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 http://servicepoint.hsw.wales.nhs.uk/files/customer/9/2/6/92631/SF.EH.0112.08 - Doc 3 - Williams Report.doc Page 2 of 35 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. http://servicepoint.hsw.wales.nhs.uk/files/customer/9/2/6/92631/SF.EH.0112.08 - Doc 3 - Williams Report.doc Page 3 of 35 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. http://servicepoint.hsw.wales.nhs.uk/files/customer/9/2/6/92631/SF.EH.0112.08 - Doc 3 - Williams Report.doc Page 4 of 35 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.