Oral - Reconfiguration of Services in North Wales

Last week in Plenary, I advised Members that I was awaiting Michael Williams’s review of the consultation processes adopted in relation to service reconfiguration at Blaenau Ffestiniog and Prestatyn hospitals. I also said that I would publish it and make a further oral statement to the Assembly this week. The report has been made available to Members this morning.
Members will be aware that proposals for service reconfiguration in north Wales have proved controversial in many aspects. My approach has been to identify the underlying difficulties that caused such public disquiet, and to put in place new procedures that will allow us to engage local populations more effectively to help to shape new and better services for north Wales.

I have now received Michael’s report, and have studied it carefully, not only for what it tells us about what took place in Blaenau Ffestiniog and Prestatyn, but for any more general lessons to be learned about consulting people on the future of health services. The report concluded that Gwynedd Local Health Board acted professionally in dealing with a difficult issue relating to changes in services. It made real efforts to meet the spirit and the letter of the Assembly Government consultation guidance.

However, the report states that the LHB failed to engage the public, despite its best efforts, and identifies a number of areas where the process could have been improved: by earlier engagement with the community and the media, and by improving its consultation booklet. These are not just lessons for this LHB, but for all LHBs across Wales. The earlier consultation process led the public to concentrate on the future use of its hospital, and not on the possibilities of providing better integrated services in the community.

The report traces the way in which, following the public consultation in 2005, the LHB implemented a number of positive service changes to community services in the area. Agreement was reached with the community health council that the 12 beds at the Blaenau Ffestiniog community hospital would be retained for a further three years, or 12 months after the commissioning of Ysbyty Alltwen. Michael suggests that, to provide a period of stability, these beds should be kept in service until 1 April 2011. The report further recommends that a new review be undertaken, one that concentrates on the possible future role of a community hospital in Blaenau Ffestiniog, while considering how other services based at Blaenau Ffestiniog might be improved.

As I said last week, we must not lose sight of what we need to do for the health and wellbeing of the community as a whole, and any further review should take this into account. As Michael has suggested that there should be a period of stability in Blaenau Ffestiniog, I would wish to defer a decision on a new review until Alltwen community hospital opens, and has been fully operational for one year. That supports Michael’s recommendation of a period of stability, and satisfies the community health council’s original request. Finally, Michael’s report concluded that the local health board and the community needed to develop and build on the positive outcomes of the 2005-06 consultation. I cannot stress enough the importance of this collaborative engagement.

On Prestatyn, the report concludes that Denbighshire LHB also failed to engage the public, but, in this case, it concluded that the LHB did not have the appropriate expertise or experience to engage effectively. It also concludes that the model of care proposed was not properly understood by the community, and that there was a breakdown in communication. The report recommends that the consultation process be rerun, which I support. It specifically refers to the need to clearly describe all available options to the community, and to explain exactly the effect of extra care housing beds on the range of future services available in this community. Michael recommends that the 12 beds in Prestatyn be retained until the rerun public consultation is completed, and I support that recommendation.

The local health board will need to take on board the lessons learned from the Williams report very seriously when it engages with the public this time around. I suggest that the regional director support the local health board throughout the process. In response to my Plenary statement on north Wales matters last week, Ann Jones made the important observation that we have to ensure a coherent approach to the development of primary healthcare in the Prestatyn area. I endorse that point and the recommendation of the Williams report. I will require the further consultation exercise to be conducted on that more comprehensive basis. The report recommends that the further consultation exercise include the services required for the population of Rhyl. That suggestion has benefits in ensuring that a more comprehensive review takes place for this stretch of the north Wales coast, and I endorse that recommendation.

The report makes a number of recommendations on the process to be used in future consultations, and on ways in which the existing consultation guidance might be improved. They include the need for openness and earlier public engagement, improved communication strategies, clinical leadership and trust involvement in the process, additional resources for community health councils, the role and composition of task-and-finish groups, and the methods of effectively consulting with the public. I have said in the Chamber on a number of occasions that I am worried about the consultation processes used by the NHS when changes to services are being considered. Michael’s report has suggested that clinicians be given a greater role in the process, which I agree with.

These recommendations, together with those of the Goodwin report in Carmarthenshire and Chris Jones’s review of community services in north Wales, will be considered and developed as part of the revision of the Assembly Government’s engagement and consultation guidance. I must stress that this revised guidance will start with the need to engage the public as early in the process as possible. My officials will start work on this important piece of guidance immediately.

That concludes my update on the reconfiguration of health services and structures in north Wales this week; I hope to provide Members with a further statement next week on the work that has been undertaken by Dr Chris Jones on community services in north Wales. Finally, I publicly thank Michael Williams for the detailed work that he has undertaken in this review, the time that he has taken going out to meet people, and congratulate him on a comprehensive piece of work, which I am delighted to support.