Agenda item

To receive a presentation by Dyfed Edwards, Chair of Betsi Cadwaladr University Health Board, on the Board’s main priorities in terms of improving services for the people of Gwynedd.

 

Dyfed Edwards, the Chair of Betsi Cadwaladr University Health Board, as well as Carys Norgain, were welcomed to the meeting to give members a presentation on the main priorities of the Board to improve services for Gwynedd residents.

 

The Chair of the Health Board referred to a paper that had been sent to all members outlining the work of the Board, the challenges and the progress made, and noted:-

 

·         As the new Chair of the Health Board, that he and other new independent members found an organisation that was unstable, with several challenges surrounding governance, finance and the quality of some services.

·         At the same time, they also discovered that a large number of people worked in the Health Board who did excellent work. Therefore, the first step, when reflecting on the situation, was to try to create stability by undertaking steps to become visible.

·         He believed that it was also fair to say that there were matters relating to the culture of the Health Board and this was one of the things that he personally wished to address, although it was not going to happen overnight.

·         That the Board had a specific work programme, working with people such as Michael West in the field of compassionate leadership, and was very keen to create a context where people could succeed in their work and feel appreciated and part of a broader team that could provide the best possible health and well-being service.

·         That the Board had recently made several key appointments permanent, namely the posts that would create stability in the Health Board and beyond.

·         That the situation was almost similar to creating a new Health Board, and it was important to deliver the requirements of the Welsh Government's special measures, and also address other matters and create success that was going to be sustainable.

·         Therefore, it was hoped that there was a future picture of the Health Board that would be ambitious, but realistic that understood the challenges.

·         That the biggest challenge was access to services and clarity was needed about the way forward and what were the expectations, particularly expectations regarding standards.

·         That there was a risk in a position of special measures to become very defensive but an attempt was being made to do the opposite, and that was one of the reasons why he was proud of this opportunity to address the Council and to be open and transparent about the challenges faced.

·         ⁠That partners, like councils, had a very important role to play with the Health Board on this journey, as health and well-being did not belong to the Health Board alone.  It was believed that there was an opportunity to do more with these partners to deliver what was needed to ensure that the people of Gwynedd and north Wales received the best possible services.

·         That the Health Board would be happy to return before the Council, or any forum of the members' choice, to provide more details about some of the services and challenges and to ensure closer collaboration between both bodies.

 

Members were given an opportunity to ask questions to the Chair of the Health Board.

 

It was enquired what were the plans to attract more GPs to the areas of Dolgellau, Tywyn and Barmouth as there was a serious and dangerous shortage in these areas.  In response, it was noted:-

 

·         That life patterns had changed for many and, in light of the pandemic, that several people, including some GPs, had reassessed their lives and were eager to do something different or were looking for broader experiences than what they had years ago.  In this respect, an attempt would be made to collaborate to find what broader experiences could be offered to GPs in terms of professional development and an opportunity to work on a wider level beyond the practice.

·         In terms of the specific areas, new marketing methods would be examined.  ⁠As well as using professional magazines such as the British Medical Journal, and videos would be used to try to show how excellent some of these areas are and to motivate people to relocate if they wished to do so.

·         Beyond this, and in the long-term, there was a need to improve the job's image by ensuring better conditions for GPs and to make young people view the job as a career. In this respect, it was hoped that the new Medical School in Bangor would be a way of promoting the rural offer and to keep our young people here.

·         As part of plans to recruit more staff in Tywyn, it was hoped to get therapists and nurses working to a higher level to shoulder some of the burden from the GP.

 

It was asked whether it was intended to extend the 'Tuag Adref' scheme which had been operating in Tywyn since the beds in the hospital had been temporarily closed while waiting for additional staff.  In response, it was noted:-

 

·         That the 'Tuag Adref' scheme was a very successful development and operational in Eryri, Alltwen and Tywyn Hospitals.

·         That the scheme was sponsored by the Regional Integrated Fund and provided assistance to patients who required some support to live independently after being discharged from hospital.

·         That there is evidence that the scheme assisted people to return home from hospital sooner, and that this released beds in the hospitals and released services.

·         It was intended to continue developing the service across these areas, including the Tywyn Area and the Bro Dysynni Area.

 

As the Welsh Government was pushing for health centres / clinics across Wales to reduce the dependency on accident and emergency hospitals, it was asked whether there was a risk that converting community hospitals, such as the Dolgellau and Barmouth Community Hospital, into a health centre/clinic would lose inpatient hospital beds.  In response, it was noted:-

 

·         That the key question was what the services were and what was the variety of services required in the areas to ensure that people got the best out of health and well-being services. In some cases, this would include hospital beds and, in other cases, maybe this would not be included and that an open mind was needed with regards to how the future of the provision would look in all areas of Gwynedd.

·         It was believed that local hospitals were needed to ensure that people who required additional care had somewhere to stay after being discharged from the main hospitals, but it was also possible to develop the services in the community hospitals on a broader level, and hospitals such as Alltwen and Eryri were excellent examples of this.

·         That beds would still be needed in several cases, but the aim was always to try to ensure that people got the opportunity to return home.

·         It was not always possible for people to return home and live entirely independent and this was why schemes such as 'Tuag Adref' existed, but there would be a future for centres locally, whatever the provision would be.

 

It was enquired whether the First Minister, Mark Drakeford should apologise to Gwynedd residents and Betsi Cadwaladr University Health Board for not proceeding with a medical training centre in Bangor over ten years ago when the Health Minister at the time, Edwina Hart, supported the project.  In response, it was noted:-

 

·         That circumstances aligned occasionally which meant that it was possible for something to happen.  It was believed that this is what had happened with regards to the Medical School and the University, with some political circumstances, some circumstances involved with a change of personnel in the University and some of the circumstances involved with the ambition of the Health Board and the ambition of the University to shift some of the mindset to find an opportunity to grow a workforce here locally.

·         Thanks were paid to the First Minister and the Welsh Government for ensuring that we now had a Medical School in north Wales, while also thanking everyone who endeavoured to ensure this.

·         That these things could not always happen within the preferred time-scale, but maybe the lesson was that perseverance was needed and this case had been a success.

·         That we would monitor the Medical School so that we could ensure that we get a workforce in the health and well-being services here in North Wales.

 

It was asked when the public would be able to see the Ernst and Young report and find out where the missing £122m had gone in the Health Board.  It was also asked why the Health Board had paid £400,000 to the Acting Head of Nursing and Midwifery Department for four months' work.  In response, it was noted:-

 

·         Historically, that the financial position of health boards in Wales had been different to local governments, and that health boards needed to learn some of the financial discipline of local government.

·         Although he, as Chair of the Health Board, along with the Chief Executive, had said on several occasions that they were eager to publish the Ernst and Young report, it was not possible to do so at present as some people were going through a process, and that publishing the report would now undermine that process.

·         That the other matters involving money were part of the investigation, but he wished to emphasise that £122m had not gone missing in the Health Board.

 

It was asked for assurance that urgent attention would be given to the crisis in the Ambulance Service, not only regarding the waiting time for an ambulance but also the waiting times outside hospitals.  In response, it was noted:-

 

·         That the Welsh Ambulance Service, rather than the Health Board, was responsible for the waiting times for an ambulance, but that the Health Board was responsible for the wait outside hospitals.

·         That the entire ambulance service was under immense pressures, and that they certainly had statistics that could be shared with members about the use of the service in Gwynedd.

·         In terms of waiting times outside hospitals, that the Government had a target that nobody should wait more than 4 hours in an ambulance until being admitted to hospital, and although the Health Service was working hard to reach the aim, it was not always possible, and it was very often due to a lack of beds.

·         If the situation were to be improved, something would have to be done about how people were not only admitted to hospital, but also discharged from hospital and released beds.

 

The representatives of the Health Board were thanked for the presentation and their responses to the questions.