SCRUTINY COMMITTEE (COMMUNITY WELLBEING AND SAFETY)

 

 

MINUTES of an extraordinary meeting held on 14th November, 2007.

 

Present:  Councillor Mrs. M.E.J. Birch (Chairman); Councillor K.R. Stockdale (Vice-Chairman); Councillors Mrs. S.M. Bagstaff, R.J. Bertin, Ms. L. Burnett, P. Church, J. Clifford, G.C. Kemp, Mrs. A.J. Preston, B.I. Shaw, J.W. Thomas and W.C. Vaughan.

 

Also present: Councillors S.C. Egan, Mrs. M. Randall and Mrs. M.R. Wilkinson.

 

Also present having been invited to attend as External Experts: Ms A. Harris (Chief Executive of the Vale of Glamorgan Local Health Board) and Mr. P. Williams (Chief Executive of Bro Morgannwg NHS Trust).

 

532     APOLOGIES FOR ABSENCE -

 

These were received from Councillors Ms. R.M. Birch, H.J.W. James,

Mrs. A.J. Moore and A.G. Powell.

 

 

533     DECLARATIONS OF INTEREST -

 

No declarations were received.

 

 

534     WELCOME -

 

The Chairman welcomed all present to the meeting and introduced the new Director of Social Services, Mr. Phil Evans, who had recently been appointed and was due to take up the post in January 2008.

 

 

535     PROPOSED MERGER OF SWANSEA AND BRO MORGANNWG NHS TRUSTS (CX) -

 

Councillor H.J.W. James had requested consideration of the matter in order that the Scrutiny Committee could discuss and debate the issue.  Mr. Paul Williams, Chief Executive of Bro Morgannwg NHS Trust was present at the meeting and advised the Committee of the proposals.  The Committee was informed that both Bro Morgannwg NHS Trust and Swansea NHS Trust had agreed to explore the possibility of merging.  The consultation document attached to the report considered whether a formal merger, which would eliminate unnecessary and artificial boundaries, could provide more efficient and effective NHS services across the area and, as a result, deliver better care to around 600,000 people.

 

To date, the two neighbouring Trusts enjoyed a natural affinity, treating patients from each other’s catchment areas and sharing services and practices.  The proposed new Trust would serve the populations of Bridgend, Neath Port Talbot, Swansea and the Western Vale of Glamorgan and would provide specialist services on a regional and sub-regional basis.  It would employ over 16,000 staff and have a budget of over £770m.  Mr. Williams also highlighted that both Trusts had a wide range of expertise amongst a considerably talented workforce and through merging experience and expertise would be pooled, thereby improving the depth and standards of services even further.  Although it had been said that merging may also not necessarily improve the depth and standards of service, Mr. Williams advised that the new Trust would be able to avoid wasteful duplication and gain economies of scale, together with the fact that having one Trust would also allow management processes and business functions to be streamlined and restructured which could then target more resources directly to patient care.

 

The report outlined the arguments for change which included the benefits to patients, to staff, to partnership working and a more effective use of resources.  However, he did stress that there would be risks and disadvantages which the report also highlighted.  Notwithstanding that forming a large organisation could be felt to be too remote from patients, staff, local communities and partners.  He responded by stating that it would be essential that the new Trust should strike the right balance between having sufficient capacity at the centre and strong local management.  The role of the centre would be to set the strategic direction, exercise overall control of resources, set and maintain the highest standards of care and establish very sound governance arrangements.  The local service units themselves would have senior management teams which would have clear devolved responsibility and would work closely with partner organisations in their particular communities.  The proposed merger also mirrored the main Welsh Assembly Government’s policies over the strategic development of the NHS in Wales.

 

Having considered the report and Mr. Paul Williams’ presentation, the following question and answer session took place:

 

Question

Answer

 

Local Trade Unions had highlighted that over 700 jobs could be lost and 86 bed closures.

 

A report that had been produced some time ago by Swansea NHS had alluded to these intentions.  However, Mr. Williams could confirm that the loss of posts would be through natural wastage.  He further stated for Members information that Swansea  did not currently have a Chief Executive.

 

Members considered that the merger and the intentions of trying to improve patient care were honourable and queried whether there was a wish list of services if and when the economies of scale were achieved.

 

There were a number of unmet needs, in particular, for example, Bro Morgannwg had never had a fully funded stroke service.  The intention of doubling the size of the organisation would be to ensure that other care requirements would then become possible as well as the achievement of a more diverse workforce.   

 

Members commented on the distances that people may have to travel, whether bigger would be  better and the number of old buildings in the Swansea NHS Trust remit which would require considerable  financial resources to refurbish them to ensure they were fit for purpose.

 

Paul Williams responded by stating that if the Trusts remained as they were there would be less opportunity to make savings and the priority was for the organisation to have the capability to deliver services and how well the services were tailored to client needs.  He further stated that the merger would result in the inheritance of old buildings and ongoing work in relation to the change programme with partner organisations would need to be undertaken.

 

Paul Williams also advised the Scrutiny Committee that the Trusts were not required to consult on the restructuring proposals but had agreed that it would be the best approach.  Officers involved had worked hard in identifying the threats and ensured good communications existed, that the website was active and they had also involved the trade unions and staff  from the beginning of the proposals to ensure that all were kept up-to-date and were brought along together by having full discussions on the proposals.  He further advised that he had been involved in a number of mergers throughout his career, they had not been easy and he advised that no merger should be undertake by a command and control approach.  It was imperative that staff were on board and were fully informed of the proposals and what would be  involved.  Members also queried the effect that the merger would have on neighbouring trusts and Mr. Williams assured them there would be no effect.  The Trust would also be one of the largest NHS Trusts in Wales.

 

RECOMMENDED - T H A T Mr. Williams be thanked for attending the Scrutiny Committee, for providing the Committee with as much information as possible and the opportunity to ask searching questions on the proposals.

 

 

536     SOCIAL CARE AND WELLBEING STRATEGY 2008-2011 (CX) -

 

The report advised that the Welsh Assembly Government required each local authority and Local Health Board to jointly produce a strategy outlining how they intended to improve the health, social care and wellbeing of local people.  Members were advised that the first round of strategies had covered the period 2005 - 2008 and the new draft strategy attached to the report covered the period 2008 - 2011.  The priorities that had been outlined in the strategy had been developed using the findings of the Health Needs Assessment and through discussion with key stakeholders as well as taking into account the priorities that had been identified by the Welsh Assembly Government.  The key areas where partners had believed improvement was needed were in services for:

 

·                    children and young people

·                    people with learning disabilities

·                    people with mental ill health

·                    people with cancer

·                    people with chronic conditions such as asthma, diabetes and heart disease

·                    older people.

 

The consultation for the new strategy would end on 24th December, 2007 and the final plan would be amended as necessary after the consultation process had expired and the strategy would then be presented to Full Council and the Local Health Board prior to its implementation from April 2008.  Consultation workshops had taken place in December 2006 with key stakeholders including the voluntary sector, user and carer representatives, LHB board and elected members and in June 2007 to finalise priorities involving director level representatives of the Local Health Board, the Council and the Voluntary Sector .  Mark Wheeler (Interim Director for Social Services) in conjunction with Abigail Harris (Chief Executive of the Vale of Glamorgan Local Health Board) advised the Committee that the current strategy was shorter, sharper and more focused than the previous one with specific emphasis on working together with partners. 

 

The following question and answer session then ensued:

 

Question

Answer

 

Members were pleased to note that working together in partnership was one the priorities and that the other priority areas were EMI, Older People, Obesity and sexual health.  Some members raised concerns in particular in relation to “life limiting conditions”.  On the whole it was reported that clients received appropriate services, however for example, MS sufferers and motor neurone sufferers do not always seem to receive the packages they require.

 

Abigail Harris advised it was essential that all partners were engaged in the process and that the full spectrum of support that was available was conveyed to clients.  Further work with the voluntary sector would need to be undertaken in order to ensure that accessible services were maintained and information provided.

 

Members queried the need for more detailed information in the outcome / actions column.

 

Abigail Harris confirmed that further discussions would be undertaken in respect of outcomes and actions before the final document was completed.

 

Mental health for children.  More work was needed to ensure that children were not classified as adults.

 

Abigail Harris responded by stating that the policy for Wales was not to classify children in this category and that all partners needed to make sure that young adults and children were accommodated in the most appropriate way.

 

How often would the strategy be monitored?

 

It would be monitored every two months by the LHB and the Scrutiny Committee would monitor the actions in its service plans.

 

How are we going to reach the people who do not have the current technology i.e. computers to assist them?

 

Abigail Harris stated that the services needed to be simplified.  The fact that schools were playing a greater part in the community as “community schools” would assist in this.    Also to encourage the use of library facilities and that the health service dovetails into all the local authority’s strategies and vice versa.

 

Women receive a number of screening facilities e.g. for breast cancer.  An issue for men was prostate cancer and there was currently no screening for this.

 

Abigail Harris advised that this was an area that the Public Health Director had also identified and would be pleased to report to a future meeting.  It was a matter that needed to be addressed at national level as well.  

 

Concern in relation to access to new drugs and the “post code lottery” was mentioned by Members.

 

Abigail Harris confirmed that Local Health Boards were not working in isolation in Wales.  They were working as a consortium and the intention was to make consistent decisions in relation to new drugs. 

 

Following the question and answer session, Mark Wheeler advised the Committee that the Social Services Department and the LHB would together, develop a Strategy of Promoting Independence.

 

Members also wished to know the result of the recent consultation exercise that had taken place in Barry and Abigail Harris confirmed that she had been pleased with the evening, that there had been a number of questions which had been extremely valid and that in general residents were pleased that the document was short and easily readable.  A key objective for both the Health Board and the Authority would be how they would be able to achieve what was set out in the strategy in the current financial climate and make sure that all partners were on board.

 

RECOMMENDED -

 

(1)       T H A T Abigail Harris and Mark Wheeler be thanked for their informative presentation and that the Scrutiny Committee monitor the actions within the strategy through the departments service plans.

 

(2)       T H A T the Health, Social Care and Wellbeing Strategy 2008-2011 be forwarded to all members of the Council for information / consultation prior to the closing date of 24th December, 2007.

 

Reasons for recommendations

 

(1&2)  For monitoring purposes and to apprise Members.