Agenda Item No
The Vale of Glamorgan Council
Cabinet Meeting: 15 July 2013
Report of the Leader
South Wales Programme Consultation Response
Purpose of the Report
1. To seek Cabinet approval for the response to the South Wales Programme consultation and options for the future provision of a small number of hospital services: consultant-led maternity and neonatal care, inpatient children's services and emergency medicine (A&E) for the people of South Wales and South Powys.
1. That Cabinet consider and approve the response to the South Wales Programme consultation.
Reasons for the Recommendations
1. That the Council submits a formal response to the consultation, which closes on the 19th July 2013.
2. Abertawe Bro Morgannwg, Aneurin Bevan, Cardiff and Vale, Cwm Taf and Powys health boards are consulting on four options for the future provision of a small number of hospital services in South Wales and South Powys. The services are consultant-led maternity and neonatal care, inpatient children’s services and emergency medicine (A&E). A formal eight week public consultation about the future of these hospital services was launched on the 23rd May 2013. The consultation document (Appendix A) is available online and in the Members room.
3. The consultation closes on the 19th July 2013.
4. Frontline doctors, nurses, midwives, therapists and paramedics have worked together over the last 18 months to look at the challenges facing these four services and the proposals to concentrate them on four or five hospitals across the South Wales area. The aim is to create a network of healthcare services for South Wales and South Powys, which provides as much care as locally as possible when safe to do so.
Relevant Issues and Options
5. The reasons for change are that patients are not getting access to the best care and services do not meet clinical standards. Senior doctors are not available at nights and weekends. There are not enough doctors to provide these services in all hospitals and although this is a UK problem it is worse in Wales. Some services are at risk of collapsing because of the shortage of doctors.
6. Feedback from an extensive 12-week engagement exercise with public, staff and stakeholders undertaken in the autumn of 2012 has informed the options that are now being consulted upon. The results of the engagement showed that there was an understanding of why services need to change and a majority supported the ideas for change. People would like services to be provided in as many hospitals as they safely can. There were also concerns about the impact on the Welsh Ambulance Service, on people living in deprived areas, on access and travel times and on public transport.
7. As part of the engagement it was explained that three hospitals are considered to be fixed points because of the range of services they provide and the size of the population they cover: University Hospital Wales Cardiff, Morriston Hospital Swansea, and a new hospital to be built near Cwmbran which will be a Specialist and Critical Care Centre.
8. Feedback from the public and clinicians during the engagement was used to develop six benefit criteria against which all options were assessed: safety, quality, sustainability, access, equity and strategic fit.
9. At the time of the engagement exercise there were six possible scenarios for the location of these services. After consideration of issues such as access and equity and the impact on the Welsh Ambulance Service and other hospitals in South Wales, two have been ruled out. These options also got the lowest scores against the above benefit criteria.
10. The four options now being consulted on for the future of these services are:
· Option 1: UHW, Morriston, Specialist and Critical Care Centre (SCCC), a new hospital which is planned to be built near Cwmbran plus Prince Charles Hospital
· Option 2 UHW, Morriston, SCCC plus Royal Glamorgan Hospital
· Option 3 UHW, Morriston, SCCC plus Prince Charles and Princess of Wales
· Option 4 UHW, Morriston, SCCC plus Prince Charles and Royal Glamorgan
11. The options have been assessed against a wide range of factors, including their impact on travel times, especially for people living in the most deprived communities, the number of doctors needed, the impact on the Welsh Ambulance Service and a high-level assessment of how much they will cost. The option which has emerged from the process as having the least impact on all the factors the South Wales Programme has considered, and is therefore the best fit, is option three – concentrating these services on five hospitals: UHW, Morriston, SCCC, Prince Charles and Princess of Wales hospitals.
12. Concentrating these services in a smaller number of hospitals means there will need to be a corresponding move of other services. It is acknowledged within the documentation that in the future some patients may have to travel 'a bit' further to access a 'small percentage' of services but that the benefits of the changes will be better standards of care and a stronger guarantee of clinical skills and expertise when people need them most.
13. As part of the consultation, discussions have taken place with interested groups and fora about the proposals, as well as a range of formal public meetings held to ensure a wide range of views will be heard.
14. It is anticipated that the analysis of the consultation responses will be completed by September when it will be shared with Community Health Councils (CHC) within the South Wales programme area. Each CHC will then formally respond to its respective health board, indicating whether it agrees to the proposals or if it is not satisfied they would be in the interests of health services in its area. Health Boards will meet in October to make a decision.
15. As part of the consultation, officers from the Cardiff and Vale University Health Board made a presentation to Members at the start of the consultation process and outlined the reasons for change, feedback on the engagement exercise in 2012 and the development of the options. Issues raised during the session included the capacity of the Welsh Ambulance Trust, the role of GPs and the need for better information and communication about which services to use and when.
16. The programme was discussed at Social Care and Health Scrutiny Committee on the 17th June and Corporate Resources Scrutiny Committee on the 25th June, and the minutes of these meetings are attached as Appendix B and Appendix C. Issues raised at these meetings have informed the draft response (Appendix D).
17. A presentation was given to the Vale Local Service Board (LSB) on the 27th June, and during discussions at that meeting a number of concerns were raised regarding whether people have understood that these changes will only affect the small number of very seriously ill and injured patients. It was agreed in the meeting that the message needs to be clearer that the majority of people will continue to receive their care in their local community, and it is only those who require more specialist services who will be affected. Transport and access to services was also raised as an issue. The LSB will not be responding to the consultation as partners will be responding directly, but these concerns reflect issues raised within other meetings.
Resource Implications (Financial and Employment)
18. The implications are unquantifiable at this stage. There may be implications in the longer term in terms of transport and vulnerable groups in terms of access to hospital services, and this could impact on demand for certain council services or on policy decisions.
Sustainability and Climate Change Implications
19. The consultation papers advise that one of the principles has been to provide as much care as locally as possible but only when it is safe to do so. A travel time study has been undertaken and formed part of the consideration and scoring of each option. During the engagement exercise, concerns about travelling by public transport to hospital were raised. An initial analysis has been undertaken, and work is being undertaken with local authorities and public transport providers to examine the impact of the options for change. Deprivation and population changes have also been taken into account in the scoring of the options.
Legal Implications (to Include Human Rights Implications)
20. The consultation under consideration relates to the options for the future provision of a small number of hospital services for the people of South Wales and South Powys. Health boards have the responsibility to provide care for their local populations and the National Health Services has a duty to do what is right for the whole of the population. Accordingly there are no direct legal implications upon the Local Authority. However, there are a number of statutory duties on Local Authorities and Health Bodies to work together. These fall into three broad categories, namely:
· The obligation to co-operate at a strategic level, in preparation of plans for the improvement of the health of the general population. Guidance issued has placed considerable emphasis on the need for partnership and collaboration between Local Authorities and the NHS. There is a statutory requirement to have Health, Social Care and Wellbeing Strategies. The guidance advises that current strategic plans should concentrate on improving health and wellbeing and reducing health in equalities and improving the provision, quality, integration and sustainability of 'overlapping services'. Health, Social Care and Wellbeing Strategies should set out clearly how services will be jointly planned, developed and managed to improve integration, eliminate waste, duplication and confusion, and minimise the likelihood of harm resulting from poor coordination of care. A Local Authority and LHB must, where a specified action or function relates to them, take all reasonable steps to perform the action or exercise the function in accordance with the strategy.
· The obligation on a general day to day level requiring cooperation in the delivery of services to individuals who are disabled, elderly or ill.
The obligation to cooperate under the Mental Health Act 1983.
Crime and Disorder Implications
21. There are no specific crime and disorder issues arising from the proposals.
Equal Opportunities Implications (to include Welsh Language issues)
22. Local Authorities are required to comply with its duty under Section 149 of the Equality Act 2010. Section 149 requires a Public Body when carrying out all of its functions to give due regard to the need to limit discrimination, advance equality of opportunity and foster good relations in respect of the protected characteristics of age, disability, gender, gender reassignment, pregnancy and maternity, race, religion or belief and sexual orientation.
23. An Equality Impact Assessment has been undertaken as part of the programme and is being used to:
· Assess whether the implementation of the South Wales Programme will have a differential impact for particular groups of people
· Propose solutions for elimination of any negative impacts which may be identified through the assessment
· Identify opportunities to promote equality
· Inform how equality issues should be considered in the shaping of the implementation arrangements.
24. In drafting a response to the consultation due regard will be given to the Corporate Plan 2013 -17 which includes the following two outcomes.
· Community leadership - Citizens of the Vale of Glamorgan can easily access efficiently managed services that are focused around their needs, have confidence in how decisions are made and are proud to live in the Vale.
· Health, Social Care and Wellbeing - Citizens of the Vale of Glamorgan are healthy and have equality of outcomes and, through appropriate support and safeguards, the most vulnerable members of our community maximise their life opportunities.
Policy Framework and Budget
25. This is a matter for Executive decision.
Consultation (including Ward Member Consultation)
26. A Member Briefing was held on the 4th June 2013 and information has been circulated to all Members and their views requested. The views of Corporate Resources Scrutiny Committee and Social Care and Health Scrutiny Committee were also sought to inform the consultation response.
Relevant Scrutiny Committee
27. Corporate Resources and Social Care and Health
South Wales Programme Presentation 4th June 2013
Helen Moses - Strategy and Sustainability Manager
Corporate Management Team
Responsible Officer: Huw Isaac - Head of Performance and Development