Agenda Item No.












Present for this item from the Cardiff and Vale University Health Board (UHB) were Mr. Peter Landstrom, Head of Operations and Delivery; Abigail Harris, Executive Director of Planning and Dr. Joe Grey, Clinical Director. 


Mr. Landstrom delivered the presentation entitled “Improving our Services for Older People in Cardiff and the Vale of Glamorgan; he began by informing Members that it was important to receive feedback and views from the Committee as part of the engagement process. 


It had been recognised that the population in Cardiff and the Vale of Glamorgan was changing and that the average age of people coming into hospital as in-patients was circa 85+.  Older people often had multiple health care needs placing increasing demands on all areas of health provision.  It was therefore imperative for modern, effective and efficient specialist older people’s services to be centred round the person.  It had also been recognised that older people spent too long in hospital which often resulted in a loss of independence and taking longer to recover.  There was an identified need to move away from hospital based, inpatient, long term care and to support people to maintain their independence for as long as possible. 


The Cardiff and Vale UHB aimed to build on the strategic themes formulated in the draft Older People’s Framework which recognised:


·               The central and pivotal place for older people in our services

·               The expert and focused care of the older person necessary throughout their care pathway

·               The need to develop and deliver more continuous and integrated care of older people across settings and hospitals

·               The opportunity to put older people’s care at the centre of medicine in Cardiff and the Vale

·               The creation of a clinical Gerontology Directorate in August 2013.


Mr. Landstrom, alluded to the current service challenges facing the Cardiff and Vale UHB:




(i)        Separated and isolated sites, impacting upon the provision of joined up comprehensive care

(ii)       Services operating out of poor quality and isolated buildings (Rookwood / West Wing)

(iii)      Difficulty in caring for patients who become unwell whilst receiving rehabilitation support due to limited out of hours medical cover and medical staff covering multiple sites

(iv)       Systems under stress through a stretched nursing and therapies staffing resources to support effective multi-disciplinary team working

(v)        Hospital based services not set up in the right way at the moment – and an inability to deliver integrated care across the whole patient journey.


In identifying the fragmentation of configured services it had been recognised that the first steps were to change services in order to provide increased and co-located specialist care for older people on a smaller number of sites in an improved environment, that medical cover in and out of hours needed to be improved and that resources focused on rehabilitation and early and consistent input into patients’ entry pathways be increased.  There was a need to balance day services with the potential to increase Elderly Care Assessment Service (ECAS), to support the move away from traditional long stay community hospital models. 


What could change?


Increase specialist input at the first point of entry into all acute services (equity across Cardiff and the Vale)

Establish a Frail Older Persons Advice and Liaison (FOPAL) Service at Llandough

Expert presence on both acute sites providing complex frail expertise and rehabilitation whilst patients are acutely medically unwell

Transfer wards to Gerontology at the Heath and Llandough

Create a single specialist hub for Medical, Stroke and Orthopaedic Rehabilitation, with improved medical cover

Transfer Rookwood W6 and West Wing MRU

Increase Medical Rehabilitation in-patient capacity

Transfer West Wing ORU

Align our services under one Clinical team wherever possible

Transfer all Stroke services to a single team

Transfer all Orthopaedic care to a single team

Provide Complex Frail Care and Comprehensive Geriatric Assessment (CGA) services from St. David’s and Barry Hospitals only

Decrease the overall bed base for CGA / Frail Care

Close Elizabeth and Neale and Kent wards and increase St. David’s capacity

Balance Day Hospital capacity across three sites

Transfer Rookwood Day Hospital to St. David’s

Increase Barry Day Hospital Capacity


Potential to consolidate and increase ECAS services

Consider option to transfer ECAS to Llandough hub increasing to 10 sessions per week and increasing new patient capacity

Ensure fit for purpose MDT input into Gerontology Patients throughout the system

'Reinvest’ released staffing resources to support improved medical cover in, support increasing ward nursing levels and therapy resources

Ensure when older people need acute care they get the same service whether admitted in the Heath or Llandough

Ensure we are focussing resources on Rehabilitation and putting the experts around the patient not moving patients between services / sites

Start to make changes that support the aims of the Older Person’s Framework and meet the needs of our patients.


Reference was made as to how the proposals would start to improve the level of care for patients.  To begin with older people who require hospital care should receive the same expert input throughout their pathways, regardless of where they accessed the care.  Increased rehabilitation focus and capacity, and the concentration of resources, would make sure that older people would be supported to return to the community and live as independently as possible.  It would be possible to deliver an improved patient experience when in hospital by no longer providing services from poor quality and / or isolated locations.  Co-locating services would ensure that there was a more flexible and robust medical cover that would remove the need to transfer patients between sites if they became ill. 

In concluding the presentation, Mr. Landstrom asked Committee Members to help the engagement process by considering these three key questions:


1.         Do you think we have missed anything in our vision for older people’s hospital services?


2.         Are there any things that you believe need to be taken into account or that we might have missed when assessing the impact of these ideas?


3.         Are there other changes to our Specialist Gerontology services you think would further help us to achieve the desired outcomes, either immediately or in the longer term?


Members were advised that answers and feedback for these questions were not needed now and that all the details were shown on the Cardiff and Vale UHB’s website and that feedback could be received in an informal and formal way.  Mr. Landstrom thanked the Committee for the opportunity to deliver the presentation and to be able to outline the Cardiff and Vale UHB’s plans and proposed developments. 


In alluding to the current progress made in respect of the engagement process, an Elected Member asked the representatives from the Cardiff and Vale UHB to summarise the plans for Barry Hospital and comment upon the affect upon people within the Vale of Glamorgan as services are relocated closer to the Cardiff area.  In reply, Ms. Harris advised the Committee that the proposals set out by Mr. Landstrom were only a small part of a much larger jigsaw that feeds into the Older People’s Framework.  As such, the plans set out proposals for greater and wider range of services to be provided at Llandough rather than at the University Hospital of Wales.  Part of these plans also included the improvement to the bus provision to the hospital in Llandough.  In reference to Barry Hospital she commented on the important part Barry Hospital has in providing services.  The Community Resource Team (CRT) at Barry Hospital was an important development and the Ear Nose and Throat (ENT) Unit had recently moved to Barry Hospital; these were some examples following integration of the commitment to keep important services and activities within Barry. 


Further to these points, Mr. Landstrom, commented that discussion with staff was a very important aspect of the engagement and consultation process.  The Cardiff and Vale UHB fully recognised the need to take into account all views and opinions in respect of plans to remodel service delivery.  He also advised Members of the relatively low number of admissions into Barry Hospital from local residents and, in many cases, there was a need for people to be transported between hospitals for specific services and that under the plans outlined people would receive care closer to their homes.  For example, an increased day hospital provision would help rebalance the service. 


In commenting upon the changes to Barry Hospital, the Clinical Director, Dr. Grey, advised the Committee that the Cardiff and Vale UHB wanted to see more equity in the location of services.  It was important for patients to receive the right treatment at the right time, particularly at the start of their journey.  Rehabilitation was a key element in ensuring a person’s independence but this input went hand in hand with medical and clinical support. 


A Member, in agreement with the creation of Centres for Excellence, made reference to discussions with local constituents who had advised that, in their opinion, the level of engagement by the Cardiff and Vale UHB about changes to Llandough had been minimal.  Llandough should be seen as more than just a hospital and it was important to understand and take on board comments from local people.  The Committee Member thought it was advisable for the plans and proposals to consider wide ranging issues other than clinical aspects, such as road access and transport links.


The Chairman enquired with the Cardiff and Vale UHB representatives whether there would be any increased costs for the Vale of Glamorgan Council following these proposals, given the shift from some people receiving in-patient treatment within their community based hospital to receiving help at home or in residential settings. 


In response, Ms. Harris advised that under the present system patients were continually shunted from one clinical site to another.  It was not the aim of the review to close Barry Hospital but to ensure resources are used properly in order to ensure that people get well as soon as possible.  People stay in hospital for far too long and that the provision for community based hospitals would still exist, but there was a need to balance service demand. 


Mr. Landstrom commented that there may be different clinical / medical activity rates and the Cardiff and Vale UHB would therefore plan with service providers in local areas where patients live.  The current plan was linked to the Older People’s Framework, with the main focus being the appropriateness of the care people receive at the right time.  As a result the Cardiff and Vale UHB did not envision any additional costs but there would not be the need for the same level of local hospital in-patient provision and they would create better links between the CRT, GPs and Social Services that should ultimately make patients better off. 


The Committee were further advised that there should be benefits for people who enter the care system in the future and for those who should receive their care under the new and improved Older People’s Services.  At this point the Director of Social Services stressed the importance for rigorous and detailed assessments being carried out when in-patients are moved as a result of ward closures, as happens in residential care so that individual and family concerns are addressed.  He felt it was vital for all parties to agree collectively so that the right decisions are made to meet the needs of the client.


In response to a Member’s query regarding timescales and the closure of wards and how the plans are to be future-proofed, the Committee was advised that the current timetable indicates that the engagement process would be concluded by the end of May.  Following this the Community Health Council would meet on 3rd June to discuss the relevant options but there may be further need for more consultation depending on the Health Board’s final decision.  Once the decision to progress has been made it is perceived that changes would be implemented before the winter months in order not to put elderly people through unnecessary disruption during the winter period.  In respect of future-proofing plans the Cardiff and Vale UHB representatives commented that this was a big challenge due to the changing population and aging profile of patients, however if changes are not made then they would be back here in one to two years’ time discussing further and more drastic changes. 


In closing the debate the Chairman noted the high importance of this issue and that the Committee was concerned with the possibility of additional costs being incurred by the Council following the implementation of the plans.  It was therefore agreed that the contents be referred to Cabinet for consideration. 


RECOMMENDED – T H A T the contents of the presentation and the accompanying consultation document be forwarded to Cabinet in view of the potential for increased costs to the Council.





Reason for recommendation


For Cabinet to consider the proposals outlined by the Cardiff and Vale UHB in respect of changes to the older people’s services in view of the potential for increased costs to the Council.






Attached as Appendix – Report to Scrutiny Committee (Social Care and Health): 19th May, 2014