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Oral - Community Health Services in North Wales

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Edwina Hart, Minister for Health and Social Services

Last week in Plenary, I advised Members that I would make a further statement this week on the work undertaken by Dr Chris Jones on community services in north Wales. Members will have received a copy of the Jones report earlier today. I asked Dr Chris Jones, chair of Rhondda Cynon Taf Local Health Board, to undertake this review because I wished to be assured that, as part of their overall plan for the future, north Wales health communities had effectively planned their future primary and community care services. Many Members and members of the public have pointed out that it is only with such an assurance about primary care that we can be confident that proposals for the future of hospital services are robust.

The Jones report recognises the effort made to pull together the plan for the whole of north Wales—’Designed for North Wales’—but concluded that this focused on hospital services and bed reductions. It also concluded that more work needs to be done in north Wales to plan and develop services outside hospitals, before any major changes in acute services can be implemented.

'Designed for North Wales’ makes proposals to re-balance the health budget for these services, but it does not adequately reflect consideration of the investment required to develop primary care and community services to cater for the changing needs of the population.

Dr Jones was very impressed with the professionalism, good intentions and hard work of staff based in primary and community settings. He recognised that localities valued their community services highly, but considered that the present and potential role of these services was insufficiently appreciated by the statutory health bodies. He suggested that the public and local communities need to buy into a new way of providing community services, and the report suggests that these be based on safety, outcomes, sustainability and access. I fully support that view.

Dr Jones found that local health boards have proposals in place to improve and strengthen community services, through their community services frameworks and health, social care and wellbeing strategies. These strategies must be in place by 1 April 2008. I have asked my regional offices to check the strategies to ensure that they conform to the principles outlined in Dr Jones’s report.

The Jones report makes a number of recommendations that are aimed at the local health community. These include the need: to strengthen and develop clinical leadership, which is a common thread in the reviews that I have published; to produce a clear plan/document setting out primary care and community services, which I will put in hand; to develop demonstrator sites and service champions to provide living examples of the sort of primary and community services that will be available in the future; and to appoint a lead local health board to manage and take forward the primary care estate, supported by the Design Commission for Wales and Welsh Health Estates.

There are also a number of recommendations for the Welsh Assembly Government. It is suggested that it should: provide clarity about governance arrangements for community hospitals, including out-of-hours provision and GP services; include community-focused targets as part of the performance management of NHS bodies; identify current levels of investment in community-based services across Wales; work with Informing Healthcare to improve technology in the field; engage the public by developing and enhancing the role of community health councils; engage with the British Medical Association and the Royal College of Nursing in developing community services staff and looking at innovative roles for primary care providers; and, as part of the work on the rural health plan, consider the role of the out-of-hours service in rural areas.

Dr Jones has provided a combination of strategic vision and practical proposals. His broad conclusion that more needs to be done to develop leadership and service proposals for primary and community care seems to me to be incontestable. Where his proposals fall under my responsibility as Minister, I will respond as quickly as possible over the coming weeks, and focus on issues of leadership and management, as well as specific service concerns. Where actions fall to local NHS organisations, it is vital that they take the initiative in using the report as a vehicle for improvement and change. I look to those involved in primary and community care services in north Wales to promote the maximum possible engagement with the agenda that the Jones report sets out.

In conclusion, Presiding Officer, I am very grateful to Dr Jones for the considerable time and effort that he has spent in undertaking this work. In this statement, I have concentrated on the key and overarching messages that his report provides. The full document contains a rich level of detail that, inevitably, I have only been able to touch on this afternoon. Now that the report has been published, I hope that Members will have an opportunity to consider it in its entirety.