Agenda item

To consider a report by the Corporate Director: Modernising and Wellbeing (copy enclosed) which recommended a final Council response to the public consultation “Healthcare in North Wales is Changing”.

A copy of a report by the Corporate Director: Modernising and Wellbeing, which recommended a final Council response to the public consultation “Healthcare in North Wales is Changing”, had been circulated with the papers for the meeting.  A copy of an update of amendments to the Council’s response was circulated at the meeting.

The Lead Member for Social Care and Children Services, Councillor R.L. Feeley introduced the report and thanked various individuals and bodies for the assistance provided in producing the response.  Councillor Feeley explained that “Healthcare in North Wales is Changing” and other Service Reviews considered by the Betsi Cadwaladr University Health Board (BCUHB) in July, 2012, contained proposals for significant changes to health services across North Wales.  A formal consultation process on the proposals extended from 20^th August to 28^th October and Council had been requested to agree formally the proposed response at Appendix I to the report.

Details of the seven key areas of which     BCUHB had undertaken reviews in the last 2 years had been incorporated in the report.  The result of the reviews “Healthcare in North Wales is Changing: report on service change proposals” had been reported to the BCUHB on 19^th July, 2012.

Council had previously received background information, a summary of the proposals, a copy of the consultation document and a draft response to the proposals prepared by a Working Group of the Partnerships Scrutiny Committee.  Members had also received a presentation by representatives of the Health Board and had been afforded the opportunity to ask questions on key issues.  Following discussions in MAGs, Town and Community Council Cluster meetings, formal consultation meetings organised by BCU and through consultation activities organised by the Community Health Council, the draft consultation response had been amended following a further meeting of the Partnerships Scrutiny Committee Working Group.  The Corporate Director: Modernisation and Well-being provided a summary of the following key amendments which had been highlighted in the report:-

·        the need to have a Strategic Group in place for Denbighshire  to enable ongoing discussion about the detailed implementation of the proposals (paragraph 1.4)

·        stronger wording about the need to have alternative services in place before existing services are closed (paragraphs 1.5, 1.6.4, 1.8.2, 2.3) and for the development of services for carers (Paragraph 1.9.2)

·        a proposal that the Health Board consider developing Denbigh Infirmary and Ruthin Hospital as a “joint hospital hub” with complementary functions (paragraph  1.7)

·        specific support for the delivery of a Minor Injuries Service in Llangollen (paragraph 1.8.3)

It was confirmed that close and integrated working with health services, especially in localities, formed a key part of the Council’s work to respond to demographic change, and the BIG Plan had set out objectives for effective joint working to support families.

Details of the potential costs to BCUHB had been included in paragraph 4.7 of the report to Council on 11^th September.  It was explained that in the process of change, especially as services transferred to communities, increased costs could transfer to local authorities, particular reference being made to adult social care and possible implications for transport provision.  BCUHB had carried out Equality Impact Assessment screening on their proposals and would undertake further work prior to submitting final proposals to the Board.

It was explained that as the proposed changes had not been fully costed the implication on Council services was currently unclear.  Issues such as transport provision would require consideration, and there would be a risk that the additional cost of the provision of more services in the community would inevitably fall on the Council’s social care teams.  Key actions to mitigate the risks identified would include the production of detailed costed implementation plans for the proposed changes which would be discussed by a designated Strategic Group.  This would enable the impact to be transparent and permit full discussion and negotiation with the Local Authority about areas which interface with Council responsibilities, and how the new pattern of services could be organised and funded.

Concerns were raised by Councillor S.A. Davies regarding the validity of the consultation process, particular reference being made to the uncertainty of the future of the minor injuries unit in Llangollen.    

Councillor J. Thompson-Hill stressed the importance of ensuring services were not withdrawn until replacement services were provided and operational.  He expressed concern regarding BCUHB financial circumstances and questioned their ability to deliver their proposals within the given timescales.  Councillor Thompson–Hill highlighted the potential ramifications the proposals could have for Denbighshire, particular reference being made to the possible impact on the Council’s revenue support grants and other external funding sources.  He referred to the detrimental impact of cost shunting on Denbighshire and the need for the Council to adopt a robust stance with regard to this matter.

The Chief Executive explained that the BCUHB Executive Director of Planning had provided a guarantee that a service would not be closed prior to the opening of a new one, in the event of this happening it would on be for a period of days rather than weeks.  An assurance had also been received that there would be no cost shunting and that the Local Authority would not be expected to pick up any additional costs as a result of the changes.  The Chief Executive stressed that it would be important for Denbighshire to adopt a robust stance when ensuring that BCUHB delivered its proposals as stated. 

The Corporate Director: Modernisation and Well-being confirmed that connections had been made between BCUHB Property and the Council’s Planning Department in relation to the re-development timescales pertaining to BCUHB buildings in the Rhyl and Prestatyn area.

During the ensuing discussion the following responses were provided by the Corporate Director: Modernisation and Well-being to questions and issues raised by Members:-

- the view was expressed that an evidence based reply to questions submitted would be forthcoming from BCUHB.   

- it was explained that the Home Enhanced Care Service was an enhanced health care service delivered at the service users home, and differed from the Home Care Service.

- in response to a request from Councillor J.A. Davies, it was confirmed that Denbighshire could emphasise the importance of the provision of a new Hospital in Rhyl when submitting the formal business case to the Welsh Government.  Councillor R.M. Murray highlighted the importance of ensuring that any new infrastructure introduced was successful prior to removing current service provisions.

Councillor Feeley explained that BCUBH had emphasised that the proposed changes had not been driven, or governed, exclusively by financial implications,  but by rapidly increasing demographics, buildings being unfit for purpose and the problems encountered in attracting the top clinicians required in certain areas of medicine.  Confirmation was provided that the majority of local physicians were supportive of the proposed changes within the service.

Members requested that the Corporate Director: Modernisation and Well-being convey their appreciation to the staff for the hard work undertaken.           

RESOLVED – that Council agree the consultation response, attached at Appendix 1 to the report, for submission to BCUHB.