Agenda item

To submit a report by the Betsi Cadwaladr University Health Board.

The Chair welcomed Mr Dyfed Edwards, Chair of the Betsi Cadwaladr University Health Board and Mrs Carol Shillabeer, Chief Executive – Betsi Cadwaladr University Health Board to the meeting.

The Chair noted that a report had been presented by the Betsi Cadwaladr University Health Board to this Committee.  In considering the report, the following were points of discussion by the Committee:-

·     Questions raised as to how it is intended to further develop joint working between the Health Board and the Local Authority’s Social Services Department.

·     Reference was made that the voice of the patient is important when dealing with their care needs.

·     Reference was made that report notes significant progress made by the Health Board in addressing the critical issues which led to special measures intervention.  Questions raised as to what the key challenges and risks will impact on the ability of the Health Board to maintain its’ continued improvement journey.

·     Questions were raised as to what degree does the Health Board share and learn from good practice examples in other areas to improve services in rural areas like Anglesey and how can Elected Members forward their electorate concerns to the Health Board.

·     Reference was made that following discussions at this Committee in November 2023 it was agreed that the Health Board would identify a contact point for response to statutory consultation processes associated with significant planning applications.  Questions were raised as to whether the Health Board has identified a contact point to respond to the statutory consultation process on planning applications.

·     Reference was made to the long delays with the Accident and Emergency Department and questions were raised as to how the Health Board will address this issue.

·     Questions were raised as to what examples can the Health Board provide to demonstrate an improvement in organisational culture in the Health Board over the last 12 months.

·     Reference was made to the waiting list for Additional Learning Needs assessment. Questions were raised as to how the Health Board and the Local Authority work in collaboration to reduce the waiting list.

·     Questions were raised as to the effect on the health service when people do not attend GP and hospital appointment.

·     Questions were raised as to the turnover of staff within the Health Board due to pressures of working in the health sector.

·     Reference was made that the dental service for under 16, has closed recently at the Penrhos Stanley Hospital.  Questions were raised as to the provision afforded for dental services for the under 16 on Anglesey.

·     Questions were raised as to how communication with patients awaiting treatment can be improved.

·     Questions were raised as to what degree does funding for end-of-life hospice care have an impact on the effective hospital discharge.

The response of the representatives Betsi Cadwaladr University Health Board and Officers to the questions raised were as follows:-

·     The Chair of the Betsi Cadwaladr University Health Board expressed his appreciation for the positive collaboration between the Health Board and the Isle of Anglesey County Council and the commitment of the Chief Officers of the Council to ensure good working relationship with the Health Board.  The Chief Executive of the Health Board said that joint working with the Local Authorities is paramount to patients care and well-being.  She gave an example of collaboration with the Local Authority as regards to the Primary and Community Care project in Holyhead. 

·     The Chair of the Health Board agreed that the voice of the patient is paramount to the improvement of the improvement journey of the Board.  The Chief Executive of the Health Board said that work has recently been undertaken as regards to Mental Health and the experience people have had during their difficult situations.  She said that the Board wishing to be an open, transparent and engaging Health Board.

·     As regards to the key challenges and risk which impact the ability of the Health Board to maintain its’ continued improvement journey, the Chief Executive of the Health Board said that there is an Annual Structural Assessment and Audit Wales prepares a report on the progress achieved together with risks and challenges.  She noted that the recent progress has resulted in clarity of the issues that needs to be addressed, and 5 strategic objectives has been set out.  She further referred that as the Health Board is in continued special measures, the Board must show continued progress to Welsh Government.  The Chair of the Health Board outlined as to how the Board needs to show a culture of continued improvement journey which is linked to Leadership and sustainability of staff.  He noted that there has been a high turnover of staff within the Leadership Team Board over the years.

·     In response to questions as to how Elected Members can communicate with the Board when matter arise within their electoral wards, the Chair of the Health Board suggested that a briefing/forum session could be arranged for Elected Members to express their concerns. 

·     Regarding questions as to improvement of Health Care provision in rural areas, the Chair of the Board said that he considered that the Health Board should lead on the discussion as regards to how health provisions are afforded within rural area and to learn from good practices within other areas to improve the service provided.

·     In response to questions as regards to a contact point in the Health Board to respond to statutory consultation on significant planning applications the Chair of the Health Board said that a framework has been established to respond to significant planning applications.  The Chief Executive said that he would discuss with the Group Leaders the focal contact between the Health Board and the Local Authority when significant planning applications are submitted as 10 to 15 houses could have a significant impact on a rural community as regards to health services in the area.  

·     As regards questions relating to the long delays in the Accident and Emergency Department the Chair of the Health Board responded that it is accepted that there are long delays and especially during the weekends due to lack of access to other medical assistance.  He expressed that the Emergency Department need to be for medical emergencies only and people should consider carefully if they need to attend A+E and.  He noted that attending a pharmacy for assistance and advice is available.  The Chief Executive of the Health Board said that there is a facility of same day Emergency Care provision in Ysbyty Gwynedd which has been successful.  She expressed that communication with people needs to be improved as regards to the other facilities provided for advice on medical issues are available rather than going into the A+E Department which can overwhelm the department with patients awaiting long periods. 

·     In response to the questions raised as to what examples can the Health Board provide to demonstrate an improvement in organisational culture in the Health Board over the last 12 months, the Chair of the Board said that through the improvement journey of the Health Board there needs to be openness with people and staff of the Board.  The Chief Executive of the Health Board said that the assistance of expert in the field of improvement of services has been undertaken with the Board.  She agreed that staff engagement is important in any organisation to improve the health service within the Board.  Training and engagement have been undertaken with staff and it is considered that they will be able to respond whether there is improvement to the organisational culture.

·     Regarding the questions raised as to how the Health Board and the Local Authority work in collaboration to reduce the waiting list for Additional Learning Needs assessment, the Chief Executive of the Health Board said that there is a nation-wide concern as to the waiting list for ALN assessments.  She accepted that referrals for ALN assessment can seem a long process with numerous appointments required to have a diagnosis.  She noted that there is an all-Wales Conference to be held at the end of this month to discuss how to address the ALN assessment process.  The Chief Executive said that the delay in ALN assessment has an impact within the schools and staff and long-term solution needs to be addressed.

·     In response to the questions regarding the effect on the health service when people do not attend GP and hospital appointment, the Chair of the Board said that some people have a tendency of attending the A+E Department rather than attending GP appointments which result in backlog in the A+E Department.  He considered that there is a need to educate people on the need to attend pre-arrangement appointments and GPs should also highlight the issue of missed appointments.

·     Regarding the questions as to the turnover of staff within the Health Board due to pressures of working in the health sector, the Chief Executive of the Health Board responded that there is around 8% of turnover within the Health Board each year.  She noted that some staff are contracted for a fixed term, staff  retire, and some staff have promotion within the health service.  There has recently been a national recruitment process to recruit nursing staff.  She expressed that it is important that staff feel that their role is fulfilling and that they are making a difference and that their skills are appreciated. 

·     In response to questions regarding the closure of the dental provision at Penrhos Stanley Hospital, the Chief Executive of the Health Board said that the Health Board has been reliant of the independent contractor models for dental provision.  She noted that independent contractors are moving away from the dental provision and dental surgeries are showing interest in affording dental facilities.  She further said that dental provision is under served within the North Wales region but there are 6 dental practices on Anglesey that afford NHS urgent dental services and other non-urgent provision.    

·     In response to questions as to how communication with patients awaiting treatment can be improved, the Chair of the Health Board said that he agreed that communication need to be improved across the Health Service.  He expressed that the experience of patients attending the health system needs to be improved.  Whilst in special measures, the Health Board is trying to improve the provision with the health and well-being sector and to ensure that the best possible health care can be afforded to the people of North Wales.  

·     Regarding the questions relating to what degree does funding for end-of-life hospice care have an impact on effective hospital discharge, the Chief Executive of the Health Board responded that revised plans are currently been undertaken by Welsh Government as to how to fund hospices.  The Health Board has increased their funding towards hospices over the year.

The Chair thanked Mr Dyfed Edwards and Mrs Carol  Shillabeer,  for attending the meeting.

ACTION :  That arrangements be made to convene a briefing/forum session with representatives from the Health Board and Elected Members so that Members can express their electorates experiences and concerns as regard to the provision of health care.