Agenda Item No
The Vale of Glamorgan Council
Scrutiny Committee [Social Care and Health] 17 June 2013
Scrutiny Committee [Corporate Resources] 25 June 2013
Report of the Managing Director
South Wales Programme Consultation
Purpose of the Report
1. To seek the views of the Committee on the South Wales Programme public consultation which outlines 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 the Committee consider the consultation documents and advise officers of any comments they would like to be considered in the drafting of the Council's response to the consultation.
Reasons for the Recommendations
1. That Members are aware of the proposals and have an opportunity to discuss the options and inform the Council's response.
2. The five health boards providing care for people in South Wales and South Powys have launched a formal eight week public consultation about the future of four hospital services. The consultation document is attached as Appendix A. The South Wales Programme public consultation outlines options for the future provision of consultant-led maternity and neonatal care, inpatient children's services and emergency medicine (A&E) for the people of South Wales and South Powys.
3. The consultation runs from May 23 to July 19 and the Council will need to consider its response to the consultation as there will be implications for local residents.
Relevant Issues and Options
4. 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 - consultant-led maternity and neonatal care, inpatient children’s services and emergency medicine (A&E). Frontline doctors, nurses, midwives, therapists and paramedics have worked together over the last 18 months to look at the challenges facing these 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.
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 will take 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. Details of local public meetings are attached as Appendix B.
14. A South Wales Programme website has been established www.wales.nhs.uk/swp and www.wales.nhs.uk/swp/hafan (Cymraeg) which provides information to support the consultation process, as well as a link to an online questionnaire and details of all public meetings. As part of the consultation views are being sought from organisations and individuals.
15. 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.
Resource Implications (Financial and Employment)
16. Any resource implications for the Council arising from the proposals will need to be considered as part of the Council's response to the consultation.
Sustainability and Climate Change Implications
17. 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)
18. 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' and that the 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, how they will measure outcomes of care and improve them over time. 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.
19. The care assessment process has a specific duty to cooperate if the assessor considers that there maybe a need for an NHS input. There are also duties to patients detained under the Mental Health Act. There are also duties in relation to after care services that are provided under the Mental Health Act.
Crime and Disorder Implications
20. There are no specific crime and disorder issues arising from the proposals.
Equal Opportunities Implications (to include Welsh Language issues)
21. 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.
22. 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.
23. Comments on the equality impact assessment evidence document that has been developed are also being sought as part of the consultation.
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. A draft response will be considered by Cabinet on the 15th July 2013.
Consultation (including Ward Member Consultation)
26. Thirteen Members attended a briefing session on the 4th June. A presentation was given by Paul Hollard (Director of Planning) and Estelle Hitchon (Assistant Director of Strategic Communication) from the Cardiff and Vale University Health Board and this was followed by an opportunity for Members to raise questions and discuss the issues. Information on the proposals has been circulated to all Members.
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
Huw Isaac - Head of Performance and Development