Agenda item

To consider a report by the Lead Member for Social Care and Children’s Services (copy enclosed) for Council to consider proposals for the reconfiguration of the delivery of NHS services in North Wales and to enable Council to formally respond to BCUHB consultation process.

 

The Corporate Director: Demographics, Wellbeing and Planning (CD:DWP) presented a report (previously circulated) that sought Council’s input to the draft response to Betsi Cadwaladr UHB Service Reviews consultation process.

 

CD:DWP gave a brief introduction to the representatives from Betsi Cadwaldr UHB  (BCUHB) and welcomed them to the meeting.  The consultation period was to run for 10 weeks from 20^th August, 2012 until 28^th October, 2012. 

 

Councillor Bobby Feeley, Lead Member for Social Care and Children’s Services, referred to the fact that changes to the Health Service were inevitable but the reasoning behind some measures were difficult to understand.  Councillor Feeley informed the BCUHB representatives of the Partnership Scrutiny Committee Working Group which had been set up and together with officers had been working through the measures. The working group were to meet at the end of September to finalise the response which would be brought to the next Council meeting on 9 October, 2012.

 

Geoff Lang, BCUHB, presented “Healthcare in North Wales is changing”.  Copies of the presentation were made available to all attending the meeting together with the consultation document for information.

 

Following the presentation, pre-planned questions were asked of the BCUHB representatives.  All members had received a copy of the question sheet and the CD:DWP had also previously sent a copy of the question sheet to the representatives from BCUHB.

 

Question 1 – submitted by Councillor Brian Blakeley.  Issues with Ambulance queues outside Glan Clwyd, beds blocked, operations cancelled, staff being sent home and waiting time targets missed.  How will the changes proposed, solve these problems?

Geoff Lang responded that work was taking place around A & E regarding recruitment  of staff.  Ysbyty Glan Clwyd was to have a new A & E Unit.  BCUHB were working with the ambulance service to ease the problem of ambulance queues.  Home enhanced care would contribute to easing the pressure of beds as the need to admit some patients would be avoided and therefore easing the pressure on ambulances.

 

Work was taking place with the Welsh Ambulance Trust to avoid use of ambulances for non emergency cases.  Currently there are no options other than to take people to the emergency unit.  Following the review of services, in the future, non emergency cases would be taken to a minor injuries unit.

 

Question 2 – submitted by Councillor Julian Thompson-Hill. How does BCUHB propose to manage and deliver the huge investment required to bring these plans into fruition considering the large budget deficit it already has (circa £65m)?.

Geoff Lang responded that generally there was a pressure upon budgets.   BCUHB had been assessing areas to save resources and resources deployed in front line services, and procurement etc.  This plan was to change the way services were delivered.  Important to recognise if BCUHB do not make these changes the financial situation would get worse and not better.  This was not the answer to all health care financial issues.

 

Question 3 – submitted by Councillor Win Mullen-James.  How confident is BCU of securing the required capital and revenue investment to open the new community based facility to serve Rhyl and Prestatyn and the new facility in Llangollen?  Have assurances been received that the business cases are sound?  How likely are they to be completed and opened by 2015.  What assurances will be given that existing services will remain functioning until the new facilities and services are open?

Geoff Lang responded that funding would not be released until final consultation had been carried out.  BCUHB were confident funds would be made available.  Some changes would be able to happen rapidly but some were more connected to facilities which would depend on the final plan produced in December. There would be no gaps in services.  For example, Llangollen closure, home care would be in place prior to the closure.  BCUHB representatives gave assurances new facilities would be open in 2015.

 

Question 4 – submitted by Councillor Martyn Holland.  Why was Denbigh Infirmary chosen as a hospital hub rather than Ruthin as we feel a case could also be made for Ruthin?

Geoff Lang responded regarding Ruthin Hospital and Denbigh Infirmary.  The size and range of facilities offered were looked into, as were extended hours and where most activity and potential of site to develop over time.  In BCUHB’s judgement, Denbigh Infirmary was best positioned to offer these facilities as a hub.

 

Question 5 – submitted by Councillor Cefyn Williams.  With the minor injuries unit at Bala closing, in addition to the proposals for Llangollen Community Hospital, are you confident that residents in the upper parts of the Dee Valley will have adequate minor health provision which is easily accessible to them?

Geoff Lang responded there had not been a minor injuries unit in Bala.  GP’s provided a minor injuries service and that would continue.  In terms of Llangollen, GP’s had been consulted to enquire if they would provide a minor injuries service but this would be in place of a minor injuries unit. 

 

Councillor Cefyn Williams asked for a more definitive response.

 

Grace Lewis Parry responded that proposals at the moment were for Llangollen Community Hospital to close and a new facility to be built.  There would be a minor injuries service provided by GP’s and no reason that service would not continue.  The minor injury service would link in with Wrexham Maelor Hospital. 

 

Question 6 – submitted by The Leader, Councillor Hugh Evans.  We understand the Health Board in July agreed to retaining a range of services on all 3 acute hospital sites (e.g. maternity, paediatric in-patient services, routine vascular services, routine general surgery, trauma and orthopaedic services) – but a lot of doubts have been expressed about whether that is viable long-term.  We wish to be assured that if this decision was reversed there would be a full public consultation about changes to services and no downgrading of Ysbyty Glan Clwyd. How will those decisions be taken and how would the public know what was happening?

Geoff Lang responded the Board had held a public meeting in July and received feedback.  The view of the clinicians was that they wished to retain core services on three sites.  The Board  were to monitor safety very closely.  If the long term plan were to change, it would be a matter for public consultation at a later date.

 

Question 7 – submitted by Councillor Raymond Bartley.  We would like some of the proposals to extend services for older people with mental health needs.  However, we are doubtful that the plans you have set out mean there will be enough resources to provide in-patient and community health services for these people and their carers.  Can you explain why you think there will be enough?

Grace Lewis Parry responded.  In terms of older persons, beds were regularly unoccupied and the evidence clinicians brought, was that if services were delivered to own homes, bed demands would decrease.  Both clinicians and BCUHB believe this would deliver more care and would meet the needs of the population.

 

Question 8 - submitted by Councillor Bobby Feeley.  We are concerned the plans would mean increased pressure on local authority social care budgets, especially as there doesn’t seem to be clear financial plans for investing in community services.  What reassurances can you give us about that?

Dr Chris Stockport responded.  Discussions had taken place as to how to deal with the issue of possible increased pressure on local authority social care budgets.  This was a service which specifically looked at providing care at home where otherwise hospital admission would be required or the patient would require a longer hospital stay.  Careful work had been carried out with officers in Local Authorities as to how resources could be used in the correct way.  It was a health initiative and would be delivered by health.  By working as one team, a more efficient and improved working service would be delivered.  There was no doubt a health intervention funded by health would be delivered.  Once discharged home, through enhanced care, health do not disable them as much as when in hospital.  This was the national experience.

 

Question 9 – submitted by Councillor Ann Davies.  The proposals would have a lot of impact on both carers and the services for carers provided for local authorities.  Would you commit to developing a comprehensive plan for carers showing how you will finance more services and especially through providing respite care?

Grace Lewis Parry responded, people were living longer and wanted to remain in their own homes but without care provided by carers the whole public sector would implode.  A Carers Measure would be available in October. Carers can get very distressed when they do not get support.  Extra support would be provided to all carers.

 

Question 10 – submitted by Councillor David Smith.  The proposals are inevitably going to rely heavily on good transport being available, both people needing ambulances in an emergency, and patients and families travelling further for community hospital beds or specialist services.  Can you tell us what consultation has taken place with the Welsh Ambulance Service Trust? What assurance can you give us that they will be able to meet the new challenges?  Can you give a guarantee that before the changes happen, a fully comprehensive and funded Travel Plan will be drawn up to help patients and carers get to and from the new services?

Sally Baxter responded.  Starting with the Welsh Ambulance Trust, BCUHB have been involved with all work streams.  Work had taken place with the Board through developing an emergency medical retrieval system and also a co-ordination centre for various services which may be needed.  BCUHB were working with community transport providers as to how they could provide additional transport. There had been a nominal investment of £80,000 for a pilot scheme regarding additional transport.  BCUHB were aware not everyone had use of a car and, therefore, used alternative forms of transport.  BCUHB are to monitor the situation and had contacted the Community Council Manager.  If proposals were accepted, would look at detailed changes.  A detailed plan was not in place at this stage as it is only the consultation process but this would be put in place once consultation had been finalised.

 

Question 11 – submitted by Councillor Alice Jones.  We would prefer intensive care for very sick newborn babies to be available in North Wales at Ysbyty Glan Clwyd. Why is Arrowe Park being considered?  What are the comparative costs of this compared with a unit in North Wales? What reassurances can you give about provision for parents and Welsh language services if this service is provided outside North Wales?  Can you explain exactly what group of babies we are talking about?  What services would stay in North Wales if Arrowe Park is chosen?

Grace Lewis Parry responded.  There were no issues regarding the standard of services and safety.  BCUHB’s proposal response is standards require BCUHB to move on.   It would cost approximately £1million to bring the neonatal unit up to national standard.  It would cost  £1million less for Arrowe Park.  Grace Lewis Parry to supply papers to the Members for information.

The Welsh language issue was set out in the contract.

As very young babies needed to be cared for, for several weeks, the feedback received regarding the family unit and access at Arrowe Park, was excellent.

 

Question 12  - submitted by Councillor Gwyneth Kensler.  Will these health changes improve services and guarantee dignity and care for those needing palliative care and for those at the end of their lives?

Dr Chris Stockport responded.  A majority of people die in hospital but most people would prefer to die in their own home.  The fact remains that because services were not configured correctly, dying people were being admitted into an environment which was very medical and did not allow them to have the natural death they requested.  The enhanced care plan was a concept used in other countries and allowed people to work out what were very important values and how BCUHB could deal with this.  A pilot scheme was to commence in North Denbighshire in a couple of weeks whereby home was the preferred place and not hospital.  

 

At this point the Chair declared there was time for 4 further questions.

 

Councillor Stuart Davies asked the BCU representatives if there was to be a minor injuries unit in Llangollen.

Geoff Lang responded.  There would not be a minor injury unit in Llangollen but would be a minor injuries service delivered by GP’s.

 

Councillor Arwel Roberts expressed concern regarding the Rhuddlan surgery and the fact that there appeared to be inadequate funding to support the surgery.

Grace Lewis Parry responded she did not have any details regarding Rhuddlan Surgery with her at the present time.

 

Councillor Rhys Hughes raised the question regarding Llangollen Community Hospital outpatients and day care departments. Would these departments be relocated into the new extended primary care resource centre?  Would they continue at present site until new facility had been built?

CD:DWP confirmed both outpatients and day care departments would be transferred to the new facility. 

Grace Lewis Parry stated that providing services was important.  BCUHB could not give a guarantee the hospital would be kept open but a range of services would be provided in the local area.

 

Further questions were raised by Members and the BCU representatives responded as follows:

 

Glan Traeth beds would be provided within Ysbyty Glan Clwyd until the new facility was built on the Royal Alexandra Hospital site.  Lawnside will be relocated as an outreach centre.  The Deanery set standards as to the number of Doctors take up of training places.  Special care baby units and intensive care could be maintained by Paediatricians and arrangements were currently being put into place.

 

BCUHB were aware of concerns regarding added pressure on GP’s due to enhanced care at home.  The Medical Committee were currently looking at GP numbers.  One mechanism is funding following on to increased capacity.

 

The opposite of job losses would occur as BCUHB were converting money from beds and buildings to staff.

 

Consultation questionnaires were available to all Members if they wished to complete same as an individual.

 

The Chair offered her thanks to Health Colleagues for their attendance at the Council meeting.

 

Resolved that subject to the above the Council finalise the draft response to BCUHB to the consultation process and the final response to be brought back to Full Council at the next meeting in October 2012.

 

 

A break was taken at this juncture (11.15a.m.)

 

Meeting convened at 11.35a.m.