Agenda item

To consider a joint report by Councillor Bobby Feeley, Lead Member for Social Care and Children’s Services and the Corporate Director: Modernising and Wellbeing summarising the decisions taken by the BCU Board on 18 January 2013 and the implications for the Council, and to receive a further verbal update at the meeting.

The Corporate Director Modernising and Wellbeing (CD:MW) introduced the report (previously circulated) summarising the decisions taken by the Betsi Cadwaladar University Health Board (BCUHB) on 18 January 2013 following consultation on the health service reviews.  The report focused on the decisions as they related to facilities and services in Denbighshire together with timescales for implementation and detailed the outstanding issues and concerns for the Council.  In terms of decision making members were reminded that the Community Health Council (CHC) was the only body that could formally refer the Board’s decision to the Minister and their response was required by 3 March 2013.  Members’ views were sought on the latest developments and next steps taking into account the report recommendations and verbal update from the Chief Executive.

 

The Chief Executive verbally reported upon a meeting between North Wales Local Authority Chief Executives and BCUHB held on 1 February when four broad areas of concern were discussed –

 

Extra costs associated with increased care in the community – the development of localities and enhanced home care could lead to an increase in demand on social services and costs.  Home care was considered a positive step but there was insufficient detail in the proposals and issues around affordability, implementation and resources.  BCUHB had given verbal assurances that costs would not be transferred to local authorities and councils had asked that a financial model be developed detailing funding costs and a clear process of implementation.

 

Capital Investment – the plans involved approximately £40m of capital investment in new provision of which £27m was in Denbighshire.  The necessary funding had not yet been secured and plans were dependent on the quality of the business case and Welsh Government providing the funding.  As this was a significant risk area assurances were sought that funding for replacement facilities would be secured before the implementation of planned closures.

 

Transport Arrangements – it was clear that more people, including vulnerable people, would have to travel for health care provision.  The feeling was that the public sector and voluntary sector had a responsibility to develop a travel plan and BCUHB had committed £80k to respond to travel needs.  The way forward would involve relevant partners developing a transport plan for those people affected.

 

Managing Transition Arrangements – plans to close services and facilities before new provisions had been established was also a key concern.  BCHUB had clarified that no patient would be without services when needed and people affected would be supported until new provisions were in place.  Assurances needed to be sought that effective transition plans had been developed.

 

Councillor Bobby Feeley, Lead Member for Social Care and Children’s Services paid tribute to staff working in the health service during uncertain and difficult circumstances.  Whilst agreeing that the review had been necessary she felt that the process could have been managed more effectively.  The Council had carefully scrutinised the plans and the establishment of a county based Health and Social Care Strategic Forum would ensure dialogue continued.  In commenting on the plans she expressed her disappointment that Ruthin Hospital would lose its minor injuries unit and x-ray services and over plans to close in-patient care beds at Prestatyn and Llangollen Hospitals before the establishment of new services.  She also highlighted the need to revisit transport arrangements and neo-natal services.  In light of the Chief Executive’s verbal report Councillor Feeley proposed an urgent meeting with BCUHB seeking a guarantee that facilities did not close until funding for new capital investment had been secured.  She also proposed a meeting with other agencies to address the transportation issue.

 

Councillor Ray Bartley, member of the CHC, confirmed that he had been keeping members updated on CHC’s progress and would continue to do so.  He would be attending the next Executive meeting on 20 February as a non-member.

 

The Chair opened the debate seeking members’ views on recent developments and the way forward.  Whilst appreciating the need for an overhaul of health services Council expressed their frustration and disappointment over decisions made by BCUHB despite local protests and fierce opposition to particular proposals which had been well documented in the comprehensive response to consultation.  Concerns were raised that public views had been disregarded during decision making and that due regard had not been given to the Council’s submission or sufficient response to provide assurances which had been sought over particular issues.  Members considered that BCUHB had been misleading and less than honest in their dealings leading to a lack of trust and confidence in the Health Board.  The speed of hospital closures and particular services was a serious concern, particularly in light of the latest announcement that some minor injury units would close within two weeks even before a response to the decisions had been received from the CHC.  It was felt that the Health Board had provided little or no assurance in response to major issues which sent a message of indifference and disregard of local views.  Members referred to their duty to represent the interests of their communities and felt strongly that a robust response was required and action taken to communicate their strength of feeling to BCUHB.

 

Councillor Stuart Davies held back from calling for a vote of no confidence in the Health Board instead proposing that the Council demanded an urgent meeting with the BCUHB to negotiate existing facilities remaining open until a firm commitment had been forthcoming from the Welsh Government on funding the new facilities and temporary facilities had been established. He added that if BCUHB was not willing to negotiate he would be putting forward a vote of no confidence at the next Full Council meeting.  Councillor Peter Evans seconded the proposition.

 

Councillor Alice Jones reported upon research she had undertaken in light of the healthcare proposals and the effect on Ysbyty Glan Clwyd (YGC) and raised concerns regarding –

 

· the downgrading of YGC to a hospital hub and loss of status

· the impact of plans for vascular services, particularly as on-site vascular surgery was a requirement of YGC becoming a Coronary Intervention Centre

· the impact on Accident & Emergency which would no longer admit a full range of conditions but would become selective impacting on patient health and leading to difficulties in recruiting trainee doctors, and

· withdrawal of emergency surgery at the hospital.

 

Councillor Jones sought Council’s support to protect the status and service of YGC as a District General Hospital and proposed an amendment to the Council’s response to include reference to their opposition to YGC being downgraded to a hospital hub and for it to remain a District General Hospital with a full surgical unit of excellence to include an emergency vascular service.  The proposal was seconded by Councillor Hugh Irving.  Whilst accepting the concerns raised the CD:MW did not consider the denotation as a hub to mean a downgrading of the hospital but rather that the services provided by hospital hubs would also be available there.  She referred to the significant investment in Accident and Emergency and theatres at YGC and felt that clarification should be sought from BCUHB regarding on-site services rather than assuming the hospital would be downgraded.

 

Councillor Arwel Roberts expressed his concerns regarding neonatal services being moved to Arrowe Park Hospital on the Wirral and referred to a cross-party group of Assembly Members who had united with a view to stop the plans.  Councillor Roberts proposed, seconded by Councillor Rhys Hughes, that all North Wales Chief Executives be called upon to oppose the move of neonatal services out of Wales.  Councillor Cefyn Williams highlighted that the Board had confirmed the move of neonatal services within 6 – 12 months after receiving assurance that Arrowe Park had secured required standards compliance.  Consequently Councillor Williams questioned the standard of care at Arrowe Park and felt that monies earmarked for neonatal care would be better spent in North Wales.

 

During debate members agreed their general areas of concern as follows –

 

· transition arrangements as BCUHB prepared to close some services and facilities before any guarantee of funding for new capital investment had been secured or temporary services established

· the level of support for carers and lack of proposals to fund enhanced home services

· transport and travel arrangements

· the potential cost to the Council as more services moved out of the hospital setting and into people’s homes

· the future of Ysbyty Glan Clwyd as a District General Hospital

· transfer of neonatal care to Arrowe Park Hospital

 

Members also highlighted the impact of the Health Board’s decisions on their particular towns and communities and raised concerns over –

 

· the closure of Prestatyn Community Hospital with patient beds being provided at neighbouring hospitals (who already had their own catchment area raising concerns about capacity) and no assurances provided that transport issues had been addressed

· Councillor Peter Evans wished it to be recorded that he opposed the closure of Prestatyn Community Hospital until new facilities had been set up in Rhyl

· services being transferred to GPs (who were already under pressure) without any provision to increase resources as a  consequence

· resources and capacity for particular services to be accommodated elsewhere resulting in additional pressure on other services

· speed over the closures of the minor injuries units at Ruthin and Llangollen and closure of the x-ray facilities in Ruthin

· the closure of Llangollen Hospital and the detrimental impact on the local community and their wellbeing and the need to invest in the hospital instead.

 

In opposing the closure of Llangollen Hospital, Councillor Rhys Hughes proposed a motion of no confidence in the consultation process and BCUHB’s proposals for the future in Denbighshire.  The proposition was seconded by Councillor Huw Williams.

 

In light of the detailed debate and number of propositions made Council considered how best to address their outstanding concerns and represent the interests of the community.  Consideration was given as to whether to take a vote of no confidence in the Health Board or to engage in further dialogue with a view to negotiation.  Councillor Huw Hilditch-Roberts proposed that an urgent meeting be called with BCUHB and to consider a vote of no confidence at the next Full Council if satisfactory responses had not been forthcoming.  On balance it was considered that a further attempt should be made to meet with BCUHB officials and negotiate a way forward and the call for a vote of no confidence in the Health Board be deferred pending the outcome of that meeting.  It was agreed that the top level meeting should include the Lead Member, Councillor Bobby Feeley together with councillor representatives for different local areas as follows – Councillors Stuart Davies, Peter Evans, Alice Jones, Pat Jones, Gwyneth Kensler, Jason McLellan, Arwel Roberts, Julian Thompson-Hill and Huw Williams.

 

RESOLVED that –

 

(a)       an urgent meeting be convened between the Chief Executive of BCUHB and the Council’s Chief Executive and Corporate Director Modernising and Wellbeing together with nominated councillors (as detailed above) to bring forward the Council’s concerns regarding the proposed service changes to healthcare provision across the region and negotiate a way forward, and

 

(b)          a report back on those discussions be considered at the next Full Council meeting on 26 February to enable members to further consider the Council’s position in light of the feedback received.