Oral - Health service Provision in North Wales

Members will be aware that a number of proposals for a reconfiguration of the health service in north Wales have proved controversial and have failed to secure the support of local populations. Since becoming the Minister for Health and Social Services, I have felt that it is important to undertake a wide range of discussions about these issues, drawing on the views of as many interested groups and individuals as possible.

During the summer recess, I travelled to north Wales, visiting a wide range of health facilities and meeting as many people as possible who have an interest in the future of our health services. I was able to hold discussions with, among others, clinicians, Assembly Members and patients, and with local groups involved in campaigns at Prestatyn, Blaenau Ffestiniog and Llandudno hospitals. Without exception, I found these meetings to be informative and held in a spirit rooted in the huge regard and affection that staff and patients feel for the Welsh national health service.

The issues raised with me at Prestatyn and Blaenau Ffestiniog were similar and included the retention of community services locally, particularly in the provision of intermediate care, palliative care and patients’ ability to access tests and local facilities. In both places, particular concerns were raised about the consultations taking place on the reconfiguration proposals. From the meetings, I formed the view that it would be sensible, given the views, to have an independent review undertaken of the consultation processes adopted, and for the review to report to me before the end of the year. The review will test in each case whether the public consultation arrangements employed by the LHBs were appropriate and effective in encouraging engagement in the process, whether the views and comments received through the consultation were considered fully by the LHB before its decisions were made, whether the decision of the LHB was then communicated widely to all stakeholders to ensure a common understanding of the way forward, and whether the arrangements for stakeholder involvement during the implementation period were appropriate. I have asked Michael Williams, the acting chair of Swansea NHS Trust, to carry out the review, and he will start work shortly. I will advise the local action groups of my conclusions when I have reviewed and considered Michael Williams’s findings. In the meantime, no action will be taken to transfer services out of the hospitals concerned.

The Llandudno Hospital Action Group raised a number of issues with me regarding the need to ensure that Llandudno Hospital serves the needs of the population. There was a particular concern about the group’s confidence in the review of the future of the hospital. As a result, I have agreed to meet the action group once the review has reported in order to have a further opportunity to hear its views on this matter. I expect the review to report in December, and I will want my meeting with the action group to take place as quickly as possible thereafter.

With regard to the review of breast surgery services at Llandudno, which has been carried out by the independent experts appointed by the local health boards, I have asked my regional office to report to me on the arrangements to ensure that clinical and non-clinical staff will be consulted on the report’s recommendations prior to any decision taken by the local health boards.

Change is inevitable in the health service. The national health service has changed continuously over the 60 years since it was set up in July 1948, and the next four years will be no exception. The lesson which I draw from my many discussions with, and about, services in north Wales is that change can only happen effectively if we engage more successfully with local populations. We have to be able to demonstrate to them that change will produce an improvement, and not a diminution, in the services available to them. As a general point, therefore, I am concerned to ensure that in future, consultation about service change is fit for purpose, and I have asked my officials to prepare new guidance to make that happen. In the short term, I will require that regional officials ensure appropriate engagement between the health boards, trusts and stakeholders concerning service change, and, in particular, that the views of clinical and non-clinical staff through their professional and representative bodies are included.

I inform Members about discussions that are under way concerning the delivery of a small number of complex cancer services across north Wales in order to improve services and meet the national cancer standards. The specific proposals are the provision of gynaecological cancer surgery on the North West Wales NHS Trust site, the provision of urological cancer surgery on the Glan Clwyd site, and the provision of head and neck cancer surgery on the Glan Clwyd site. The North Wales Cancer Network and the Surgical Services Redesign Group have recommended that the complex surgery for each of those sub-specialties should only be performed at one site in north Wales to improve services, meet clinical standards and improve patient outcomes. The recommendations apply to the in-patient element only of the treatment. Out-patient appointments can, and will, continue to be provided locally. These recommendations will shortly go to the local health boards for approval, taking into account the input from the community health councils.