The pressures that winter brings to the NHS are well documented - and this year they are compounded by a global pandemic.

Here Hywel Dda University Health Board chairperson Maria Battle reveals how the health board is planning to rise to the challenge.

"With autumn firmly on our doorstep and winter fast approaching we are totally focused on preparing for the winter challenges ahead together with our communities, staff, volunteers, carers and partners.

"The onset of the Covid-19 pandemic has forced us to behave differently, in ways that many of us are still trying to get used to. 2020 has been a year in which we have had to fundamentally change the way we live, work, interact with and care for each other.

Tragically, there continues to be a real human cost to the pandemic and many families have lost loved ones before their time. Many others have survived, but the journey to recovery continues for them - and for us.

Everyone is naturally tired and weary. The disease is resurgent and we are once again on the cusp of a national 'firebreak' lockdown across the whole of Wales to help stem the spread of the virus and allow our health service to look after the increasing number of people who will fall seriously ill. This will have an impact on our staff and communities. It affects NHS services and social care at a time of the year when services are often under extreme pressure.

Our workforce has worked tirelessly to change the way that we provide our services and care for people. We have worked hard to stay ahead of the curve since the onset of the pandemic.

In the first wave we set up Wales’ first Community Testing Units, and a local command centre to provide critical information and guidance to our staff and partners.

We changed our hospital, primary care and community environments to abide by new regulations to keep people safe. At the same time we have continued to deliver emergency and critical care safely where needed the most.

We’ve sourced and distributed personal protection equipment in the most challenging global market. We delivered field hospitals and have retained much of the expanded bed base ready for a second spike.

Digital solutions in primary and secondary care have been put in place to transform the way that we interact with our patients on telephone and devices. Our ICT staff have delivered over 220 tablets to help inpatients to keep in touch with family and friends while visiting is so restricted and families are separated. Our family liaison officers are trying to maintain that essential contact with loved ones.

Our GPs, hospital clinicians, care home commissioners and redeployed staff are continuing to support our care homes residents and staff, including a mammoth testing programme.

We’ve contributed to research and development into treating COVID19 and will continue to do so.

We have greater access to testing now, with enhanced arrangements in Aberystwyth and Llanelli. There is adequate local capacity for testing, despite some issues with the UK portal, and we’re also working on a more hybrid system, to run alongside the UK portal that will enable us to offer more local testing for our communities

We have been building on our Test, Trace, Protect strategy through our TTP Regional Response Cell, and we are working closely with Public Health Wales and all of our local authority partners who lead the local contact tracing teams, helping us to spot clusters early and break chains of transmission. Over 90 per cent of our contacts have been successfully traced and we thank you all for your continued help in working with our teams.

Our focus is also on re-establishing elective care where we can as we live alongside Covid19 and this has started in our hospitals. For many people this has been the main impact on them of the pandemic. We intend to contact each person individually to explain why there is a delay, what they can do to self- manage their condition and what they can do should they deteriorate and when they can expect their operation.

We know the impact of this will be felt for years to come, but we have been astounded with the support for our NHS in Hywel Dda.

It is more important than ever at this time to get protection against respiratory illness and our GPs and pharmacists and teams are working tirelessly to enable people in the priority groups to receive their flu jabs safely.

In the first wave of the pandemic some people were afraid to access health care. Our infection prevention and control teams, our housekeeping staff and all our workforce are making our hospitals as safe as possible. We are there for you if you need us.

It sometimes harder, as time goes on, to remember to stick to the basics that will keep us safer. These are:

• Always observe physical distancing (two metres).

• Wear a mask or face covering when you are in indoor public areas like shops.

• Wash your hands regularly. Hand sanitiser is great when you are out and about.

• Stay home and arrange to get a test if you develop any of the following symptoms: a high temperature, a new continuous cough and a loss or change of taste or smell

The Welsh Government has recognised the efforts of Hywel Dda Health Board recently by taking us out of targeted intervention. This is a tribute to all our staff and their tireless dedication and expertise.

Every pandemic in the history of mankind comes to an end. This one will too. We are prepared for the worst but are working for the best possible outcomes for our population. Together we will get through this winter stronger than ever.

For everyone who has sacrificed – thank you.