Agenda and draft minutes

Apologies were received from Councillors Jeanette Chamberlain-Jones (Chair), Pat Jones and David Williams.

Prior to the commencement of business the Vice-Chair and Committee members requested that their best wishes for a fully and speedy recovery be sent to the Chair.

Councillor Gareth Davies declared a personal interest for items 5, 6 & 7 as an employee of Betsi Cadwaladr University Health Board.

There were no urgent matters.

To receive minutes of the Partnerships Scrutiny Committee meeting held on

14 December 2017 (copy enclosed).

10.05 a.m. – 10.10 a.m.

The minutes of the Partnerships Scrutiny Committee held on 14 December 2017 were submitted.

Referring to the Denbighshire Homelessness Strategy and Denbighshire Supporting People / Homelessness Prevention Plan Councillor Butterfield asked whether the Authority had a policy defining residency. The Corporate Director: Communities responded that ‘residency’ sat across a number of legislative frameworks and applications had to be considered on a case by case basis. Members might want to consider the complexity by referring it to the Scrutiny Chairs and Vice-chairs Group.

RESOLVED that subject to the above, the minutes of the meeting held on 14 December 2017 be received and approved as a correct record.

The Chair of the meeting welcomed the Area Director:  Central Area; Assistant Area Director of Primary Care and Commissioning; Director Clinical Services Therapies; and the Assistant Area Director of Community Services – Central; from the Betsi Cadwaladr University Health Board (BCUHB) to the meeting to update members on the progress made to date in relation to the business items relating to health establishments and services.

To receive a verbal update from representatives from the Betsi Cadwaladr University Health Board on the Healthy Prestatyn initiative

11.40a.m. – 12.15p.m.

The Health Board’s Assistant Area Director of Primary Care and Commissioning briefed the Committee on the background to the establishment of the Healthy Prestatyn Iach initiative.  During her introduction she advised that:

·         General Practitioner (GP) practices were private entities, they ranged in patient caseload size.  The smallest GP practice in Denbighshire had circa 2K patients registered with it, whilst the average GP practice size in the county had in the region of 7K patients;

·                     the Healthy Prestatyn Iach model, which served patients registered with surgeries in Prestatyn, Rhuddlan, Meliden and Ffynnongroyw was a new way of delivering primary medical care, intervention and well-being, which was managed directly  by the Health Board.  It comprised of four teams within the surgery which dealt with the management of chronic cases, a fifth team which undertook home visits along with another team that delivered acute medical services for patients using the walk-in service;

·                     the Health Board managed service had been established to deliver primary medical care services in the area following a number of GPs in the area notifying the Board that they would be retiring or terminating their contracts for delivering GP services.  In establishing this innovative new model for delivering primary services the Board had also incorporated into the new model a more holistic approach towards the delivery of primary medical services and the general well-being of the population;

·                     the Service currently received was contacted by the public circa 100K a year, dealt with an average of 420 patients a day of whom around a 100 were seen on the day of contact.  The number of patients seen on a daily basis exceed the daily average for the Emergency Department (ED) at Ysbyty Glan Clwyd; 

·                     the Tŷ Nant facility, which the Health Board rented from the Council was a fantastic facility which supported the service-delivery model well;

·                     a new patient IT system had recently been installed which was working well:

·                     Health Inspectorate Wales (HIW) had inspected the Healthy Prestatyn Iach service during 2017 and had concluded that it was overall providing safe and effective care;

·                     there were challenges ahead, particularly in relation to the recruitment of clinical staff, training provision to the private provider sector and a continual increase in the demand on its services.  Between January and March 2018 there had been an increase of 6% in appointments and a 15% increase  in home visits undertaken by the service;

·                     moving forward the focus would be on recruiting an additional GP and an advanced nurse practitioner.  It was pleasing that a GP had indicated an interest in joining the service and that a nurse was currently training to qualify as an advanced nurse practitioner.  The Service was also planning to recruit a paramedic to complement the range of services it could offer and to appoint a Head of Service Manager – an operational manager to co-ordinate the work and back office functions for all sites operating under the auspices of Healthy Prestatyn Iach;

·                     the establishment of this innovative service had been a learning journey, particularly in relation to the different demands on the Service when delivering primary and secondary care.  Consideration was currently being given to linking into a study being undertaken by Bangor University on training and mentoring requirements for delivering primary care;

·                     the Health Board acknowledged that more work was needed with the third sector in the Prestatyn area in relation to understanding the types of services required in the area and how public sector organisations such as the Health Board, the local authority and third sector partners could work effectively together to deliver these services in the  ...  view the full minutes text for item 5.

To receive a presentation from Betsi Cadwaladr University Health Board

representatives on the progress made to date with the development of the

new facility and the expected timescale for its delivery.

10.10 a.m. – 10.50 a.m.

BCUHB’s Director Clinical Services Therapies informed the Committee that the Health Board was currently working on the second stage of the Welsh Government’s (WG) 3 stage business case process for the developing the site of the former Royal Alexandra Hospital in Rhyl into a community hospital for North Denbighshire.  By means of a PowerPoint presentation he displayed an illustration of the proposed new building emphasising that the new community hospital would be far more than just a hospital:

•              the proposed service model to be developed on the site would include a multi-agency multi-disciplinary team which would design their services around the needs of the service user, supporting the ethos of reablement to empower service users to live independently by collaborating with social care and third sector partners to improve prevention and enhance well-being;

•              it would support more integrated working between primary and community based health care with a focus on older people with a view to ease the pressure on Ysbyty Glan Clwyd, deliver integrated physical and mental health service for older people, provide urgent same day health care services and a range of ambulatory and outpatient services closer to the patient’s home; and

•              the development would take the form of a Healthcare Campus which would make use of the Grade II listed former Royal Alexandra hospital building in conjunction with the proposed new hospital building.  The campus would include same day minor illness and minor injuries provision, outpatients clinics, integrated older persons’ mental health outpatient services, a 28 bed inpatient ward with a multi-disciplinary assessment unit, an intravenous (IV) therapy suite, diagnostic services, therapy services, extended community dental services, extended sexual health services, a community hub which would include a café and third sector meeting rooms.  It would also accommodate an integrated working base for the Single Point of Access (SPoA) Services, Child and Adolescent Mental Health Services (CAMHS) and offices for integrated support teams.

The Committee was informed that:

•           the Health Board had approved and submitted the Outline Business Case (OBC) for the North Denbighshire Community Hospital Project to WG in January 2017.  Included in the OBC was the case for capital investment in the new build and the provision of new services on the site, along with the rationale for additional investment in the Grade II listed building;

•           subsequent to the OBC’s submission to WG Board representatives had met with WG officials in July and September 2017 to discuss the proposals.  The Project Team had regrouped to respond to challenges identified as part of the OBC approval process and an independent Gateway Review of the business case and process had been commissioned.  The findings of the Gateway Review had proved extremely useful with a view to moving the project forward;

•           the WG wanted assurances in relation to how the OBC would support the delivery of the Health Board’s Living Healthier Staying Well strategic plan, a redefined workforce strategy and greater clarity on the benefits realisation of the plan.  The latter related to the use of the existing listed building, by utilising this mainly as office accommodation, the Health Board was confident that it could secure the building’s future and provide additional healthcare services within the new building.  Workforce related issues were not unique to this project they were

•           work was currently underway to re-draft the annex to the OBC which detailed the estates’ proposals, this would include a clear statement on the function of the Grade II listed building following a proposed investment of circa £200K.  More detail would be included in the OBC, prior to its re-submission  ...  view the full minutes text for item 6.

To receive a presentation from Betsi Cadwaladr University Health Board

representatives on the latest position regarding the closure of wards at

Denbigh Infirmary, alternative provision put in place in the interim, and future

plans for the hospital.

10.50 a.m. – 11.30 a.m.

The Assistant Area Director of Community Services – Central briefed members on the reasons that led to the Health Board’s decision to close 10 beds on the upstairs ward in the Infirmary in the wake of the Grenfell Tower disaster.  The Infirmary was built in the early 1800s and accommodated 40 inpatient beds, 23 beds on the ground floor with 17 beds on the first floor.  Following the Grenfell Tower disaster the Health Board undertook an extensive fire safety assessment of all its buildings.  That assessment highlighted fire risk concerns at both the Infirmary and Mold Community Hospital.  The specific concerns with respect of the Infirmary related to the fact that the floor of the upstairs Lleweni Ward, part of which was situated immediately above the hospital’s kitchen, was supported by wooden joists.  The risk was exacerbated further as this part of the building was not compartmented which would help to reduce or at least slow down the spread of fire.  When the extent of the risk became apparent the Health Board considered a number of options for addressing the risk, ensuring patient and staff safety whilst causing the minimum amount of disruption to all concerned. 

However, due to the need to ensure that all patients could be safely evacuated in the event of a fire the least disruptive safe option that could temporarily be put in place was to reduce the number of beds on Lleweni Ward from 17 to 7 - with the caveat that the remaining beds had to be occupied by patients who would not need mechanical support for their mobility needs in the event of evacuation.

The WG’s Estates Department who had undertaken the fire risk assessment had made a number of recommendations in relation to improving the fire safety measures as the building.  A number of these recommendations had been implemented, including compartmentation work.  In addition the Health Board had commissioned a second, more intrusive survey, from consultants Mott McDonald.  Whilst the findings of this survey were initially expected to be available during April, due to the need to take all necessary precautions to safeguard engineers, patients and staff, in case asbestos was present in the building and disturbed during the surveying work there had been a slight slippage.  However, the consultant’s report should be available in May 2018.  

In a bid to manage the impact of the temporary loss of 10 beds at the Infirmary the Health Board had opened 5 temporary beds at Ruthin Community Hospital, with other work being undertaken within the community to care and support for people in their own homes.  The Health Board had proactively engaged with staff in relation to changes to work patterns, however it had experienced staffing pressures relating to the additional beds at Ruthin Hospital which had led to the need to use agency and bank nursing staff to provide care.  Ruthin GP practices had been extremely supportive and had increased their availability to cover the additional in-patient beds at the hospital. 

Despite fewer beds being available in Denbigh Infirmary at present the Health Board advised that between both Denbigh and Ruthin hospitals there were community hospital in-patient beds available on the majority of days for patients to be either admitted directly there or to be transferred from the district general hospitals.  Health Board officers confirmed that GP practices in Denbigh were very supportive of the Infirmary and the services provided there.

The Health Board was providing on-going support and advice to staff at the Infirmary, with regular monthly briefings being held for them.  Regular training sessions were also being held for staff  ...  view the full minutes text for item 7.

To consider a report by the Scrutiny Coordinator (copy enclosed) seeking a review of the committee’s forward work programme and updating members on relevant issues.

12.15p.m. – 12.30p.m.

The Scrutiny Co-ordinator (SC) submitted a report (previously circulated) seeking members’ review of the Committee’s work programme and provided an update on relevant issues. She reminded the Committee that the next meeting was scheduled to be held in Rhyl to visit the Single Point of Access unit (SPOA) in Russell House.

The SC highlighted the three items on the agenda for May’s Partnership Scrutiny Committee:

·         Homelessness Strategy and Prevention Plan

·         Pooled Budgets (Health and Social Care) and

·         Support Budgets for People Eligible for a Care and Support Plan.

The Corporate Director: Communities advised that the items on homelessness and support budgets were both substantial, therefore the Committee may wish to defer the item on pooled budgets to June’s meeting.

Councillor Butterfield requested that the £1million homelessness grant from Welsh Government be covered by homelessness report.

The Corporate Director: Communities informed the Committee that the Betsi Cadwaladr University Health Board was expecting one of the reports on the lessons learned in respect of the Tawelfan Ward to be published on 3^rd May 2018. The Committee agreed to convene a special Partnerships Scrutiny Committee meeting within a week of its publication in order to consider the report fully.  It was also agreed that the special meeting should be held in Rhyl in order to facilitate a visit to the site of the proposed North Denbighshire community hospital.

Referring back to the report the Scrutiny Coordinator highlighted that:

·         appendix 3 – Cabinet Forward Work Plan - was for information purposes and

·         appendix 4 provided an update on Committee’s resolutions.

The Chair of the Partnerships Scrutiny Committee had requested that September’s meeting be moved from 13^th to 20^th in order for her to be able to attend. The Committee agreed to the deferment.

RESOLVED subject to the above to:

(i)            Confirm the Committee’s forward work programme;

(ii)          Convene a special meeting for week commencing 10^th May 2018 to review the Tawelfan report and

(iii)         Change the date of September’s Partnerships Scrutiny Committee to 20^th September.

To receive any updates from Committee representatives on various Council Boards and Groups

12.30p.m. – 12.35p.m.

Councillor Hugh Irving reported that he had a meeting the following week for the preparatory agenda for a lines of enquiry for Service Challenge.

Meeting closed at 13:04