Oral - NHS Reconfiguration in Powys and North Wales

Last week, I was able to make a statement to Plenary on the reconfiguration of health services and structures in south Wales. I indicated then that I hoped to return today with a similar statement of progress in relation to north Wales and Powys.

Members will be aware that proposals for service reconfiguration in north Wales have proved controversial across the whole of the area. My approach has been to identify the underlying difficulties that have caused such public disquiet, and to put in place new procedures which, I hope, will allow us to take local populations with us in shaping new and better services for north Wales. Today, I want to bring together four strands in that approach, so that Members can be aware of the full picture as it currently stands.

First, Members will already know from my oral statement of 25 September that Michael Williams, the acting chair of Swansea NHS Trust, has been commissioned to undertake a review of consultation processes adopted in relation to service reconfigurations at Prestatyn and Blaenau Ffestiniog. I remain convinced that we must find new ways of ensuring that consultations are fair, open and thorough, and that they are perceived to be so by local patients and clinicians. The Williams report will be with me in December, and I intend to study it carefully, not only for what it will tell us about what took place in Prestatyn and Blaenau Ffestiniog, but also for any general lessons on consultation that it may contain. In the same statement, I set out new arrangements for consultation on proposals in relation to Llandudno Hospital, making it clear that no service changes should proceed until that new consultation had been completed. That work is now under way, with the community health council in the lead role.

Secondly, I have concluded that, in north Wales, as in the south, one of the key reasons why secondary care proposals have run into difficulty is that plans for developing primary and community health services had been underdeveloped and under described. I have therefore asked Dr Christopher Jones, Rhondda Cynon Taff Local Health Board chair, and a general practitioner himself, to undertake a review of the current plans in north Wales for community services, and to provide me with a report on their appropriateness for the communities that they serve. I want to ensure that primary and community services in north Wales are as strong and as forward thinking as we can make them. The report that Dr Jones has agreed to produce by December 2007 will help to make that happen and, in the process, will give confidence to patients that services are being strengthened rather than diminished.

Thirdly, in reviewing reports of what has taken place so far and in meeting individuals and groups across north Wales, I have become aware of the importance of clinical governance issues in some of the decisions that come forward about individual sites and services. The proposed closure of Abergele Hospital, for example, turned to a large extent on clinical governance considerations. I have agreed to meet local representatives from Abergele in the near future to hear their views on these proposals, but I cannot ignore the considerable governance concerns expressed by local clinicians about the current services. Abergele is only one place in north Wales where these issues have come to the fore. As part of my general effort to secure and bolster public confidence in bringing about change in the health service, I have decided to obtain an independent view of those clinical governance issues, which are already a matter of public debate, from the Academy of Medical Royal Colleges in Wales, and to continue to do so as and when such matters arise in future.

Finally, and in order to complete the picture of outstanding work, I turn to a somewhat different issue, which has arisen in relation to the structural integrity of a major block in Ysbyty Glan Clwyd. While I am pleased to confirm to Members that the building remains safe for its current use, my concerns are that the design of the block is not capable of supporting the improvements in services that will be necessary in the future. I have therefore asked my officials to commission a review of the structural issues in the context of the proposed changes at Ysbyty Glan Clwyd, and to report back to me in December.

Taken together, the four different reports that I have outlined this afternoon will provide vital pieces in the jigsaw of service development that I want to see taking place in north Wales. By January 2008, I shall be in a position to take a view on the results of the work that I have commissioned, and I shall provide Members with a further statement at that time.

In the meantime, I repeat the principles that I set out in relation to services in south Wales last week. Where there is sound local endorsement of proposals to reform services, I do not intend to stand in the way of those reforms proceeding. The completion of the new  Porthmadog community hospital and the closure of Bronygarth hospital will go ahead, as will the completion of the new hospital at Holywell and the closure of Lluesty and the existing Holywell hospitals, to cite just two developments that are proceeding. Where there is no local agreement, however - for example, in Blaenau Ffestiniog and Flint - no further change will take place until the work identified has come to fruition.

That concludes my update of major issues in relation to north Wales. I am as anxious as any Member to make progress towards an agreed and settled set of proposals in every part of the north, but I am even more anxious to do so in a way that demonstrates that local concerns have been listened to carefully, and with real respect. I am under no illusions that it will be possible to satisfy every group, or every individual objection, to what finally emerges. However, I am determined that we do everything that we can to find ways forward that command confidence and credibility among patients, staff and the public.

I now turn to the situation in Powys, where, as Members know, the general review of community hospitals by Powys Local Health Board has been halted. Over the past few weeks, however, Powys Health Authority and Powys Local Health Board have worked together to address the future of services that should be provided in the Builth Wells area, with particular thought being given to the provision of more comprehensive and integrated health and social care services for that area. Those organisations now wish to consult further with their local population on how services there might be provided for the future. I endorse this approach, which shows encouraging signs of a new partnership between the local health board, the local authority, the community health councils, local general practitioners, associated clinicians, as well as wider patient and service-user representatives. If, as I hope, the Builth Wells experience continues to develop positively, it seems to me that a blueprint may emerge that could be followed in relation to other community schemes, in Powys and across Wales, to develop and deliver effective, high quality services for the future.