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Hugh Pym visited the Royal Glamorgan Hospital to hear about hospital management improvements and found that the challenges facing A&E departments are the same nationwide. The Welsh government had to defend its A&E records. "On the whole compared with England, Wales is doing worse on a number of indicators," said Nigel Edwards, chief executive of the Nuffield Trust. Social change has had a big effect on the pressures on A&E teams, as patients visiting the departments require different treatment skills to those previously required. Dr Ruth Alcolado, clinical director of acute medicine and A&E at Cwm Taf University Health Board, explained some of the issues faced: "We now have large cohorts of frail elderly with multiple other illnesses that they carry with them, because medicine has been successful in keeping people alive for longer."
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