BRECKNOCK AND RADNOR COMMUNITY HEALTH COUNCIL

Minutes of a meeting held on Friday 29th November 2013 in Bishop Meadow Motel, at 10.30 am.

Present: CHC Members: Cllr Mrs D G Thomas – Chairman Mrs H Barrow – Vice Chairman Mrs A Mathias Cllr H Williams Cllr I Williams

Co-opted Members: Mr G Davies Mrs J Eason Mr G Greaves Mrs M Morris Mr J Steadman Mrs B Whitticase

In Attendance : J David Adams, Chief Officer, CHC Jayne Thornhill, Deputy Chief Officer, CHC Gill Coles, Office Manager, CHC Dr Brendan Lloyd, Medical Director, THealth Board Mr Andrew Evans, Local General Manager, South Powys Mr Bruce Whitear, Director of Planning

Three members of the public were present.

Action FC/91/13 There were no apologies for absence.

FC/92/13 Declarations of Interest: There were no Declarations of Interest.

FC/93/13 Chairman’s announcements: There were no specific announcements by the Chairman.

th FC/94/13 Minutes of the Meeting held on 16 September 2013 th The minutes of the meeting held on 16 September 2013 were AGREED as a correct record.

FC/95/13 Matters Arising and Not Listed on the Agenda

a) Ystradgynlais Community Hospital Minor Injuries Service Locality General Manager, Andrew Evans reported that the appointment of a nurse practitioner for the Minor Injury Unit at Ystradgynlais Hospital had been made. The successful candidate was currently employed at Morriston Hospital and a release date was being negotiated. 1

Mrs Heather Barrow stressed the need to advertise the minor injury service to the public once the person had taken up the post. b) Proposal to transfer the mental health resource centre from “The Larches” to the hospital The Chief Officer reported that a brief on the current situation for the transfer of the mental health resource centre from “The Larches” to Ystradgynlais Community Hospital had been received at a recent meeting of the Ystradgynlais Health Focus Group. The information had been welcomed by those present. It was noted that the service would move into the hospital in March/April 2014. c) The Chief Officer informed the meeting that the questionnaire to monitor the Virtual Ward service operated at the Ystradgynlais, , Brecon, Hay and GP Practices had been finalised. Distribution of the questionnaires had commenced at the beginning of November. No completed surveys forms had been received at the CHC office to date. It was noted that prepaid addressed envelopes were being issued with the questionnaires and the CHC office number was being included should anyone need assistance with completing the questionnaire. Ann Mathias suggested publicising the survey with a report and photograph in the local press. d) Implementation of the Recommendations from the Review of Community Health Councils. The Chief Officer reported that there was no certainty concerning the date for joining the two CHCs in Powys to form a single CHC. Progress was being made by the two CHCs to work more closely together. In the meantime, a Joint Executive Group of the two CHCs had been formed and would be meeting on 10th December. e) Pain Management Clinic It was noted that the Manager of the Pain Management Clinic, Hospital would be invited to give a presentation to the full CHC meeting in January 2014 on the current developments for long term conditions. At the AGM of Powys THealth Board members had been advised that the residential aspect of the Pain Management Clinic had been closed temporarily following a fire safety audit. The CHC had not been advised of the future arrangements for the service.

Locality General Manager, Andrew Evans informed the meeting that the residential facility had been closed temporarily due to compliance with fire regulations. Patients who were undergoing treatment had been moved to local 2

Bed Breakfast accommodation. Residential pain management treatment would be postponed during December and January. The situation would be addressed in January.

FC/96/13 Ministerial Appointments to Brecknock and Radnor Community Health Council The Chief Officer confirmed the Ministerial appointments to Brecknock and Radnor CHC as indicated in his letter to CHC members dated 21st November 2013:

st th From 1 December 2013 to 30 November 2017

Mrs Barbara Whitticase Mrs Jane Eason Mr Geoffrey Davies

st st From 1 April 2014 to 31 March 2016

Mrs Jacqueline Wilding

A number of other candidates interviewed for the ministerial appointments had been invited to have their names added to a waiting list pending a vacancy arising within the CHC membership.

Two Ministerial appointments had been made for st Montgomeryshire CHC – one member appointed from 1 st December 2013 and one from 1 July 2014.

Induction training would be organised for new members of both Powys CHCs at a venue in and all existing members would also be invited to attend. The Chairman encouraged all members to attend the induction training to meet the new members.

The Chief Officer reported that revised guidance on annual appraisal arrangements had been received. He also advised that a recruitment process would take place in conjunction with Powys Association of Voluntary Organisations to fill the existing vacancies for voluntary organisation members.

FC/97/13 Response from Powys Teaching Health Board concerning the transfer of the Stroke Rehabilitation Service from Bronllys Hospital to Breconshire War Memorial Hospital The Chief Officer presented his report updating members on the arrangements the Health Board had and was making to respond to the caveats imposed by the Community Health 3

Council in relation to the transfer of the stroke rehabilitation service. The report set out the position and findings of the CHC’s Monitoring Group in respect of each of the caveats imposed by the CHC. The CHC was particularly concerned over the clinical leadership for the stroke rehabilitation service. The Health Board’s response to the concerns raised by the CHC on this issue was outlined in the Chief Officer’s report. The Chairman invited the Health Board representatives to report on the action taken and being taken by the Health Board to address the issue of clinical leadership for the service.

Director of Medical Services Dr Brendan Lloyd explained that currently Consultant Physician: Age Care, Dr Dunn was the consultant lead for the stroke rehabilitation service. He advised that Dr Dunn would be retiring in the next 12 to18 months. He reported that there was a major shortage of specialists in care of the elderly nationally and it was necessary to build a more sustainable model for the stroke rehabilitation service in Powys. It was intended that Consultant Physician: Age Care, Dr Pinhorn would extend her remit while Dr Dunn was still in post to take on the lead role in rehabilitation care.

The Health Board had looked at the possibility of recruiting a specialist for Mid Powys with sessions from Wye Valley NHS Trust. However the Trust had also experienced difficulties in recruiting to two Consultant posts at Hereford for stroke services. Consequently support to Powys could not be offered by Wye Valley NHS Trust.

Geoffrey Greaves stressed the importance of involving the Local Authority Social Services Department to improve care in patients’ homes when discharged from hospital. Multi- disciplinary teams were essential. Locality General Manager, Andrew Evans assured the CHC that the Health Board worked closely with Social Services to enable patients to return to their own homes as soon as possible after suffering a stroke.

Ann Mathias asked if the Health Board had been aware of the difficulties with clinical leadership prior to the consultation exercise. She commented robustly that members were very disappointed to be informed at this time that this situation had arisen.

Dr Lloyd replied that sustainability of the service would always be dependent on recruitment of a consultant in that specialty. There had been numerous discussions with Dr Dunn and Dr Pinhorn. He said the Health Board had 4 consulted on the provision of the service not on consultant cover arrangements.

The Locality General Manager informed members that at the time of the consultation the Health Board was not aware that Hereford would be unable to provide a service because of recruitment difficulties. Neither did the Health Board know that the Consultant Physician would be retiring. The Health Board’s proposals would create a more sustainable model for rehabilitation service.

Geoffrey Davies commented on the high regard for the service at Bronllys and reminded of the CHC’s proviso that the high standard of service currently at Bronllys Hospital must be maintained and replicated at Breconshire War Memorial Hospital.

In response to this observation, Dr Lloyd informed members that Dr Pinhorn had worked in Powys for a number of years and with the support of the multi-disciplinary team, he assured CHC members that the quality of the service would be maintained and improved.

Jane Eason reminded that stroke rehabilitation was not an acute service. She said there was already a robust rehabilitation service at Breconshire War Memorial Hospital. Members needed an assurance that the service would continue. Dr Lloyd responded that whilst it was not possible to give guarantees of continuity, the health board was implementing a more sustainable model for Consultant provision.

Cllr Huw Williams commented that in 18 months’ time it appeared that the service would go from two to one consultant. Dr Lloyd confirmed the service would rely on one consultant physician and it would be difficult if the health board was unable to recruit.

Dr Lloyd gave an assurance that the Consultant Physician at Breconshire War Memorial Hospital had a broad experience of knowledge in rehabilitation. She would be provided with a package of training to extend her knowledge in stroke rehabilitation. Following a question on monitoring the service, Dr Lloyd informed that the service would be audited each year and compared with previous years. Dr Lloyd confirmed that Dr Dunn would be continuing to provide a service in South and Mid Powys until her retirement. Further, he explained in detail the work progressing in the health board about the multi-faceted clinical leadership of the stroke rehabilitation service in Powys, in particular South 5

Powys. He explained the work being taken forward in relation to succession planning preparing for the retirement of the current consultant together with the work associated to the implementation of a sustainable model of care into the future. Dr Lloyd emphasised that the consultant physicians in Age Care were working together to enable succession planning leading to a sustainable model of care. He confirmed that the number of consultant Age Concern sessions between Bronllys Hospital and Breconshire War Memorial Hospital would remain at the same level as at present. In addition he confirmed that the health board would engage with the CHC concerning the longer term arrangements for consultant services in South Powys.

The Chief Officer requested that the CHC be provided with the clinical audit data as part of the CHC monitoring and scrutiny activity. It was also requested that officers of the Health Board attend CHC meetings, whether Council or committees, when the information was being considered in order to clarify any issues raised.

It was noted from the report of the CHC Chief Officer that:

a) in the short term, the health board had improved the availability of car parking spaces at Breconshire War Memorial Hospital by transferring 15 non-clinical members of staff away from the hospital. The health board would be looking at rescheduling activity to relieve pressure on the car park on Wednesday mornings. The CHC was also content with the health board’s longer term plan to increase car parking spaces at the hospital. It was AGREED that the CHC continue to monitor the car parking situation at Breconshire War Memorial Hospital.

b) Members were content with the action taken in relation to public transport with bus stops provided close to the hospital on Cerrigcochion Road.

c) In relation to the caveat concerning the future development of Bronllys Hospital, the first meeting of the Bronllys Hospital Site Development Group took place on 7th November 2013. The health board aimed to have a business case for the future of the site completed by the end of March 2014. Dates for public engagement events had been identified.

Members RESOLVED that they were assured that the health board was addressing the CHC’s caveats and consequently the health board could proceed to implement the transfer. 6

The CHC would continue to monitor and scrutinize the progress with the implementation plan and was concerned that:

(a) the health board and its consultant physicians in Age Concern continue to progress the development of a sustainable model of care.

(b) clinical audit data from the stroke rehabilitation service is provided on a regular basis to the CHC by the health board and that the health board assists CHC members in the interpretation of the data.

(c) the health board engages with the CHC about the emerging proposals for consultant services in South Powys.

(d) the health board continues developing a clear and robust plan for the future of health services at Bronllys Hospital.

FC/98/13 Community Health Council response to the consultation on the South and South Powys Programme Members received a report prepared by the Chief Officer. The reported reminded members that the consultation concentrated on three hospital services:

consultant-led maternity and neonatal services; inpatient children’s services; and emergency medicine (A&E)

The report also summarised many of the documents provided to members during and following the consultation exercise. The options for the delivery of the three services identified above were:

• Option 1: University Hospital of Wales, Cardiff Specialist Critical Care Centre, Llanfrechfa Morriston Hospital, and Prince Charles Hospital, Merthyr.

• Option 2: University Hospital of Wales, Cardiff Specialist Critical Care Centre, Llanfrechfa Morriston Hospital, Swansea and Royal Glamorgan Hospital, Llantrisant.

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• Option 3: University Hospital of Wales, Cardiff Specialist Critical Care Centre, Llanfrechfa Morriston Hospital, Swansea and Prince Charles Hospital, Merthyr and Princess of Wales Hospital, Bridgend.

• Option 4: University Hospital of Wales, Cardiff Specialist Critical Care Centre, Llanfrechfa Morriston Hospital, Swansea and Prince Charles Hospital, Merthyr and Royal Glamorgan Hospital, Llantrisant.

The Chairman invited the Director of Planning, Powys Health Board, Bruce Whitear, to address the meeting. The Director of Planning outlined the background to the consultation on the and South Powys Programme proposals due to the challenges nationally in terms of medical recruitment and the need for a robust clinically led process. There had been a good volume of responses from Powys to the consultation exercise. Much work had been undertaken analysing the results since the consultation exercise had closed.

The Chairman reminded members that the CHC needed to consider which option was best for South Powys residents. The Chief Officer reported that members had been provided with an extensive range of documents and reports, including the full analysis report of the responses.

Geoffrey Greaves congratulated Powys Health Board on their Equality Impact Assessment.

Ieuan Williams commented that the CHC must maintain the pressure to include Prince Charles Hospital, Merthyr in the options. He considered that this hospital was vitally important to South Powys area.

Geoffrey Davies referred to the document on transport which stated on page 16 that “generally most areas with dense population can reach an NHS A&E, paediatric, neonatal, or obstetric service containing facility within 60 minutes by public transport and on foot.” Mr Davies stated that transport was of paramount concern to the residents of Powys. Powys patients were not on an equal footing to those in urban areas such as Gwent and other areas. He reminded that Powys was unique in its transport requirements. There was a need to consider the mode of transport and the roads to be travelled. Mr Davies considered the current transport would not be adequate for 8

Powys residents.

Ann Mathias commented that there was great concern that Nevill Hall and the Royal Gwent Hospitals must keep their current status. The CHC should emphasis strongly that services at these hospitals must be maintained in the interim until the Specialist Critical Care Centre was built.

The Chairman also expressed her concern that the proposals in the South Wales Programme were based on a hospital which had not yet received full approval. There was great concern about services being maintained in the interim within Nevill Hall Hospital.

Jane Eason spoke about paediatric services. She commented that Powys Health Board should be represented on the Clinical Reference Group. Jane Eason stated that there was no suitable model at the present time. South Powys patients have to travel to specialist centres for paediatric services. Powys would benefit from a service available at Prince Charles Hospital. In response the Director of Planning, referring to transport, stated that there would be variations in travel time depending on where the patient lived. He said the key point was clinical safety. He was confident that in a situation where time was critical then the patient would reach the service in time. With regard to paediatric services he informed that the health board were involved through the Women and Children’s Directorate. Involvement was challenging due to the size of Powys and spread of the population.

Comment was made that there was concern that services would be removed from Nevill Hall Hospital, Abergavenny. Medical and nursing recruitment would be more difficult at this hospital because of the uncertainty over the future. This would have an adverse effect on the delivery of services. There must be an assurance on what was happening at Nevill Hall Hospital in the interim period prior to the commissioning – provided it is approved for construction – of the Specialist Critical Care Centre.

Following comments on patient flows, Bruce Whitear stated that with the remodelling of services following consultation people did not indicate they would necessarily go to the nearest critical care centre. The health board would encourage patients to go to the nearest hospital providing these specialist services.

Comment was made that patient flow may change if services currently delivered at Hereford were provided further away. 9

More patients might find it more convenient to travel to, or be taken to Nevill Hall Hospital.

There was further discussion on the sustainability of services at Prince Charles Hospital. It was considered that it was crucial to South Powys residents that this hospital be included in the preferred option.

Concern was expressed by a number of members that the consultation included the Special Critical Care Centre at Cwmbran which had not yet been approved by the Minister and Welsh Government for construction.

It was proposed that option 1 would be the best option for South Powys. It was RESOLVED to AGREE to support option 1 of the proposals as described in the South Wales

Programme as the CHC’s preferred option.

It was further AGREED that members would not support any option which did not include Prince Charles Hospital.

Members were also concerned that:

Until the Specialist Critical Care Centre was built, services were maintain at Nevill Hall Hospital and not transferred to the Royal Gwent Hospital.

The Air Ambulance was suitably financed and did not rely on charitable funding. Although it might remain under charitable control.

Proposal for the formation of a Joint Committee to FC/99/13 embrace the CHC’s existing Visiting, Monitoring and

Scrutiny Committee and the Public and Patient

Engagement Committee

The proposal from the two sub committees of Council, the

Visiting, Monitoring and Scrutiny Committee and the Public

and Patient Engagement Committee to form one combined

committee was APPROVED.

Unconfirmed minutes of a Joint Meeting of the FC/100/13 Visiting, Monitoring & Scrutiny Committee and the

Public and Patient Engagement Committee held on

16th October 2013 The unconfirmed minutes of a joint

meeting of the Visiting, Monitoring & Scrutiny Committee

and the Public and Patient Engagement Committee held on

16th October 2013 were RECEIVED and ACCEPTED.

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FC/101/13 Minutes of a Meeting of the Joint Services Planning Committee held on 25th June 2013 The minutes of the meeting of the Joint Services Planning Committee held on 25th June 2013 were RECEIVED and NOTED. This was considered to be an important and worthwhile committee.

FC/102/13 Any other urgent business a) The Chief Officer informed members of the Primary Care Project Plan developed by the Chief Officer of Cardiff and the Vale Community Health Council. The project set out the timescales for the implementation of the roll-out of Primary Care inspections across Wales. The first activity in the process was to conduct an audit of all GP practice leaflets. This information would be reported to the project lead for compiling into an all Wales report.

b) Members noted that the Powys Health Board meeting would be held from 1.00 pm to 5.00 pm on 18th December 2013.

c) An arrangement would be made for members to meet with the new Chief Executive of Powys THealth Board.

FC/103/13 Date and time of next meeting: 21st January 2014, 10.00 am, venue to be arranged.

FC/104/13 Motion to Exclude Members of the Public and Press It was RESOLVED to APPROVE the following motion:

The motion under Section 1(2) Public Bodies (Admission to Meetings) Act 1960: “Representatives of the press and other members of the public shall be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest”.

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