Report by the North Wales Health Audit Sub-Group

Report by the North Wales Health Audit Sub-Group North and Mid Wales Association of Local Councils

NORTH WALES HEALTH STUDY

11 December 2014

Prepared by Ian Jones ACIS, BA Hons. Clerk of the Council & Financial Officer Connah's Quay Town Council Town Council Offices, Quay Building, Fron Road, Connah's Quay, Flintshire CH5 4PJ Tel: 01244 819420 Email: [email protected] Web site: www.connahs-quay.co.uk

1 CONTENTS

No Heading Page

1. Introduction 3

2. Remit of the Study 4

3. Area for the Study 6

4. Survey methodology 8

5. Summary and results of the survey 9

6. Threats and Opportunities 12

Appendix

A Survey results schedule 14

B Copy of questionnaire 15 (English and Welsh)

2 1. Introduction

1.1 This report has been prepared on behalf of North and Mid Wales Association of Local Councils.

1.2 The report has been completed to inform all interested parties and the Welsh Government of the results of the survey on NHS satisfaction survey carried out across North Wales.

1.3 The method, area and remit of this report was approved by the North Wales Health Audit Sub-Group appointed by the North and Mid Wales Association of Local Councils.

1.4 The information set out in this report was gained over the period from 5th September to 5th November 2014 and a summary of the results set out include findings and observations arising from the report’s findings. People were still returning survey forms until 20th November 2014 and these have been included in the results and their views taken into account.

3 2. Remit of the Study

2.1 The survey was carried out in accordance with the survey methodology as approved by the North Wales Health Audit Sub-Group approved on 26th June 2014 and reported to the North and Mid Wales Association of Local Councils on 18th July 2014.

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

To consider a way forward taking into account the subjects listed below including a questionnaire, methodology, findings, any recommendations and report. Reporting back to the Association the initial remit was established as follows:-

The remit should allow for a satisfaction rating, concerns, compliments and comments on the following areas of National Health Services provision:

Ambulance Service A and E Services Outpatients Stroke Services Specialist services MS and Parkinson’s Nurse Provision etc. Waiting Lists Drugs issues English v Welsh issues Cross Border Issues Community Hospitals Mental and dementia issues Transport issues Utilisation of services

The Study also asked for other comments of those taking part which was an open invitation to voice views on any NHS related matter and public opinion.

4 2.3 Plan of Action

Matters arising were likely to include the following:

1 Services – What are they and what is lacking? 2 How are patients treated - Are the Public generally satisfied 3 Designed questions to be inserted into survey document 4 How will Survey be conducted – Circulation and results 5 Establish the need to report to Welsh Government 6 Other issues/comments 7 Geographical and regional considerations 8 Staff vs users’ opinions 9 Report back to the Association.

2.3 Members of the North Wales Health Audit Sub-Group

Cllr D Hainge Bangor City Council

Cllr E Butler Bangor City Council

Cllr B McLoughlin Towyn & Kinmel Bay Town Council

Cllr M Roberts Towyn & Kinmel Bay Town Council

Cllr H Meredith Bay of Colwyn Town Council

Cllr T Renshaw (Chair) Flint Town Council

Cllr P York Holywell Town Council

Cllr G Williams Rhuddlan Town Council

Cllr S Beach Ruthin Town Council Cllr A Roberts Ruthin Town Council

Cllr C Williams Bagillt Community Council

5 3. Area for the Study

3.1 The area of the Study as agreed in the remit was North Wales covering the Administrative Counties of:

Conwy Denbighshire Flintshire Gwynedd Wrexham Yns Mon

Health Board area covering Betsi Cadwaladr University Health Board, North Wales.

6 7 4. Survey methodology

4.1 The Survey responses to inform this report were gained over the period from 5th September to 5th November 2014 by the following methods:

8 The survey had no funding and was done with the goodwill of the people and organisations involved. The whole of the area of the Survey received publicity about the Study by the following means:

Media coverage in the local newspapers.

Emails/hard copies to the majority of Town and Community Councils in North Wales and subsequent circulation.

On line – various Council web sites giving information as to how and where to complete the survey.

On-line dedicated questionnaire on Surveymonkey.com for the period from 5th September to 5th November 2014

Town and Community Councils assisted in the distribution and collection of responses from a number of public buildings and Primary and Secondary Health Centres

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

5. Summary and results of the survey

9 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 percentage satisfaction rates are detailed below together with the key points that have come out of the survey are:

1) Ambulance Service – Satisfaction rating 72% yes 28% no The general opinion was quite good with excellent staff, well equipped and excellent care but could benefit from more crews. Continued training was highlighted. Monitoring of the management and administration is essential to maintain and sustain improvement. Some delays were experienced and some queuing outside main hospitals caused by excessive handover delays. Concern expressed that South Wales was benefitting from extra crews and resource management with the North left with less emphasis.

2) Accident and Emergency – Satisfaction rating 47% yes 53% no A small majority of respondents were dissatisfied with the service with Glan Clwyd and Gwynedd hospitals having particular criticism for waiting times. Wrexham Maelor had varied reports. Reports of very long waits also – up to 5 hours to see a doctor. Some comments about under-staffing, staff under pressure and cleanliness. Triages were identified as being a better service.

3) Outpatients – Satisfaction rating 74% yes 26% no The satisfaction level with regard to outpatients was very good with almost three quarters of respondents being satisfied with the services offered and delivered. Some reported Llandudno and Glan Clwyd as excellent although there were some complaints at long delays, costly travel, lack of staff and Deeside identified as poor.

4) Specialist Services – Satisfaction rating 59% yes 41% no Stroke/MS/Dementia Parkinson’s/Social Care/ Nurse Provision/Cancer/ Mental/specify other

This shows a very mixed picture of delivery of specialist services. Cancer services came out with the highest praise stroke services good but not for rehabilitation, haematology, gastroenterology and mental health received good reports but with mental care there were some poor reports too. Dementia care and elderly support received some bad comments and ratings, especially in Glan Clwyd, however Wrexham Maelor dementia care was highly-rated. Poor management of district nurses and GP/Specialist communications not cited as acceptable. St. Asaph eye facility was given a poor rating. A general shortage of staff was a familiar theme in responses.

5) Waiting Lists – Satisfaction rating 35% yes 65% no The waiting Lists were cited as problematic and indeed received the lowest satisfaction rating amongst respondents. Worst areas identified 10 were orthopaedics, physiotherapy, and endocrinology; also appointments relating to cardio and optical were cited as slow. Once diagnosed the wait for surgery was long in some cases (up to 12 months). A different story was evident with cancer treatment which was cited as first class and prompt. Waiting time for hip operations was cited as being excessive and commonly 12 months and in one case 18 months. Some indicated that there were shortages in staff in North Wales and patients not keeping appointments was raided as a contributing factor.

6) Medication, Drug, Prescribing, New Drugs and Exploration – Satisfaction rating 66% yes 34% no

The differing drugs being available in England was cited as an issue. There was common concern among respondents that some more expensive cancer drugs were not available and sometimes it depended where the patient was residing if the drugs were administered. Statins were cited as being problematical to receive. Overall there was general satisfaction in this area with Wrexham Maelor pharmacy receiving particular praise in dispensing, whereas other hospital pharmacies’ took too long to dispense leaving patients waiting to leave the premises. It was considered by many that GP’s tended to overprescribe and under- listen, also GP appointments were very difficult to achieve. Some indicated that a charge should be re-instated for prescriptions to avoid overprescribing and wastefulness.

7) Cross Border Issues – Satisfaction 49% yes 51% no The differing level of specialisms/proceedures/services available in England was evident as an area of concern. Post code lottery was cited in a lot of the comments and it was generally felt that the NHS in England was better equipped to cope with the increasing demand than in Wales. Also some GP’s unable to refer to specialists services over the border e.g. Gobowen following instructions from Welsh Government.

8) Community Hospitals – Satisfaction 74% yes 26% no The satisfaction level with regard to Community Hospitals was very good with almost three quarters of respondents being satisfied with the services offered and delivered. Those highlighted were Holywell, Mold, Colwyn Bay, Chirk, Denbigh, Deeside, Llandudno. Some felt that Deeside was underused and could incorporate minor injuries clinic.. More beds were requested at Ruthin and there appeared to be a lack of staff at Llandudno. Most agreed that Community Hospitals should be retained as they were highly regarded locally and much appreciated, therefore there they should be used more and there should be more of them. The loss of the Flint facility was disappointing.

9) Transport and Parking – Satisfaction rating 58% yes 42% no

Generally a mixed response. There was a concerning issue regarding Glan Clwyd with most complaints against parking there and lack of help for the disabled or people with reduced mobility. Parking should

11 improve with the park and ride. Wrexham suffered parking abuse by shoppers, people walking into town etc., and some felt that a multi storey was the answer. Some wanted charges but most just wanted a system to stop the abuse and congestion. Transport had proved difficult for those who couldn’t drive or for those leaving hospital prevented from driving.

10) Other Comments –

Positives – Excellent, caring, both at G.P.s and hospitals - Wrexham Maelor came in for some excellent praise and oncology had good care. Grumbling about the services doesn’t help staff Many were satisfied given the difficulties.

Negatives – Administration, management and communications could be handled better. more GPs improve and look after older generation, under pressure. Food, cuts in services lack of funding and investment. Concern re: language choices on automated services.

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 experienced in surveys and the meaning of the results.

6. Threats and opportunities

6.1 Summary of people’s views The survey highlighted people’s views and the following are seen as threats and opportunities for the NHS both now and in the future. The responses have been co-ordinated so that they are not repetitive. However, the same theme came through from almost all respondents.

6.2 Threats to the NHS

12 From the returns the following threats were identified:

Funding (lack of it) Rural service provision England/Wales issues Elderly care reductions Low staff moral Staff shortages Consultant shortages Administration issues Some infrastructure issues Loss of local services Waiting times Training and skills People using A & E rather than Local Surgery General Practice pressures and appointment difficulties Political involvement South Wales sucking resources Excessive criticism Pressures on NHS Excessive parking issues Centralisation

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

Wales/England review Free-up A&E More consistent/uniform services in the wider geographic area Prescription review Ambulance training Paramedics equipped better Keep NHS together Local delivery of services Shorter waiting time Transport and parking review Improve GP appointments Use cancer care as a role model for other specialisms Improve and enlarge local hospitals to provide more care Small operations locally Technology improvements Better records/databases to avoid errors more devolved services Improve administration, management and communications APPENDIX A

Survey results schedule

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

i) Number and location of persons responding There were 126 responses from individuals.

Conwy 45

Denbighshire 28

Flintshire 15

Gwynedd 2

Wrexham 16

Yns Mon 1

Not Stated 19

a) NHS Staff Those responding to the survey were: 4

b) NHS Users Those responding to the survey were: 96

c) Not Stated 26

APPENDIX B

North and Mid-Wales Association of Councils NORTH WALES HEALTH AUDIT QUESTIONNAIRE Remit for the study: To assess potential issues and satisfaction in areas of the Health Service and identify improvements needed in health care provision for those living in North Wales Are you content with the following Services?

Y/N please explain why Ambulance Service

A and E Services

Outpatients

14 Specialist Services eg Stroke/MS/Dementia Parkinson’s/Social Care/ Nurse Provision/Cancer/ Mental/specify other Waiting Lists

Medication, Drugs prescribing issues, use of new drugs & exploration

Cross Border issues

Community Hospitals (specify location)

Transport and parking

Other comments

County of residence NHS Staff Y/N NHS User Y/N Please complete hard copy or electronically/and return to any Town or Community Council in North Wales By 5/11/2014 (email: [email protected]). https://www.surveymonkey.com/s/ZKJBTNV Cymdeithas Cynghorau Gogledd a Chanolbarth Cymru HOLIADUR ARCHWILIAD IECHYD GOGLEDD CYMRU Pwrpas yr astudiaeth: I asesu materion potensial a boddhad yn rhannau o’r Gwasanaeth Iechyd a chanfod gwellhad sydd eu hangen mewn darpariaeth iechyd i’r rhai hynny sydd yn byw yng Ngogledd Cymru A ydych yn fodlon gyda’r Gwasanaethau canlynol?

Ydwyf/ Esboniwch pam, os gwelwch yn dda Nac ydwyf Gwasanaeth Ambiwlans

Gwasanaethau Damweiniau ac Achosion Brys

Cleifion allanol

15 Gwasanaethau Arbenigol ee Strôc/MS/Dementia/ Parkinson’s/ Gofal Cymdeithasol/Darpariaeth Nyrsio/ Cancr / Meddyliol /nodi’r arall Rhestr Aros

Meddyginiaeth / materion pennu Cyffuriau / defnydd o gyffuriau newydd ac ymchwilio

Materion Croes Ffin

Ysbytai Cymunedol (nodwch leoliad)

Cludiant a Pharcio

Sylwadau eraill

Sir a breswylir ynddi Staff GIG Ia / Na Defnyddiwr GIG Ia / Na Cwblhewch ar-lein/ a dychwelwch i unrhyw Gyngor tref neu gymuned yng Ngogledd Cymru erbyn 5/11/2014 (ebost: [email protected]). https://www.surveymonkey.com/s/ZKJBTNV