Venue: Siambr Arfon, Council Offices, Penrallt, Caernarfon, Gwynedd. LL55 1BN. View directions
Contact: Glynda O'Brien 01341 424301
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APOLOGIES To accept any apologies for absence. Minutes: Apologies were received from Councillors
E. Selwyn Griffiths, Peter Read, Dewi
Wyn Roberts and W. Gareth Roberts (Cabinet Member for Adults, Health and
Well-being). The following also tended their apologies as
a result of declarations of personal interest: Councillors Elin Walker Jones, Dafydd Owen
and Rheinallt Puw. |
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DECLARATION OF PERSONAL INTEREST To receive any declaration of personal interest. Minutes: (i)
Councillor Eryl Jones-Williams declared a personal
interest as he represented the Council on the North Wales Community Health
Council, and following guidance from the Senior Solicitor it was noted that he
could discuss the matters in question.
(ii)
Councillor Linda Ann Wyn
Jones stated that she could not take part as a member of the committee
following guidance from the Monitoring Officer, and she was present on behalf
of the Ffestiniog Memorial Hospital Defence
Committee. |
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Minutes: The Chairman explained that this extraordinary meeting had been convened
as a result of a Notice of Motion submitted by Councillor Glyn Daniels at a
meeting of the full Council on 15 June, 2017 stating as follows: "I propose that
Gwynedd Council supports the Hospital Defence Committee and the residents of
Blaenau Ffestiniog to press on the Betsi Cadwaladr University Health
Board and relevant authorities to ensure that appropriate and necessary
facilities are provided in the new hospital being built in the town. With this I mean facilities
that are usually found in local hospitals, such as a x-ray unit, minor injuries
unit and a sufficient number of beds for inpatients. Given that Blaenau Ffestiniog
is the third largest town in Gwynedd, and also that the response of the vast
majority of residents in a recent referendum insisted that the town deserved to
be treated in a better way, I believe that there is no reason why the Council
should not support this proposal." RESOLVED to refer the matter immediately to the Care
Scrutiny Committee and to discuss it as soon as possible." Representatives from the Betsi Cadwaladr University Health Board and the Ffestiniog Memorial Hospital Defence Committee were
welcomed and invited to submit relevant information and evidence regarding the
suitability of the proposed health provision for the residents of Blaenau Ffestiniog and the area. |
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Copy of report enclosed Minutes: (A) Betsi Cadwaladr University
Health Board (i) The Chief Executive, Betsi Cadwaladr University Health
Board, noted that he appreciated the importance of this issue, and in the same
manner that the Health Board had questions to be answered. Whilst recognising that the matter
had some history, it was trusted that the report submitted would set out the
Health Board's reasoning in terms of reviewing the service, the implications of
this review in terms of arriving at a point where there is a better range of
services across north Wales and that those are as effective and sustainable as
possible. Also, in terms of moving
forward the Health Board believed that the new Health Centre would enable them
to develop new services as those aimed across the whole of north Wales. These new services were not based on beds,
but they would be effective and sustainable within the proposed clinics in the
new Health Centre. One basic point that
the Health Board had to accept was that they had made some changes giving the
impression that some matters would be implemented before those changes had been
done. This was an error on behalf of the
Health Board, however, having said that, the Chief Executive was of the view
that the rationale established by the Health Board was robust and appeared to
work well in other places. It was hoped that people would see the Health Board
achieving its commitments with a more positive picture of moving forward when
the new services are operational as part of the Health Centre. (ii) Ffion Johnstone, Area Director (West),
referred to the proposed structure that was trying to get care closer to the
homes of individuals by creating community hubs within the communities. In
terms of consistency and safety for the patient, they endeavoured to get health
services with the same opening hours in the community hubs and within a journey
of 40 minutes by car for patients across north Wales. It was noted that x-ray services together
with minor injuries were available from 9.00 a.m. until 5.00 p.m. from Monday
to Friday in the community hubs. In
terms of Blaenau Ffestiniog, it was proposed to
establish an integrated health and care centre that would include health and
care services as well as the third sector.
It was further noted that it was proposed to hold new clinics at the
Centre such as coronary and pulmonary clinics and to expand learning disability
services and palliative care. (i) In terms of the strategy in the community, Dr Siôn Jones, Consultant in Elderly Care at Ysbyty Gwynedd, reported on the way forward to offer a more personal service to individuals in their own homes. He noted that frailty and the number of older people were increasing in communities and often admission into hospital was not ideal for some of these individuals. They were trying to develop a service to deal with any emergency within the community and to be able to identify frailty early on. Reference ... view the full minutes text for item 4. |
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An opportunity for the Care Scrutiny Committee Members to question representatives of the Betsi Cadwaladr University Health Board and to receive their response. Minutes: Members of the Scrutiny Committee were given an opportunity to ask
questions to the Health Board representatives.
(i)
In response to an enquiry
regarding the consistency of provision across Gwynedd and if there was evidence
to justify this, the Chief Executive of the Health Board noted that this was difficult
to answer. He explained that the Health
Board had tried to locate the Community hubs in order that people could get
access to facilities within 40 minutes of travelling time. It
was difficult to compare, but at the time, the decision was made on the
location of the community hubs by the Health Board based on the density of
population and the catchment-area. It
was further noted, in terms of the record, that the Health Board should possess
the activity data. (ii)
Reference was made to a comment made that only 2
patients on average attended the Minor Injuries Unit at Ysbyty
Alltwen and it was asked how many patients travelled
on to Ysbyty Gwynedd in Bangor. In response, it was noted that on average 5%
of the West were referred to Ysbyty Gwynedd. It was added that the Ysbyty
Alltwen Matron was currently formulating the criteria
for visits to the Minor Injuries Unit and was looking at ways for the out of
hours service to collaborate with the Minor Injuries Unit. (iii)
It was asked how long on average did individuals
have to stay in community hospitals. In
response, it was noted that on average 26.2 days was the stay in Ysbyty Alltwen and the following
figures were listed for a period of four years. 2013/14 - 29.5 2014/15 - 24.3 2015/16
- 21.3 2016/17
- 31.8 (iv)
Considering the popularity of Blaenau Ffestiniog now, with visitors taking part in outdoor
activities available in the area it would make sense to have x-ray and minor
injuries units in Blaenau. In response,
it was noted that at the time the decision was made regarding the locations of
the hubs, the level of activity going through the minor injuries department at
the time was considered. Whist
recognising that matters had developed and there might be more demand, the
minor injuries service was available at Ysbyty Alltwen. However, in
terms of current best practice when dealing with head injuries, eye socket
injuries, these had changed over the years, and therefore they were referred to
a larger accident and emergency department. The Health Board service model
currently noted that patients would go to Ysbyty Alltwen and then onwards to Bangor, if required. (v)
It was asked if the residents of the Ysbyty Alltwen area were being
deprived of beds in the Hospital, bearing in mind that residents from the
Blaenau Ffestiniog were being referred there? In response, it was confirmed that there were
6 additional beds available at Ysbyty Alltwen for the the demand. (vi) In response to a query regarding the future of community hospitals, it was noted that the intention was to have integrated hubs and to collaborate with Social ... view the full minutes text for item 5. |
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Additional documents:
Minutes: (i)
Councillor Glyn Daniels
took the opportunity to thank the Care Scrutiny Committee, on behalf of the Ffestiniog Memorial Hospital Defence Committee and the
residents of Blaenau for the opportunity to submit their evidence to get health
facilities back in Blaenau Ffestiniog. (ii)
On behalf of the Ffestiniog Memorial Hospital
Defence Committee, Mr Geraint Vaughan Jones guided Members via slides through
the background and evidence of how it was decided to close Ffestiniog
Memorial Hospital. Attention was drawn to the additional responsibility on
Gwynedd Council and the Health Board under the Well-being and Social Care Act
2014 to give serious consideration to the disorder caused by the Health Board
over the last five years as a result of this decision. A decision
was made by the Health Board in 2008 to close Blaenau Ffestiniog
Memorial Hospital and to construct a new building that would offer a less
effective service than the residents of Blaenau Ffestiniog
and the area had previously received, and less than what is offered in much
smaller villages than Blaenau within Meirionnydd. It was
emphasised that the residents of Blaenau Ffestiniog
could not forget the past when it was resolved to close the Memorial Hospital in
order to save money. He proceeded
to explain that prior to the establishment of the Betsi
Cadwaladr University Health Board, the Memorial
Hospital was one of the best hospitals and was a memorial hospital for 353
young men who lost their lives in the Great War. In 2012, there were 12 beds in regular use,
experienced nursing staff, permanent GP practice with 4 doctors, surgeries
two/three times a week in Llan Ffestiniog
and Dolwyddelan; physiotherapy clinic, x-ray unit in
regular use by the doctors and all of this for a cost of £800,000 per annum. When the
Health Board voted to close the Memorial Hospital all the services outlined
above disappeared overnight even the dependable GPs service that was available
previously, and this despite every protest and local petition. By today, it was noted that the Blaenau Ffestiniog medical practice was dependent on 'locums' who
barely knew their patients, and on some days only one locum was available. It was obvious from the Health Board's
decision that the residents of Blaenau did not deserve the same service as
other towns in Meirionnydd, and it was strongly felt that the Blaenau Ffestiniog area had been dealt with unfavourably. Attention
was drawn to the fact that the First Minister had stated in 2012 that no
hospital would be under the threat of closure, however, the Health Board
produced the proposed structure despite what was said by the First
Minister. By creating the well-being areas in accordance with the Act, the intention of the Health Board was to create a hospital hub in Dolgellau, retain and improve Tywyn Memorial Hospital, build Ysbyty Alltwen in place of Penrhyndeudraeth Hospital, retain Bryn Beryl Hospital and retain Ysbyty Gwynedd in Bangor. However, in the context of the Welsh uplands, the decision was to close Ffestiniog Memorial ... view the full minutes text for item 6. |
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An opportunity for the Care Scrutiny Committee Members to question representatives of the Ffestiniog Memorial Hospital Defence Committee and to receive their response. Minutes: Members of
the Scrutiny Care Committee were given an opportunity to ask questions to the
representatives of the Ffestiniog Memorial Hospital
Defence Committee. (i)
In
response to a question regarding evidence that the people of Blaenau needed
community hospital beds on top of what was available at Ysbyty
Alltwen, Dr Walt Evans, Ffestiniog
Memorial Hospital Defence Committee, noted that a great many individuals in Ysbyty Gwynedd were waiting for a bed at Ysbyty Alltwen. He added that
this did not occur when the Ffestiniog Memorial
Hospital was in operation. In addition, there was evidence that many were sent
to other hospitals such as Dolgellau, Eryri, Bryn
Beryl which meant miles of travelling for their families to visit them. In addition,
reference was made to the numbers of persons from the Blaenau Ffestiniog area who were in hospitals / homes in Llandudno,
Pentrefoelas, Llanrwst, Porthmadog, Pentrefelin and one
had been sent to Tywyn due to the lack of beds, and a
bus journey made it impossible for the family to go and visit. (ii)
It was asked what evidence was there that other areas in Gwynedd
received a better service than Blaenau. Dr Walt Evans responded by
noting that every town had a community hospital and there was a real need for a
hospital in Blaenau with an x-ray service and a minor injuries unit. It was noted that the situation was very
complex in Blaenau and there were many complaints as could be seen from the
petitions. Reference was made to the
list of clinics by the Health Board at the proposed Centre, but these clinics
were not special as they should be available in any well-being area. Therefore,
what kind of well-being area would Blaenau Ffestiniog
be. It was asked how
rheumatology clinics could take place without any x-ray unit. (iii)
It was asked if there was any evidence of persons who received a service
at Ysbyty Alltwen who were
unhappy with the service? A member of
the Defence Committee responded by referring to a personal experience where she
had to find a nursing home for her mother, and if she had not done so her
mother would have to go to a home miles away or even in England. She referred further to another personal
experience where a error was made in a patient's records and when Ysbyty Gwynedd Bangor was telephoned to complain it was
said that they had a Concerns Department and not a Complaints Department. (iv)
In response to an enquiry regarding how many letters received attention
from the Health Board, it was noted that the package presented to the Care
Scrutiny Committee was only a small percentage and that several letters had not
been acknowledged and had not received a reply. (v) It was asked what distance was reasonable for people to travel to hospital. Mr Geraint Vaughan Jones noted that it would be necessary for the people of Dolwyddelan to travel 20 miles to a hospital and ... view the full minutes text for item 7. |
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An opportunity for the Care Scrutiny Committee Members to ask additional questions to Members of the Health Board and representatives of the Defence Committee. |
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DISCUSSION Discussion
by members of the Care Scrutiny Committee and Council Officers arising from the
presentations. Minutes: During the ensuing discussion, amongst the Care Scrutiny Committee
Members, the following observations were highlighted: (i)
Concern regarding travel difficulties to Ysbyty
Alltwen for patients and families. (ii)
From the comments made by the Defence Committee, that it was necessary
for the Betsi Cadwaladr
University Health Board to review the following matters: ·
Lack of consultation and communication with local residents and have the
correct facts as there were lessons to be learnt from the last review. ·
The popularity of outdoor activities and tourism in Blaenau Ffestiniog, and therefore the possibility of an increase in
the demand for x-ray and minor injuries services. ·
Undertake another independent review as the previous one was now
historical and therefore there was a golden opportunity to change the decision
to get inpatient beds back / x-ray unit and minor injuries service that was
really needed in Blaenau Ffestiniog. ·
Difficulties in terms of home care for patients in Blaenau Ffestiniog as many of the houses were unsuitable for
hospital beds ·
Consider the provision of extra care housing (iii)
Whilst sympathising with the residents of Blaenau Ffestiniog
in losing a resource, it was felt that they had to be realistic and that the
service was sustainable, safe and the same for the rest of the County. (iv)
The 10 service hubs operated had to be taken into consideration with 3
of these in Gwynedd namely 30%, and it might be difficult to argue for a fourth
to be located in Blaenau Ffestiniog. In
response to the above comments: The
Corporate Director noted: ·
whilst accepting the above
comments, it would be possible to ask the Health Board to monitor and collect
evidence regularly to see what impact these changes have on the residents of
Blaenau Ffestiniog for further consideration by the
Care Scrutiny Committee after the Memorial Centre opened in October this
year. By undertaking a review it would
be possible to compare the service in the Blaenau Ffestiniog
area compared to the rest of the County. ·
In terms of the lack of staff
recruitment, it was recognised that there were difficulties in Gwynedd and
specifically in the rural areas and it would be useful to commission a piece of
work jointly with the Health Board to try and address this problem. The Head of
Adults, Health and Well-being noted: ·
that concerns had been voiced in
the past regarding the public transport system from the Meirionnydd coast and
how convenient it was to reach Ysbyty Alltwen and a survey was conducted at the time. Stemming
from this, amendments were made to bus time-tables to ensure that they turned
up to Ysbyty Alltwen,
however it may be timely to ask the Care Cabinet Member and the Environment
Cabinet Member to commission work to look again at this provision. · In terms of extra care housing that a symposium would take place on 13 October with the Council's Housing Department / Cartrefi Cymunedol Gwynedd and Cynefin to discuss this matter and it would be beneficial to invite ... view the full minutes text for item 9. |
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RECOMMENDATIONS To draw up draft recommendations
in consultation with the officers for presenting and consideration, if
necessary, to the next Scrutiny Care Committee on the 21 September 2017. Minutes: Resolved: (a)
To accept, note and thank the Health Board and the Ffestiniog
Memorial Hospital Defence Committee for their presentations. (b)
To agree on the following recommendations, but that the exact final wording of
the recommendations are presented for final approval to the Care Scrutiny
Committee at its meeting on 21 September 2017: (i)
That the Care Scrutiny Committee calls on the Betsi Cadwaladr University Health Board to share all the background information that was part of the original decision to change the provision of facilities and health services
in the Blaenau Ffestiniog area. (ii)
That the Scrutiny Committee calls upon the Betsi Cadwaladr University Health Board to regularly monitor information and data in relation
to the effectiveness of current
health services in the Blaenau Ffestiniog area and the well-being of its residents and
to commit to adapting/changing the provision if there is evidence
to justify this. The Committee was
of the view that it would be useful if this work
was undertaken by an independent agency or at least confirmed by an independent agency and the information is submitted for the attention of the Care Scrutiny Committee in a reasonable time. (iii)
Stemming from the evidence submitted by the Blaenau Ffestiniog Memorial
Hospital Defence Committee regarding the lack of response to petitions and correspondence in the past, that the Board give detailed
consideration to engagement
and consultation shortcomings in the past in order to improve
future arrangements. The
Health Board is encouraged
to communicate regularly and effectively with the residents of the Blaenau
Ffestiniog area in relation to the provision of facilities and local health services.
(iv)
The Cabinet Member for the Environment and the Cabinet Member for Care are requested
to commission an assessment of the convenience and accessibility of health services via public and
community transport within the Ysbyty Alltwen catchment
area. Once the priority given to this catchment area is completed, it can be considered if there
is a benefit to undertake similar assessments in other areas.
(v)
That the need for suitable
homes for older people included
the provision of extra care housing in
the Blaenau Ffestiniog area is fully
aired jointly with the Cabinet Member for Care, Cabinet Member for Housing, Leisure and Culture and
the Health Board together with the Gwynedd Housing Partnership. (vi)
That the Care Scrutiny Committee calls
on the Betsi Cadwaladr
University Health Board and Gwynedd Council to work closely and jointly and
take appropriate practical steps to recruit care and health staff in order that
there are full teams in place to maintain services in the Blaenau Ffestiniog area and across the County. |