NHS in Newport stands up to Storm Emma
We've all heard about winter pressures on the NHS in Wales. But this was the day when winter really seemed to have arrived.
From the nurses wrapping up to trudge through the snow to reach elderly patients in their homes, to the hospitals - gearing up for a flurry of patients with broken bones after falls on icy pavements.
In Newport, they were well-prepared for Storm Emma and whatever she could throw at them.
At the hospital
Staff arriving at the Royal Gwent in the city started with a team meeting from across all wards and departments for an update on current pressures.
It was partly about keeping an eye on a deterioration in the weather later - and making those early hours count.
Judith Paget, Aneurin Bevan health board's chief executive, said: "We wanted to make sure we can get people home before the really bad weather sets in later and making sure we had enough staff for the night.
"They've been brilliant, a lot arrived with overnight bags, recognising that they probably would not be able to get home tonight but also that staff due to come in later to relieve them might not be able to get in."
4x4 vehicles were also being organised to help get some staff into work - others relied on volunteers or even family members to ferry them in.
"The staff of the NHS always go the extra mile, especially in adverse conditions."
Outpatient clinics were cancelled, along with non-urgent operations for Friday too but it was emphasised that emergency cases would be seen.
"The primary consideration has been the safety of patients," said Ms Paget. "We don't want them to be out on the road in conditions where everyone is telling us, stay at home unless you really have to."
"People who need to get here, will get here - and we will have staff to see them."
Accident and emergency was relatively quiet - but it was standing by for any increase due to the weather.
A&E senior nurse Claire Parks said: "Pavements become icy and cold and we do see an increase in slips, trips and falls causing minor injuries
"Obviously the cold weather puts vulnerable patients at increased risk, with chest infections and flu.
"Today it's calmed down a little - the transport difficulties cover patients, staff and visitors and we've seen that today."
Chief operating officer Nick Wood said: "Our message to people is our services are there and ready - but don't come unless it is absolutely necessary."
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Helping out at home
The team of 60 district nurses, who go out to care homes and house-bound patients across Newport, were ready for the worst the weather could throw at them.
An emergency meeting was held on Wednesday to plan ahead to get to priority patients, with staff helping each other to get to work - with some volunteering to come in on days off.
Julie Meredith, district nurse team leader, said: "People, living on their own with nasty wound infections, they can change very rapidly - so we'd need to see them and to see those who need injections like insulin. We'll get there, one way or another.
"We have a brilliant team here - I have off duty staff who've rung in, know what we're up against and come in and they've been walking up hills to the places cars can't get to."
Jane Jordan, a nursing sister, was visiting Margaret Tolley, 81, in a sheltered housing complex to give her insulin and check her blood sugar level.
"We've been planning for days because we knew that this weather was coming in," said Jane.
Margaret said: "I'm one of the good ones, some are pretty poorly in here. They're always cheerful and kind, you couldn't ask for anything better."
What is happening elsewhere?
In Cwm Taf health board area, all outpatient appointments and routine operations were cancelled for Friday. They will be re-arranged as soon as possible.
In Betsi Cadwaladr covering north Wales, health managers arranged for 4x4 transport to help get staff into work as well as identifying vulnerable patients in the community.
"We currently have no plans to postpone routine operations or services, but will continue to review capacity over the coming days," said a spokesman.
In Cardiff and Vale, all routine surgery has been postponed for Friday; some urgent and cancer day cases would go ahead; outpatient appointments, except urgent ones, were being cancelled due to the deteriorating weather.
In Powys, some services were cancelled and patients were being contacted to let them know if their appointment would need to be rearranged.
In Abertawe Bro Morgannwg, some routine surgery was cancelled; outpatient clinics went ahead as normal on Thursday morning with some urgent appointments being brought forward. But all routine outpatient appointments for the afternoon and Friday were postponed. Radiotherapy, chemotherapy and renal dialysis appointments are unaffected.
Public health advice
Health officials are monitoring the situation minute by minute.
Chief medical officer for Wales Dr Frank Atherton said people needed to keep warm, check on neighbours and if they go out - take care on the roads or to wear sensible shoes.
"We're not used to very cold weather in this country. People need to understand these messages. It's really a matter of common sense but sometimes people do ignore those messages."
He said cold snaps brought extra pressures on the health service, including more strokes and heart attacks, with peaks in illness. So it was important to limit the number of falls and resultant pressures on accident and emergency.
"Anything we can do to relieve that pressure is very important."