Minutes of Planning Committee Aneurin Bevan Community Health Council Meetings Room, Raglan House, Llantarnam Business Park, Cwmbran Tuesday 12th February 2019 PART A – PUBLIC SESSION

Members Present: Mrs Janet Griffiths Chair Mr George Clemow Cllr Alan Davies Mr Brian Kember Mrs Sonia Stainer

Co-opted Members Present: Mr Ian Blackburn Mr Robert Dutt Mr Edward Watts

In Attendance: Mrs Angela Mutlow Chief Officer Miss Jemma McHale Deputy Chief Officer Dr Gareth Oelmann Vice Chair, Gwent Local Medical Committee Mrs Nicola Prygodzicz Director of Planning, Aneurin Bevan University Health Board Mr Andrew Walker SCCC Project Director Planning, Aneurin Bevan University Health Board Ms Jan Wall Administrative Officer

Apologies: Mrs Pat Cory Cllr Mrs Mandy Moore Mrs Sue Sandham

Absent: Mr John Pearce Cllr Julian Simmonds 1

P.18/76 WELCOME AND APOLOGIES ACTION

The Chair welcomed all Members to the meeting; with a special welcome given to Mrs Ann Vincent who had recently joined the Aneurin Bevan Community Health Council.; Dr Gareth Oelmann, Vice Chair, Gwent Local Medical Committee, Mrs Nicola Prygodzicz, Director of Planning and Mr Andrew Walker, Specialist Critical Care Centre (SCCC) Project Director of Planning, Aneurin Bevan University Health Board.

Apologies were received from Mrs Pat Cory, Cllr Mrs Mandy Moore and Mrs Sue Sandham.

P.18/77 CHAIR’S ANNOUNCEMENTS

a) Planning Committee meeting format

The Chair explained the new format of the Planning Committee meetings. All future meetings will be held in two parts. Part A will be open to the public and Part B will be a private session. A separate set of minutes will be produced for each part. The Chair announced that there were no members of the public present at today’s meeting.

i) Meeting Timings

The Chair requested that; due to the time constraints of the new meeting format, any questions from members following presentations given by the Aneurin Bevan University Health Board should be kept short, sharp and relevant. The Chair informed Committee that if any members require additional clarification on their question then this can be discussed with herself or the Chief Officer at a later date.

ii) Planning Committee member

The Chair informed Committee that Mr George Planning PART A - 12.02.19 FINAL JW 2 Clemow, Chair of Council was attending his last ACTION Planning Committee meeting today as he has elected to join the Scrutiny Committee going forward.

P.18/78 DECLARATION OF INTEREST

Mr Brian Kember declared an interest in item 4 on the agenda: Presentation from Mr Andrew Walker on the integrated Health and Well-Being Centres in Tredegar and Ringland.

P.18/79 PRESENTATIONS FROM ANEURIN BEVAN UNIVERSITY HEALTH BOARD

Mrs Nicola Prygodzicz, Director of Planning and Mr Andrew Walker, Specialist Critical Care Centre (SCCC) Project Director of Planning gave a presentation to Committee on the Clinical Futures – Estates Strategy.

a) Clinical Futures - Estates Strategy

Mrs Prygodzicz stated that the Aneurin Bevan University Health Board are keen to make sure that the estates needs are maximised to support the delivery of the clinical service models and to make sure that the estates are fit for purpose. A plan for the current/future development and management of the estate strategy in the next 5 – 10 years is very important and includes far more than the new Grange University Hospital.

Mr Walker continued and stated that the presentation would cover the following areas:

i. Where are we now? ii. Where we want to be? iii. How do we get there?

i) Where are we now?

Mr Walker updated Committee on the current and future health care needs and condition of all hospital sites and the key issues at each site.

Planning PART A - 12.02.19 FINAL JW 3 1. Three acute hospitals - , ACTION Nevill Hall Hospital and Ysbyty Ystrad Fawr.

i) Key Issues:

Mr Walker stated that the total floor area of the Aneurin Bevan University Health Board estate is just under 300,000 m2 with the Grange University Hospital covering 55,000 m2, which will significantly increase the Aneurin Bevan University Health Board’s footprint. The total operating estate costs is £56 million. Significant replanning/rationalisation will be required at the Royal Gwent, Nevill Hall and St Woolos Hospitals. St Woolos Hospital being key when inpatient beds are planned to be moved to the Royal Gwent Hospital when the Grange University Hospital opens. There will be little change at Ysbyty Ystrad Fawr but full utilisation of the site will be addressed. There is a plan at this site for a breast unit.

Most of the high significant backlog maintenance of £17.6 million is across the acute hospital sites. There is a large amount of office based services on these sites and car-parking is a problem, but following the opening of the Grange University Hospital the hope is to free up parking space, on these sites particularly at the Royal Gwent and Nevill Hall Hospitals.

2. Three owned Community Hospitals – County Hospital, and St Woolos Hospital.

i) Key Issues:

13% (8,000m2) of the Community Hospitals estate is underutilised or empty. There is a high and significant risk backlog of £3.2 million. St Woolos is largely not fit for purpose and will need major rationalisation following the opening of the Grange University Hospital. County Hospital is not fit for purpose with major redevelopment required. There will be little change at Ysbyty Aneurin Bevan but full utilisation of the site will be addressed.

Planning PART A - 12.02.19 FINAL JW 4 3. Two Private Finance Initiatives (PFI) Community ACTION Hospitals - Chepstow & Monnow Vale.

i) Key Issues:

Chepstow and Monnow Vale hospitals will need little change but full utilisation will be addressed as Chepstow and Monnow Vale hospitals have very high leasing costs of £2 million per year.

4. Mental Health Hospitals – St Cadoc’s Hospital, Llanfrechfa Grange Hospital, Maindiff Court & Ysbyty Tri Chwm. 8 units and 5 Learning Disability (LD) Residence.

i) Key Issues

41% (22,000 m2) of the Mental Health Hospital estate is underutilised or empty. St Cadoc’s Hospital is an older estate and is not fit for purpose with significant empty space. Llanfrechfa Grange Hospital and Maindiff Court are not fit for purpose and also has significant empty space with little clinical use. Agile working will need to be considered for the administration staff at both these sites. Ysbyty Tri Chwm is a relatively modern building with a plan for the mental health beds to be accommodated at Nevill Hall Hospital. The future of Ysbyty Tri Chwm is to be confirmed although there is potential to convert this site to a health and well- being centre for the Ebbw Vale area.

5. 161 Primary & Community Care sites, 26 owned, 18 leased, 117 GP owned

i) Key Issues

32% (4,000 m2) of the owned estate is underutilised or empty. There are 160 premises in total i.e. 25 Aneurin Bevan University Health Board owned premises; 117 GP owned premises and 18 leased premises. There is more work required on utilisation and disposition of all units in the context of GP and other public sector premises.

Planning PART A - 12.02.19 FINAL JW 5 6. Nine Non-Clinical Leased Premises ACTION

ii) Where do we want to be?

Mr Walker summarised the strategic drivers and objectives required to provide longer term health strategy, environmental strategy and estate performance criteria.

Strategic Drivers

1. Continued implementation of Clinical Futures 2. Grange University Hospital – Catalyst for major service and infrastructure change 3. Rationalisation and Centralisation of certain services 4. More services provided in primary and community settings 5. Health and Well Being Centres / Hubs 6. Mental Health becoming a priority 7. Technology 8. Advent of the “Agile” workforce 9. Integration with Public Sector partners

Strategic Objectives:

1. The reconfiguration of and rationalisation of Royal Gwent Hospital as a Local General Hospital, Elective Care Centre and Centre of Excellence for Care of Older People. 2. The reconfiguration and rationalisation of Nevill Hall Hospital as a Local General Hospital, Cancer Centre and Day Case Surgery Centre. 3. To ensure that existing services at Ysbyty Ystrad Fawr are appropriate, sustainable and fully utilised in the context of the new clinical models and develop proposals for a Centralised Breast Unit. 4. The reconfiguration of services on the St Woolos Hospital site following relocation of inpatient services to Royal Gwent, potential disposal/demolition of older site or whole site. 5. To review service provision required on the County Hospital site in the context of primary care/community services required in that area Planning PART A - 12.02.19 FINAL JW 6 followed by consideration of redevelopment ACTION potential on a smaller scale. 6. To ensure existing services and facilities at Ysbyty Aneurin Bevan, Chepstow and Monnow Vale are appropriate and fully utilised in the context of new clinical models. The Chepstow lease ends in 2025. 7. To review and understand existing Private Finance Initiatives (PFI) arrangements for Chepstow and Monnow Vale hospitals to ensure value for money. 8. To pursue the potential further development of St Cadoc’s as a “specialist” Mental Health Centre for Aneurin Bevan University Health Board via the Strategic Outline Case currently with Welsh Government. 9. To explore the potential for disposal/demolition of the older St Cadoc’s estate if the above is achieved. 10. To relocate in-patient services from Ysbyty Tri Chwm to Nevill Hall Hospital and explore the potential for the hospital to be re-used for other primary care and community based services. 11. To explore the potential for disposal of the whole or vast majority of the Maindiff Court site. 12. To urgently review the future use of the Llanfrechfa Grange site not required for the Grange University Hospital in the context of previous intentions to dispose of the site for Housing and the proposed Medi-Park. This needs to be looked at in more detail for possible future expansion of Aneurin Bevan University Health Board services. 13. To review location, content, condition and utilisation of existing Primary Care, Community Care and Mental Health Community based facilities in each Neighbourhood Care Network area in the context of other Aneurin Bevan University Health Board/Public Sector facilities. 14. Following the above review to produce a costed and prioritised plan for the creation of the proposed “Hubs” and other proposed service changes utilising the existing estate as far as is possible. Planning PART A - 12.02.19 FINAL JW 7 15. The Aneurin Bevan University Health Board to ACTION introduce a clear policy on the adoption of Agile Working principles that is fully endorsed as a means to assist in the reduction of the significant amount of office accommodation within the organisation. 16. Immediate – To assess the robustness of the calculation of high and significant risk backlog maintenance information. Following this a prioritised action plan will be produced to address and reduce the high and significant risks. To benchmark maintenance costs with other relevant organisations and assess how levels of maintenance can be increased over and above the current unacceptable levels and to finalise the new Energy Strategy which will contain specific, targeted and costed initiatives to both reduce emissions and achieve the Welsh Government Energy performance target.

Mr Walker stated that the above strategic drivers and objectives will develop realistic and feasible option(s) for the future estate that deliver the health strategy and improve estate performance.

A question and answer session followed.

a) A member queried if St Cadoc’s Hospital is the only site that has significant opportunities to realise capital receipts from underutilised areas, which could be spent on solving problems in other hospitals.

Mr Walker replied that the main site with this opportunity would be St Woolos Hospital which has been identified as being emptied/disposed of with services being moved into the Royal Gwent Hospital which may require some capital. This is now being looked into in more detail as it has its challenges i.e. whether to retain some of this area for car parking. Although this is a big opportunity it will require a lot of work with local authority to obtain planning permission etc.

The member felt that the capital receipts could be Planning PART A - 12.02.19 FINAL JW 8 spent on providing extra car parking which would ACTION ease the car parking situation at the Royal Gwent Hospital which is a major issue.

Mrs Prygodzicz stated that there has been an early discussion regarding the parking situation at Royal Gwent Hospital which is on-going at the moment.

b) A member asked when would consultation with the public commence on what will need to be retained at the County Hospital site.

Mr Walker replied that talks with stakeholder involvement needs to take place first and quite soon to consider what the redevelopment plan will look like but added that this will take time and monies. Mr Walker advised that consultation with the public will need to take place now as the services that need to be retained at this site for the local residents needs to be clear.

Mrs Prygodzicz stated that Mr Nick Wood, Director of Primary Care and Community, has said that this is a key project to take forward under his leadership and a key work-stream that will be bringing the key partners together.

c) A member enquired if with all the changes taking place could an urgent care assessment unit be set up in Ysbyty Tri Chwm.

Mrs Prygodzicz replied that if beds in Ysbyty Tri Chwm are transferred to Nevill Hall Hospital when the Grange University Hospital opens then this will free up space for other primary care services to be placed in Ysbyty Tri Chwm. Discussions are taking place to make the best use of the space.

d) A member requested more information on the reconfiguration and rationalisation planned for the Royal Gwent Hospital following the opening of the Grange University Hospital.

Mr Walker stated that there will be a big reconfiguration at the Royal Gwent Hospital with Planning PART A - 12.02.19 FINAL JW 9 approximately 470 maternity and trauma beds being ACTION transferred to the Grange University Hospital. 100 beds will be transferred from St Woolos Hospital to the Royal Gwent Hospital but space will still be available in Royal Gwent Hospital.

e) A member mentioned that she would be interested to see what the plans for the Centre of Excellence for the care of older people looks like and asked if there is a plan to increase the Springfield Day Hospital.

Mr Walker stated that the Springfield Day Hospital, located in the Casnewydd Unit at St Woolos Hospital, has 31 beds. The division would like to reduce the number of beds to 24 to accommodate more therapy space, rather than have separate therapy space. This is the physical plan that is currently being worked on for the day hospital.

Mrs Prygodzicz stated that there are a lot of plans that are a work in progress and informed Committee that an elderly frail unit model will be in place at the three acute hospitals Nevill Hall Hospital, Ysbyty Ystrad Fawr and Royal Gwent Hospital. The unit will not be called the centre of excellence but will incorporate a frail elderly unit which will include an assessment unit. Mrs Prygodzicz stated that this information had evolved since the current presentation that had been given to Committee at today’s meeting.

f) A member stated that he felt the site plans for St Woolos Hospital would cause consternation within the public as historically services had been transferred to the St Woolos Hospital due to lack of space at the Royal Gwent Hospital. The member stated that engagement with the public regarding these changes would need to be clear, concise and robust.

Mrs Prygodzicz stated that when the Grange University Hospital is opened, 8-10 wards will be moved from the Royal Gwent Hospital into the new hospital. Mrs Prygodzicz stated that engagement Planning PART A - 12.02.19 FINAL JW 10 with the public on the plans for St Woolos Hospital ACTION will need indeed to be articulate.

g) A member queried how many beds will be lost from St Cadoc’s Hospital, Llanfrechfa Grange and Maindiff Court.

Mr Walker replied that no beds will be lost in the reconfiguration; the beds will be transferred to other sites.

Mrs Prygodzicz stated that there will be no change to the number of beds available; 300 beds from Royal Gwent Hospital will be moved to the Grange University Hospital as will 170 from Nevill Hall Hospital; 100 beds will be moved to the Royal Gwent Hospital from St Woolos Hospital. This will free up physical space in both the Royal Gwent Hospital and Nevill Hall Hospital to accommodate beds from estates identified as not fit for purpose or underutilised. Mrs Prygodzicz reiterated that there was no planned reduction in the amount of mental health beds available at this point.

Mrs Prygodzicz offered to provide a presentation to Committee of what the bed shift will look like for Committee.

h) A member queried what, from a comparison factor, is the percentage of vacant or underused space in Aneurin Bevan University Health Board compared to other Health Boards.

Mr Walker replied that he did not have exact figures but stated that the percentage of vacant or underused space in Wales is high. Mr Walker stated that in comparison to the Carter report produced in England in 2016, Wales’ figures are bad. The Carter report target is set at 2.5 per cent unoccupied or underused space.

The member enquired as to how much capital is required going forward.

Mr Walker stated that there is a very high level of Planning PART A - 12.02.19 FINAL JW 11 capital needed going forward but did not have exact ACTION figures to quote but stated that it is approximately £200 million over the next five to ten years.

i) A member asked for clarification that if a patient is treated in the Grange University Hospital and then transferred to one of the acute hospitals for rehabilitation then the number of beds will surely need to remain the same in the acute hospitals.

Mrs Prygodzicz stated that this element has been included as part of the whole bed plan model in terms of the numbers.

The Chair requested a presentation for Committee from the Aneurin Bevan University Health Board on the bed shift proposals.

Action: Aneurin Bevan University Health Board NP to give a presentation to Committee on the bed shift proposals in the future.

b) Integrated Health and Well-Being Centre’s in Tredegar and Newport East by Mr Andrew Walker, SCCC (Special Critical Care Centre) Project Director, Planning.

Mr Walker stated that the presentation today would cover both Tredegar and Newport East (Ringland) Well-being centres as they had similar backgrounds in terms of GP issues, workforce, retirements and the increase in inpatient demand, which all impacted on sustainability. Discussions have taken place with Welsh Government regarding these sites since 2009/2010; with 20% of consultations dealing with social problems the concept of the health and well- being centre, which will house services that will take demand from GPs, was discussed. There is a lack of integrated services at the moment, which has resulted in poor health outcomes and chronic conditions for the population in these areas and also both sites are in a very poor condition.

Mr Walker stated that the current position is that Planning PART A - 12.02.19 FINAL JW 12 Welsh Government has approved capital for ACTION commencement of the outline business cases which will progress to full business case; with all building to be completed by December 2021. Stakeholder workshops have taken place for both sites and each centre will cost circa £14 million each.

Mr Walker talked through some of the challenges of this project, one being a tight programme and stated that Welsh Government will be scrutinising capital cost and building size. The Aneurin Bevan University Health Board will need to demonstrate that the running costs of the buildings are affordable with independent contractor stakeholders. Ownership of the projects going forward is very important because they are multi-use buildings and will need managing. Agile working is also important e.g. not creating huge office space. Developing real integration between the health services, well-being services and local authority services.

Mr Walker continued with the potential service provision of the Health & Well-Being Centres and the Neighbourhood Care Network Hub.

i) Integrated Place Based Team

1. General Medical Services 2. Midwifery 3. Public Health Nursing a. Health Visiting, School Nursing, Flying Start 4. Primary Care Mental Health 5. Community Multi-Disciplinary Team a. District Nurse, CRT, Adult Social Care, Third Sector providers

Mr Walker stated that the Newport East Neighbourhood Care Network Hub could potentially have the following services:

1. Family & Therapy Services 2. Sexual Health, Speech & Language, Direct Access Physio, Audiology, Dietetics, Podiatry 3. Mental Health & Learning Disability Services Planning PART A - 12.02.19 FINAL JW 13 Community Mental Health Team (CMHT), ACTION Memory Assessment Service, Community Learning Disabilities 4. Community Dental Services 5. Specialist Care e.g. Paediatrics, Cardiology 6. Well-being Support

Mr Walker drew attention to the slides demonstrating the outlay of the sites for the Tredegar and Newport East Sites.

Mr Walker stated that it would be preferable to demolish the existing hub on the Newport East site and the preferable plan at Tredegar is to keep part of the Hospital and also to utilise some of the land for car parking facilities.

A question and answer session followed.

a) A member enquired if the land in Bedwelty Park would be available for purchase as it is covenanted to the people of Tredegar and not the Council.

Mr Walker replied that following recent discussions the land in Bedwelty Park would not be required unless the Council demand that guideline parking is provided.

b) A member enquired when consultation will take place with the patients/public on both these projects.

Mr Walker replied that consultation has already taken place with stakeholders but further engagement will take place in the near future.

A member stated that in Tredegar, children’s services are lacking in the area and suggested that the café being introduced within the new well-being centre via the third party sector could be used for some of the services that are no longer offered in the area e.g. cessation of smoking, sexual health services and also training opportunities.

Planning PART A - 12.02.19 FINAL JW 14 Mrs Prygodzicz stated that there are a lot of ACTION discussions taking place on community opportunities within the Neighbourhood Care Network meetings.

c) A member enquired what method/avenues are used to communicate with the public to advertise proposals/consultations etc. as she has not seen any communication of this kind in her area.

Mr Walker stated that communication with the public is carried out in a variety of ways and stated that the Newport Community Hub is a location for stakeholder events which is publicised via health centres, newsletters and wherever public communications are placed for each area.

Mrs Prygodzicz stated that Mrs Claire Harding, Associate Director of Engagement has a workshop session tomorrow on ‘more formal engagement strategy’. Mrs Prygodzicz stated that 3 Talk Health Forums are held per year in each of the 5 boroughs and information is also distributed to Town Councils, Women’s Institutes, Youth Forums and Carer Networks and stated that if there is a specific issue then special sessions are set up. Mrs Prygodzicz stated that social media is also used to promote the information and that Aneurin Bevan University Health Board is keen to broaden its areas of communication with the public.

The Chief Officer stated that a presentation on the communication and engagement on the Integrated Health and Well-Being Centres in Tredegar and Newport East had been arranged some months ago but had unfortunately been cancelled. The Chief Officer expressed Committee’s disappointment regarding the lack of engagement detail delivered in the presentation. The Chief Officer stated she would be keen for a presentation on the communication strategy to be given to Committee at the next Planning Committee.

Action: Mrs Prygodzicz to give a presentation to NP the next Planning Committee on the Planning PART A - 12.02.19 FINAL JW 15 communication strategy. ACTION

A member expressed surprise that a comment had been made by Mr Walker that patients are not communicated with and stated that the Community Health Council should be involved from the beginning of any consultation and particularly the patients that are attached to any GP practice in question and to use the Community Health Council as a sounding base for any engagement.

Mr Walker replied that when there is something to share to user groups, professionals and patients it will be shared.

d) A member asked if there was any user involvement at the ground floor.

Mr Walker again replied that when there is something to share to user groups, professionals and patients it will be shared.

P.18/80 MRS NICOLA PRYGODZICZ DIRECTOR OF PLANNING AND PERFORMANCE, ANEURIN BEVAN UNIVERSITY HEALTH BOARD

a) Integrated Medium Term Plan (IMTP)

Mrs Prygodzicz stated that all Health Boards are required to submit a 3 year Integrated Medium Term Plan (IMTP) to Welsh Government on an annual basis. Mrs Prygodzicz stated that the Aneurin Bevan University Health Board’s Plan for the period 2019/20 – 2021/22 had been submitted to Welsh Government and is available to download online. The plan covers 100 pages. A 10-12 page summary plan will be available. A copy of the 100 page document will be forwarded to Members.

Action: The Administrative Assistant to forward AO a copy of the summary Integrated Medium Term Plan (IMTP) to members of the Planning Committee.

Mrs Prygodzicz continued with the seven service Planning PART A - 12.02.19 FINAL JW 16 change plans within the plan: ACTION i. Improving Population Health and Well Being ii. Delivering a Seamless System of Health, Care and Wellbeing iii. Management of Major Health Conditions iv. Mental Health and Learning Disabilities (MH/LD) v. Urgent and Emergency Care vi. Planned Care vii. Service Sustainability and Regional Planning

The key enablers being:

i. Workforce ii. Innovation, Development and Research iii. Digital Health iv. Finance v. Capital and Estates vi. Governance

Mrs Prygodzicz discussed with Committee the topics that have been strengthened this year within the Integrated Medium Term Plan (IMTP). There is increased detail on the 3 year plan in Clinical Futures, particularly the transition plans leading up to the opening of the Grange Hospital; also work with Local Authorities through the Regional Partnership Board (RPB), which emphasises the work being carried out on some of the main transformation areas.

Mrs Prygodzicz suggested that it may be useful for the Planning Committee to have a presentation on the 4 big projects that have been submitted by the Aneurin Bevan University Health Board with regard to the funding of £13 million received from Welsh Government for three transformation projects.

Mrs Prygodzicz stated that improved performance is probably the biggest challenge within the plan. Detailed trajectories are required with the 36 week waiting times, Accident and Emergency (A&E) performance, Mental Health access and smoking. The highest profile being obtaining a zero balance on the 36 week referral to treatment waiting list, which is planned to be realised by March 2019 and also Planning PART A - 12.02.19 FINAL JW 17 sustaining this balance. Although pressures ACTION experienced in the Accident and Emergency (A&E) department over the current winter period will have an effect on reaching this target. Another priority is diagnostics with patients waiting 8 weeks and sustaining this throughout the year. A key focus is to improve performance in Accident and Emergency (A&E) and the unscheduled care system, as patients waiting 12 hours and ambulance handovers taking 4 hours is not acceptable. The target is 95%. The aim is to improve performance in these areas significantly.

Financial balance over the three years is a key requirement. Welsh Government has given a 2% uplift in general growth this year to enable the Health Board to counter balance the financial planning.

Mrs Prygodzicz stated that as part of the Health Board’s commitment to delivering this plan, ten key priorities have been deduced, which will be given greater focus and enhanced executive leadership during 2019/20 to ensure delivery with pace and purpose i.e.

1. Progress at pace systems which support the positive engagement with and improving the well-being of Health Board staff.

2. An enhanced focus on smoking prevalence in the most deprived areas to reduce cancer inequalities across the Gwent region.

3. Fully implement the integrated well-being network, alongside the new workforce model for primary care in five Neighbourhood Care Network (NCN) areas to improve sustainability of Primary Care Services.

4. An innovative and patient centred approach to meeting needs of complex care in mental health; looking at new models of delivery to support patients closer to home.

Planning PART A - 12.02.19 FINAL JW 18 5. Implementation of a more integrated mental ACTION health and well-being services for children and young people (the ICEBERG model).

6. Significant improvement in the performance across the urgent and emergency care system with a focus on appropriate assessment, optimising flow and effective discharge to assess services with the ambition of eliminating 12 hour breaches.

7. An enhanced focus on efficiency, productivity and value based care with specific reference to clinical variation, theatre productivity and outpatient based projects including reduction in delayed follow ups.

8. An enhanced focus on our patient’s experience and working across the system to improve services based on feedback and active involvement from patients to better understand what matters to the people that use Health Board services.

9. Finalise and deliver transition plans leading up to the opening of The Grange University Hospital with a key focus on paediatric, obstetric and neonatal services in 2019/20.

10. Development of updated Cancer Strategy and 5 year plan including a key focus on delivering the single cancer pathway.

Mrs Prygodzicz stated that the Aneurin Bevan University Health Board has received approval status of the Integrated Medium Term Plan (IMTP) from Welsh Government over the last 4 years and is hoping to again achieve approval on the recently submitted Integrated Medium Term Plan (IMTP).

A question and answer session took place.

a) A member enquired about the 95% target that is set for performance in the Accident and Emergency (A&E) department. Is this target set Planning PART A - 12.02.19 FINAL JW 19 by Welsh Government? and does the Aneurin ACTION Bevan University Health Board set their own targets? The member felt, that although targets should be challenging, this target was unachievable.

Mrs Prygodzicz replied that Welsh Government set the target and that some Health Boards do reach the 95% target and recognised that a patient waiting 4 hours or more is too long. The Aneurin Bevan University Health Board is hoping to reach a target of 80-90% this year which will be a considerable improvement on last year’s figures.

b) A member enquired if the Neighbourhood Care Networks (NCN’s) have their own sub objectives and are they independently funded.

Mrs Prygodzicz stated that Neighbourhood Care Networks (NCN’s) bring people together in their area i.e. primary care, secondary care, third sector and social services with the main objective being to look at the needs of the local neighbourhood. They do receive some funding to meet local needs but the amount is relatively small. Neighbourhood Care Networks (NCN’s) are evolving with a greater level of maturity and is a development area.

c) A member enquired if there would be any benefit, during the winter period, in opening Ysbyty Aneurin Bevan or County Hospital over the weekend for minor injury patients.

Mrs Prygodzicz replied that minor injuries are not an issue in the Royal Gwent Hospital and in fact some of the majors are seen in the minor injury unit. Mrs Prygodzicz stated that she would take this suggestion back to the Aneurin Bevan University Health Board.

Action: Mrs Prygodzicz to take a members NP suggestion of opening Ysbyty Aneurin Bevan or County Hospital over the weekend for minor injury patients back to the Aneurin Bevan University Health Board.

Planning PART A - 12.02.19 FINAL JW 20 d) A member queried why Whiteheads car parking ACTION area is not utilised to site the porta cabins that are currently in situ on the Royal Gwent Hospital site which would free up car parking spaces in the Royal Gwent Hospital.

Mrs Prygodzicz stated that the Whiteheads site will be lost in the future plans so this would not be a viable option.

e) A member queried why obesity was not included in the ten key priority areas to be targeted in the Integrated Medium Term Plan (IMTP).

Mrs Prygodzicz stated that, although obesity is not listed in the ten key priorities in the Integrated Medium Term Plan (IMTP), the work in this area is still on-going within the Aneurin Bevan University Health Board. Mrs Prygodzicz suggested that she could provide a summary of the work being carried out on obesity in the Aneurin Bevan University Health Board for the member.

Action: Mrs Prygodzicz to provide a summary of NP the work being carried out on obesity in the Aneurin Bevan University Health Board for member, Mrs Ann Vincent.

b) Clinical Futures Progress

Mrs Prygodzicz continued with an update to Committee on the progress of the Clinical Futures strategy.

Mrs Prygodzicz stated that the Clinical Futures Delivery Board has been working hard over the last 6 months where all services have been looking at their 3 year plans with regard to how they work now and how they will work under the future system. Particular concerns were raised regarding how another hospital will be staffed and also staffing another acute medical take into the system.

47 clinical models went through the planning process Planning PART A - 12.02.19 FINAL JW 21 challenge review. The models have been consolidated ACTION to create a system wide map of service provision across the healthcare system to reaffirm and clarify the role and purpose for each site. This is broadly consistent with the model described within the original consultation of the Clinical Futures Strategy.

Some workforce challenges have been identified on the four sites. There is a need for 10 middle grade doctors to enable the Ysbyty Ystrad Fawr, Royal Gwent and Nevill Hall Hospitals to run as general hospitals with the Grange being the main majors unit. It was decided initially to recruit 6 of the 10 middle grade doctors although, 100 applications were received and as the level of candidate was so high, 10 candidates were recruited. The new recruits will now be trained ready for the model that is being put in place.

Mrs Prygodzicz stated that communication with the public will begin shortly regarding the role of each of the hospitals going forward.

Five Talk Health Forums are planned from February to April 2019 to discuss the following:

i. Clinical Futures update ii. 111 Service iii. Women and Children’s Services

The remit of the 4 hospitals are as follows:

1. The Grange University Hospital

The Grange University Hospital will be a place people only access when they need specialist and/or critical care. A central hospital in Gwent that will provide care for people who are seriously ill or have complex problems or conditions that cannot safely be managed in one of the Local General Hospitals. It will provide a 24/7 emergency admissions service for patients requiring specialist and critical care services and a non-selective emergency take post 20:00 hours. Paediatric in-patient facility, neonatal care and consultant led obstetric service. Health Board Planning PART A - 12.02.19 FINAL JW 22 Trauma Unit. ACTION

2. Ysbyty Ystrad Fawr, Royal Gwent and Nevill Hall Hospitals

Ysbyty Ystrad Fawr, Royal Gwent Hospital and Nevill Hall Hospitals will all deliver the majority of hospital services focusing on general and routine care; elective, sub-acute, rehab, palliative, therapies, out patients, investigations. A 24/7 Minor Injuries Unit, Out of Hours Primary Care Centre. Assessment and Treatment Centre for Care of the Elderly and Frailty through Elderly Frail Units. Enhanced services will include MRI (Magnetic Resonance Imaging), CT (Computed tomography) and medical assessments (8:00 to 20:00).

3. Royal Gwent Hospital

The Royal Gwent Hospital will be the main elective inpatient surgery centre with enhanced post-surgical recovery facilities.

4. Nevill Hall Hospital

It is planned that Nevill Hall Hospital will have a Satellite Radiotherapy Unit with a local Cancer Services hub.

5. Ysbyty Ystrad Fawr

Ysbyty Ystrad Fawr will also be a Breast Care Centre and remain the centre of excellence for foot and ankle surgery.

A question and answer session followed:

a) A member asked if there will be a clear definition of what minor injuries are.

Mrs Prygodzicz replied that engagement regarding communicating the clear definition of minor injuries will take place with the public via an engagement plan, which will also include scenarios. Mrs Prygodzicz stated that a telephone triage system is Planning PART A - 12.02.19 FINAL JW 23 being considered. ACTION

The Chair asked if the engagement plan was available to view.

Mrs Prygodzicz stated that the final engagement plan is not yet available.

The Chief Officer stated that a draft version of the plan had been viewed by the Aneurin Bevan Community Health Council and concerns within the plan had been forwarded to the Aneurin Bevan University Health Board. The Chief Officer stated that a presentation of the final engagement plan would be advantageous for a future Planning Committee meeting.

Action: Mrs Prygodzicz to offer Committee a NP presentation on the final engagement plan.

P.18/90 QUESTIONS FROM MEMBERS OF THE PUBLIC

There were no members of the public present.

P.18/91 DATE OF NEXT MEETING

The Chair informed all attendees that the next Planning Committee meeting would be held on Tuesday 9th April 2019 at 10.30 am.

Planning PART A - 12.02.19 FINAL JW 24