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 Services and others such as the third
sector and to focus on care in the home.
(vii)
It was asked how much pressure was there on Ysbyty Gwynedd in terms of releasing beds, where it was
seen that some patients should be moved closer to their home. It was confirmed that there was collaboration
with Ysbyty Gwynedd to take patients out into the
community. It was added that the Health
Board had an excellent multi-agency team operating at Blaenau Ffestiniog.
(viii)
It was asked if Blaenau Ffestiniog
houses were suitable for home care and specifically for hospital beds, bearing
in mind the size of some of the houses, stairs etc. In response, it was explained that the
Hospital Discharge Coordinators were looking into what was available. However, the Health Board intended to look
further into the extra care housing provision.
(ix)
It was noted that a planning application had been
submitted for 26 extra care housing at Llan Ffestiniog and this was refused by the Snowdonia National
Park Authority, and it was asked if the Health Board had taken this into
consideration when Ffestiniog Memorial Hospital was
closed. In response, it was noted that
the Health Board did not close the hospital because of the above.
(x)
It was asked if it was possible to change the
decision and to establish a Community Hospital in Blaenau Ffestiniog
what would the impact of this be on hospitals or other services within Gwynedd. In response, it was noted that the locations
of the community hubs were based on travelling distances for individuals to
receive treatment i.e. a journey of 40 minutes.
It was noted that travelling from Blaenau Ffestiniog
to Ysbyty Alltwen was 13.5
miles, approximately 20 minutes travelling, with journeys from Bala to Dolgellau, Aberdaron to
Bryn Beryl longer and therefore the Health Board had to re-map the distances
across the whole of Gwynedd. It was added that the Health Board would have
difficulty to recruit staff for more community hubs than they proposed namely
10. In addition, the model would enable
better proactive care in the home for patients and would assist to prevent
their health from deteriorating and in some cases this meant that they would
not have to be admitted into hospital.
(xi)
It was recognised that it was not possible to care
for every patient at home, and in some cases individuals would have to be
admitted into hospital from their communities.
If a patient required intensive care then it was necessary to go into
hospital. However, it was reasonable
for the Health Board to provide the best service to the best of its ability,
and that more could be done to prevent people from deteriorating and it was
necessary to make an effort to get the correct number of units in the correct
locations to meet with the needs.
(xii)
It was asked if the geographical nature of Gwynedd
was the problem and would it not be reasonable to get more community hospitals
to respond to the needs? In response,
it was recognised that the geographical nature of the county created more of a
challenge to the Health Board but it was also necessary to consider the skills
of practitioners together with evaluating what was available locally. It was felt that the Health Board had
considered the best possible options for the correct locations for the
community hubs.
It was added that
the number of admissions to Ysbyty Alltwen had reduced by 34% and approximately 97 were
admitted to hospital in 2014/15 and 34 last year, this was due to the community
nursing service introduced in Blaenau Ffestiniog and
available twenty four hours for seven days a week and the fact that patients
received care in their own homes.
(xiii)
In response to how many clinical failures had occurred
as a result of the closure of Blaenau Hospital, it was noted that no failures
had been noted in the case of Blaenau Ffestiniog.
(xiv)
It was asked how the service compared with other
places / areas within Gwynedd and how would the Memorial Centre's success be
measured.
It was noted that
there were a number of clinics that would open and it was a requirement for the
Health Board to produce evaluation reports to the Welsh Government on the
project. Via the Engagement Officer they
would also receive input from Centre staff and users and would deal with any
complaints received. It was added that
letters of approval had been received already for the services here.
(xv)
It was asked if there was evidence that people who
had received treatment since the closure of the hospital had experienced any
difficulties / concern?
In response, it
was recognised that the question was difficult to answer without looking at all
the complaints. However, nothing looked any different to any other areas of
Gwynedd. It was further noted that one
of the clinics existed before the closure of the Hospital, and nurses' working
hours had been expanded and the x-ray and minor injuries units were available
at Ysbyty Alltwen.
(xvi)
In terms of respect, services, positivity and value
for money for the residents of Blaenau Ffestiniog,
the Chief Executive of the Health Board noted that he had the greatest respect
for the people of the community and Betsi Cadwaladr staff. He felt that it would be a positive step when the new Centre
was in operation, especially with more clinics.
He noted that he had had experiences in other places where the
challenges were satisfied and he appreciated the points made by the residents. There were 13 locations and the decision was
made by the Health Board that 10 could provide a better service within 40
minutes travel for service users.