Agenda item

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 on the management of action plans, risk assessments, fire safety and evacuation procedures.  In relation to stakeholder engagement Board officials had met with the Infirmary’s League of Friends, local councillors and others, all of whom were very supportive of the Board’s efforts to find solutions to the risks identified and to see the establishment operating at full capacity as soon as possible

Responding to members’ questions Health Board representatives:

·                     confirmed that Denbigh Infirmary had 40 in-patient beds, prior to the temporary closure of 10 on fire safety grounds.  Of the 40 beds 6 were for respiratory care, 12 were for Care of the Elderly, with the remainder being managed by Denbigh’s GP practices.  The total did include the beds on the Macmillan Ward which were not always needed for palliative care and were consequently available for other types of care.  Beech House Surgery who did not use the Infirmary for GP-led medical care did utilise the beds on the Macmillan Ward;  

·                     advised that the option of closing the kitchen and having food delivered to the Infirmary had been considered as a potential solution to the risks identified rather than having to temporarily close beds.  However, this was not a viable option as white goods such as fridges and freezers would still be required on site therefore the risk of fire would not be sufficiently reduced to enable the beds to stay open;

·                     advised that it would be highly unlikely that the Infirmary would have 17 sufficiently mobile patients at any one time to enable them all to be located on the first floor ward;

·                     confirmed that staffing pressure were a persistent problem at the Infirmary, but his was not unique to the Infirmary it was a problem experienced across the NHS;

·                     confirmed that in total four members of staff had left Denbigh Infirmary since Christmas, 2 had indicated their intention to leave before the beds had been temporarily closed.  The other two had left due to future uncertainties, although one had transferred to another similar hospital nearby.  Naturally a number of staff were concerned about the future due to having encountered similar situations at the Royal Alexandra Hospital, Rhyl and the former North Wales Hospital at Denbigh.  However, the Health Board was currently actively recruiting for both Denbigh and Ruthin hospitals and there was a ‘Community Hospital Recruitment Day’ scheduled for 28 April 2018;

·                     informed the Committee that Denbigh Infirmary was at the forefront of the ‘Pyjama Paralysis Campaign’ which focussed on the importance of getting people out of their nightwear and dressed as part of their recovery and reablement;

·                     confirmed that there were no shortage of community beds in the Health Board’s Central Area, covering the counties of Conwy and Denbighshire, it was Ysbyty Glan Clwyd and other acute hospitals which had bed shortages;

·                     confirmed that the Health Board had no plans at present not to re-open the 10 beds closed temporarily at the Infirmary, if and when the time was right.  It was aware that it needed to be open about the future of Denbigh Infirmary, and required to engage with citizens and with the Council on the future medical needs for the Denbigh area;

·                     advised that the WG Estates fire risk assessment report had been shared with the Council.  Health Board officials did not foresee any problems relating to sharing the consultants’ report with the Council once available.  However, they did advise that this report would a very technical report;

·                     confirmed that all hospitals were at present operating at high bed occupancy rate, which sometimes made it difficult to transfer patients from the acute hospitals to community hospitals;

·                     advised that there were times due to staff shortages when the Matron would be called upon to work on the wards, this was usually at times of high staff sickness levels;

·                     confirmed that the Infirmary did still operate a midwifery-led maternity unit.  Whilst this was not widely used it was important as it had a legacy attached to it whereby a young person born at the Infirmary may be eligible to a apply for a scholarship if attending university;

·                     that GPs in Denbigh were aligned to the Health Board’s South and Central GP cluster.  The Health Board’s strategy was to provide services as close as possible to the patient’s home, consequently a range of services were provided at Denbigh Infirmary;

·                     confirmed that the Health Board was currently working on its Community Strategy which would include shaping community hospitals for the future.  The Council would have an opportunity to contribute towards  the strategy through the Public Services Board (PSB); and

·                     advised that the Health Board was keen to discuss with the Council’s Chief Executive how both the Board and the Council could jointly engage with local communities.

At the conclusion of the discussion the Committee:

Resolved: - subject to the above observations to request that the Health Board be invited to a future Council Briefing session to discuss with elected members its Community Strategy on shaping community hospitals in the county in future.