Report prepared by Welshpool Town Council to inform the Mid Health Study prepared by the Welsh Institute of Health and Social Studies for the Welsh Government.

MID WALES HEALTH STUDY

for the NORTH AND EAST MONTGOMERYSHIRE AREA served by SHREWSBURY,TELFORD AND GOBOWEN

FINAL REPORT

1st August 2014

Triangle House Union Street Welshpool SY21 PG Tel 01938 553142 Email: [email protected] Web site: www.welshpooltowncouncil.gov.uk

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CONTENTS

No Heading Page

1. Introduction 3

2. Remit of the Study 4

3. Area for the Study 6

4. Survey methodology 7

5. Summary and results of the survey 9

6. Focus Groups 11

7. Threats and opportunities 14

8. Stories to tell 15

9. Recommendations 17

10. Signatures to the Report 20

Appendix

A Area of Survey 21

B Survey results schedule 22

C Copy of poster and flyers 25

D Copy of questionnaire 26

E Cross Border NHS Protocol 31 2

1. Introduction

1.1 This report has been prepared by Welshpool Town Council in consultation with the North Montgomeryshire Local Council Forum.

1.2 The report has been completed to inform the Welsh Institute for Health and Social Care being prepared by Marcus Longley and Mark Llewelyn for the Welsh Government.

1.3 The method, area and remit of this report was approved by the Welsh Institute of Health and Social Studies and has been prepared in accordance with the Methodology Document approved on 6th May 2014.

1.4 The information set out in this report was gained over the period from 1st to 15th July 2014 and the results set out including a summary of findings and recommendations arising from the reports findings. People were still returning survey forms until 31st July 2014 and these have been included in the results and their views taken into account.

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2. Remit of the Study

2.1 Welshpool Town Council has completed the survey in accordance with the Survey Methodology Document approved on 6th May 2014 by Marcus Longley and Mark Llewelyn.

2.2 The remit for the study and survey as agreed and for the record is:

To diagnose the issues and identify potential solutions (including models) for providing accessible, high quality, safe, and sustainable healthcare services, which are best suited to meet the specific needs of those living in Mid Wales.

The study should set out what could be done now and in the future, specifically considering:

– including: preferences for care to be delivered close to home; tackling health inequalities; Welsh language service provision; and evidence of the effect of wider determinants of health (e.g. physical and social isolation, access to transport, lower than average earnings) observed in the population of Mid Wales; The study to include seeking out those services needed which are not provided at present.

– including profile, recruitment and retention, professional standards, service implications (quality and configuration) and future models (e.g. plans for developing the rural practitioner role, generalists, buddying arrangements with tertiary centres, outreach clinics etc);

– including plans and perspectives on the configuration best suited for delivering high quality, safe (in line with national agreed standards) and sustainable services for Mid Wales;

– including, the extent to which there are firm proposals, or wider opportunities, for the utilisation of health technologies and telemedicine, tele-health, Skype, phone, e mail and other digital technology to improve accessibility and service quality;

4 – opportunities for strengthening partnership working, particularly the health and social care interface and voluntary sector providers; and

service delivery by the Health Boards over the border.

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3. Area for the Study

3.1 The area of the Study as agreed in the Methology Document (approved on 6th May) is as set out on the map at appendix A of this report.

3.2 The main areas from which there were responses are:

Welshpool Newtown Llanfair Caereinion Llanfyllin Llanidloes Montgomery Churchstoke

The overall area was North and East Montgomeryshire.

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4. Survey methodology

4.1 The information to inform this report was gained over the period 1st to 15th July 2014 by the following methods:

GENERAL area The whole of the area of the survey received publicity about the Study by the following means:

Media coverage on My Welshpool and My Newtown including a banner on the home page of My Welshpool.

Media coverage in the local newspapers.

Facebook notifications.

10,000 bi-lingual flyers delivered in number to each Town and Community Council in the area for distribution to their local public places.

On line web site for the purpose of the survey.

WELSHPOOL and area In this area the following took place:

The Town Council newsletter included full information on the study and was delivered door to door.

There was publicity placed in the area via posters, leaflets, news web sites, facebook and local newspapers.

A series of drop in days when people can come, see displays and complete their forms. (many who called were glad of help in filling in the form with their experiences.)

People could collect surveys and return them to the Council Offices, Market Halls, Tourist Information Office or Local Library.

There was a bespoke Web Site with online survey at www.midwaleshealthstudy.org.uk

Small focus groups visited and information gained.

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NEWTOWN and area In this areas the following took place:

There was publicity placed in the area via posters, leaflets, news web sites, facebook and local newspapers. There was a bespoke Web Site with online survey at www.midwaleshealthstudy.org.uk

LLANFYLLIN and area In this areas the following took place:

There was publicity placed in the area via posters, leaflets, news web sites, facebook and local newspapers. There was a bespoke Web Site with online survey at www.midwaleshealthstudy.org.uk

LLANFAIR CAEREINION In this area the following took place:

There was publicity placed in the Institute. There was a facebook page, leaflets, web site and local newspaper. There was an open day for people to call in at the Institute. There was a bespoke Web Site with online survey at www.midwaleshealthstudy.org.uk

4.2 A copy of the poster and flyer used is included at appendix C.

4.3 There was also newspaper and internet news coverage to advertise the study.

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5. Summary and results of the survey

5.1 The full results and analysis for each discipline have been made available to the Welsh Institute of Health and Social Studies.

5.2 Key points The key points that have come out of the survey are:

1) First Point of Contact The care received was of a high standard if the first point of administration is good. If the first point of administration is not good the whole system fails. Various departments have differing standards of administration range from 25% satisfaction to 96% satisfaction.

2) Where care is delivered A majority of respondents would like to see care delivered more locally, however people were prepared to travel a reasonable distance if the care they received was very good.

3. Administration The satisfaction level with regard as to how the administration side of the service is very mixed - for example the survey results showed the following:

Urology Only 25% said they received a good service Cancer Only 37.50% said they received good service Mental Health Only 40% said they received a good service. A and E 62.86% said they received good service Doctors Surgery 70.85% said they received good service Eyes 91.30% said they received good service Orthopaedic 96.00% said they received a good service

This shows a very erratic delivery of administration in some areas.

4) Travel Travel distances (with little public transport available) were highlighted. There was deep concern that Shrewsbury might be withdrawn leaving North and East Montgomeryshire with no viable Accident and Emergency Hospital.

9 5) Waiting times The waiting times differing from those in England were sighted as an issue. Many expressed the view that the Health Service should be 'National' and not treated differently in Wales and England. This was evidenced by the Cross Border issues.

6) Drugs and treatment The different drugs available was blind as a matter. There was concern among cancer patients that the life saving drugs more expensive available in England but not in Wales or indeed in English hospitals for Welsh patients. Many have expressed the view that the health service should be ' national ' and not treated in a different way in Wales and England.This was evidenced by the cross-border issues.

7) Funding of the service There was strong support for a prescription charge to provide extra funding for the NHS with a level of charge being around £3.

8) Language issues There were very few language issues identified in the area of the study.

5.2 When choosing a hospital The survey questionnaire asked what people took into account when choosing where to source their treatment. The results showed the percentage of people who thought this was important to them:

Length of travel time 77% Quality of care 86% Ease of relatives to visit 62%

Recommendation of healthcare professional 57% Advice of family & friends 58% Familiarity of Hospital Site 62%

Reputation of hospital 76% Speed of administration of care 75%

In general people felt all the reasons listed were all important to them.

5.3 Detailed results of survey The detailed results of the survey have been made available to the Welsh Institute of Health and Social Studies who are leading the Mid Wales Health Study for the Welsh Government.

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6. Focus Groups

6.1 An offer was advertised seeking small groups to meet and discuss the issues. The groups took up the offer are listed below.

6.2 MS Society (Montgomeryshire Branch) The MS Focus Group met on Thursday 24th July 2014 and discussed issues surrounding their experiences. The details of the Focus Group are:

Location Welshpool Town Council Date Thursday 24th July 2014 Time 2.30pm Present 7 members of the MS Committee. (some with MS) Group lead by Robert Robinson Town Clerk Welshpool Town Council

The issues raised were:

i) Information on MS and such chronic illness is not readily available leading to people feeling left to fend for themselves.

ii) Lack of MS Nurse who can visit was sighted as an issue with many members being housebound and not having seen an MS professional for a signifigent time (in some cases many years).

iii) The MS provision is Shrewsbury is taken up by Shropshire Patients leaving many MS sufferers in Montgomeryshire waiting.

iv) The level of care once it has been sourced was considered to be very good.

11 6.3 Darby and Joan Club Welshpool The Newtown Focus Group met on Thursday 17th June and discussed issues surrounding their experiences. The details of the Focus Group are:

Location Newtown Town Council Offices Date Thursday 23rd July 2014 Time 2.30pm Present 24 members of the public aged over 60. Group lead by Robert Robinson Town Clerk Welshpool Town Council

The issues raised were:

i) Waiting time to see your own doctor is approx 2 weeks which was considered to be too long.

ii) Generally care levels received were considered to be very good once care is accessed.

iii) Comments about having to repeat personal details and medical history to a hospital in England was sighted as it appears that the computer system in Wales is different to that in England.

12 6.4 Newtown Focus Group The Newtown Focus Group met on Thursday 17th June and discussed issues surrounding their experiences. The details of the Focus Group are:

Location Newtown Town Council Offices Date Thursday 17th July 2014 Time 2.30pm Present 9 members of the public aged over 60. Group lead by Robert Robinson Town Clerk Welshpool Town Council

The issues raised were: i) Wales England timescales Waiting times for all of the UK should be uniform. We all pay the same amount into the service via taxes. ii) Appointments Appointments have been made with Shrewsbury hospital out patients only to find when turning up the appointment has been cancelled without any prior notice. iii) Doctors Surgery Appointments for doctors are often 4 or 5 weeks if you wish to see a specific doctor. If not it is only days. A doctor who know you gives better care. iv) Ambulance times in rural area The ambulance times are variable, some only waited 10 minutes and others 40 minutes. v) Newtown Community Hospital The hospital has several issues which are: a) Rooms not used as they house GP beds with no GP visits. b) Car park always full (used by locals to park for free but who are not using the facilities of the hospital) vi) Shrewsbury Hospital Mixed reviews. Actual medical service good to very good. Administration not so good. When transfer from Shrewsbury to Stoke (with a stroke) the records did not go with them (2 cases of this). vii) Physio at Shrewsbury Hospital There is an 8-10 week wait. The view was expressed that this is partly due to lack of space as other services have taken some up.

All the above were taken from personal or family experiences of the Medical Services.

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7. Threats and opportunities

7.1 Summary of peoples views The survey asked for people to list what they saw as threats and saw as opportunities for the NHS in coming years. The responses have been co-ordinated so that they are not repetitive. However, the same theme came through from almost all respondents.

7.2 Threats to the NHS From the returns the following threats were identified:

Funding (lack of it) Rural area service provision Illness due to drinking Illness due to smoking England/Wales issues Elderly care reductions Aging population Low staff moral Consultant shortages Administration issues Poor infrastructure Loss of services Waiting times Drugs availability Bed blocking People using Local Surgery for no reason General Practice pressures Training and competency Lack of MS Nurse Closure of day centres Hygiene issues Sale of hospital land To much political involvement Private health Staff shortages Low staff wages (nurses) Excessive criticism Immigrant cost and pressures on NHS

7.3 Opportunities for the NHS From the returns the following opportunities were identified:

Wales/England NHS together Altering lifestyles Dietary changes Prescription charges Local delivery of services Understanding rural needs MS Nurse Shorter waiting times Return of Matrons Public transport to medical care issues Keep NHS intact Provide a Mid Wales Hospital Improve cottage hospitals Consultants to visit local hospitals Pride in the service Better home care Immigrant controls New technology Better data bases Compatible computers with rest of UK Improve administration Gene mapping More local surgery delivery Small operations locally Annual over 50's checks Permanent funding streams

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8. Stories to tell

8.1 The stories that people wished to tell use about the NHS were based around the following:

Border Issues The difference in treatment delivery between Welsh and English residents is stark with complaints of: i) Shropshire patients in A and E being seen before those from Wales. ii) Differing drugs for English and Welsh residents. (in some cases a life threatening condition - ie Cancer)

Administration Poor administration is sited in almost 60% of the 'stories to tell'. For example: i) trying to get appointments (having to chase up) ii) not being able to get a regular appointment on leaving the hospital. iii) waiting for treatment and having to chase it all up to gain a result - in one case the file had not been handed over so the Doctor did not know the patient was waiting.

Doctor/Consultant Two cases referred to poor treatment and mis-diagnosis.

Space Issues The issue of being left on trolleys (or in one case a storage room) for hours and hours awaiting treatment was sited in 3 cases.

Ambulance times There were 3 cases where the ambulance did not arrive for 2-3 hours.

15 Local doctors In some cases the local doctor was not able to diagnose the illness leading to worsening effects.

Care One case sited needing to go to the toilet (help was needed) but the patient had to wait as the nurses were changing shifts, some 3 and half hours later the person was taken to the toilet.

Information One case sited a minor taken to A and E and it taking over 36 hours for the hospital to inform parents.

Local Doctors Many complaints of having to wait 2-3 weeks to see a specific local doctor. There is no evidence that if it were an emergency this delay takes place.

ME There was one patient who received poor local advice from the local doctor and poor support for the illness.

Transport Issues Patients who have had to travel to Telford for their treatment have found great difficulty where they need public transport.

In one case Hospital Transport was given to Telford using a unit from Shrewsbury as Powys would only pay for transport to Shrewsbury and not Telford.

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9. Recommendations

9.1 The Recommendations informed by this report are set out under the headings of the remit as follows:

1. Shrewsbury Hospital Recommendation The A & E and support services are retained at Shrewsbury until at least there is proper Mid Wales provision to serve the area of the Study. Reason There is a strong feeling that removing A and E along with other services from Shrewsbury would put lives at risk and further disadvantage the population of Mid Wales.

2. Funding of the NHS Recommendation The funding of the NHS in Wales needs to be re-addressed with more funding going direct from the Welsh Government to the Trusts that deliver the services directly. Reason There is a strong feeling that more money is being spent on the 'middle men'. For just 3m people Wales has 8 area health authorities which is probably too many for the delivery of the services for such small population.

3. Travel times and location of treatment Recommendation A Hospital Transport Scheme needs to be introduced, perhaps a mini bus service from set centres to Shrewsbury and Telford, to support the lack of public transport to points of care at both the above hospitals. Reason There are many elderly in Mid Wales who do not have their own personal transport and need to rely on public transport for their hospital treatments (particularly in out-patients).

17 4. Administration & first point of contact Recommendation To introduce two administrative systems in hospital and medical care as follows: i) To allow the making of appointments (for regular persons attending) before leaving the point of care for current treatment. ii) A simple check to ensure that patients details are recorded correctly on first point of contact. iii) A simple system of communication between consultants, doctors and nurses who are involved on the same day with the same patient. iv) Review the administration procedures in the areas identified as falling short in this area of activity. This recommendation should be considered seriously as it is probably the most important identification of difficulties encountered by patients. Reason It is vital that at the point at which people register or are first seen at the point of care the administration is right. The administration appears to be very complicated and needs to be able to deliver the communications needed to maintain an excellent service delivery. It is clear from the survey that if the administration is delivered correctly at the first point of contact all goes well, if not all does not go well.

5. Medical Care Recommendation The system of ward management of 'Matrons' should be re-introduced to raise the standards of care. Reason The survey showed that the actual medical care given at all levels by Doctors, Consultants and Nurses was (except in a very small number of cases) to be excellent. It was the management and administration that fell short where there were problems.

6. Local Care delivery Recommendation That a system of minor operations and consultant appointments be developed so that it can be delivered locally at either Welshpool or Newtown. Reason With an aging population, lack of public transport and distances to travel it is felt that more care should be delivered locally to help both the Medical Professionals and the local population.

18 7. MS Nurse provision Recommendation That a part time MS nurse is appointed with all speed to work out of Shrewsbury serving home visits in Montgomeryshire. Reason There is no support for those with MS in Montgomeryshire who are housebound. The MS Society locally has pointed out that there are many of its members who have not see an MS professional for many years which is affecting their deterioration in health. A part time MS nurse who can visit and is based at Shrewsbury or locally is essential. 8. Cross border Recommendation The provision of services cross border needs to be on a level playing field with services offered to English Residents being the same as Welsh Residents. Procedures need to be put in place to ensure that the Welsh Residents are not prejudiced by not living in Shropshire. Reason There is a strong feeling that the Welsh Residents are getting a 'second class' service compared to their English counterparts. The point was consistently put that all pay the same for their NHS care and that the NHS should be national and not regionalised as it is now.

9. Local Doctors Surgery Recommendation The provision of more GP's in local doctors surgeries so that two objectives can be achieved as follows: i) People can see their own doctor more easily. ii) Reduce waiting times for seeing a specific doctor. To advance tele-medicine at a local level to reduce those actually visiting the surgery with minor ailments which could be treated simply by such advice. Reason The satisfaction level of doctors surgery services was very high. The only point of concern was the length of time to see gain a doctors appointment (on average 2 weeks).

10. Chronic Illness Recommendation The provision of information packs for those with chronic illness such as MS, Parkinson's etc to be located at Doctors Surgeries. Reason The lack of information at doctors surgeries for such illness was sighted as a missing link leading to correct care.

11. Computer links Recommendation The provision of a universal computer system compatible in all areas of the UK to share information. Reason There appears to be a problem with the Welsh and English Computers being able to communicate with each other.

19 9.2 Surveys Their were a signifigent number of people who commented on the extensive number of surveys being carried out and felt they were now 'surveyed out' with little sign of results from such surveys. It is felt that there is a need to ensure that any outcomes from the Study are well published.

9.3 Cross Border Protocol The Council is aware of the Welsh Government Protocol on Cross Border Services dated April 2013. A copy of the list of aims and objectives of the protocol is set out at appendix E. Although this protocol is in place the study results show that there are still issues to be addressed.

10.00 Signatures to the Report:

Cllr E Bleivas

Cllr A Bowen

Cllr H Evans

Robert Robinson Town Clerk

Welshpool Town Council

Dated August 2014

20 Appendix A

Area of Survey

The area of the survey and the subject of this report is North and East Montgomeryshire.

21 APPENDIX B

Survey results schedule

This is an overall summary of the results of the survey:

i) Number and location of persons responding There were 417 responses from individuals who have used a Medical Service in Montgomeryshire over the past 24 months.

Welshpool/Llanfair Caereinion (west) 83% Newtown/Llanidloes (south west) 5% Llanfair Caereinon (west) 4% Llanfyllin (north) 5% Churchstoke (south) 3%

a) Gender balance Those responding to the survey were: 40% male 60% female

b) Age range The age range balance from the survey was: 5% were under 25 11% were under 60 84% were over 60

c) Emergency and Non Emergency The number who used each service from the survey was: 82% non emergency 18% emergency

d) Hospital or service location The number of respondents indicated the location of their service delivery as: 71% Shrewsbury 7% Telford 2% Gobowen 20% Local (doctors, minor injuries etc)

22 e) Times for emergency transport to arrive Those whose treatment was of an emergency nature waited on average under 20 minutes for their transport to arrive. (either ambulance or other form of personal transport) f) Time waiting at point of care The average time for waiting to be seen once at the point of care was under 20 minutes. g) Delivery of administration The level of satisfaction with the administration side of the treatment was 45% Very good or good. 55% Average, fair or poor. h) Delivery of treatment The level of satisfaction with the treatment received was: 94% Very good or good. 6% Average, fair or poor. i) Discharge from point of care The level of satisfaction with the way people were discharged after their treatment was completed was: 92% Very good or good. 8% Average, fair or poor. j) Dignity of treatment The level of satisfaction with the way the dignity of the treatment was delivered was: 95% Very good or good. 5% Average, fair or poor. k) Access to treatment The level of satisfaction with the way you could access the treatments available was: 80% Very good or good. 20% Average, fair or poor. l) Disability and language From the respondents the following were noted: 2% belonged to a disability group. 1% had language issues at the point of treatment.

23 m) Prescription charges There was a strong feeling that prescription charges should be introduced for two reasons:

i) To reduce the number of unnecessary visits to the doctor to gain free drugs. ii) To help aid the funding of the NHS in Wales.

The support for prescription charges was:

85% in favour of a prescription charge 78% in favour of a charge of £3. n) Shrewsbury Hospital There was over 82% stating that they would be unhappy or very unhappy with the relocation of Shrewsbury Hospital further away from the Mid Wales area its serves.

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Copy of poster and flyers APPENDIX C

MID WALES HEALTH STUDY www.midwaleshealthstudy.org.uk

(for the people of Montgomeryshire)

IMPORTANT INFORMATION REQUIRED FROM YOU TO HELP SHAPE THE WAY SERVICES ARE DELIVERED TO RESIDENTS IN THE MONTGOMERYSHIRE AREA OF WALES

Drop in Days for discussion and survey completion Please call into the Town Hall on any of the dates below to express your views or complete the survey online:

Thursday 3rd July - Town Hall Welshpool - 10am to 9pm Saturday 5th July - Town Hall Welshpool - 9am to 6pm Monday 7th July - Town Hall Welshpool - 10am to 9pm Saturday 12th July - Town Hall Welshpool - 9am to 6pm

Look out for posters advertising other locations in other local areas.

This survey is being conducted by Welshpool Town Council to inform the Welsh Institute for Health and Social Care in their report to the Health Minister of the Welsh Government. www.midwaleshealthstudy.org.uk

25 APPENDIX D

MID WALES HEALTH STUDY SURVEY Please tell us about you last experience of seeking health care.

Complete a survey entry for each department or service you have used. Please tick the box for each answer you wish to give.

Introduction

Which is the nearest town to where you live?

WELSHPOOL NEWTOWN LLANIDLOES LLANFYLLIN CHURCHSTOKE CEREDIGION TOURIST OTHER

What was the service you required?

EMERGENCY NON ENEMERGENCY

What type of hospital visit did this result in?

A & E In patient stay Out patient stay Doctors surgery Other

What is your gender?

Male Female Other

What age range do you fit into?

0-1 2-10 11-25 16-40 41-60 61-80 81+

26 With which department was your most recent experience.? (tick box)

Department Tick Department Tick Accident and Emergency Alzheimer's/ Dementia Blood (Haematology) Bowels, Tummy, Stomach (Gastro) Burns and Scalds Cancer (oncology) Chest/Lungs (respiratory) Children Chiropody/Podiastrics Dental Diabetes, Thyroid (endocrinology) Dietary (dietician) Drugs & Alcohol Addiction Ears, Nose and Throat (ENT) Eyes (ophthalmology Heart and Angina (cardiology) HIV Liver (herpetology) Maternity (obstetrics) Mental Health Minor Injuries Neurology Orthopaedic Paramedic Physio Renal (Kidney) Rheumatism Shropdoc (out of hours doctor) Stroke Surgery (General) Tropical Vascular Urology X-ray/MRI-CT Scan/ultrasound - radiology Doctors Surgery/family doctor Patients Office (if you have bereavement

How was your experience?

Where was your treatment delivered?

Shrewsbury Telford Bronglais Family Doctors Hospital Hospital Hospital Surgery Gobowen Pharmacy Home Hospital

Who delivered the care?

Doctor Nurse Consultant Paramedic Pharmacist Health Visitor Midwife Other

If it was an emergency how long did you wait for a medical professional to arrive?

Under 20 mins 30 mins 40 mins 60 mins plus

If it was an emergency how long did you wait for your transport?

10 mins 20 mins 30 mins 45 mins 60 mins + Non Emergency

If it was a non emergency how long did you wait for an appointment?

1 week 2 weeks 1 month 3 months 6 months

Have you experienced any cancellation of your appointments?

YES NO

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What was your transport to the place of care?

Personal Public Ambulance Air Hospital Ambulance Transport

What was your current travel time to:

Shrewsbury Hospital Telford Hospital Bronglais Hospital

......

How long did you wait when you arrived at your point of treatment?

10 20 30 45 1 2 more mins mins mins mins hour hours

How was the administration delivered?

V good Good Average Fair Poor

How well was your treatment delivered?

V good Good Average Fair Poor

How was your discharge handled?

V good Good Average Fair Poor

Could your treatment have been delivered nearer to your home?

YES NO

If your treated would be delivered at Shrewsbury Hospital and assuming you had the same quality of care how would you feel if you had to receive care at either Telford Hospital or Bronglais Hospital?

Much Happier The Less Very happier same happy unhappy

Was the dignity of your treatment?

V good Good Average Fair Poor

How was access your treatment?

V good Good Average Fair Poor

28 How important are the following factors when it comes to making decisions about where to access your hospital care? (Please rate each one 1-5 with 5 being very important and 1 being the most least important)

Length of travel time ...... Quality of care ......

Ease of relatives to visit ...... Recommendation of healthcare professional ......

Advice of family & friends ...... Familiarity of Hospital Site ......

Reputation of hospital ...... Speed of administration of care ......

Are you in a disability group?

YES NO If yes please specify......

Did you have any language issues?

YES NO

Please return this form to Welshpool Town Council Offices or the Tourist Information Centre in Vicarage Gardens (close to the SPAR)

( supplementary questions)

Would you be prepared to pay a prescription charge to fund a better service? (The current exemption from charges would still apply)

YES NO

If yes how much?

£1 £2 £3 £4 £5 £6

Should certain medications be paid for? -( i.e. Paracetamol - Aspirin etc)

YES NO

Almost there

Please list 3 headings under each of the following?

Threats facing Health Care Opportunities for Health Care

1...... 1......

2...... 2......

3...... 3......

29 Do you have a story to tell?

For yourself For someone else

Please write your story here and overleaf:

30 APPENDIX E

Department for Health and Social Services of the Welsh Government and the NHS Commissioning Board Protocol for Cross-Border Healthcare Services

The following was noted as the Protocol for cross border healthcare:

The Welsh Government and the NHS CB will put in place arrangements on each side of the border to ensure that local NHS bodies work together to: a. ensure no treatment is refused or delayed due to unc ertainty or ambiguity as to which body is responsible for funding an individual’s hea lthcare provision; b. ensure that the different financial regimes that operate either side of the border do not create inappropriate barriers to patient care; c. ensure that the border is no block to accident and emergency services or to emergency treatment when required; d. allow NHS and other staff safely to cross the border where needed with full indemnity cover; e. facilitate access to redress from patients coming for treatment from across the border; f. create and manage mechanisms for identifying and managing cross border issues; g. ensure arrangements are in place so that bodies engage populations across the border in discussions on quality and changes to services provided; h. ensure that safe, reliable and integrated arrangements, including protocols for communications and dealing with problems, are in place regarding out-of- hours services, night-time hospital discharge, transport, social services and community services for residents dealt with by providers across the border; i. publicise information on the web so that people can easily access what they need to know; j. ensure entitlements and ways of accessing services e.g. screening are clear to patients, their own LHB/CCG, GPs and other clinicians; k. ensure commissioning for mental health care reflects the needs of the patient and their legal rights in their home country;

31 l. NHS bodies maintain good open communications with neighbouring bodies across the border within a locally agreed framework; m. ensure there are well-defined and clear protocols for managing changes in where a patient is treated; and n. ensure people along the border – GPs, patients, advocate organisations, etc - have easy access to information.

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