Montgomeryshire Community Health Council

Response to Betsi Cadwaladr Community Health Council in respect of the Betsi Cadwaladr University Health Board “Healthcare in North Wales is Changing” consultation August – October 2012

1. Background and Information

1.1 Betsi Cadwaladr University Health Board, (Betsi Cadwaladr UHB), which provides services to some of Powys residents on behalf of Powys teaching Health Board, published its proposals for changing health services across their area in a consultation document "Healthcare in North Wales is Changing" in August 2012

1.2 Approximately 10% of patients from the Llanfyllin Practice area use services provided by Betsi Cadwaladr UHB.

1.3 Montgomeryshire Community Health Council (CHC) urged the residents of North West Powys to make their views known regarding Betsi Cadwaladr UHB's proposals for changes in services. The closing date for the consultation period was 28th October 2012.

2. Montgomeryshire CHC consultation with Powys residents

2.1 Powys teaching Health Board (PtHB), and Montgomeryshire CHC hosted a public meeting to engage with the communities of North West Powys, on Thursday 18th October 2012, from 6.30pm-8.30pm, in the Cain Valley Hotel, Llanfyllin. Betsi Cadwaladr UHB and PtHB had representatives present at the meeting to answer the public’s questions.

2.2 The meeting was Chaired by Dr John Morgan, Chairman of Montgomeryshire Community Health Council (CHC). Senior staff represented PtHB, and BCUHB.

2.3 A GP from the Llanfyllin Medical Practice and four members of the public were in attendance.

2.4 Montgomeryshire Community Health Council additionally facilitated a meeting of the Llanfyllin Patients panel on Monday 15th October. The “Healthcare in North Wales is Changing” consultation document was discussed and the findings from this meeting are included in our consultation response.

3. Findings

3.1 Most of Betsi Cadwaladr UHB proposed changes do not affect Powys residents, but there is an overlap of services and patient flows into Betsi Cadwaladr UHB area.

3.2 Powys residents raised concerns and questions in the following areas:

 Obstetrics  Community Services  Minor Injury Services  Echo cardiograph facilities  Mental health services  Vascular services

3.3 Obstetrics 3.21 In the Llanfyllin area of North Powys the main pathway for obstetric services is Royal Shrewsbury Hospital. However the obstetrics services will be moving from Shrewsbury to Telford by 2013, and it is anticipated as a result that the numbers of Powys mothers accessing the Betsi Cadwaladr UHB Wrexham Maelor hospital will increase.

3.22 Montgomeryshire CHC note that for Llanfyllin patients requiring very high specialist obstetrics care the pathway is currently to Liverpool and therefore the proposals are not seen to affect Llanfyllin patients to any degree, as they appear to be a continuation of the current processes.

3.4 Community services 3.31 The proposals are unlikely to have any impact on Powys residents apart from those in the Machynlleth, Llanidloes and South Gwynedd areas.

3.32 Montgomeryshire CHC urge Betsi Cadwaladr UHB and Powys tHB Board to consider how they will provide better community services, and respond to the increase in demand and increased public expectations.

3.5 Minor injuries services 3.41 Montgomeryshire CHC note that few GP practices within the Betsi Cadwaladr UHB area provide minor injuries services, and that Betsi Cadwaladr UHB want to ensure Wrexham Maelor Hospital provide a minor injuries service on site that is separate from the A&E service.

3.42 Llanfyllin Practice currently operates a minor injuries service and therefore this proposal is unlikely to have any impact on Powys residents.

3.6 Echo cardiograph facilities 3.51 The current pathway for access to echo cardiograph facilities for patients in the Llanfyllin areas is Royal Shrewsbury Hospital.

3.52 Patients would like a choice of accessing echo cardiographic facilities in the Betsi Cadwaladr UHB area, in addition to the Royal Shrewsbury Hospital. Montgomeryshire CHC would urge Betsi Cadwaladr UHB to continue discussions with PtHB in relation to developing these as outreach services.

3.7 Mental Health Services 3.61 Betsi Cadwaladr UHB proposals for Older Peoples mental health services were seen to have little impact on patients from the Llanfyllin area.

3.62 Montgomeryshire CHC notes that the Betsi Cadwaladr UHB proposed model is something that PtHB is looking to develop in Powys. However, Montgomeryshire CHC also notes that PtHB is some way behind Betsi Cadwaladr UHB regarding the planning of mental health services and that a review is on-going.

3.63 Montgomeryshire CHC supports a move towards a service providing illness driven care as opposed to age driven mental health care in Powys.

3.7 Vascular Services 3.71 The proposed changes by Betsi Cadwaladr UHB to have one single centre where all complex surgery would be undertaken and the provision of local abdominal aortic aneurysm screening was not seen to affect patients in the Llanfyllin area.

4. Conclusion 4.1 Montgomeryshire CHC appreciate that most of the Betsi Cadwaladr UHB’s proposed changes do not affect Powys residents, but are aware of an overlap of services and patient flows into Betsi Cadwaladr UHB area. However, the consultation has raised three key areas of concern to Powys residents in relation to:

 Community Services  Pathways of choice  Mental Health Services

4.2 In relation to Community Services Montgomeryshire CHC urge Betsi Cadwaladr UHB and Powys tHB to consider how they will provide better community services, and respond to the increase in demand and increased public expectations.

4.3 Patients would like a choice of accessing echo cardiographic facilities in the BCUHB area. Montgomeryshire CHC urge Betsi Cadwaladr UHB to continue discussions with PtHB in relation to developing these as outreach services

4.4 Montgomeryshire CHC support a move towards a service providing illness driven care as opposed to age driven care in relation to mental health services in Powys.