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Annual Report

2006-2007

Membership information and a summary of the activities undertaken by the Health Council

1st April 2006 to 31 st March 2007

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CONTENTS

Subject...... Page Number

Contact Details ...... 3

The Chief Officer’s Report...... 4

Membership Changes ...... 6

CHC Staff...... 6

Membership Schedule ...... 7

The Committee Structure ...... 8

Membership/External Representation...... 9

Council Member’s Participation in Meetings and Events ...... 10

Member Attendance at Council Meetings ...... 11

Accident & Emergency Services Report ...... 12

Acute Services Report ...... 13

Mental Health & Learning Disabilities Services Report ...... 14

Primary Care & Community Services Report...... 15

Monitoring Visits...... 16

Financial Statement ...... 17

A Vision for the Future ...... 18

“The People’s Vision”...... 18

Complaints Advocacy ...... 20

The NHS Complaints Procedure...... 22

Mission...... 25 3

Pembrokeshire Community Health Council Contact Details

Address: Suite 2, Cedar Court, Haven’s Head, , Pembrokeshire, SA73 3LS

Telephone: (01646) 697610

Fax: (01646) 697256

Email: [email protected]

Website: www.patienthelp.wales.nhs.uk/pembrokeshire

Chairman: Mr Geoff Wright

Vice-Chairman: Mrs Christine Roberts

Vice-Chairman: Mr Barrie Woolmer

Chief Officer: Mr Ashley Warlow

Office Manager/ Personal Assistant: Mrs Moira Jenkins

Complaints Advocate: Ms Donna Coleman*

(*Ms Coleman is not regularly based in the local office)

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THE CHIEF OFFICER’S REPORT alternative plan, ably supported by Barrie Woolmer and Geoff Wright in The past year was dominated by the our many stakeholder meetings. Acute Services Review exercise, a Equally I would thank the CHC’s project initially labelled “Case for informal ‘Transport Group’ Change” and which was subsequently comprising Cllr Henry Jones, Gary published by the Welsh Assembly Hicks and Stan Spinner for their Government as “Designed to Deliver”. significant study work to support the alternative option that was developed. Dialogue on the subject began via a These members did much research on Project Board, with a late invitation to travel times and distances within West the CHC to participate, and then our and referenced proposals to the resignation after attending just one Wales Spatial Plan. This all served to meeting. The media publicity which highlight the rural situation of surrounded the topic at this time also Pembrokeshire and in so doing then resulted in an increased tension and admirably complemented our friction between the CHC and this alternative proposal. Project Board. There were numerous media articles. Subsequently that Following subsequent discussions situation was resolved and we moved within the Pembrokeshire LHB and forward constructively. the Project Board it was ultimately decided by the Minister for Health and In due course, in co-operation with the Social Services that a new Planning Pembrokeshire LHB we were pleased Forum should be set up to look again to facilitate a series of public meetings at the delivery/reconfiguration of across the County on the ‘Designed to acute hospital services across the three Deliver’ proposals for change. These counties of West Wales. Our CHC is meetings took place through the represented on that new Forum and its summer months of last year when meetings are to be held in public. The more than 3,000 people attended, this progress of this Forum will be a key probably the largest turn-out to a component of the Pembrokeshire CHC series of public meetings in the county work plan this year and into next. for very many years. The two options that were being proposed, both of Additionally during the year we which would involve service changes facilitated a consultation exercise with at Withybush General Hospital, were Health Commission Wales upon firmly rejected and the CHC was proposals for changes to Adult given a mandate to develop a third Neurosurgery Services in South and option. We did this in association West Wales. with representatives from key stakeholder groups and delivered our There was significant public alternative entitled the “People’s opposition here and elsewhere to the Vision” to the Pembrokeshire LHB on suggestions that were being made to the 28 th July 2006. Separately, a transfer these specialist services to proposal to merge the three Trusts in Cardiff. Following this consultation West Wales was also firmly rejected the Minister asked Health by the public. Commission Wales to rethink its proposals. I must particularly thank Christine Roberts for her work on this 5

Early in the year we had also formally both of these organisations. Similarly conducted two consultation meetings, we would thank the Ambulance Trust one in the north of the County and one and its Locality Officer for also in the south, to look at a small number regularly attending and supporting of service changes that were being Council activities. proposed by the Pembrokeshire & Derwen NHS Trust as it developed We were particularly pleased to have South Pembrokeshire Hospital and been invited and to have sent looked also at the introduction of representatives to the Trust’s Annual some cost saving measures. These Conference in late 2006 and more changes were all accepted. recently welcomed an initiative where we attended a joint seminar with The Council held two internal Review members of the Trust Board and of the Day events, one in June and one in Pembrokeshire LHB Board. We all December, both of which proved very share a collective vision for sustaining successful. We reviewed our Standing and improving healthcare and Orders and Terms of Reference and associated services for the patients and also held an internal Performance public here in Pembrokeshire and Review following the standard format working together, and understanding implemented by the Board of CHCs in each others business, is paramount to Wales. We have introduced CRB achieving that goal. We hope to have checks and almost all of our members more such joint events in future. are now registered. Our Chairman continues as a member of the Wales Members have continued to work Board of CHCs. Additionally we lead together superbly well, and without the Federation of CHCs. These the input and support of everyone this are both important activities. Council would not be nearly as successful as it is. I will particularly A number of members attended the thank the Chairman and the two Vice- HPE Training Day in mid-year and Chairmen, and the Chairman of each then also participated in our detailed of Council’s sub committees. We are HPE inspection visits to both the old only a small organisation from an and new Hospitals and to administrative perspective, but we Withybush General Hospital. have set some high standards.

We continued to attend Board Last year was probably the busiest meetings of the Pembrokeshire & year that there has ever been in terms Derwen NHS Trust and the of time commitment and members Pembrokeshire LHB; it is pleasing to attended many of the consultation see that a number of members also meetings which were described regularly attend these meetings as earlier, in addition to the many special observers. meetings and the group meetings that were held with stakeholders. We are pleased that the Chairman and the Chief Executives and other senior There was also the intense activity staff of both the Trust and the LHB through August when Council regularly attend and support our launched a petition seeking support public meetings and include the CHC for the ‘People’s Vision’ as an in other aspects of its business. We are alternative way forward for acute involved in a very wide range of healthcare services in Pembrokeshire. workgroups and committees within This culminated in our attendance at 6 the Pembrokeshire County Agricultural Show and by the end of that week we had obtained 15,000 signatures of support from local residents.

As Chief Officer I look forward to the year ahead and working again with our membership; there is little doubt that the provision of healthcare will remain a high profile topic and will continue to have regular attention of the local media. Public expectations remain high as we move into a period of new government administration in Wales.

Ashley Warlow ChiefChChCh ief Officer

MEMBERSHIP CHANGES

Through the year, and until the recent resignation of our Chairman Geoff Wright in March 2007, we have enjoyed a full complement of members. Cllr Simon Hancock and Janet Waymont joined us as newly co- opted members at the start of the term in April 2006. At that same time we also welcomed three new Welsh Assembly Government appointed members, these being Stan Spinner, Tony Wales and Elizabeth Griffiths. Several other members were returned to office in April 2006 for further terms, including our representatives from Pembrokeshire County Council.

CHC STAFF

The activities of the Pembrokeshire Community Health Council are supported by two full time members of staff, these being Chief Officer Ashley Warlow and Moira Jenkins as Assistant to the Chief Officer.

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MEMBERSHIP SCHEDULE

MEMBER NAME ADDRESS APPOINTMENT TERM ENDS Cllr Jim Codd 7 Church Close, New Road, Begelly, Pembrokeshire 2008 , SA68 0YP County Council Cllr John Cole 10 Westhill Avenue, Pembrokeshire 2008 Milford Haven, SA73 2RD County Council Dr Elisabeth David 53 Queensway, Haverfordwest, Pembs Carers 2010 Pembrokeshire, SA61 2NU Outreach Mrs Beryl Davies ‘Windrush’, Steynton, Welsh Assembly 2008 Milford Haven, SA73 1HH Government Mrs Penny Drew DL Cwm-pibau, New Moat, Co-opted 2007 Pembrokeshire SA63 4RE (Red Cross) Ms Elisabeth Griffiths 11 Meadowbank, St Twynnells, Welsh Assembly 2010 Pembrokeshire, SA71 5HZ Government Cllr Simon Hancock 35 Honeyborough Green, Co-opted 2007 Neyland, SA73 1RG Mr Gareth Hicks 8 Lilac Close, Milford Haven, Welsh Assembly 2008 Pembrokeshire SA73 1DF Government Cllr Islwyn Howells 31 Elm Park, Crundale, Pembrokeshire 2008 Haverfordwest, SA62 4DN County Council Cllr Henry Jones Park House, Park Street, Pembrokeshire 2010 Fishguard, SA65 9HN County Council Cllr Sue Perkins The Powder House, Richmond Road, Pembrokeshire 2008 P Dock, SA72 6TG County Council Mrs Dee Polacarz Sunnybank, Camrose, National Childrens 2010 Haverfordwest, SA62 6JA Home Mrs Tracey Price 15 Goat Street, Haverfordwest Welsh Assembly 2010 Pembrokeshire SA61 1PX Government Mrs Chris Roberts Tynewydd, Cefn Y Dre, Fishguard, Welsh Assembly 2008 (Vice-Chairman) SA65 9QS Government Mrs Sheila Russell MBE Quay House, 9a Hakin Point, Co-opted 2007 Milford Haven, SA73 3DG Mrs Anne Sequeira 2 Driftwood Close, Broad Haven, Pembs Federation 2008 Haverfordwest, SA62 3JZ of WIs Mr Stanley Spinner Cherry Cottage, Cold Blow, Welsh Assembly 2010 Pembrokeshire, SA67 8RL Government Mrs Connie Stephens White Rock, Broad Haven, Welsh Assembly 2008 Haverfordwest, SA62 3JX Government Mrs Vivien Stoddart Court Farm, Liddeston, Milford Co-opted 2007 Haven, SA73 3QA Miss Mary Thomas MBE 196 Haven Road, Welsh Assembly 2010 Haverfordwest, SA61 1DG Government Mrs Beryl Thomas-Cleaver 7 Percy Terrace, Barn Street, Pembrokeshire 2008 Haverfordwest, SA61 1TD Young Carers Mr Tony Wales North Norton, , Welsh Assembly 2010 Pembrokeshire, SA70 7SR Government Mrs Janet Waymont Colby Mill, Llawhaden, Co-opted 2007 Pembrokeshire, SA67 8EA Mrs Eluned Williams Gwaunydd, Newport, Co-opted 2007 Pembrokeshire, SA42 0LX, Ms Jeanette Williams Grace Cottage, 42 Pill Road, Co-opted 2007 Milford Haven, SA73 2NR Mr Barrie Woolmer 27 Bayview Drive, Hakin, Welsh Assembly 2010 (Vice-Chairman) Milford Haven, SA73 3RJ Government Mr Geoff Wright Lower Druidston Farm, Emmanuel 2010 (Chairman) Haverfordwest SA62 3NE Christian Centre

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THE COMMITTEE STRUCTURE

The Chairman and the two Vice-Chairmen Executive Committee together with the Chairman of each sub-committee form the Executive Committee. Additionally any Chairman outgoing Chairman or Vice Chairman not returned Mr Geoff Wright to office at Council’s AGM remains a member of Vice-Chairman the Executive for a one year term until the next Mr Barrie Woolmer following AGM. Vice-Chairman Mrs Christine Roberts Council members are expected to serve on at least Mrs Beryl Davies two of the sub committees and may serve on a Cllr Sue Perkins third sub committee should they so wish. Mrs Tracey Price Mrs Beryl Thomas-Cleaver Representatives of the Pembrokeshire & Derwen Chief Officer NHS Trust and the Pembrokeshire LHB and the Mr Ashley Warlow Wales Ambulance Service NHS Trust attend

meetings of the sub committees.

Accident & Emergency Services Acute Services

Mr Geoff Wright** Mrs Beryl Thomas-Cleaver** Cllr John Cole Cllr John Cole Mrs Beryl Davies Dr Elisabeth David Ms Elizabeth Griffiths Mrs Beryl Davies Cllr Simon Hancock Ms Elizabeth Griffiths Mr Gary Hicks Cllr Simon Hancock Cllr Henry Jones Cllr Henry Jones Mr Stanley Spinner Mrs Christine Roberts Mrs Vivien Stoddart* Mrs Anne Sequeira Mr Tony Wales Mrs Vivien Stoddart* Mrs Eluned Williams Miss Mary Thomas MBE Mr Barrie Woolmer Mr Tony Wales Mrs Eluned Williams

Primary Care and Mental Health & Community Services Learning Disability Services

Mrs Beryl Davies** Mrs Tracey Price** Cllr Jim Codd Cllr Jim Codd Dr Elisabeth David Dr Elisabeth David Mrs Penny Drew DL Ms Elizabeth Griffiths Mr Gary Hicks Cllr Sue Perkins Cllr Islwyn Howells Mrs Dee Polacarz Mrs Christine Roberts Mrs Sheila Russell MBE Mrs Sheila Russell MBE Mrs Anne Sequeira Miss Mary Thomas MBE* Mr Stanley Spinner* Mrs Beryl Thomas-Cleaver Mrs Connie Stephens Mrs Janet Waymont Mrs Janet Waymont Mr Barrie Woolmer Mr Geoff Wright Ms Jeanette Williams

(** indicates Chairman of Sub Committee * indicates Vice-Chairman of Sub Committee) 9

MEMBERSHIP/EXTERNAL REPRESENTATION

PEMBROKESHIRE LOCAL HEALTH BOARD Associate Member of the Board Chief Officer Attendance at LHB Board Meetings Chairman/Vice Chairman*/Members* Clinical Governance Mrs B Thomas-Cleaver Secondary Care Commissioning Group Mrs C Roberts Complaints & Litigation Management Committee Chief Officer Palliative Care Forum Miss M Thomas MBE Patient & Public Involvement Chief Officer Pharmacy Group Miss M Thomas

PEMBROKESHIRE & DERWEN NHS TRUST A&E Redevelopment Project Group Mrs B Davies Attendance at Trust Board Meetings Chairman & Chief Officer/Members* Bereavement & Care of the Dying Miss M Thomas Clinical Governance & Risk Management Mrs V Stoddart Complaints and Litigation Committee Chief Officer Disability Access Group Mrs B Thomas-Cleaver Executive Meetings with Trust Board Executive Committee Members Mental Health Learning Disabilities (Key Stakeholders) Mrs D Polacarz Mental Health Planning Group Mr S Spinner Modernisation Group/Board Mrs B Davies/Mrs C Roberts MRI Project Ms E Griffiths Out Patient Project Team Mrs B Davies Patient and Public Involvement Chief Officer Prevention and Management of Violence Mrs B Thomas-Cleaver Psychiatry in Old Age Strategy Group Mrs T Price Smoking Cessation Mrs A Sequeira Stroke Rehabilitation Dr E David

WALES BOARD OF CHCS Board Member Chairman Chairman Networking Group Chairman Corporate Identity Group Chief Officer Performance Evaluation Group Chief Officer Visiting Monitoring Group Chief Officer

DYFED FEDERATION OF CHCs Federation Committee Meetings Chairman, Vice-Chairmen & CO All-Wales Ambulance Group Meetings Mr G Wright

WALES AMBULANCE SERVICES NHS TRUST Information meetings with Regional Ambulance Officer Chairman, Chairman A&E, & CO

OTHER EXTERNAL REPRESENTATION Cardiac Rehabilitation Project Group Dr E David Mid & West Wales Regional Maternity Services Liaison Mrs V Stoddart Orthodontic Services Mr G Wright Pembrokeshire Strategic Partnership Board Chief Officer SHAPES Project Board Mr G Hicks St Thomas Surgery PPG Chief Officer Three Counties Planning Forum Mrs C Roberts Transport Mr G Hicks, Mr S Spinner Pandemic Flu Group Mr Barrie Woolmer/Chief Officer

[*Observers to meetings]

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COUNCIL MEMBER’S Special Meetings PARTICIPATION IN Additionally during the year MEETINGS AND EVENTS members attended 6 specially convened meetings of Council The past year has been the busiest for specifically to debate matters very many years and our members appertaining to the Acute Services participated in a wide variety of Review. meetings and activities, these being: Regular Meetings The regular activities of our CHC Public Meetings also continued through the year with 6 full meetings of Council held in 7 public meetings to consider public. Separately there were 6 proposals under the “Designed to meetings of the Primary Care & Deliver/Acute Services Review” Community Services Committee, 6 exercise. These meetings were each meetings of the Acute Services facilitated by the CHC, and were Committee, 5 meetings of the Mental held at the following locations: Health & Learning Disabilities Services Committee. The Children’s Crymych, Fishguard, Services Committee met once during St Davids, Milford Haven, the period, and the Executive Haverfordwest, Tenby Committee three times. (All Pembroke. members are asked to participate in at least two sub-committees of 2 further specially arranged meetings Council). were held to consider the “Designed to Deliver” exercise; these held in Other Activities Burton and in Neyland , were also Members also attended the Annual open to the public and again Statutory Meeting between our CHC facilitated by the CHC. and the Pembrokeshire Local Health Board which took place in A separate public meeting was held September. in Haverfordwest , again facilitated by the CHC, this to consider Health Two internal ‘Review Day’ events Commission Wales’ proposals in were held, again attended by the respect of Adult Neurosurgery majority of members. Services in South and West Wales. Aside from the foregoing obligatory Special Events meeting attendances a number of The Pembrokeshire Community members participated in training Health Council also took space at the programmes, attended meetings as Pembrokeshire Agricultural Show for representatives of Council on three consecutive days in August. external stakeholder groups, and The purpose was to engage with the attended many other meetings of the large numbers of public at this prime Pembrokeshire LHB and the event and solicit views on the CHC’s Pembrokeshire & Derwen NHS Trust “People’s Vision” as a response to as observers. the Acute Services Review exercise. A number of members attended in The dedication and commitment of support of this initiative which everyone to meet this significant and resulted in approximately 15,000 time consuming schedule is people giving their support. appreciated.

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MEMBER ATTENDANCE AT COUNCIL MEETINGS

The Council held six ‘Full Council’ meetings through the year, these on the following dates:

15 th May (including AGM), 17 th July, 18 th September, 20 th November, 15 th January, and 19 th March.

These meetings were open to the public and were also regularly attended by the Chairmen and Chief Executives of the Pembrokeshire Local Health Board and of the Pembrokeshire & Derwen NHS Trust. Other senior representatives of these two organisations also attended, as did the Locality Officer of the Welsh Ambulance Services NHS Trust.

Full Council Meetings Council Committee Meetings

MEMBER total poss % total poss %

Cllr Jim Codd 4 6 67% 10 12 83% Cllr John Cole 5 6 83% 5 12 42% Dr Elisabeth David 5 6 83% 15 18 83% Mrs Beryl Davies 6 6 100% 16 21 76% Mrs Penny Drew MBE 5 6 83% 2 7 29% Ms Elizabeth Griffiths 6 6 100% 12 18 67% Cllr Simon Hancock 3 6 50% 6 12 50% Mr Gary Hicks 2 6 33% 9 12 75% Cllr Islwyn Howells 6 6 100% 4 7 57% Cllr Henry Jones 6 6 100% 5 12 42% Cllr Sue Perkins 3 6 50% 3 10 30% Mrs Dee Polacarz 1 6 17% 3 7 43% Mrs Tracey Price 4 6 67% 9 10 90% Mrs Christine Roberts 6 6 100% 12 15 80% Mrs Sheila Russell MBE 5 6 83% 7 12 58% Mrs Anne Sequeira 4 6 67% 11 12 92% Mr Stan Spinner 6 6 100% 10 13 77% Mrs Connie Stephens 6 6 100% 5 7 71% Mrs Viv Stoddart 6 6 100% 9 12 75% Miss Mary Thomas MBE 4 6 67% 8 12 67% Mrs Beryl Thomas-Cleaver 6 6 100% 12 16 75% Mr Tony Wales 6 6 100% 10 12 83% Mrs Janet Waymont 5 5 100% 4 8 50% Mrs Eluned Williams 6 6 100% 8 12 67% Ms Jeanette Williams 4 6 67% 5 7 71% Cllr Barrie Woolmer 6 6 100% 7 15 47% Mr Geoff Wright 3 6 50% 13 21 62%

i. The attendances shown above only include Full Council and in-house committee meetings of the Council, and meetings of the Executive Committee. ii. In addition to the above Council also held two Review Day meetings and several special workshop meetings/forums on particular topics. These statistics are not shown. iii. Members of the Council also attended a number of public consultation meetings that were held across Pembrokeshire through the year (which were facilitated by the CHC). iv. Many members of Council also attended committee and workgroup meetings with other NHS partner organisations. These attendances are not in the schedule. v. Member attendance at training events, seminars and visit planning meetings etc is also excluded from the above schedule. 12

ACCIDENT & EMERGENCY A&E activities although in recent SERVICES REPORT months the Trust has discontinued its publication of this data. I am aware The past year was a busy one and the that following discussions in this latter committee met on a regular bi- respect we hope to again have monthly basis. We have been pleased meaningful Performance Data for to have the regular support at our review in the not too distant future. meetings of senior representatives from the Pembrokeshire Local Health We were disturbed to learn that a Board, the Pembrokeshire & Derwen protocol which we understood to have NHS Trust, and from the Welsh agreed to be between the Ambulance Ambulance Services NHS Trust. Trust and the Pembrokeshire & Without this commitment from our Derwen NHS Trust to allow some partners our activities would prove emergency patients to be taken to the more difficult. MIU’s at South Pembrokeshire and Tenby Hospitals had still to be In the year we have largely been implemented. We were told a year involved in looking at progress, or ago that the protocols were in place otherwise, of the ambulance services and we hope that situation will also modernisation programme entitled soon be resolved. “Time to Make a Difference”. Aligned to this there were also changes to We continued to review the Out of staffing arrangements and working Hours/Care on Call services provided hours under the NHS Agenda for by the Pembrokeshire LHB and are Change programme that was being regularly updated on its activities. We implemented within the ambulance also received a detailed overview of service. the Out of Hours service. During the year we have visited the Ambulance A number of issues were raised, Control centre in Carmarthen, the new particularly across year-end and into Milford Haven Ambulance Station early 2007, upon alleged shortcomings and the Care on Call Handling Centre within the service. We were disturbed in Winch Lane and its Treatment to learn of situations when all of the Centre at Withybush Hospital. county’s emergency ambulances were active outside of the county boundary An exciting development from our with some even dealing with perspective will be the new Accident emergency calls in Neath, Port Talbot & Emergency project at Withybush and Swansea. Following protestations General Hospital. We have supported which we made to the Chief Executive this project from the outset, fully of the Ambulance Trust we now have recognising the inadequacy of the an assurance that this will not again existing facilities. We were delighted occur and that a minimum number of when the proposal was formally emergency vehicles will always be approved by the Welsh Assembly retained within Pembrokeshire. We Government. The monitoring of this are pleased at having achieved this project will be a key component of our successful outcome. work in the year ahead.

We have regularly reviewed performance statistics of both the ambulance service in its response Report by Vivien Stoddart times and the Pembrokeshire & Vice Chairman - Accident and Derwen NHS Trust in respect of its Emergency Services Committee

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ACUTE SERVICES REPORT We have debated staffing numbers and recruitment exercises and more As Chairman of this sub committee recently there has been discussion through the past year I would like to upon the Trust’s Rehabilitation Service thank all the members for their and its Day Hospital facility which is support and also our stakeholder soon to be relocated elsewhere. partners from the Pembrokeshire & Derwen NHS Trust and from the We have made a series of monitoring Pembrokeshire LHB; their attendance visits to the hospital and have made is invaluable to the success of our particular reports on visits to Ante meetings. We have been very busy in Natal, to Maternity and to Ward 9. the period. The key activity in the visiting programme was the annual Hospital We have representatives on a wide Patient Environment (HPE) visits in number of Trust working groups and October where we made both a night- committees and their reports and time and an all-day visit to Withybush minutes of the meetings which they General Hospital. We appreciated have attended are received and that the Chief Executive and senior reviewed at our committee meetings. staff of the Trust were able to attend We are most pleased to contribute in our feedback session at the end of the these ways and appreciate the day; this helped to make the event all opportunity that is given to us by the the more worthwhile. We were Trust in this regard. impressed that a number of concerns identified in earlier years had either During the year we have discussed a been addressed or else were being number of issues and concerns and programmed for future attention. have sought comment, and change when appropriate, from the Trust Additionally we were pleased to have where there have been alleged been involved throughout in the shortcomings. In this latter respect its development of the new out-patients rheumatology, audiology and department. We are pleased that the podiatry services have featured fairly new facility has recently been regularly throughout the year. We successfully commissioned and I have also had some significant debate would commend the Trust for the on the new three counties work that has been undertaken. ‘Ophthalmology Hub’ that was Hopefully the further enhancements introduced last autumn and which associated with the new A&E Project from an administrative perspective will be equally successful. continues to be somewhat troublesome. The services provided at Withybush General Hospital are crucial to us all We have had discussions on renal here in Pembrokeshire and with the dialysis and will welcome the eventual new A&E, commissioning of an MRI development of a new dialysis facility scanner and a renal dialysis unit we at Withybush Hospital. There have will have a facility for which we can been discussions on patients being continue to be justifiably proud. transferred to other hospitals outside of Pembrokeshire, on the hospital’s revised appointment system and upon its recently introduced policy for the Report by Beryl Thomas Cleaver wearing of staff uniforms. Chairman Acute Services Committee 14

MENTAL HEALTH & Early in the year we had a detailed LEARNING DISABILITIES discussion upon the serious incident SERVICES REPORT that had occurred at the Havenway facility in Pembroke Dock and we As newly appointed Chairman of the appreciated the Trust sharing its Mental Health & Learning Disabilities information with the CHC . Services Sub Committee of Council I would like to briefly report the We were pleased within the year to highlights of our work programme have attended a joint seminar with the through the past year. Before doing so Trust and the Pembrokeshire LHB however I would like to thank my upon the new Mental Capacity Act. predecessor, Mrs Tracey Price, who This seminar, delivered by a legal had to stand down from the position a practitioner, was most interesting. A few months ago. I would also thank number of members also attended a all members of the committee for their one-day workshop seminar that was dedication, enthusiasm and support organised by the Trust’s Mental and also our stakeholder partners who Health division at which a range of regularly attend these meetings. presentations were made to explain the wide variety of patient services We have regularly received and that were being provided locally; this reviewed the minutes of the was a very meaningful event. Pembrokeshire Mental Health Planning Group and of the Mental We have separately invited members Health Collegiate Commissioning of the Trust’s mental health staff to Group which oversees work across the make presentations at each of our three counties. We have reviewed committee meetings and this too is these at each bi-monthly meeting. proving successful. Representatives of Council have also attended and contributed to these We have made several visits to local external meetings. mental health facilities during the year and this will continue in the year We have also received and reviewed ahead. We have now formally on a regular basis the reports on the adopted the visiting protocols that Learning Disabilities “Fulfilling the have been developed by the Wales Promises” initiative; this was a Board of CHC’s for this purpose. worthwhile initiative and we are a little saddened that upon the cessation Finally, we are aware that service of funding that this has been modernisation is being discussed and discontinued. Fortunately, some very with the recent demise of the Mental good work was undertaken, and much Health Collegiate Commissioning of this will continue under different Group we will need to ensure guises. involvement in the modernisation process. I understand that the Chief We have also reviewed the Trust’s Officer has written to the Acting Mental Health Performance Data at Director of Mental Health Services in each of our bi-monthly meetings the Pembrokeshire & Derwen NHS although this data, which was of great trust in this regard. interest to us all from a monitoring perspective, is no longer published by Report by Stan Spinner the Trust. We would hope that this Chairman Mental Health & Learning will again be provided soon. Disabilities Services Committee 15

PRIMARY CARE & We monitored the redevelopment of COMMUNITY SERVICES the South Pembrokeshire Hospital and REPORT the patients who had been temporarily moved into an adjacent facility for the I am pleased to report as Chairman of construction period. The new hospital Council’s Primary Care & Community has recently been commissioned and Services sub committee. I would like having formally visited we would to thank all members of the committee commend the Trust on this exciting for their support through the year. I new development. would also thank our stakeholder partners for their attendance and We have been involved in the LHB’s support. ‘Primary Care Estates Strategy’ and attended meetings to discuss outline We have had an interesting year proposals for new GP resource centres looking at a range of community in Crymych and Milford Haven. We healthcare activities and undertaking a also formally visited the first of these number of visits. We have dealt with new facilities in Pembrokeshire, this issues on changes to surgery hours being the large Argyle Street Medical and sadly witnessed the closure of Practice in Pembroke Dock. several further branch surgeries when we lost those at Letterston, Croesgoch During the year we had some concerns and Trevine. We were particularly about the administration of the disturbed that one GP practice had SHAPES equipment loan store and are chosen to close its Letterston branch pleased that situation is now resolved. surgery even prior to consultation. We have several members attending Dental services remained a great external committees and working concern for us with the lack of groups with our NHS partners. In adequate NHS dental services; we are addition to regular monitoring visits particularly concerned at through the year, a special visit was shortcomings in dental services for made to the Park House Nursing children. On a positive note we did Home in Tenby to ensure the well- see the opening of a new dental facility being of the patients that had been in Whitland which has taken a large transferred from the old Tenby number of patients from the Cottage Hospital which was closed Pembrokeshire waiting list. More down for health and safety reasons. recently we have learned of some additional dental services that are to We have discussed various pharmacy be made available in Pembrokeshire. changes. We have also looked at Hopefully, we may now have turned health clinics and the range of services the corner on this issue, but there is being provided to patients in the still a long way to go. community.

We debated the proposed closure of All in all then, a very busy year, and I the Fairwood Hospital Lodge in feel sure that the year ahead will be Swansea which is utilised by local equally demanding. patients undergoing cancer treatment in Swansea. An alternative solution was achieved which would provide Report by Beryl Davies residential accommodation to patients Chairman, Primary Care & from Pembrokeshire. Community Services Committee 16

MONITORING VISITS The following visits were undertaken by Council members through the year.

Withybush General Hospital Ante Natal Clinic Delivery Ward Ward 9 Ward 10 Cwm Seren SHAPES Loan Store

Hospital Patient Environment (HPE) Monitoring External Areas, Main Entrance Corridor, Stairwells & Stairs, Lift Area, Chapel and WRVS, North Entrance Corridor, Physiotherapy Corridor, Lower Ground Floor, Ward 1, 3, 5, 6, 8 MAU, 9, 10, 11, 12, Radiography Department, Day Surgery, Accident & Emergency Department, Out Patient Department

Tenby Cottage Hospital Hospital Patient Environment (HPE) Monitoring External Areas, Entrances and Main Reception Areas, Common Areas, Ward Areas, and Departments at Tenby Cottage Hospital.

Pembrokeshire LHB ‘Out Of Hours’ Service Care On Call Centre, Winch Lane Care on Call Treatment Centre, Withybush General Hospital

West Wales General Hospital Duad Ward

GP Surgeries Dr Allen, Narberth Health Centre, Narberth St Davids Surgery, 36 New Street, St Davids The Surgery, Caerludd, Crymych The Health Centre, Ropewalk, Fishguard The Surgery, Long Street, Newport, The Surgery, The Norton, Tenby Meddygfa Wdig, Main Street, Goodwick Cysgod Yr Eglwys, Solva St Thomas Surgery, Haverfordwest 17

FINANCIAL STATEMENT The expenditure incurred in the year 2006-2007 was as follows:

Fixed Costs (Staff, office, accommodation, rent, business rates, insurance) £80,669.25

Office Expenses (Telephone rentals, internet charges, Office equipment leases and maintenance) £2,924.19

Staff Travel £3,215.16

M ember Travel £6,184.52

Electricity etc. £1,205.91

Consum ables (Printing, Stationery, photocopier etc) £2,714.76

M eetings (Room Hire, Catering, Conferences) £1,463.77

General & M iscellaneous Expenses (Subscriptions, advertising, computer maintenance) £1,758.22

Postage Costs £1,361.58

£101,497.36

Annual Budget £100,067.00

Variation (overspend) (£1430.36)* *The overspend was accommodated from the overall financial surplus within the Board of CHCs in Wales.

The staff and member travel costs incurred in the financial year, and indicated in the above schedule, only represent the costs incurred by the Pembrokeshire CHC. All member travel costs to undertake Hospital Patient Environment (HPE) training and visits is charged elsewhere. Additionally all travel to activities, meetings and work groups organised by the Board of CHCs in Wales is paid for directly from the Board’s Expense Account. If all these were added to the Pembrokeshire travel costs it would reveal that collectively members and staff have travelled well in excess of 20,000 miles during the year on behalf of the patients of Pembrokeshire. This is a significant achievement.

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A VISION FOR THE FUTURE It was deemed crucial to our proposal “THE PEOPLE’S VISION” that the individual component parts of the three counties Service Delivery Our major activity and engagement in Unit should be committed to working the year was in a review of acute towards a fully complementary, hospital services in West Wales under a mutually supportive and well programme entitled “Designed to integrated model with as little Deliver”. duplication of services as possible.

During a four month public In the CHC proposal Withybush consultation period the people in General Hospital would have: Pembrokeshire were asked their views on two options. Option 1 offered a • 24/7 Unscheduled Care Centre “new” hospital “to be built somewhere (A & E) with a fully integrated between the towns of Haverfordwest Medical and Surgical and Carmarthen” but this would be Assessment Unit. accompanied by the closure of • Broad range of inpatient Withybush General Hospital. Option 2 services proposed a significant downgrading of • Intensive Care, High Withybush and the transfer of most of Dependency Care and the existing acute hospital services to Coronary Care Services Carmarthen. Both options were • Broad range of elective resoundingly rejected by the public. inpatient surgery • Broad range of day case Accordingly, through June and July surgery 2006 the Pembrokeshire CHC worked • Emergency operating 24/7 closely with health and social care • Consultant led Obstetrics and professionals, and members of the Maternity service With a public, to produce an acceptable network of antenatal and alternative. This alternative proposal, postnatal activity accessed locally unanimously supported by these in GP surgeries and Health and stakeholders, was designed to provide Social Care Resource Centres “A locally accessible, high quality • Special Care Baby Unit (SCBU) Health Service for the people of Neonatal Intensive Care (NICU) Pembrokeshire”. elsewhere - as now. • Full inpatient paediatric The CHC proposed a networked service Service Delivery Unit (SDU) or acute • Extended day paediatric hospital network covering the three investigation and treatment counties of Ceredigion, services To be provided from a Carmarthenshire and Pembrokeshire. new community based Children’s The network would be based on the Resource Centre • existing District General Hospitals Full outpatient service (DGHs). Each DGH would develop Much of the activity eventually the critical mass of core services moving out to Health and Social necessary to sustain an effective A&E Care Resource Centres • Department. This would ensure that The hospital to form the hub all the population of the three counties of an extensive, locally would have as equal as possible access accessed 24/7 Diagnostic to all the required services. Service to include MRI.

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To ensure an efficient, effective and that this service had the capacity and integrated model of health care for the leadership to respond appropriately, people in Pembrokeshire our option and was both clinically focused and proposed the complementary able to respond within given time development of a network of GP frames, moving patients in a safe and surgeries, health and social care effective manner. resource centres and intermediate care and rehabilitation facilities, most of This vision for the future for the people which had been previously outlined in of Pembrokeshire was complemented the “Primary Care Estates Strategy” by a series of comprehensive and on which the public had appendices. These stressed the rurality previously been consulted. of the county, supported by transport and travelling data which detailed the We said that in order for more people potential impact of the various options with chronic diseases and disabilities to on the population. A separate be able to continue living in their own appendix made reference to the “Wales homes, and for hospitals to be able to Spatial Plan” which had seemingly discharge people earlier, there must be been ignored in the development of the easy access to supportive health and two initial consultation options. social care services. We recommended that community health, primary and The final – page document entitled social care services should move “The People’s Vision” was formally towards a model that is fully integrated submitted to the Pembrokeshire LHB with the Local Authority and is closely on 28 th July 2006. Subsequently, at a linked to a strong and vibrant meeting of the LHB on 14 th September voluntary sector. Carer support must 2007, the document was formally be given a higher priority and local endorsed when the LHB Board passed transport links reviewed in line with a resolution that “ the proposal patient flows. submitted by the CHC be used as the basis for the work to be undertaken by We explained that forward planning the Planning Forum”. should begin early in order to identify the travel needs of patients, and their carers, families and friends and to adjust or develop local transport services accordingly. Adequate provision must be made for the funding of these transport services and artificial boundaries between the responsible agencies removed, to enable the best possible provision on the ground, within the available funds.

We stressed that an integrated and accessible health and social care service also required a fully resourced modern and flexible Ambulance Service: working across acute, primary and community services, across all organisational boundaries, treating patients in the home or in the community. We said it was essential 20

COMPLAINTS ADVOCACY and complaints are recorded on the database. This means that patients The service continues with its busy and their families can receive support workload. The number of patients from any relevant CHC staff member and their families utilising the service and thus helps to provide a seamless has further increased this year. service. Awareness of the service is also increasing significantly and links with Complainant contact details, Trusts, Local Health Boards and other complaints issues and actions organisations have also been undertaken by the CHC and Advocacy developed and further improved. The Service with regards to each complaint Advocacy Service works across the are recorded. Trend analysis can be Dyfed Federation although complaints undertaken. for each individual CHC are monitored by the relevant Chief Continuing Officers in each county. complaints

Usually complaints come directly from At the beginning of the year there the patient or family concerned. were 18 complaints within However referrals from LHBs and Pembrokeshire carried forward into Trusts also occur in an effort to help the new financial year. The resolve matters. Voluntary complaints were subdivided as organisations, Assembly Members, follows: Hospital/Ambulance Trust MP’s, County Councillors and Local complaints 14, others eg LHB, GP, Authority representatives are also Dentist etc 4. aware of the CHC’s advocacy role and either signpost potential complainants Complaints are carried over either or make direct referrals themselves. because they were received towards the end of the financial year and Local Staffing arrangements Resolution is ongoing or they may be cases where Local Resolution is The Advocacy Service is staffed for 57 completed and the case is at hours per week. This comprises one Independent Review Stage or with the full time advocate (37 hours) – Donna Ombudsman. Coleman who has been in post since June 2003 when the Advocacy Service New was rolled-out on a national basis. In complaints addition, there is 20 hours of administrative support for the service. During 2006/07, 47 new complaints Staff are based in the Carmarthen were formally registered with CHC office but travel throughout the Pembrokeshire CHC. These West Wales area. complaints were against the Hospital and Ambulance Trust , and 10 against Recording others eg: LHB, GP, Dentist etc. complaints At the end of 2006/2007, a total of 21 A database is in use across the three complaints were carried forward into CHC’s in the area. It is accessible in all the new financial year. These offices by all members of staff and complaints are subdivided into Local allows complaints data to be shared by Resolution 19, Independent Review 1, relevant staff. All incoming enquiries and Ombudsman 1. 21

The new complaints involved the regarding our performance and helps following kinds of issues: to identify good practice and address any weaknesses.  Inappropriate treatment  Infections 93% of clients responding to the  Fail/Delay treatment survey felt that the support given was  Wrong diagnosis good/very good/excellent and all  Delay in diagnosis would recommend the advocacy  Failure to diagnose service.  Appointment systems  Staff attitudes  Nutrition  Poor prescribing/issue of medication

Informal Complaints and Enquiries

In addition to the formal complaints dealt with by the Advocate a large number of informal complaints and enquiries were handled within the office. These are typically administered and resolved locally.

 General Health enquiries  Information requests  Closure of GP Surgeries  Opening hours of GP Surgeries  GP Surgery Appointment Systems  GP Surgery Telephone Systems  Out of Hours Services  Dental Registration  NHS Staff Attitudes  Ophthalmology Services  Audiology Services  Public Transport to Hospitals  Community Services  Waiting Lists  Availability of services  Out of area treatment  Renal Dialysis  Treatment of Minor Injuries

 Prescribing

Satisfaction Survey

At the end of the CHC’s complaints process, the majority of complainants are issued with a “Satisfaction Survey” to complete. This allows feedback 22

organisation which is subject to the THE NHS COMPLAINTS complaint. The CHC’s Complaints PROCEDURE Advocate will also attend these meetings to support the complainant. Local Resolution Independent Review The first stage of the NHS Complaints Procedure is called Local Resolution If complainants remain dissatisfied and this involves dealing directly with after the Local Resolution Stage, they the organisation involved in the can apply for an Independent Review complaint itself. Almost all (IR). The IR process removes the complainants using the advocacy complaint management from the NHS service approach the CHC at this organisation concerned. For stage. A few complainants will only complainants this is often seen as very approach the Advocacy Service when important as they may remain they reach the second stage of the concerned that the ‘self analysis’, complaints process – Independent which is the element of local Review. A small number only resolution, will not have been approach the Advocacy Service for unbiased. However the IR stage does assistance when their complaint has not necessarily mean that an finally progressed to the Ombudsman. Independent Review Panel will be convened. Often it is more difficult to provide support for clients who have initially A request for IR can have the been through Local Resolution following outcomes: independently of the CHC simply because their documentation may be  referral of the matter back for less well organised or there are limited further Local Resolution details of meetings/discussions held  upholding the complaint in etc. Often complainants may not want whole/in part without Panel to engage with Local Resolution  upholding the actions of the NHS because they immediately want the organisation in whole/in part matter to be investigated in a more without Panel independent manner and thus there  recommending action outside the may be a need to provide explanations NHS Complaints Procedure of how the NHS Complaints  establishing a Panel to formally procedure is structured. review the complaint.

Local Resolution generally involves The Ombudsman submission of a complaint (written or verbal) and a response – either a The Ombudsman is appointed to look formal written response or a meeting. into complaints about public services In the majority of cases, complainants in Wales. The service is free of charge, prefer to receive a written response independent and unbiased. first for fear of being overwhelmed by technical detail at a meeting. The Ombudsman can look into complaints about unfair treatment or a Meetings are generally held at a later bad service through some failure on stage of the local resolution process the part of the organisation providing bringing together the complainant it. The service considers complaints with service staff from the about a wide range of matters. 23

The Ombudsman normally expects a complainant to have first raised the matter with the organisation concerned, and given them a reasonable opportunity to investigate and respond. Many complaints can be settled in this way.

People unsure about whether to raise a complaint with the Ombudsman may seek direct advise by contacting the

Public Services Ombudsman for Wales office at the following address:

Public Services Ombudsman for Wales, 1 Ffordd yr Hen Gae,

Pen coed, CF35 5JL, Tel: 0845 601 0987 (local call rate) or email [email protected] website www.ombudsmand-wales.org.uk

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MEDIA ACTIVITIES Howells) who provides interviews etc. through the medium. The Council has continued with a policy of publicising its work via the Articles and comments have appeared local media so as to alert patients and in the following newspapers: the public to key activities in which CHC members are engaged. This also The Western Mail serves to enhance public recognition of The Western Telegraph the Pembrokeshire Community Health The Milford Haven Mercury Council. The Tenby Observer The Fishguard Echo Representatives of the media are The Tivvyside Advertiser invited to all meetings that are held in public and are issued with agendas Radio interviews have been conducted and papers beforehand. Additionally with : press releases are also issued to the local media following these meetings. Radio Pembrokeshire One member (Mrs Viv Stoddart) BBC Wales assists in the note taking and Radio Cymru. preparation of these regular press releases. Television interviews have been given to :

From time to time ad hoc press BBC Wales releases are also issued on special HTV Wales topics of interest. Importantly the S4C Council also has a policy of responding to any media enquiries Several of the media articles have been that are made on health related given further publicity on matters. web/internet based news sites.

A key feature within Pembrokeshire has been a desire to publicise good practice and positive patient experiences as well as to highlight any particular service shortcomings.

Through the past year there has been a lot of media coverage across a wide range of topics. Not unexpectedly, significant media attention was given to the Acute Services Review through several months of the year.

The prime CHC contacts for media relations are the Council’s Chief

Officer and the Chairman, although from time to time other members may be asked to provide support. The

Council also has a dedicated spokesperson (Councillor Islwyn

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MISSION

The key function of Community Health Councils (CHCs) is to represent the interests of the public in the health services in their district – ie., to give people an independent voice in their local NHS and the services it provides.

The Chairman, members and staff of the Pembrokeshire Community Health Council have endeavoured to meet this obligation fully and effectively through the past year to the very best of their ability.

We will continue to act in the best interests of the patients and the public within Pembrokeshire, working with our key stakeholder partners to achieve this goal in the coming year and beyond.

Pembrokeshire Community Health Council Suite 2, Cedar Court Haven’s Head Milford Haven Pembrokeshire SA73 3LS

Telephone: 01646 697610 Fax: 01646 697256 Email: [email protected] Web: www.patienthelp.wales.nhs.uk