Agenda and draft minutes

None tendered.

Members to declare any personal or prejudicial interests in any business identified to be considered at this meeting.

Councillor Kelly Clewett declared a personal interest in business item 5, ‘Urgent and Emergency Care:  Flow Out of Hospital – North Wales Region’ in her capacity as an employee of Betsi Cadwaladr University Health Board (BCUHB), as a Community Resource Team Lead – Community Resource Team.

Notice of items, which in the opinion of the Chair, should be considered at the meeting as a matter of urgency pursuant to Section 100B(4) of the Local Government Act 1972.

No items of an urgent nature had been drawn to the attention of the Chair, or the Scrutiny Coordinator, prior to the commencement of the meeting.

At this juncture the Chair informed members that as a result of the formation of the new Denbighshire Independent Alliance political group there had been a change in the Council’s political balance.  A consequential effect of the change in political balance was the composition of the Committee’s membership.  This had resulted in Councillor Bobby Feeley leaving the Committee and being replaced by Councillor Merfyn Parry.  The Chair thanked Councillor Feeley for her valuable contribution to the Committee’s work and welcomed Councillor Parry to his first meeting.

To receive the minutes of the Partnerships Scrutiny Committee meeting held on 13 February 2025 (copy attached).

The minutes of the Partnerships Scrutiny Committee meeting held on 13 February 2025 were submitted were submitted.  The Committee:

Resolved:  that the minutes of the Partnerships Scrutiny Committee’s meeting held on 13 February 2025 be approved as a correct record of the proceedings.

Matters arising  page 9, ‘Royal Alexandra Hospital (RAH) Development – responding to an enquiry the Corporate Director:  Social Services and Education confirmed that the procurement stage of the delivery plan had slipped slightly due to technical matters, but work was on-going with a view to concluding this stage in the near future.  Despite this, other matters had progressed satisfactorily i.e. discussions relating to car parking and arrangements for decanting staff ahead of the redevelopment.  A further progress report was scheduled for presentation to the Committee at its September 2025 meeting.

To consider a report by the Head of Regional Collaboration (copy attached) which seeks the Committee’s observations on the work being taken forward under the auspices of the North Wales Regional Partnership Board in response to the Audit Wales report on patient flow out of hospital.

10.05am – 10.50am

The Lead Member for Health and Social Care and the Corporate Director: Social Services & Education (CDSSE), alongside the Acting Assistant Director – Care Homes Support and Continuing Health Care Commissioning and Director of Public Health (BCUHB), presented the Urgent and Emergency Care: Flow out of Hospital – North Wales Region report (previously circulated).The aim of the report was to provide an updated account/information to partners regarding the associated work undertaken since the first publication of the Audit Wales report and combined organisational response in September 2024.

The Committee were informed that overall, it was found that whilst partners understood and showed a commitment to improving patient flow out of the hospital, performance remained extremely challenging with adverse effects on patient experience and care. Partners continued to work both individually and collaboratively to set and implement clear guidance, mitigate the challenges posed by reduced capacity and increased complexity of care, and ensure the impact of activities was continually monitored, challenged, and maximised.

The original report found that the extent of discharge delays in North Wales had grown significantly in recent years. Between April 2023 and February 2024, each month, there were, on average, 334 medically fit patients whose discharge was delayed, with completion of assessments the leading cause for delay. For the year up to and including February 2024, the total number of bed days lost to delayed discharges was 71,871, with a full-year cost equivalent of £39.202 million. The consequent impact on patient flow within hospitals and the urgent and emergency care system was significant, with waiting times in emergency departments and ambulance handovers falling well short of national targets. In February 2024, there were over 8,000 lost ambulance hours because of handover delays, and the average wait within the Health Board’s emergency departments was around 8.5 hours. Difficulties with discharge also impacted the ability of partner organisations to meet some patients' needs effectively, especially in the west of the region, where a significant proportion of patients were placed in temporary accommodation post-hospital discharge.

Members drew attention to several areas within the report and discussed the following further –

• whether the continual negative press/media coverage received by the Health Board contributed to the difficulties encountered in recruiting staff at all levels, thus impacting the flow in and out of the hospital.  Officers responded that negative press coverage was an issue. However, it had no impact on staffing, and the staffing levels were acceptable in all disciplines other than mental health, which was still proving challenging to hire staff.
• the steps being taken to ensure that vulnerable patients were not discharged home in the middle of the night with no one to receive them when they arrived. What support was made available to them to make sure they fully understood when and how to take their medication etc and whether any follow-up visits were scheduled. Responding officers acknowledged there were issues with the discharge process and agreed with members that vulnerable people should not be discharged in the middle of the night. BCUHB officers emphasised that vulnerable patients should not be discharged in the middle of the night and without support.  If this was happening it should be reported as an incident.  The Health Board held hourly discharge data, which was closely monitored, and worked closely with the community health team to ensure follow-ups were being carried out. 
• The Health Board had recently finalised its hospital discharge policy win cooperation with the local authority and other stakeholders.
• whether communication channels were sufficiently effective to ensure that patients deemed medically fit for discharge were  provided with proper support to aid their discharge.  ...  view the full minutes text for item 5.

To consider a joint report by the Council’s Corporate Director:  Environment & Economy, the Head of Highways & Environmental Services, and the Risk & Asset Manager (copy attached) which seeks the Committee’s feedback to help inform the next steps in relation to the project to replace Pont Llannerch.

11am – 12pm

The Lead Member for Environment & Transport alongside the Corporate Director: Environment & Economy, the Head of Highways & Environmental Services, the Risk & Asset Manager and the Senior Engineer - Bridges & Construction presented the Committee with a report (previously circulated) updating members on the Pont Llannerch project.

Due to the complexities involved with this specific subject the Head of Highways & Environmental Services guided members through the report's contents.  He also welcomed Dŵr Cymru Welsh Water’s Head of Water Production to the meeting to answer the Committee’s questions on their operations in the bridge’s vicinity and how any proposals may impact on those operations. 

Following the collapse of Pont Llannerch during Storm Christoph in January 2021, Highways & Environmental Services has been working on a project to build a replacement bridge. The project was split into three stages: Optioneering, Detailed Design, and Construction. It had now reached the end of the Detailed Design stage. The detailed design stage had been complicated and lengthy and has raised significant challenges. The main challenge being the consideration of the foundations required for a new bridge. This discussion had been complicated because Pont Llannerch was located above a freshwater aquifer, which was within a layer of weathered sandstone, and because Dŵr Cymru Welsh Water (DCWW) had a freshwater abstraction site situated directly next to where the old bridge was located. This aquifer and freshwater abstraction site provided water to around 85,000 homes in the region, therefore, the freshwater aquifer and water abstraction assets were extremely important to many DCWW customers. Consequently, the Council would need to ensure that it did not compromise these assets when building a new bridge.

A preferred design using raft foundations had been chosen because raft foundations worked by distributing the load over large areas of ground. However, significant risks still existed because construction would require sheet piling – essentially drilling into the rock below where the foundations would sit. This drilling created a risk of compromising the assets. Provisional ground investigations at the pioneering stage determined that this weathered sandstone sat between 12 and 36 metres below ground level and extended as far upstream as Ruthin. Further ground investigations during the detailed design stage showed the water level to be as close as 10 metres beneath ground level. There was a standard for assessing the predicted scour depth of a bridge, and this showed that all 10m of the riverbed gravel in this location would likely erode in the future. Therefore, to protect a new bridge and to ensure it was not undermined, the newly constructed sheet pile curtain containing the new raft foundation would need to be drilled/driven into the area beneath where the foundations were placed, and this would penetrate the weathered section of sandstone in which the aquifer sits. Drilling into the aquifer could potentially compromise water quality at the DCWW abstraction point at Llannerch Park. Compromising the site would present a risk of supply loss to 85,000 DCWW customers. The project team had been working closely with DCWW throughout the Detailed Design Stage, and the DCWW view was that all risk assessments had failed to provide suitable evidence that the drilling work would not introduce risk to this critical asset.

DCWW has stated that drilling into the aquifer would ultimately create a pathway for the risk of water supply contamination, compromising the aquifer local to the abstraction point could lead to several factors related to risk and safeguarding for their customers. An introduction of significant risk associated with the water supply had the potential to introduce a public health risk with wide-reaching consequences. DCWW has also stated that  ...  view the full minutes text for item 6.

To consider a report by the Scrutiny Coordinator (copy attached) which seeks the Committee to review its programme of future work and updates members on relevant issues.

12pm – 12.20pm

The Scrutiny Co-ordinator introduced the report and appendices (previously circulated), which sought the Committee to review its future work programme.

Members were informed that there were not any substantial changes to the work programme; there was one item scheduled for the May meeting, which was the Household Waste Recycling Centres.  Enquires could be made to see if the North Wales Economic Ambition Board Annual Report 2024/25 would be available to be presented at the next meeting.  Members agreed that enquires be made to this effect.

Members were advised that the next Scrutiny Chairs and Vice-Chairs Group (SCVCG) meeting was scheduled to be held on 28 April 2025. Their attention was drawn to Appendix 2, which contained the Members’ Scrutiny Proposal form. This form required completion and return if members had any topics, they wished to be considered for inclusion on a future scrutiny committee forward work programme. The Committee:

The Committee:

Resolved:  subject to the above, to confirm its programme of future work as set out in Appendix 1 to the report.

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

None.

Meeting concluded at 1.25pm.