Review of Public Consultation in Blaenau Ffestiniog undertaken by the Gwynedd Local Health Board in 2005, and a Review of Public Consultation in Prestatyn undertaken by the Denbighshire Local Health Board in 2005 - 6.

Michael A H Williams LLM BA [Hons] FCIM MIOD

Michael A H Williams is Acting Chair of the Swansea NHS Trust. Visiting Professor of Housing and Social Care, University of Glamorgan. He is Chief Executive of Grŵp Gwalia Cyf a leading social housing and care provider.

Contents

Section Heading 1 - 4 Introduction 5 – 7 Summary of Principal Findings and Recommendations 8 – 11 Gwynedd Local Health Board Principal Findings 12 – 17 Principal Recommendations Blaenau Ffestiniog Memorial Hospital 18 – 20 Denbighshire Local Health Board Principal Findings 27 – 33 Principal Recommendations relating to Prestatyn Community Hospital, Chatsworth House 34 – 36 Recommendations for the Welsh Assembly Government and LHBs 37 – 47 Approach to the Reviews 48 – 61 Gwynedd Local Health Board [GLHB] 62 – 65 GLHB and Blaenau Ffestiniog Memorial Hospital 66 – 73 GLHB Health Review Task and Finish Group 74 - 81 GLHB “Have Your Say…” 82 - 90 Public Consultation in Blaenau Ffestiniog 91 Blaenau Ffestiniog – Opposition to Bed Closures 92 Ysbyty Alltwen – New Hospital near Porthmadog 93 - 98 GLHB Board’s Decision 99 - 103 Blaenau Ffestiniog Implementation Group 104 - 114 Conclusion Blaenau Ffestiniog 115 - 122 Denbighshire Local Health Board [DLHB] 123 – 124 DLHB and Prestatyn Community Hospital 125 - 126 Project Board and Task and Development Group 127 – 134 Concerns of the PPI Public Relations Communications Group 135 – 137 Extra Care Housing 138 – 143 “Modernising and Improving the Health Services in Prestatyn - Your Voice in Your Future” 144 – 145 Health Impact Assessment 146 – 153 Objections and Public Meetings 154 – 156 Clwyd Community Health Council 157 – 160 DLHB Board’s Decision 161 - 164 DLHB Implementation Group 165 - 172 Prestatyn Community Hospital, Chatsworth House Interviewees

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Introduction

1. In September 2007 the Minister for Health and Social services, Edwina Hart MBE AM, announced a review of the Denbighshire and Gwynedd Local Health Boards (DLHB and GLHB) approach to the reform of health services in Prestatyn and Blaenau Ffestiniog. In both cases, the LHBs proposed revisions and improvement to the provision of community health services. Denbighshire proposed the closure of the community hospital in Prestatyn. Gwynedd wished to retain Blaenau Ffestiniog Memorial Hospital but as a health centre with no beds.

2. The Minister requested a report that considered four areas:-

• Whether in each case, the public consultation arrangements employed by the LHBs were appropriate and effective in encouraging engagement in the process. • Whether in each case the views and comments received through the consultation were considered fully by the LHB before its decision was made. • Whether in each case the decision of the LHB was then communicated widely to all stakeholders to ensure a common understanding of the way forward. • Whether in each case the arrangements for the stakeholder involvement during the implementation period were appropriate.

3. The Minister visited North Wales in the summer of 2007. Following my appointment, I made the same journey and met with, as many people as I could that were involved in the consultation. The major concern of both communities was the fear of a loss of important services provided by their Community Hospital. There was concern as the quality and delivery of the proposed community health services.

4. The procedure adopted for this inquiry included:

• A review of all documentation relating to the meetings of the relevant organisations, LHBs, NHS Trusts, their Committees and working groups, the Community Health Councils, and Local Authorities. • Interviewing groups involved in campaigns to keep their hospitals, councillors, general practitioners, and others. • Interviews, correspondence, and emails with leading politicians, senior members, and officers of the health and statutory authorities. Because the matters being considered started up to 4 years ago, it has not been possible to contact some people involved in the consultation process. Their views were expressed in reports, letters, and emails and were very helpful. • Review of the extensive media coverage, in both areas.

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Summary of Principal Findings and Recommendations

5. The questions put by the Minister initiated a review of the quality of the public consultation undertaken by the two local health boards. I have concluded that Gwynedd LHB needs to Review issues relating to the closure of beds in the Memorial Hospital. Denbighshire LHB needs to undertake a full Public Consultation.

6. Difficulties relating to the conduct of public consultations are not restricted to Local Health Boards subject to this review.i The legislation and rules relating to consultation can work if they are effectively followed. There is an urgent need to train staff in health bodies involved in public consultation. Without training staff are not able to properly communicate with the public and they are put under considerable pressure during the consultation process. There is need for resource and investment in;

• preparing for consultation, • managing the process properly, • getting the message across, • taking ownership of the process, • implementing and monitoring progress.

This will require commitment, time, and money. Investment at this stage will save money later and help to create a positive engaging relationship with the public.

7. The outcome of poor consultation methods is detrimental in a number of ways i.a.:-

• It is expensive if the review has to be re-run in whole or part; • It causes the public to distrust the motives of politicians and health bodies trying to reform and improve the health service; • It confirms the public’s suspicion that the NHS wants to cut costs and the consultation is a sham; • It fails to win “hearts and minds” of the public; • Most importantly, it delays necessary reforms and may prevent them happening at all.

Gwynedd Local Health Board Principal Findings

8. GLHB followed the WHC (2004) 84 Guidance for Involving and Consulting on Changes to Health Services. Even so, it failed to engage the public during the consultation process despite making the effort to do so. It had to adopt a defensive position from the start of the process. It was unable to manage the media and had to deal with opposition from the whole community. 9. Its booklet, “Have Your Say…” provided the public with details of the proposed change, but it gave the impression that GLHB had made up its mind. Therefore, large sections of the community felt that the consultation process was insincere.

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10. The public meetings were difficult to control and unproductive. The results from all the workshops were conclusively against GLHB’s proposals. The correspondence and nearly all the evidence show there is firm, overwhelming, opposition to the bed closures in the Blaenau Ffestiniog Memorial Hospital. GLHB’s challenge was to debate and counter the opposition. It was unable to do so. 11. The consultation process and the subsequent implementation process did have positive outcomes.

• The improvement of the community health services in Blaenau. • The development of the Health and Care Services Group (HCSG) • The HCSG is involved in developing an Extra Care Home in Llan Ffestiniog with Social Services and Cymdaethais Tai Eryrie. The 40- unit scheme is the Council’s second priority in the Social Housing Grant bids for 2009/10. Depending on planning permission and contractors, the developing association hopes it will be completed by 2012 or sooner.ii • Gwynedd County Council intends to add 9 nursing beds to their nursing home, Bryn Blodau, Llan Ffestiniog. It is possible that the capital is available for this project in the authority’s 2007 to 2008 capital budget.

Principal Recommendations relating to Blaenau Ffestiniog Memorial Hospital

12. There should be a new Review concerning the future of the Blaenau Ffestiniog Memorial Hospital principally considering the closure of its beds. The Review needs to consider how the other services based at the hospital are delivered. Because of the progress made by GLHB it does not need to re-run the Public Consultation. During the Review, measures should be taken by the Trust and the LHB to ensure that the beds are retained. To provide a period of stability it is recommended that the beds should be kept until 1st April 2011. The Review will consider the final outcome so far as beds are concerned. It will report to DLHB and WAG in this respect.

13. Due to the difficulties created in the Public Consultation it is recommended that in this Review the Regional Office of the Welsh Assembly Government should assist the GLHB. This recommendation is to provide the community with the assurance that the Review will not be a gesture with an inevitable outcome. It will consider the future of the hospital in light of the progress made since the Public Consultation and the development of health care in the county. The future of the hospital and the service it provides needs to be justified on clinical and financial grounds, as well as recognising the importance of the hospital to the community in Blaenau Ffestiniog.

14. The work of the Health and Care Services (Implementation) Group is important. Its overview of the improvements being introduced by the LHB should be should be much easier if the tensions relating to the hospital are removed and consider in the recommended Review.

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15. Meirionnydd Community Health Council (MCHC) role is crucial. When a hospital bed closure review or consultation is being carried out it would assist MCHC if it could employ a suitably experienced consultant to advise and support community, and patient groups. It would help to establish the consultant’s independence if relevant community groups were involved in the appointment.

16. The main reasons for recommending a new Review are:

• The flaws in the original Consultation process, although not deliberate, led to polarised views in relation to the hospital. This was not in the best interests of the community, and it caused the public to concentrate on the hospital’s fate and not the development of an integrated service for the community. • There is distrust of the LHB in the community that needs to be addressed. • The Meirionnydd Community Health Council requested a Review concerning the future of the Blaenau Ffestiniog Hospital once the Alltwen Hospital had been established for a year. • The Review needs greater involvement from and engagement of clinicians from the North West Wales NHS Trust, the general practitioners, nursing staff, occupational therapists and other health professionals working at the hospital and in the community. If possible, a clinician who has a strong connection with the hospital, and the Blaenau area should lead the Review.

17. The new Review should consider the future use and purpose of the Blaenau Ffestiniog Memorial Hospital. It should clarify i.a.:

• How hospital services can be developed in Blaenau in what is now effectively a rural town and area. • How it relates in a rural setting to the other community hospitals, nursing and care homes in Gwynedd. In Blaenau, the question is not limited to the introduction of services at Ysbyty Alltwen and the nine beds proposed in Bryn Blodau. This would be in line with the view taken by the Community Health Council.iii • Whether it is possible to apply a rural toolkit to help determine its future use,iv Toolkits have been used to good effect in all parts of the UK. • Its relationship with general practice and health services in the area. • Its links to the district general hospital, • Its links with community medicine, telemedicine and general practice, • Whether there is any possibility of working with the LHB, the Trust, Social Services, the private and the third Sector to provide beds for a certain category of patient. A partnering approach would mean taking a collaborative approach to funding the hospital.

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Denbighshire Local Health Board Principal Findings

18. DLHB followed the WHC (2004) 84 Guidance for Involving and Consulting on Changes to Health Services. However, it failed to engage the public during the consultation process. DLHB planned for the consultation but did not have the expertise or experience to do so effectively. In order to effect a change as emotionally challenging as the closure of a community hospital there has to be a high level of communication. The public and their political leaders must be clear as to the proposals, why they are necessary and the evidence to support them. DLHB did try to engage with the public and politicians. However, rather than leading the debate it had to react to events. It had to respond to demands for information. Instead of adopting a positive approach to the changes, it had to defend its position.

19. DLHB’s communication strategy in the case of Prestatyn Community Hospital, Chatsworth House, did not successfully convey its underlying intention to improve the health service to the community in Prestatyn.

20. Evidence was provided that:

• Suggests that the communication strategy was rushed; • Indicates there were internal communication difficulties in some of the LHB Task and Finish Development Groups and the Project Team. • Suggests there were tensions in meetings with staff of the Prestatyn Community Hospital. • The public meetings were unsatisfactory. There was considerable public disagreement with the proposals. Meetings were disrupted and the proposals of the LHB could not be communicated. The drop- ins were not well attended.

Principal Recommendations relating to Prestatyn Community Hospital, Chatsworth House

21. A fresh Public Consultation needs to be run by DLHB, with the assistance of the WAG Regional Office. Clinicians from primary and secondary care need to take a leading role in this process so that they are able to explain to the public the reasons for and the need for service change.

22. During the period of consultation and since the decision of DLHB, the future development of health services in Rhyl has been under consideration. Prestatyn and Rhyl are close to one another and may have similar health needs. The minister may wish to consider a Public Consultation covering services in both towns to improve the health service to this part of the North Wales coastal belt.

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23. The DLHB preferred Option included 10 units/beds in a proposed Extra Care Housing Scheme in Prestatyn. Denbighshire CC, and Wales and the West Housing Association have the social housing capital grant for the Extra Care Housing. It would be wrong to hold up the development, which is in itself important to older frail people in Prestatyn.

24. The 10 units/beds proposed by the LHB at the scheme are not crucial to the scheme’s success. Before developing a unit of this kind its suitability in the context of Prestatyn needs further clarification. There has to be a better explanation of its purpose to the public, health staff, and clinicians. DLHB promised that the hospital would keep its beds until the ten extra care beds are provided.

25. Prestatyn Community Hospital should be re-assured that it would retain its beds until its future is decided following the new Public Consultation. This will give the staff, the patients, and the community security and time to plan. It will be for the new Public Consultation to determine the future of the hospital and health services in the community of Prestatyn.

26. Clwyd Community Health Council has to be able to engage with the community in Prestatyn in the Consultation period. It needs to have the resources in time and revenue to dedicate to the task. It is recommended that its officers visit the hospital to carry out an inspection and seek the views of patients and staff. If the Public Consultation is accepted by the Minister, CCHC should employ a suitably experienced consultant to advise and support community, and patient groups. It would help to establish the consultant’s independence if relevant community groups were involved in the appointment. CCHC would require additional resources to provide this level of support to the community.

Recommendations for the Welsh Assembly Government and LHBs

27. Recommendation (1). Community Hospitals provide a mix of care. In-Patients are often elderly. Payments for their health needs fall between two statutory bodies Social Services and the LHB. The dividing line between the two can be blurred. The Welsh Assembly Government is in a position to facilitate a more flexible approach to the support of in-patients in rural and urban Community Hospitals. A partnership between social services, the trust, the third sector (voluntary sector), and the LHB could develop an innovative approach to providing beds in Community Hospitals.

28. Recommendation (2). In both communities the LHB on the advice of Welsh Assembly Government firmly identified an option for service change as being their preferred one. The public response was to regard this as an indication that the consultation was meaningless and a predetermined sham. Each option should be properly assessed and discussed with the public. Consideration should be

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given to developing a preferred option during the consultation process so that a preference emerges form that process.

29. Recommendation (3). Public Consultation requires consultation at every stage. It requires openness, planning, time, honesty and adequate effectively applied resources. The WAG circular relating to consultation provides a sensible foundation on which to base public consultation.

30. Recommendation (4). In order to improve this guidance there are areas that could be considered by consulting bodies.

a. The LHB should have a policy of public openness and accountability from the time it decides it has to review or reform services. Not only must there be a policy of openness and accountability, it must in practice, be seen to be open. b. The LHB should seek the views of opinion formers and the leaders within the community concerned, such as, Members of the UK Parliament, the National Assembly for Wales, and County Councillors, Staff and Unions, Patient Groups, Ministers of Religion, relevant Voluntary Groups representing a cross section of people who are elderly, disabled, mentally ill or other service users; c. Winning the “hearts and minds” of the public for change is extremely difficult. The more accessible the information is at the early, pre-formal consultation stage the better for the future public consultation. d. Careful preparation of the brief for a health service review task and finish group is essential. Engaging the public is a difficult task. LHBs without experience of organising successful public consultations need to work closely with the Assembly Government when planning their approach. Time and effort at this stage will be of benefit throughout the whole consultation and implementation period. e. When major health service changes are anticipated, the LHB should consult the public about the Terms of Reference and Membership of a Task and Finish Group before it is established. The distrust of this group and the LHB’s ability to manipulate it means it is essential that it be regarded as an independent consultative/advisory body. f. Advertising for public involvement; explaining the need for the Task and Finish Group; and asking for expressions of interest in membership of the group will help counter the accusation that such a group is exclusive as opposed to inclusive. g. When contemplating major changes it is sensible to engage the services of independent mediators or consultants with the experience of conducting public meetings. This has to be at the beginning of the consultation process. To ensure that the consultants are accepted as impartial a public patient interest group or community group should be involved in their appointment. h. At any stage there is bound to be conflict if a section of the public feel that they are losing a public service. Large, hostile, meetings in which health officials cannot get their message across are not worth holding. Consultation methods include the use of public meetings but they are often the least effective means of consulting. People

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who are passionate about an issue will take them over. Many people will not or cannot speak in public meetings. Whilst the closure of beds will inevitably result in a packed meeting other important but less controversial issues will attract a small audience.

31. Recommendation (5) Press Coverage and Public Information require honesty, a clear strategy, and positive leadership.

a. All LHBs should have a general Communications Strategy that can be applied to any occasion. This should be strengthened and adapted for specific projects e.g. to close hospitals, beds, or any major health service re-configuration. Public information through all forms of media needs to take into account the likely reaction of sections of the public to change. Public reaction to change needs to be treated with respect. Explanations to meet public comments and objections need to be thought through. An approach that suggests secrecy or arrogance will result in public anger and rejection. b. A lead officer for public relations should be identified and appointed by the LHB or the Trust. The public relations officer should work closely with all parties including the Regional Office of the NHS to ensure that preparations are well thought out and there is an adequate plan to implement the public consultation. c. The public relations officer needs to develop and agree with all parties to the consultation a strategy that covers the pre- consultation, consultation, post-consultation and implementation stages. d. The public relations officer needs to develop media contacts to ensure that the proposed changes are properly, honestly, and clearly described in the media. Information should not be suppressed. The public is entitled to receive clear information about its local hospital and health services.

32. Recommendation (6) Clinician Leadership and Trust Involvement are essential for a meaningful public consultation.

a. Trust Clinicians, such as the Medical and Nursing Directors, alongside their LHB colleagues and senior management should lead and advocate the proposed change. b. Trusts must be prominent in the consultation process. Although it is understood that it is the legal responsibility of the LHB to lead a consultation.

33. Recommendation (7) Community Health Council Involvement needs resources to represent the public especially on difficult consultations.

a. The resources available to the CHC mean that its involvement in the public consultation has to be limited. CHCs will often have many public consultations about service change at any one time. Thus its resources become overstretched. b. CHC chairs should not be persuaded to chair public meetings on behalf of a LHB. In a hostile meeting, the CHC’s chairing of the

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meeting can be misinterpreted and the CHC chair’s position compromised. c. CHCs cannot lead or assess public opinion unless they are trained and resourced to have a meaningful input to the process of change from its inception to its implementation. d. When CHCs are faced with major changes in service they should be able to call on additional resources to engage staff or consultants experienced in engaging the public and representing public opinion. e. CHC should be required to prepare for and arrange visits to community hospitals that are faced with closure. They should listen to the views of the public, clinicians and staff at the hospital. f. CHCs undertaking such exercises as street surveys must have the expertise and resources to carry out surveys and the ability to analyse them. If they do not have such expertise, they need to be resourced to employ people or organisations experienced in this work.

Extra-Care Housing

34. Extra-Care Housing provides leasehold or rented housing for people wishing to live in a retirement apartment. The scheme care staff provide services to tenants. Because tenants are able to access care services any stay in hospital can be shortened. The tenants’ need for hospitalisation is reduced by the care package they receive in their home. It is an excellent provision in the community. This review is not intended to jeopardise the proposed schemes in Prestatyn or Llan Ffestiniog.

35. An extra care scheme with NHS levels of patient care run by the NHS and the care provider is feasible but requires careful planning. The scheme proposed in Ffestiniog is different to that proposed in Prestatyn.

36. Health professionals and the public have expressed some confusion to me as to how the Prestatyn scheme will work. If the scheme is to put forward again it needs to be better explained. The public must be assured that the LHBs proposals will meet a patient’s needs in a safe and clinically sound manner.

Approach to the Reviews

37. In order to understand the work of the two Community Hospitals I visited Blaenau Ffestiniog Memorial Hospital, and Prestatyn Community Hospital (Chatsworth House), unannounced in October. Both hospitals were full and the standard of care I witnessed was excellent. These visits provided useful background information.

38. On subsequent visits to Prestatyn and Blaenau Ffestiniog, the people and groups I met were very helpful, and wanted health services for their communities to be the best that NHS Wales can provide.

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39. The NHS Regional Director Derek Griffin and Deputy Regional Director Elwyn Price-Morris provided all the relevant paperwork and a wealth of background information. There is information regarding the reconfiguration of health services in both areas on the internet.

40. North Wales’ newspapers, the BBC etc provided wide and detailed coverage on the closure of the hospitals and the protests against the closures. The press cover was limited in relation to other aspects of the reviews.

41. During October, November, December and January I met with the groups and people concerned with the proposed changes. I have listened to all the parties. In addition, telephone calls and exchanges of email broadened the range of the consultation.

42. It was not possible to meet with everyone connected with the original consultation process. A small number of people have retired or moved to new posts, or do not wish to participate in the review. Evidence of their views is contained in letters or from the reports and minutes of the meetings, they attended.

43. I gathered the views of the local authorities, the NHS Trusts and the LHBs through written communication and/or through interviews with senior members and officers.

44. The Chief Executives and Directors of the housing associations involved in the proposed extra care housing schemes were helpful.

45. I am grateful to the assistance given by elected members, who were able to provide me with an overview and insights in relation to the review in their respective constituencies.

46. The campaigners for the retention of the hospitals were without exception polite and reasonable in the way they put their cases for the retention of their respective hospitals.

47. In conclusion, this report has identified issues in relation to the way that public consultation worked in relation to two hospitals in North Wales. Gwynedd and Denbighshire LHBs are not alone in finding public consultation on bed closures or hospital closures an extremely difficult and contentious process. The Welsh Assembly Government may wish to consider issuing revised guidelines to all NHS bodies in light of its experience of public consultation since the issuing of its circular in 2004.

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Local Health Boards Reviews

Gwynedd Local Health Board’s Approach to Consultation

48. A Review concentrating on the Blaenau Ffestiniog Memorial Hospital’s role should be undertaken. This is the legal responsibility of the GLHB but it would beneficial if the Review was facilitated and supported by the Welsh Assembly Government’s Regional Office in North Wales.

49. Despite criticisms of the GLHB’s public consultation exercise, it has resulted in reforms to the provision of health care in the area. An external evaluation of service changes is being undertaken by Bangor University School of Nursing.

50. The work of the “Task Group for the Development of Health and Care Services in the Ffestiniog Area” and the Extra Care Housing scheme is a benefit to the community. It does not depend on the hospital beds closing.

51. GLHB prepared for the public consultation. Had it been able to spend more time in preparation and had it had more resources it would have had a more positive engagement with the community.

52. GLHB established a Task and Finish Group but there was some confusion as to its purpose and questions as to the impartiality of its membership.

53. GLHB should have engaged sooner with local opinion formers such as the Assembly Members, Members of Parliament, Councillors, Patient Representatives, Staff and others before its proposed changes became public and before establishing the Task and Finish Groups;

54. The failure to engage the media led to the protesters gaining a significant advantage. The message of the protesters featured frequently in all forms of the media whereas the reforms proposed by the GLHB were not given adequate coverage;

55. GLHB engaged consultants to work with the Task and Finish Group. Unfortunately, they introduced a complicated scoring system for the options being considered by the Task and Finish Group. The way in which the options were prioritised seems to have been rushed and would have benefited from a more measured approach.

56. The booklet explaining the changes failed to communicate the GLHB’s proposals clearly.

57. The appointment of a second firm of consultants was made because of early opposition to the closure of the Memorial Hospital. The

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appointment was a reaction to a problem and it did not assist the public consultation as much as it could have;

58. The GLHB Board had to rescind its November 2005 decision relating to the Blaenau Ffestiniog Memorial Hospital and the health service improvements proposed for the community. GLHB had to convene another Board in December 2005 to confirm its November decision.

59. The questions put by the Minister in the case of Blaenau Ffestiniog cannot all be answered in the affirmative, but there was an attempt to correct mistakes as they arose.

60. The views and comments received through the consultation were considered by GLHB before its decision was made. An analysis of the comments of the community shows an overwhelming support for retaining the hospital.v

61. GLHB members and officers acted professionally in dealing with what was a difficult emotional issue. The community has shown a strength in resolve and argument that deserves respect. Both sides need to develop and build on the positive outcomes of the 2005/6 review. A reconsideration of how the hospital can best serve the community needs to be discussed in a positive way by both the GLHB and the community. There is a common consensus that the hospital has a future. There is a responsibility on all parties, the community, the LHB and the Trust to agree its future.

Gwynedd Local Health Board and Blaenau Ffestiniog Memorial Hospital

62. The Gwynedd Health Social Care and Well-being Partnership in April 2005 published its strategy for 2005 to 2008 based on an assessment made in October 2004. The plan indicates i.a. the need for a strategic review of community hospitals and a review of community based services.vi A strategy for primary care estates in 2004 states that “Most contributors saw community hospitals as playing a key role in maintaining access to services, but suggested that some smaller hospitals might develop more as health resource centres…and little or no inpatient care.”vii

63. The LHB established a sub committee for community hospitals in May 2003. On the 9th July 2004, members expressed their concern that the review of Blaenau should be to review its role in the local community and finance should not dominate the process although they recognised that in a comprehensive review financial considerations were relevant.

64. It questioned whether the Wanless assertion that community hospitals must have 30 beds in an area such as rural Gwynedd was relevant and felt that a review should test that statement.viii

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65. At its meeting of the 15th July 2004, it was decided that a review of community hospitals should commence with those that did not “comply with the Wanless 30 bed recommendations. It was noted that Tywynix and Blaenau Ffestiniog Hospitals would be reviewed.”

Gwynedd Local Health Board’s Health Review Task and Finish Group

66. The Blaenau Ffestiniog Health Review Task and Finish Group’s first meeting was in September 2004 chaired by the LHB’s Director of Development and Performance Management. The Memorial Hospital Defence Committee, elected members, and others questioned the representative nature of the membership of the group. A CHC report notes that “Extensive criticism of the task and finish exercise has been noted with strong feelings expressed that decisions had been taken before consultation with the communities.”

67. However, the CHC later considered that the consultation process itself successfully delivered “opportunities to express views and opinions.”x

68. There were 7 senior health managers, 2 senior nurses from the hospital, 2 from Gwynedd Social Services, 2 CHCs representatives, 1 user representative, 1 member of the Friends of the Hospital, 1 manager from Barnardos, 1 GP, 1 Town Councillor, and 2 County Councillors.

69. The 2007 survey undertaken by the Hospital Defence Committee of five local members of the group including the GP expressed unhappiness with the way in which the work of the group was conducted. The GP stated that the “audit, commissioning, statistics were presented in such a way that all but one of the options were deemed unsafe … the evidence presented did always seem to support the chosen option.”

70. All respondents expressed their disappointment with the process and the outcome. I met with the GP Practice who felt that the group was not able to consider the need for the review in an open and satisfactory way and it was working to a pre-determined outcome. A member of the Task and Finish Group, and the Implementation Group, stated, “In retrospect, if the Task and Finish Group were to be considered unsatisfactory then it would have been because its original purpose as a consultative forum was not clearly stated and understood at the beginning by members, including myself.”

71. “The group,” it was explained,” developed four options that were considered against an agreed set of criteria. The complexity of the assessment exercise overseen by Secta introduced a further difficulty for members unused to such assessment techniques and this led to a sense of frustration that was eventually partially responsible for the complaint to the Minister. There was no attempt to mislead members.”

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72. The LHB employed Sectaxi an independent and informed facilitator. Their remit was to support the review of the Blaenau Ffestiniog Memorial Hospital including “a review of the current service and performance across all services and develop options for the future of community hospitals” and “to undertake a formal option appraisal process with the task and finish group to assess each of the options.”

73. The result of this work was the production of a plan for consultation through public meetings, focus groups and leaflets explaining the options to put to the public. The LHB considered the options and agreed the document “Have Your Say” a review of Blaenau Ffestiniog Health Care Services that was published in July 2005 with a closing date for the consultation given as Friday 23 September 2005.

Gwynedd Local Health Board’s “Have Your Say…”

74. The booklet explaining the options for the delivery of health services in Blaenau Ffestiniog is entitled “Have Your Say…” The booklet gives four options from A to D with the LHBs preferred option stated as being Option B. This would be the development of a primary care centre with no inpatient services. The reasons for supporting this option are stated. It is stated that the physiotherapy building would no longer be required if Option B is adopted. Options C and D are dismissed as not viable. Even if it is not the intension, it gives the impression that the LHB has already decided the way forward.

75. The booklet refers to the non-feasibility of various options but does not provide financial or other meaningful information to verify this. Statements against an option are listed as “constraints.” Phrases such as “offer higher clinical risk and is therefore not deemed as clinically safe” are not easily understood. Whereas, “the option is also too costly,” is understood. It adds to the suspicion that the exercise is financially driven.

76. The headline for Option A – “do nothing – locally provide inpatient facility” is in itself provocative. It attracts more constraints than the other options. The impression given is primarily financial and includes the constraint “does not provide efficient use of financial resources.” Option A is dismissed in one line under the heading “The Proposed Service Model.” “Option A … would not provide services needed for the future or demonstrate an efficient use of resources.”

77. In the community feedback form the question put is “will the proposed service model (Option B) deliver improved access to health services?” Options A, C, and D are not referred to in the community feedback form.

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78. GLHB did not accede to requests for comparative data on the use of District General Hospitals to put the Blaenau figures in context. GLHB felt they were inappropriate due to the nature of the services to be provided. Addressing this issue would have assisted the consultation process.

79. GLHB on advice of WAG included commentary on its preferred option. The other options were briefly mentioned as they “are options put to the task and finish group.” It was considered that to leave, “all options with no preference could be misleading as due to the constraints of implementations only one option was considered as now viable.”xii

80. The document promised three workshops managed by consultants Thomas Jones and Batten. There would be a feedback open meeting in Blaenau on September 22nd2006. The document states that posters should be distributed and the media briefed to ensure public awareness.

81. The booklet was agreed by the NHS Trust, Gwynedd Council, and the Meirionnydd CHC.

Public Consultation in Blaenau Ffestiniog

82. Thomas Jones and Batten, consultants, were appointed after a difficult public meeting of the Blaenau Ffestiniog Town Council. An official of the GLHB was unable to inform the council of the results of the Task and Finish Group. It had not completed its work and the formal consultation had not started. As the consultants state “As a result of this, the consultation process had a somewhat difficult beginning.”xiii

83. Their brief was to help the “residents of Blaenau Ffestiniog and the surrounding area to voice their concerns, ideas and aspirations as regard the services provided in Blaenau Ffestiniog and to seek their views on the proposals set out in the consultation document “Have Your Say...”

84. Stakeholders and key players were identified. The facilitators held pre-meetings with them. Between July and September 3 public workshops were held in Blaenau Ffestiniog with additional workshops in Llan Ffestiniog and Trawsfynydd. A request to meet in Dolwyddelen was refused. Senior officers from the GLHB and the Trust attended the workshops.

85. The workshops were well attended. The consultants reported that the workshops were emotionally intense. They described their approach in their report, which states clearly the views of those attending the workshops and opposition to the closure of the hospital. Participants wanted option A with the proviso that the hospital should be upgraded.

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86. Common concerns that arose from the community consultation were i.a.- • The nature of the Rapid Response Service; • The comprehensiveness of the proposed community-based services; • Palliative care in the community.

87. On 15th September 2005, a workshop with people with learning difficulties was held at Seren. The responses are overwhelmingly in favour of keeping the hospital. Clywed consulted Ysgol Moelwyn pupils. They unanimously decided that the hospital should be retained and upgraded.

88. The public perception was that the closure was purely based on a financial view. The hospital was too expensive in revenue and capital terms and therefore it had to be closed. The public’s counter reaction was to point out many instances of public expenditure being misdirected that could have been used to retain the hospital beds.

89. The GLHB produced a list of frequently asked questions and answers in September 2005 trying to meet the issues being raised.

90. The period of consultation was 12 weeks beginning on 1st July 2005 and ending on 23 September 2005.xiv A public meeting “to discuss the feedback” from the public was called for the 22nd September. The MCHC considered the GLHB the proposals, public comments and objections between 26th September and the 23rd October 2005.

Blaenau Ffestiniog – Opposition to Bed Closures

91. There a great deal of opposition:-

• A 2,500 signature petition arranged by the Campaign for the Protection of Rural Wales against closure of Blaenau and Tywyn; • Blaenau defence committee petition of 4128 signatories opposed the downgrading of the hospital, • A petition of 337 pupils of Ysgol y Moelwyn wanted the hospital upgraded and they complained about the narrow scope of the consultation. • 336 consultation documents were returned the majority against the preferred option. Between 600 and 700 attended the workshops, the public meetings attracted approximately 500 people. • In September 2005 a 1000 people marched through Blaenau to oppose the closure. • Local political leaders and local clinicians were united against the closure. • In September 2005 Gwynedd Care Scrutiny Committee recommended that the LHB’s recommended option should be opposed by the authority.

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• From the beginning of the consultation process, the hospital nursing staff and the GPs who served the hospital voiced concerns about the closure of the hospital.

Ysbyty Alltwen – New Hospital near Porthmadog

92. The LHB anticipates that a new 30-bed hospital, Ysbyty Alltwen, Tremadog, Porthmadog, will be able to serve the Blaenau area. In 1993, the plan for a new hospital was approved by the Welsh Office. It was agreed that Blaenau Ffestiniog Hospital should be retained. There is concern for a number of reasons regarding the expectation that Alltwen would provide beds to replace those in Ffestiniog. The distance to the new hospital is approximately 15 miles but in the summer holiday traffic blocks the roads and in winter the weather makes the journey difficult. It is suspected by the Defence Committee members and the local GPs that Alltwen will not be large enough to meet the needs of the area served by the Memorial Hospital and the Porthmadog area.

Gwynedd Local Health Board’s Decision

93. On the 3rd November 2005 GLHB’s Board Meeting in Dolgellau outlined the consultation process, summarised the feedback and indicated a way forward. It was reported that following the consultation that MCHC agreed to a modification of the LHB proposals. The MCHC supported the LHB’s resolution with some important provisos and the MCHC’s Chief Officer was concerned that one third of the Board Members entitled to vote in relation to Blaenau Ffestiniog did not do so.xv

94. MCHC accepted that the Memorial Hospital would retain 12 beds for three years or 12 months after the commissioning of Ysbyty Alltwen whichever is the latest. It requested a robust independent review of the services Alltwen could provide for Blaenau before the decision concerning the Memorial Hospital was made. MCHC wished for a strong Implementation Group to monitor the implementation of the review.

95. The Board was advised that the modifications were agreed by MCHC and they could be taken forward without further public consultation. A 6 point alternative proposal had been devised for Blaenau Ffestiniog:-

• Implementation Group of key stakeholders to ensure public involvement in changes chaired by the NWWT; • Development of Community Health Services and the investment in them; • Social Care Provision including a review of residential care and other social care support; • Continuation and development of other facilities and services including clinics, heart failure service, physiotherapy, minor injuries,

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X-ray, minor operations, community dental service, Hearts and Mind project and Corun y Sawdl; • Possible additional services such as substance misuse and the integration clinical nurses with the out of hours service; • 8 to 12 beds to be retained until locally acceptable provision was in place probably linked to opening of Alltwen and the review of residential accommodation. It was anticipated that this would be no longer than 3 years. A new health and social care facility would provide NHS beds.

96. There was a long debate. The lay representative asked for verbal amendments to be put relating to Blaenau Ffestiniog proposals. The Chair ruled that verbal amendments could not be accepted. Following the meeting senior politicians requested that the GLHB reconsider its position. It did. A Board Meeting was held on Friday 9th December 2005 in Bangor.

97. After a debate, the Board again passed the proposals put to the November Meeting. In relation to Blaenau Ffestiniog, the cost of the proposals would cost approximately £450,000 a year but would lead to future savings.

98. The Board of the LHB receives an annual report concerning the review. The second was produced on November 26th 2007.

Blaenau Ffestiniog Implementation Groupxvi

99. An Implementation Group was established in Blaenau Ffestiniog. GLHB’s intention was to ensure that local people are fully involved in the change process. It was formed to act as a reference group to evaluate new and existing services. The group met on the 3rd April 2006. It is chaired by Cllr Arwel Jones. The Chair believes the Group can facilitate and nurture the “promising cooperation between the Health Board and Gwynedd Council.” The group was renamed as the group for the “Development of Health and Care Services.”

100. The group takes decisions by reaching a consensus and not by a vote. This was felt to be the correct approach as the group is an advisory committee, not a sub committee of GLHB. For the same reason financial decisions are the responsibility of GLHB and not the group. This approach is firmly opposed by the members of the defence committee who have reluctantly accepted places on the group. The Hospital Defence Committee felt that they had to be on the group to ensure that their interest in keeping the hospital open was protected.

101. In October, the Group agreed that the hospital should be 12 beds in the “implementation period.” The Defence Committee do not accept it is an interim agreement and do not want to lose any beds.

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102. An Intermediate Care Team was established in April 2007. GLHB and Social Services have developed joint proposals in relation to residential care. At Llan Ffestiniog, an Extra Care Housing Scheme is proposed as well as an extension to the residential home in Llan Ffestiniog. The extension could accommodate patients who require nursing and palliative care.

103. An external evaluation of service changes is being undertaken by the School of Nursing in Bangor University. GLHB’s Board have considered and evaluated the progress made in 2006 to 2007 in its December Meeting. The report states that the Implementation Group has met 12 times. It records the many achievements of the year. It is not necessary to record them as they can be read on the GLHB’s website.xvii

Conclusion Blaenau Ffestiniog

104. This review has shown how difficult it can be to bring about change. GLHB have a statutory responsibility to deliver the best possible health service to the whole of the area it serves. This will from time to time result in the need to instigate changes in the service provided for a particular community. The consultation in Blaenau Ffestiniog provides GLHB with some helpful lessons for future consultations.

105. The early stages of the consultation process are crucial. A clear communication policy needs to be developed that can be adapted to specific consultations. The policy should allow for the dissemination of information to those who influence decisions, staff and the public.

106. A holistic patient centred approach to consultation is essential to gain the hearts and minds of the public. GLHB emphasised the need for an affordable service and claimed that the hospital is expensive. It would have assisted a proper debate if the cost of different options both in revenue and capital terms were made available to the public.

107. Some local members of the Task and Finish Group were not entirely clear as to its purpose. The consultants Secta added further complexity to the process of assessing the options. However, the employment of specialist consultants was a commendable attempt to inject impartiality into the process.

108. The appointment of further consultants for the consultation period seems to have been the result of a difficult meeting with the Blaenau Ffestiniog Town Council. Their feedback report of the workshops they held is comprehensive and helpful.

109. The distrust of the LHB’s motives, however, ill founded resulted in wide spread protest. The size of the petitions, the numbers on marches, the response to the public meeting, and the return of consultation documents show a considerable level of interest in the

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community. There was an overwhelming opposition to the LHB’s proposal. The objectors skilfully manipulated the media and won public sympathy.

110. The need to change could have been explained better. “Have Your Say” contains a lot of information crammed into a small booklet. The language is not easy to understand. This booklet is the first time that the majority of the public are informed of the GLHB’s intention it has to communicate a difficult and complicated message.

111. Despite the difficulties during the consultation process the LHB moved quickly to the implementation of their decision. The Development of Health and Care Services Group is making some progress.

112. The co-operation with Gwynedd County Council over the provision of an Extra Care Housing Scheme and the extension of the Nursing Home in Llan Ffestiniog will lead to the provision of needed supported accommodation, and nursing home beds. I understand that the Extra Care Scheme may not be available for letting until 2011. The nursing home beds may be available sooner.

113. The need for the retention of the Memorial Hospital has to be considered not just in the light of the provision in Ysbyty Alltwen and the new care in the community services in Blaenau but also in light of the new provision planned for Llan Ffestiniog.

114. GLHB with WAG should consider the role of the Memorial Hospital in relation to the other community hospitals serving South Gwynedd. The reason for maintaining a community hospital needs to be established and its purpose clearly defined. Clinicians from the Trust, GPs, Nurses and other Health Professions must be involved together with patient representative and staff organisations. To give patients and staff security and to assist in reassessing the people of Blaenau the hospital should be promised a period of stability to 1st April 2011 and a modest capital injection to ensure that patients and staff are safe.

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Denbighshire Local Health Board [DLHB]

115. The consultation process in Prestatyn did not adequately engage the public it needs to be re-run under the guidance of the Welsh Assembly Government’s Regional Office in North Wales. The Welsh Assembly Government could consider extending the review to include Rhyl and the future of the Royal Alexandra Hospital. The two coastal communities have similar and complementary health and care needs that would benefit from a joint public consultation.

116. DLHB did not take an appropriate amount of time to prepare for the public consultation. The Task and Development Groups could have developed their options further than they did. DLHB could have more fully engaged and briefed the Assembly Members, Members of Parliament, Councillors, Patient Representatives, Staff and others, before the public became aware of the proposed changes.

117. DLHB did not have time to manage the media. Their arguments to reform the service in Prestatyn should have been better communicated to the public. Throughout the period of the consultation, the protest groups dominated the media.

118. These early failures were in part responsible for the strength of the subsequent protests.

119. The booklet that explained the changes did not adequately inform the public of DLHB’s intentions. The preferred option included the provision of NHS beds in Extra Care Housing. Even now, long after the consultation period, there is confusion as to what this provision will be.

120. The way in which the Board’s decision was taken added to the public alarm and heightened the level of distrust between the public protestors and the DLHB.

121. Clwyd Community Health Council was able to influence the proposed service change to a limited degree. It could have questioned the proposals in more detail.

122. The views and comments received through the consultation were considered by DLHB. The preferred options of the community were not debated. The decision of DLHB could have been communicated more effectively. The public understanding as to the development and management of the preferred option is not clear. An implementation group continues to develop the extra care option.

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Denbighshire Local Health Board and Prestatyn Community Hospital

123. DLHB’s Board in May 2005 considered the use, and condition of the community hospitals in Denbighshire. The process to consider the future of the Prestatyn Community Hospital, Chatsworth House, had commenced.

124. The community hospital review was in part a result of the 2002 “Wanless” report.xviii The report called for a review of the community hospitals. Their efficiency and effectiveness in meeting the requirements of the local population needed to be reviewed. Wanless questioned the role of hospitals with fewer than 30 beds. In 2005, WAG published its strategy for health, “Designed for Life.” Design for life advocates the improvement of community based health service.

Project Board and Task and Development Group

125. Prestatyn Community Hospital Project Board

a. Prestatyn Community Hospital Project Board met on July 25th 2005xix. The role of the Project Board was to oversee the project. It was to be accountable for the success of the project and to approve the option for public consultation. Members were appointed in a personal capacity or as representative of organisations and groups. The Board established the terms of reference of the Task and Development Groups.xx b. In its Board Meeting of the 9th of September 2005, it decided to work up 4 options. The adoption of any of them would lead to the closure of Chatsworth House. The minutes reveal that staff are “angry and felt that their views were not being taken into account.” A Town Councillor “reported that the people of Prestatyn felt things were moving too slowly and concern was expressed at the uncertainty.” Despite these observations, a 15th September 2005 meeting of the Ratepayer and Tenants Association to be attended by “local politicians” was told, “That a review was taking place and options being worked up. A clear consultation would commence at the end of October 2005. It would need to be stressed that Prestatyn Community Hospital cannot be sustained in its present state for the foreseeable future.”xxi c. The mounting concern of the public is expressed by the League of Friends, who stated, “there is heated feelings over the closure of the hospital.”xxii Denbighshire NHS Trust representative said that he “wished to make it clear that the Project Board understand that if any of the above options be chosen, Prestatyn Community Hospital would not stay open.” The Project Board was warned that demonstrators could be expected at the drop-ins and assured that precautions had been taken to protect the public from intimidation.xxiii

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126. Four Task and Development Groups were established:-

a. Patient and Public Involvement (PPI) T&D Group - The key role of the group was to ensure that patients, public and other stakeholders were central to the development of health services, engaging with them at all levels and stages during the consultation process. The group was to plan the consultation by identifying the most effective ways in which events can be designed and managed in order to ensure that there is full engagement with all stakeholders during the 12-week public consultation and there is an opportunity to provide feedback on the options or proposals. Membership included members of CHC, LHB, Conwy and Denbigh NHS Trust PPI Forum, Local Authority members and staff and the Community Hospital League of Friends. b. Option Development T&D Group - The group considered options to be presented for consultation and consideration. The options had to improve quality of care, service options, ensure effective use of resources and ensure developments were sustainable. Membership included members of CHC, hospital staff, GPs, Therapists, District Nurses, MacMillan Nurses, Voluntary Sector, Local Authority, LHB Staff, PPI Forum, and Social Services. The Option Development Group met twice to identify a series of options that were to be presented to the Prestatyn Community Hospital Project. Options were considered and rejected including retaining or redeveloping the hospital. At this stage the preferred options included one that advocated extending the existing site and services at Chatsworth. Following an option appraisal the 4 options presented to the public emerged. The appraisal considered the safety of the service for patients and staff; the local service fit; meeting local health and social care needs; efficiency and best use of funds; as well as sustainability and affordability. c. Staff Engagement T&D Group - The group considered the views and concerns of staff. Staff groups from the Community Hospital and the Trust together with Union and Human Resources. This group had some difficult meetings. d. PPI, Public Relations and Communications T&D Group - The group considered and agreed the communication strategy. The Project Board agreed the Communications and Public Relations Action Plan. It was to ensure press releases etc were effective and it was to “monitor the effectiveness of the consultation.” Membership included representatives from the CHC, Trust, County Council, LHB Board Member, League of Friends, PPI Forum, Age Concern and Community Hospital manager. PCH Staff were not involved.

Concerns of the PPI Public Relations Communications Group

127. The group was keen to promote a positive message of people involvement and positive changes for the Prestatyn community. It considered how to organise the formal public consultation. It is therefore important to outline some of the concerns it expressed in it’s evaluation of its own work.

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128. Their report states, “Members felt that they were inadequately informed about the project prior to the formation of the PPI/Communication Group and that the deadlines set prevented full planning and preparation for the consultation process. Some members felt that there was “confusion about the project.”

129. Summer annual leave for staff caused a delay in convening the first meeting thus there was pressure on the group to work at speed. It was felt that these timescales had been imposed by the Project Board.

130. The Group felt had it been involved earlier and better informed and given more time they could have arranged a greater level of public involvement. Had matters been different the Group claims that there would have “been a more pro active approach to ensuring balance and positive media exposure.”

131. Members felt that they had insufficient input to the final consultation document, “which should therefore be seen as a priority for future consultations.” On this occasion timescales for the options development, translation and printing prevented full involvement. Involving key workers in the group earlier in the process would have enabled them to plan for and advise on the consultation process.

132. Members felt that there was a lack of experience in major consultation exercises and suggested that closer working between groups would have been beneficial.

133. Communication between the PPI/Communication Board was so poor that it caused problems with the planning of venues because of timetable changes. More time for planning and preparing the consultation document was provided because of delays in the launch rather than a planned extension.

134. The impact of the project on the group members was burdensome but a considerable learning experience. Unfortunately, “responding to individuals and groups in the community has been difficult on occasions particularly at the public meeting.”xxiv

Informing Decision Makers

135. The elected representatives expected the consultation to be robust and that an option to retain Chatsworth would be included. A local Assembly Member expressed the hope that “there will be an option for investment in Chatsworth to provide palliative care, convalescence and outreach surgeries which will ensure a sustainable future for the hospital.”xxv

136. The correspondence from political representatives to the DLHB indicate that there was no briefings for them before the public consultation started.

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137. The Liberal Democrat and Plaid spokespersons wrote to DLHB. The Liberal Democrats opposed the closure. Plaid wished to see the hospital retained and its services combined with a primary health care centre. Plaid spokesperson’s comments are reflected by other correspondents and commentators. He writes, “Along with many residents I am appalled by the process of ‘consultation’. In effect the key decision to close Prestatyn Community Hospital has already been taken.”xxvi

“Modernising and Improving the Health Services in Prestatyn - Your Voice in Your Future”

138. The booklet “Your Voice in Your Future” was considered to by some members of the Project Board to be “a good piece of work.” The Project Management Teams intended “to keep it simple.” xxvii However, the language and sentence structure is in some places complex. It has a great deal of information for the reader to digest.

139. The font size and colour makes it difficult to read especially when the background colour is not white. It was produced on “silk finish” paper that made it difficult to write on and fill in the feedback form. The booklet was available on DLHB’s website. A version of the booklet was available from DLHB in large print and the Aberconwy Talking Newspaper.

140. The booklet did not encourage involvement from all sections of the community. The case study Sally’s Story should have been better thought out. It emphasises the health needs of older people in Prestatyn. Whereas the proposed changes concern the health needs of the whole community.

141. There were 4 options given:-

ƒ Extra Care Housing ƒ Care Home ƒ Primary Care Resource Centre/Home Care ƒ Hospital Care outside Prestatyn

142. The document describes how Sylvia a 66 year diagnosed with breast cancer would be treated in the Community Hospital and the alternative venues. The way in which the options are put there is no real argument for changing the current situation.

143. Option 1 is described as an “NHS funded unit within Extra Care Housing.” These are adapted “flats for short term admission.”

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Health Impact Assessment

144. On April 25th 2006 the Welsh Health Impact Support Unit facilitated a meeting that undertook “a rapid Health Impact Assessment of the Modernising and Improving of Health Services in Prestatyn.” The people attending the group were described as key stakeholders and the event was “a participatory stakeholder workshop.” The list of 30 participants was drawn up during a scoping session.

145. The session considered options 1 and 2 put forward to replace the Community hospital. This was not an open meeting and there were 6 attendees out of 15 that were not from the statutory sector. The purpose of the meeting was to examine the impact on the local population from a wellbeing and health point of view; and the effect of the impact especially in relation to vulnerable groups.

Objections and Public Meetings

146. Before and after the consultation period began, there were many letters of objection to the proposal to close the hospital. These increased following the public meetings. Prior to the first public meeting there was a meeting with the hospital staff. This caused concern and resulted in disquiet amongst staff despite reassurances that the hospital would not close until other services were in place.

147. The “Public Launch” on the 8th November 2005 was by invitation. 81 invitations were sent out and 49 people attended. The meeting was chaired by the Chair of the DLHB, Meirion Hughes.

148. The November 23rd 2005 meeting was chaired by the Chair of Denbighshire Area Committee CCHC. Up to 125 people were present. The meeting was addressed by the Chief Executive and the Director of Nursing of the LHB. They were prevented from giving their prepared power point presentation by the audience. The protesters dominated the meeting. There were a few objections to the behaviour of the protestors.

149. On January 27th, the Chief Executive, Alan Lawrie, presented the Hospital Project Board with the estimated cost of bringing the hospital up to standard and the cost of providing a new 30-bedded hospital. The NHS Trust provided the estimates. Upgrading would cost £1.9m with an extra £300k in addition to current costs of £600k revenue cost. This would bring the hospital up to the “same standard of premises as a specialist nursing home provision or extra care housing facility.” A new 30-bedded hospital would cost £13.495m with revenue costs of £2.5m. The “ten beds in an extra care nursing home at the level of dependency presently experienced would cost £360k.” This equalled 270 patients and released £240k for healthcare. These figures were revealed to the Upper Prestatyn Residents Association before being reported to DLHB Board.xxviii

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150. February 6th 2006 a meeting at the Nova Centre was attended by 132 people. It was chaired by Ann Jones AM. The meeting was heated and lengthy. Officials were on the defensive. The LHB produced a most frequently asked questions and answers for the second meeting. 3 smaller meetings were held - “Drop In Sessions.” The LHB felt they were useful but they did not attract many people. On February 13 2006, the LHB and CHC met North East Wales Carers Information Service (NEWCIS). The NEWCIS meeting had 6 carers present. The group did not understand extra care housing. The note of the meeting concludes with the following comments:-

ƒ “General feeling that the decision has already been made and that people are being consulted to pacify them; ƒ People are fed a load of crap (sic) and told what management think they want to hear; ƒ The final report must be written in plain English as must any public consultation!! ƒ Do not want booklets – just short to the point information.”xxix

151. As soon as there was a rumour that Chatsworth House was to close there was opposition from local people. A group of people formed a Committee to prevent closure of the Hospital. They received wide coverage in the papers, radio, and television both locally and nationally.

152. Positive views about the DLHB’s proposals are few. Of the few there are, they tend to come from other statutory bodies and not patients, the GPs, or the public.

153. Ann Jones AM was presented with a 2000 signature petition against the closure of Chatsworth. She presented it to the DLHB. The signatures were collected in October 2005. The petition was organised by the group supporting Chatsworth. The LHB issued questionnaires to allow the public to state which option they favoured. Of the 610 returned 548 were in favour of retaining or expanding the hospital.

Clwyd Community Health Council [CCHC]

154. The CCHC decided to support option 1 & 2 providing the Prestatyn Community Hospital remained open until the new provision was in place. The options favoured were 1 – Extra Care Housing and 2 – Specialist Nursing Home.

155. During the consultation period, the Community Health Council conducted 2 street surveys that produced 171 completed or partially completed questionnaires. CCHC had limited resources to carry out a survey. It shows that a majority want to keep Chatsworth. The outcomes the CCHC identified from the survey resulted in the recommendation “that the Denbighshire LHB looks at developing the site at Chatsworth House to provide more Community Hospital Services and to use the resources available to develop the site to

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provide a Tier 2 Community resource Centre.”xxx The CCHC’s formal response moves away from this position.

156. A spokesperson for the CCHC stated that the CCHC did not meet the groups wanting to save the Hospital. The CCHC did not visit the hospital. CCHC relied on the reports of the DLHB when considering the condition of the hospital.

Denbighshire Local Health Board’s Decision

157. The decision to adopt Option 1 and therefore eventually close Chatsworth was made by the LHB on 10th May 2006. This meeting was held in Council Chamber in Rhyl. Only 23 members of the public were allowed to listen to the deliberations of the Board.

158. In the May meeting, a Report on the Modernising and Improving Health Services in Prestatynxxxi was considered by the DLHB Board. The Board were required to approve option one – Extra Care Housing. This “meets the national, regional and local needs and can expand to meet future demands.” The report provides a profile of the Prestatyn Community Hospital. The paper is a narrative of events and the views expressed during the consultation process. It provides an overview of the objectors’ case against closure.

159. The protesters were given more ammunition to use against the DLHB as police were present outside the Rhyl Council Office. DLHB claims it did not request a police presence. It did inform them of the meeting. Inevitably, it resulted in a negative press.

160. The Board decided to approve the preferred option to provide 10 units/beds in the Extra Care Housing Scheme as a partner to Denbighshire Social Services. It agreed to improvements in the community health service for people in Prestatyn.

Denbighshire Local Health Board Implementation Group

161. DLHB Conwy and Denbighshire NHS Trust and Social Services have formed an implementation group to develop the Extra Care Housing Project.

162. Wales and the West Housing Association [WWHA] is the partner to Denbighshire Social Services to develop the project. It will be a tremendous asset to Prestatyn when it is built.

163. However, the planned 10-unit NHS extension does not seem to have been thought out properly. It is not clear as to how the number of 10 units has been arrived at. The admission criteria, the care and support patients will receive and many other issues need to be clarified.

164. A group of people undertook some exploratory visits to extra care schemes with NHS funded beds. This included a visit to the

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ExtraCare Charitable Trust scheme in Much Wenlock, England. DLHB’s commitment to the Prestatyn Extra Care scheme is based on a proposed revenue agreement between the DLHB and the provider of the care.

Prestatyn Community Hospital, Chatsworth House

165. The history of Chatsworth House is given in the literature about the hospital. It was not built as a hospital. It has been adapted over many years to its current configuration and use.

166. There were plans to keep it as a Community Hospital. In the 1990s, planning permission was granted to enlarge the hospital and provide car parking. This permission has now lapsed. For the campaigners to keep the hospital this indicates the site can be developed for a Community Hospital. The suitability of the site can be addressed in the Public Consultation.

167. Despite the beds being on the first floor, a local GP uses Chatsworth as much as possible and he cannot understand how the proposed Extra Care Housing Scheme could afford anything like the service to Prestatyn that Chatsworth does.

168. Denbighshire LHB’s approach to the consultation lacked direction and clarity. The PPI Public Relations and Communications Task and Development Group’s review is highly critical of the process.

169. There is a strong argument for the consultation to be re-run by DLHB under the supervision of the WAG Regional Office.

170. Denbighshire CC and WWHA have the social housing capital grant for the Extra Care Housing. It would be wrong to hold up the development, which is in itself important to the older frail people in Prestatyn.

171. During the period of the Prestatyn Consultation and since the decision of DLHB, the future of the Royal Alexandra in Rhyl has been debated. Prestatyn and Rhyl are close to one another and have similar health needs. It would be sensible to develop a strategy for Prestatyn and Rhyl that would consider the future of the Royal Alexandra Hospital and the Prestatyn Community Hospital, Chatsworth House.

172. Prestatyn Community Hospital staff do a wonderful job to provide the highest level of care despite the unsuitability of the building. Out of concern for them and their future patients, a period of time needs to be identified to re-assure them of the continuing use of Chatsworth House. At least the “status quo” needs to be maintained until the new Consultation is concluded and the DLHB and WAG have decided on the way forward. It will be for the new Public Consultation to determine the future of the hospital and health services in the community of Prestatyn.

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Appendix 1

Interviews and Consultations

I have not listed the many papers, letters, newspapers and other sources of evidence provided by the statutory authorities and members of the two communities

1. Gwynedd Local Health Board

Blaenau Ffestiniog Memorial Hospital

Members of Staff

Edwards Agnes Cllr CHC Town Council Implementation Group Ellis Meirion Jones Geraint V Chair Jones Glyn Chair League of Friends Jones Huw Emyr Jones Linda Wyn Cllr Lloyd Morfydd Perkins Dewi Price Gwilym League of Friends Roberts Val Mai Williams Arthur Cllr Ffestiniog Town Council Williams Eifion Williams Evan Glyn Sec. Defence Committee

Blaenau Ffestiniog General Practitioners

Evans Dr Jones Dr Jones Dr Parry Dr

Cymdeithas Tai Eryri

George Walis CEO

Gwynedd County Council

Thomas Harry CEO Lewis Dafydd P. Director Care Services

Gwynedd Local Health Board

Lewis-Parry Grace CEO Miles Lyndon Dr Chair

Gwynedd Local Health Board Implementation Group

Jones Arwel Cllr (Chair)

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Meirionnydd Community Health Council

Jackson Caroline Chair Owen Gareth CE retired

North and West Wales NHS Trust

Roberts Elfed Chair

Minutes and Notes of all relevant meetings.

Political Representatives

Elis-Thomas Dafydd AM Lord

Correspondence on file from Elfyn Llwyd MP and other senior politicians

The list of literature and correspondence is considerable and includes all correspondence from the public, politicians as well as records of meetings, newspaper and other reports.

2. Denbighshire Local Health Board

Clwyd Community Health Council

Mead Jean Public Involvement Officer

Clwyd and Denbighshire NHS Trust

Kershaw Gren CEO Lewis Alun Chair

Denbighshire Local Health Board

Baxter Sally Chief Executive Benbow Alan Chair Trowman Jane Director of Nursing

Correspondence, Minutes and Notes with views of Merion Howells (Chair at time) and Alan Lawrie (CEO at the time)

Minutes and Notes of all relevant meetings.

Political Representatives

Jones Ann AM

Correspondence on file from Chris Ruane MP, Mark Isherwood AM, Brynie Williams AM, John Sproston, and Mark David Jones.

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Prestatyn General Practitioner

Jessop Edmond Dr.

Prestatyn Hospital

Members of Staff Colquhoun Lilian Hornby John Smith Pat Ward Sue Wells Veronica

Wales and the West Housing Association

Hembrow Shayne - Operations Director, Hinchey Anne - Chief Executive

The list of literature and correspondence is considerable and includes all correspondence from the public, politicians as well as records of meetings, newspaper and other reports.

Michael A H Williams Acting Chair Swansea NHS Trust February 2008

i The report by Dr Neil Goodwin CBE, “Independent Inquiry into the Processes on Consultation and Implementation of the Reconfiguration of General Surgery Services in Carmarthenshire,” is a recent example ii Page 13 iii CHC letter G Owen 22 December 2005 iv Wales http://www.rural-health.ac.uk has links for good practice in the UK. v Main Themes of Feedback Blaenau Ffestiniog 29/09/05 vi Better Health, Better Gwynedd – Gwynedd Health, Social Care and Well-being Strategy 2005/08. vii Integrated Healthcare Strategy Gwynedd LHB 2004/2005. viii Notes of Hospital Sub Committee 9th July 2004 ix Minutes of Community Hospital Sub Committee 15/06/04

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x CHC letter G Owen 22 December 2005. xi Secta published an Option Appraisal in May 2005 xii Briefing Paper Community Hospitals Review 28 July 2005 xiii Report by Thomas Jones and Batten for the Gwynedd LHB Sept 2005 xiv Have Your Say page 12 xv CHC letter G Owen 22 December 2005. xvi Terms of Reference see GLHB Annual Report on the review of … Blaenau Ffestiniog Memorial Hospital 26/11/2007. xvii Gwynedd Local Health Board (LHB) Annual report on the review of Tywyn Memorial Hospital and the review of Blaenau Ffestiniog Memorial Hospital (as at 26th November 2007) http://www.wales.nhs.uk/sites3/page.cfm?orgid=273&pid=29427 xviii Securing Our Future Health: Taking a Long Term View” xix Denbighshire LHB Project Initiation Document Appendix C Roles and Responsibilities, D – Terms of Reference Task and Development Groups xx Project Initiation Document. xxi Prestatyn Community Hospital Project Board Minutes 9th September 2005 xxii Prestatyn Community Hospital Project Board Minutes 7th October 2005 xxiii Prestatyn Community Hospital Project Board Minutes 2nd December 2005 xxiv PCH – PPI and Communication Group Evaluation Monitoring of the Task Group. xxv Journal 26/10/2005 xxvi Letter 15/01/06 xxvii PMT Wed 5/10/2005 xxviii Prestatyn Community Hospital Project Board Minutes 27th January 2006 xxix Report of Carers Meeting Monday 13th February 2006 xxx CHC Modernising and Improving Health Services in Prestatyn – Survey of Public Opinion January 2006. xxxi Report on Modernising and Improving Health Services in Prestatyn including Prestatyn Community Hospital ‘Your Voice in Your Future.’

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