CONWY LOCAL HEALTH BOARD

Minutes of the Meeting held on Friday15 September at Conwy Business Centre, Llandudno Junction

Present: / Mr D Scott / - / Chair
Mr W Thomas / - / Chief Executive
Dr M Duerden / - / Medical Director
Mr A Jones / - / Director of Public Health - Conwy & Denbighshire LHB
Mrs S Owen / - / Nurse Director
Mr N Stevens / - / Director of Finance
Mrs P Mowll / - / Director of Commissioning and Performance Management (Co-opted Member)
Mrs S Davies / - / Voluntary
Dr P Emmett / - / General Practitioner
Ms J Galvani / - / NHS Trust Representative (Associate Member)
Mr M Hughes / - / Optician
Mr I Howard / - / Conwy & Denbighshire NHS Trust (Co-opted Member)
Mrs B Jones / - / Local Authority (Director of Social Care and Health)
Mr G Jones / Local Authority
Mrs G Jones / - / Community
Mr P Jones / - / CHC (Co-opted Member)
Mr I Mitchell / - / Therapy
Mr D Owen / - / CHC (Associate Member)
Dr D Prichard / - / NHS Consultant Representative (Associate Member)
Mrs A Robinson / - / Carer
Mr A Taylor / - / Pharmacist
Mr A R Todd / Local Authority
Mr K Toy / - / Local Authority
Dr M Walker / - / General Practitioner
Mrs A Westmoreland / - / Voluntary
Dr D Whyler / - / General Practitioner
In Attendance: / Miss L Bellamy / - / Secretary, Corporate Services
Mrs N Temple - Morris / - / Executive Assistant
Apologies: / Miss M Blagojevic / Corporate Services Manager
Miss C Dubourg / Dentist
Mrs J Murfin / - / Nurse
Mr M Stevens / - / Trade Union Representative (Associate Member)

06(080)APOLOGIES/PERSONALIA

Apologies were given to the Board by Miss C Dubourg, Mrs J Murfin, and Mr. M Stevens.

The Chair welcomed the Board Members and the Public to the extra ordinary meeting, and expressed his awareness of the depth of feeling as the attendance showed.

06(081)DECLARATIONS OF INTEREST

Dr Paul Emmett, Dr David Whyler, Dr Mark Walker Mr Iain Mitchell and Dr David Prichard expressed Declarations of Interest.

06(082)DESIGNED FOR NORTH WALES – A VISION FOR THE HEALTH COMMUNITY AND A PLAN FOR THE MAJOR HOSPITAL SERVICES

The Chief Executive gave a short presentation on the ‘Designed for North Wales’ consultation.

Board Members then held a discussion about the principles of the review and the specific implications of taking the recommendations

forward.

There were a number of concerns raised about the lack of detail in the report, especially in the area of developing services within community and primary care settings to release capacity in the district general hospitals. The Chief Executive advised the Board that detailed plans would need to come back to Board to provide the detail and gain approval before service changes were implemented.

Concern was also expressed about the limited involvement of primary care and social care in the projectwith the possible outcome leading toadditional unfunded work in these sectors. The Chief Executive re-iterated the fact that detailed plans would need to come back to the Board and that these plans would be developed in consultation with primary and social care staff.

Board Members also sought clarification about the additional capital; and revenue costs to the plan. The Chief Executive informed the Board that there was significant additional capital money available (subject to business case approval) at the Welsh Assembly Government over the next few years should any investment of this type be required in acute or community facilities. The Chief Executive also acknowledged that the assumption at the planning stage was for the revenue consequences contained within the plan would be contained within the recurrent £850 million funding already being utilised within N. Wales; however it had been identified that some transitional funding may be required and there were now some indications that WAG had recently acknowledged this fact.

Board Members then requested that a caveat to recommendation 7.2.1 be developed to provide them with the necessary assurances regarding the above. A ten minute adjournment was taken to enable a draft of the agreed wording of the caveat to be produced.

The Board then discussed in detail the proposed transfer of the Coronary Care Unit and Breast Surgery from LlandudnoHospital. The Medical Director of the North West Wales NHS Trust provided the clinical reasons for the proposals including National Service Frameworks, clinical support in and out of hours and the ability of the Llandudno site to meet the necessary standards for theseservices without a significant increase in resources. The Medical Director of the LHB reinforced the views given.

Board Members sought clarification on the level of investment required for other site options. A discussion also took place on the implications for the Ambulance Service and both DistrictGeneralHospitals of transferring the Coronary Care Unit from Llandudno. There was also a discussion on whether there was any scope to expand breast services at LlandudnoHospital and subsequently why Llandudno wasnow not considered a suitable site for breast surgery centralisation, when it had been the preferred site just over a year ago.

While Board Members generally were persuaded of the clinical arguments to move the CCU, there was concern that any transfer should only take place when additional capacity was established at the two district general hospitals and the implicationsfor the Ambulance Service has been identified.

Board Members also requested further information to be provided on the implications of developing Llandudno as the Breast Surgery Centre for the North West Wales and Conwy & Denbighshire health communities as they did not believe they had enough information to support the proposal as it stood. In addition the Board requested that no transfer take place until it had received a full and detailed report on this matter.

The Board then considered the individual recommendations in the report and resolved as follows;

It was resolved that:The Board acknowledged the comments and concerns expressed during theconsultation process. The recommendations before the Board had been prepared inthe light of the consultation. The programme of work spelt out in sections 6.1, 6.7, 6.8, 6.9 and 6.10 of thispaper was designed to address those concerns through the next phase of development,and the Board committed to progressing this work in partnership with other agencies.

1.That the Board formally approves the following:

1.1.That it will redesign services, as appropriate, such that resources currently invested inhospital beds will be reinvested more effectively in community services. This willprovide better access for patients and will help manage the growing demand on healthservices into the future. This was agreed subject to there being effective and adequate plans in place for primary, community and social care services, these plans must clearly demonstrate that the new services will be in place before existing services are withdrawn.

1.2.That the acute services currently provided in North Wales are consolidated onto thecurrent three major sites in North Wales, Ysbyty Gwynedd, Ysbyty Glan Clwyd andthe Wrexham Maelor hospital. These will be underpinned by the development ofclinical networks of care across the sites.

1.3.That the residents of North Wales will continue to use the services at Countess ofChester, Bronglais Hospital, Aberystwyth, and Robert Jones and Agnes Hunt Hospital,Gobowen

.

1.4.That there will be consequential changes to the location of some services.

These are:

1.4.1.For LlandudnoHospital

  1. The acute medical and coronary care services currently provided at LlandudnoHospital site will transfer to Ysbyty Gwynedd and/or Ysbyty Glan Clwyd once the Board is assured by North West Wales, Conwy & Denbighshire and the Welsh Ambulance Services NHS Trusts that effective services are in place to meet the needs of the population.
  1. Given clinical and public concern about the transfer of breast surgery from Llandudno Hospital, the Boardwas not persuaded that the case had adequately been made for the transfer of this work to a district general hospital, and asked that;
  1. Further work was done to consider the clinical, operational and financial consequences of developing Llandudno as the breast surgery centre for the North West Wales and Conwy & Denbighshire health communities, and
  1. That no transfer took place until the work was completed and the Board received and considered the findings.
  1. The development of the site to have a major role in the provision of level 1 andlevel 2 services to the local population and the wider North Wales community.The process for settling the details will be led by Conwy LHB and agreed with theCHCs and Conwy County Borough Council and completed within six months.

2.4.2For AbergeleHospital

  1. The movement of the orthopaedic services to YsbytyGlanClwydHospital.

2.4.3For H.M.StanleyHospital

  1. The movement of ophthalmology services to YsbytyGlanClwydHospital oralternative suitable accommodation.
  1. The movement of stroke rehabilitation services to more suitable accommodation.

2.5That the highly specialist, tertiary services will continue to be provided as currently, with most of these services being in the major centres in Liverpool and Manchester.

2.6That the programme of work will be undertaken in partnership with the other agencies whose support is critical to delivering the changes. These include the local authorities, the voluntary and independent sector providers of care and the CHCs.

2.7That the suitability of the current organisational structures to support the future reconfiguration of services will be tested.

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ConwyLHB – Public15 September2006