Transforming Clinical Services Phase 2 Consultation Closing Report 1 Contents 1. Introduction .......................................................................................................................... 5 1.1 Background .................................................................................................................... 5 1.2 Structure of the Closing Report .................................................................................. 7 1.3 What is Transforming Clinical Services ..................................................................... 8 1.3 Health Services in Hywel Dda University Health Board ....................................... 10 1.3.1 The Hywel Dda University Health Board landscape ...................................... 10 1.3.2 What we have at present .................................................................................... 11 2. The need to change ......................................................................................................... 12 2.1 Our Changing Health Needs ..................................................................................... 12 2.2 Our Key Challenges ................................................................................................... 13 Safe services .................................................................................................................. 13 Sustainable Services ..................................................................................................... 14 Accessible Services ....................................................................................................... 15 Kind Services .................................................................................................................. 15 2.3 The National Context .................................................................................................. 16 3. Approach to Engagement ................................................................................................ 19 3.1 Background .................................................................................................................. 19 3.2 Internal and External Assurance .............................................................................. 20 3.3 Formal Engagement (Stage 1) ................................................................................. 22 3.3.1 Engagement through Phase 1 - The Case for Change ................................. 23 3.3.2 Engagement through Phase 2 - Shaping the Future of Health and Care ... 26 4. Options Development and Proposals for Future Models of Care ............................. 27 4.1 Developing the Options .............................................................................................. 27 4.2 The proposals for future models of care ................................................................. 31 4.2.1 The Strategic Vision for Community Services ................................................. 31 4.2.2 The Three Proposals ........................................................................................... 32 4.2.3 Areas Not Open to Influence .............................................................................. 34 4.2.4 Areas Open to Influence ..................................................................................... 35 5. The Consultation (Stage 2) ............................................................................................. 35 5.1 How did we engage and communicate with people during the consultation ..... 37 5.2. Approach to Equality Impact Assessment ............................................................. 42 5.2.1 Equality Impact Assessment .............................................................................. 43 2 5.2.2 Consultation Events and Additional Activity with Equalities Groups ........... 46 5.3 Continuous Review of Feedback .............................................................................. 48 5.3.1 What we heard and how we responded during consultation ........................ 49 5.4 The Consultation Responses .................................................................................... 52 5.5 The Consultation Analysis ......................................................................................... 53 5.5.1 The Case for Change .......................................................................................... 53 5.5.2 Community Services ........................................................................................... 53 5.5.3 Planned and Urgent Care ................................................................................... 55 5.5.4 Support for the Proposed Options ..................................................................... 57 5.5.5 Meeting the challenges ....................................................................................... 58 5.5.6 Proposal A ............................................................................................................. 59 5.5.7 Proposal B ............................................................................................................. 60 5.5.8 Proposal C ............................................................................................................ 60 5.5.9 Another Alternative .............................................................................................. 60 5.5.10 Other Feedback ................................................................................................. 60 5.5.11 The Consultation Process ................................................................................ 61 5.5.12 The Political View .............................................................................................. 62 5.5.13 Equalities Related Feedback ........................................................................... 63 5.5.14 Petitions ............................................................................................................... 66 5.6 Interpreting the Consultation Analysis ..................................................................... 68 5.7 Feedback from the Consultation Analysis .............................................................. 69 5.7.1 Travel, transport and access .............................................................................. 69 5.7.2 Infrastructure ......................................................................................................... 69 5.7.3 Ambulance Capacity............................................................................................ 70 5.7.4 Resourcing ............................................................................................................ 70 5.7.5 Location of the new hospital ............................................................................... 71 5.7.6 Community Hubs and Beds................................................................................ 72 5.7.7 Lack of Detail ........................................................................................................ 72 5.7.8 Transition Plan ................................................................................................. 72 5.7.9 Another alternative for Pembrokeshire ............................................................. 73 5.7.10 Regional considerations ................................................................................... 73 5.7.11 Alignment with Mental Health .......................................................................... 74 5.7.12 Integration across health, social care and third sectors .............................. 74 3 5.7.13 Prevention ........................................................................................................... 74 5.7.14 Primary Care ...................................................................................................... 74 5.7.15 Technology Enabled Care ................................................................................ 75 5.8 Considering the Consultation Analysis Feedback ................................................. 75 5.8.1 The Plan for Conscientious Consideration ...................................................... 75 5.8.2 The Outcomes of Conscientious Consideration ............................................. 78 5.8.3 Alternative proposals and suggestions ............................................................. 89 5.8.4 Consideration of alternative locations for proposed new hospital site ........ 91 5.8.5 Formal Response from Hywel Dda CHC ......................................................... 94 6. Recommendations ............................................................................................................ 98 8. Programme approach for developing the Health Strategy ....................................... 107 9. Annexes............................................................................................................................ 108 10. Appendices .................................................................................................................... 108 Appendix 1 – Equalities Impact Assessment Screening .................................... 109 Appendix 2 – Points Raised at Mid-Point Review and Action Taken .............. 113 Appendix 3 – Summary of Written Submissions .................................................. 116 Appendix 4 – Petitions ................................................................................................. 118 Appendix