients, and we are sensitive to the affection many people have for the hospital and its dedicated team of staff. However, we feel the time is now right to introduce services which are both more effective, and sustainable for the future care of older people. We believe that the current model no longer meets the evolving and challenging needs of 21st Century care provision for older people within the locality. We know this care is vital, so we want to deliver it in alternative ways to ensure patients get access to services which meet their needs, and are modern and sustainable. We are therefore proposing that this care is no longer delivered at Gellinudd Hospital, but in different ways, which we have laid out in this document. In summary, by providing hospital care for those few patients who need it in our acute (main) hospitals, not only will patients benefit from specifically designed purpose built facilities but there will be improvements to patient care. There will also be more rapid access to diagnostics, medical advice out of hours, or medical procedures without the need to transfer patients between hospital sites. In addition, the strengthening of community services will improve the care in the community, facilitating earlier discharge, and allowing patients to be managed in their homes for longer, and live more independently, avoiding hospital admission wherever possible. 14. NEXT STEPS The Health Board approved this consultation document at its meeting on 26 th March 2013 and is undertaking formal public consultation on the future of Gellinudd Hospital for six weeks from Wednesday 27 th March 2013 to Tuesday 7 th May An update on the consultation will be given to the Health Board at its May meeting and the views of the Community Health Council obtained on the outcome of consultation prior to any changes being made. Your views are important to us and you can provide comments in the following ways: By attending the public meetings, which are being held on : Monday 15 th April at Neath Civic Centre Public Meeting 6.30pm Monday 22 nd April at Pontardawe Arts Centre 16 P age

17 Drop In and Talk to Us 3-6pm Public Meeting 6.30pm By writing to: Paul Roberts Chief Executive ABM University Health Board One Talbot Gateway Baglan Port Talbot SA12 7BR Or referencing Gellinudd Hospital in your response. Or send your views to ABM Community Health Council, Water Street Business Centre, Water Street, Aberafan, Neath Port Talbot, Sa12 6LF Further information can be obtained at All comments received on these proposals by the Health Board will be shared with the Community Health Council at the end of the consultation process. Hard copies of this document can be obtained on request by ringing (01792) Copies of the document are also available in Welsh, large print, easy to read, Braille (English and Welsh), talking book and BSL versions. Please ring (01792) to request any of these formats. 17 P age

18 Copies of the documents will be sent to the following stakeholders and the opportunity given for the Health Board to attend discussions on the Public Consultation document: DISTRIBUTED TO NPTCBC C&CoS AMs & MPs for Swansea & NPT County Councillors, Swansea and NPT Older People s Planning Group Swansea Older People s Planning Group NPT NPT CVS Swansea CVS NPT HSCWB Partnership Swansea Partnership Board NPT LSB Swansea LSB Health Staff at Gellinudd Hospital ABMU Stakeholder Reference Group ABMU Partnership Forum ABMU Health Professionals Forum ABMU Local Medical Committee All GP Practices in NPT All GP Practices in Swansea ABMU Patient Participation Forum ABMU Third Sector HSCWB Network NPT Carers Forum Swansea Carers Action Group NPT Older People s Forum NPT Older People s Council Swansea Over 50s Forum Cilybebyll Community Council Pontardawe Town Council Gellinudd League of Friends Local Community Groups in Pontardawe area Libraries in NPT area Libraries in Swansea area Raynors Ltd, Optometrist, Pontardawe Herbert Street Dentist, Pontardawe 18 P age