Saturday, 25 February 2012

Aberystwyth Promenade must remain our jewel in the crown...........

I recently read a Ceredigion County Council report on the Aberystwyth Regeneration Area which is to be presented to Council Cabinet on the 21st February. This gives authority for Council officers to proceed with identified regeneration projects – one of which is the long-overdue redevelopment of the Promenade’s former Bay Hotel (Grade II listed) and the land to the rear which is currently the Bath Street Car Park.

It goes without saying that Aber’s Victorian Promenade should be the ‘shop window’ of our town and I’m sure everyone will welcome that steps are now being taken which have the potential to reinvigorate the area and stimulate the local economy. It’s good news that the report highlights the need for a high quality mixed use scheme which responds to the unique historic character of the site, as well as supporting the tourism economy of the town; in other words, something which properly fits in with Aber.

Any future scheme will be tied in with the Welsh Government’s Regeneration Area funding of £10.2 million and prospective developers will also have to adhere to the principles set out in the Aberystwyth Masterplan of 2007. Mention of the Masterplan will no doubt remind regular readers of how two years ago the ambiguity surrounding regeneration proposals for Chalybeate Street caused a great deal of angst and uncertainty. Similarly in 2010, there were also concerns that the Promenade’s new motorcycle corral (located opposite the Bandstand), was passed by Cabinet with inadequate consultation. Whatever type of development is eventually chosen for the site of the ‘Bay Hotel’, I sincerely hope that the local authority will learn from the mistakes of the past and will ensure that as well as the required stakeholder consultation process, we see clarity and accountability from our elected representatives on these matters.

Sunday, 19 February 2012

When is a consultation not a consultation: when it’s an engagement and listening conversation with options!

Last Thursday morning at County Hall, Aberaeron, representatives of the Hywel Dda Health Board met with Ceredigion County Council to make a presentation regarding their latest controversial document:Your Health Your Future. Councillors had asked for the Health Board to attend this meeting some time ago and the Chamber was full - (a high turnout of councillors and also members of the public who were sitting in the public gallery).

The presentation comprised of showing the DVD which accompanies the Health Board’s document, (a copy of which has now been sent to every household within the Hywel Dda area). This figure has not been confirmed, but it is said that this DVD has cost around £ 120,000 to produce. I listened with interest when I heard the Hywel Dda Chief Executive, Trevor Purt, state that the purpose of going out to the public with this information was not to consult, but rather to ‘engage, listen and have a conversation’. He went on to say that the set of loosely formed ideas being put forward in the presentation were just that. They were in no way proposals or plans; simply ‘options’ for people to consider. Given the alleged cost of the DVD, I will leave readers to draw their own conclusions on that particular point. However, at some stage over the next few weeks, the Hywel Dda Health Board actually hopes to put together a consultation document which will apparently have clearer, stronger proposals in it.

The Hywel Dda representative who introduced the presentation listed the problems which we are faced with in this area and acknowledged the geographical service area of Bronglais Hospital to North Cerdigion and Powys, but then unfortunately, promptly forgot to mention South Gwynedd. It is estimated that 35%-40% of patients who use Bronglais reside in these areas outside of Ceredigion, although they will not have received a copy of the Engagement with Options DVD.

The challenges we are faced with were once again duly listed:
• an ageing population
• rurality equals too few patients plus extra challenges
• 40 % of patients are in hospital who do not need to be there (allegedly)
This was polished off with the Health Board’s mantra: ‘Standing still is not an option……….’
(Something we all accept, but which doesn’t mean that we should adopt plans which are inadequately researched and patently unsafe).

Community and Primary Health Care

The Health Board representative went on to say the way forward needs to be placing an emphasis on self-management of chronic health conditions and Trevor Purt said that they would be investing more money in primary and community health services which would enable people to stay at home for longer, although at this stage, no figures were mentioned.
This of course would require communities being able to access nursing care on a 24/7 basis. This currently does not happen in Ceredigion. The introduction also mentioned that Tony Chambers who is in charge of the Board’s Operational Planning would be going on to talk in detail about community services - I was really looking forward to this part, particularly as I thought we might get some meat on the bones on the funding detail and how this idea would be rolled out in parallel with a reduction in hospital based services. However, when we eventually got to the slide about primary and community care, disappointly, he made reference to this being a ‘work in progress’ and then moved swiftly on.
The chair of the Social Services Committee for Ceredigion County Council stated that Hywel Dda were currently not really offering community services on a health basis at all and that in his experience, continuing health care packages were not being offered. He urged the Health Board:
‘Get your act together now, and then we’ll support you about changes………’
At this juncture, Trevor Purt acknowledged that ‘things are not good……’
The councillor went on to say:

‘There is currently a cutting back of continuing health care packages, so how can there possibly be 24/7 care?’

The unique geographical location of Bronglais Hospital

Mr. Chambers told us that Hywel Dda was probably one of the largest rural health providers in the UK - (a fact you never would have guessed I’m sure!), but full marks, he did actually remember to mention South Gwynedd, even though later on when questions were asked, the HDdHB said that they were not commissioned to develop services for Mid Wales, even though this is the geographical area which Bronglais Hospital serves. Apparently discussions are going on with both Betsi Cadwaladr University HB and Powys LHB, but no detailed information was given about this or when the results of these discussions might be revealed.

When the Chief Executive was asked by one councillor;
‘Is there an argument to say that Mid Wales deserves it own health area or are we just hostages to fortune to the other health boards down the road?’,
Mr. Purt responded:
‘If Bronglais wasn’t part of Hywel Dda, it would be under even greater threat..’

The Golden Hour and transporting patients

No mentioned was made by any Hywel Dda Health Board personnel of the ‘Golden Hour’, however, they acknowledged how important it will be to have an excellent ambulance transfer service for emergency and trauma cases. No mention was made of the fact that both Glangwili and Singleton Hospitals are respectively 80 mins and 100 minutes driving time from Bronglais Hospital and that this of course falls well outside of the ‘Golden Hour’. Trevor Purt said that the HDdHB was looking to fund air ambulance transportation on a 24/7 basis. He may be interested to know that following presentations made to the Community Health Council in Aberystwyth last month, I can tell him that the Air Ambulance costs approx. £1,400 per mission. This money is raised through charitable donations although I understand that the actual training of paramedics is funded by the Welsh Government. As he was keen to tell us that he is a qualified pilot, Mr. Purt will know that the Air Ambulance can only be operational in appropriate weather conditions and does not generally fly at all at night – so much for 24/7! Presumably, the extra funding that Mr. Purt talks of which is needed to grow this service will be coming from the Welsh Government, but he didn’t offer any detail on this at all.

Hywel Dda HB and attendance at public meetings.

Apparently, the Health Board have not attended / failed to turn up to public meetings to which they have been invited because oftentimes, they experience hostility and abuse and it is logistically difficult to attend every meeting. One councillor quite rightly pointed out that not turning up to meetings (as was the case in Tregaron), after asking for community engagement and co-operation, was simply feeding a vicious cycle and equated to a PR disaster. If Hywel Dda has said that local support is crucial, then surely, so is turning up to meetings! Another councillor criticised the current programme of engagement meetings for Ceredigion which have thus far been held at times which are not convenient for working people to attend. There hasn’t been a mid-county meeting and the HDdHB have chosen not to follow any of the suggestions put forward by Ceredigion Community Health Council in terms of community engagement.


• Whilst I’m sure that the Health Board will have been pleased with their performance at this extraordinarily long meeting (4 hours plus), I’m afraid that they failed to come up with any proposals which maximize healthcare opportunities at Bronglais as a central hub hospital for Mid Wales. Of course, it is not their intention to do so or even listen to suggestions that this is worth exploration.
• Whilst they say they are conscious of Bronglais’ isolation, they do not acknowledge the importance of the ‘Golden Hour’, or the distances Mid Wales patients will be forced to travel in unsafe circumstances.
• HDdHB obviously do not want to discuss primary and community healthcare in any detail
• They are still not able to be clear in explaining the difference between ‘consultant led’ and ‘consultant-delivered’. Perhaps the truth is that they don’t even know themselves.
• Finally, these plans (….er sorry, ‘options’) have not been costed or logistically worked through.

I have lost all confidence in Hywel Dda Health Board’s intention of carrying out any listening activity at all. I do not believe that they are fit for purpose. Only the Minister can alter this situation if she has the courage to do so. If she fails to listen to the will of the people of Mid Wales at this most critical time, she will have missed a massive opportunity.

Tuesday, 14 February 2012

Wales can't afford to tax tourism

Following Silk Commission submissions last week, for those who are thinking of introducing a tourism tax, they might like to know that a recent proposal from a local authority to introduce a tourism ‘bed tax’ on overnight visitors in the city of York has been written off by the city’s tourism operators as discriminatory and damaging.
Apart from the damaging effect a tourism tax would have in these straitened times, in practical terms, it would be extremely difficult to enforce and collect. Those of us concerned with tourism will remember that the idea of a bed tax was suggested in the Lyons Report on Local Authority funding in 2006, but was instantly dismissed by the then Labour government. It is extremely surprising to discover that this idea has been resurrected and put before the Silk Commission as part of submissions received on ways to levy new taxes in Wales.
Currently, the British hotel industry already has to carry a 20 per cent VAT burden which overall, results in UK tourism being uncompetitive.
The fact is that all but three other EU member states have a reduced rate of VAT on hotel accommodation and many have also accorded a reduced rate on attractions and restaurant meals. Most hoteliers would agree that the current high rate of VAT makes the UK uncompetitive and that a ‘bed’ or tourism tax would only exacerbate that position.
At a time when we need to be supporting many SMEs, the fact is that coupled with extortionately high business rates already experienced by many operators, a tourism tax would encourage many small operators to close their doors altogether, particularly in Wales where we depend on the industry more than any of the other UK nations.
Deloitte’s Economic Case for the Visitor Economy (Final Report) illustrates the importance of tourism to Wales compared to other parts of the UK:
Total contribution to the Visitor economy in Wales in 2009 = £ 6.2 bn of GDP (13.3 % of the total economy)
This compares to 8.6 % in England and 10.4 % in Scotland which has a much stronger marketing brand than Wales.
The tourism industry in Wales employs 13% of the workforce compared to 8.3% in England and a quarter of all VAT registered businesses in Wales are in the visitor economy.
Tourism is essentially a labour intensive industry and creates jobs as well as supporting local and rural economies.
The fact is that in Wales, as an economic driver, as an employer and in its role as the guardian of both community facilities and opportunities, the tourism industry is of paramount importance and is irreplaceable. We can’t afford to tax it.

Sunday, 12 February 2012

Symud Ymlaen - Leaving the Welsh Conservatives

After long and careful consideration, last September, I took the decision to resign from the Welsh Conservatives. For those who are interested, (and a number of people have asked me), here’s why:
Politically speaking, it would be fair to say that I shall always espouse the politics of the centre- right, however, it won’t have been any secret to those who know me well that within the Welsh Conservatives, I was very concerned about the way the party is run and more particularly, about how the membership is treated. There were a number of members who shared my views and many friends and former colleagues urged me to either 'bite the bullet', or to try to change things from within. However, I discovered that sadly, there is very little appetite from within the party to bring about positive change to this effect, and last September I made up my mind. To rather crudely mix my metaphors, I arrived at this conclusion: if a horse doesn’t want to be led to water, then there ain’t no point flogging it until it’s dead!

Whilst it cannot be denied that Welsh Conservatives have done well in recent elections, it’s my belief that the way the party is run may not augur well for sustaining these good results and more importantly, for recruiting new members and appealing to people from all walks of life. No one individual is to blame for these problems, but as was evidenced by the party’s poor communication problems over the recent cancellation of their Welsh Conference, there really does need to be radical root and branch reform.

I think that most people would agree that the progress of any organisation is dependent on its reputation. In my opinion, in order to improve this, the Welsh Conservatives need to get their marketing right and to properly serve their members, (the people who are after all, the ‘shareholders’ in the company).
• Members need to see evidence that the professional party in Wales (the salaried arm of the party charged with administration) is properly performance managed.
• There needs to be better communication from the Party’s Management Board to the Party members.
It is a pity that it always seems to have been a struggle to find volunteers who are willing to stand for election to the Management Board, to such an extent that within the Party over the last few years, members have seen the same old suspects from the voluntary party hierarchy being ‘recycled’ back onto the Board. This is not good for party democracy or for introducing new ideas.
• There needs to be better communication with Party members overall.
Members want and need to feel a sense of belonging and inclusion and that their opinions are valued – this means making regular contact and not just asking them to deliver leaflets at election time!

Over the past twelve years that I was a member, I made many friends within the party and I was privileged to have served in the Assembly with a group who were for the most part talented and hard-working. I am very grateful to have experienced all of this and trust that the many friendships will remain, but I feel sure that those who know me well will understand that in order to remain true to myself, I now need to plough my own furrow.

Saturday, 11 February 2012

The fight for Bronglais - is it personal and emotional? You bet your life it is!

Last night in Penparcau Aberystwyth, 547 people squeezed into both Neuadd Coffa and St. Anne’s Parish Hall across the road to show their support for Bronglais Hospital and to oppose the proposals being put forward by the Hywel Dda Health Board in respect of health services within the area. The meeting was superbly organised by Aberystwyth Town Council and knowing the strength of feeling and the likely high turnout, a video link was set up to relay proceedings from one hall to another.
As the numbers swelled in Neuadd Coffa, the doors were opened up so that those who were standing outside could also hear what was going on. It was biting cold, but no-one seemed to notice. People came from Dolgellau, Tywyn, Corris, Machynlleth, Aberaeron, Tregaron, Llanidloes and Llangurig in a display of solidarity for their nearest District General Hospital – Ysbyty Bronglais and its staff.

Whilst they had been invited to attend, conspicuous by their absence were representatives of the Hywel Dda Health Board.

ABER* Group member, Jack Evershed gave a very clear and precise presentation about what the proposed changes would mean for the hospital and for health services in our communities - a presentation which contrasted markedly with the vacuous engagement document: Your Health Your Future which has been put out by Hywel Dda in an attempt to elicit public opinion about their proposals.

As has been said before, removal of colo-rectal surgery from the hospital means effective removal of skilled abdominal surgery. This in turn leads to a diminishing of A & E because A & E cannot be properly supported without skilled abdominal surgery. In a medical emergency, this impacts on people’s survival chances and also upon the ‘Golden Hour’ - so vital for anyone living in any of the areas mentioned above.

We in Ceredigion, have been asked to comment on Hywel Dda’s proposals. Proposals which have not been properly costed or thought through – plans which are so scanty in their detail that they are an insult to the intelligence of the people of Ceredigion, South Gwynedd and Western Powys. What also needs to be said here is that the people of South Gwynedd and Western Powys, (who actually make up approx. 30% - 40% of the service users of Bronglais), have not even been consulted about these proposals because they do not live within the boundaries of the Hywel Dda area.

Hywel Dda tell us that more care in the community is needed and more health care at home to prevent ‘bed-blocking’, but they give no indication of resources involved in improving social care and medical care in the home, or any real detail of how this will happen.

Last summer my Mum was admitted to Meurig Ward in Bronglais as an advanced cancer patient suffering with edema. Following treatment, we were desperate to get her home. Mum knew the seriousness of her illness and she had made it clear to my Dad and I that she wanted to spend whatever time she might have left with both of us in her own surroundings. But she could not be released from hospital because there were no carers available to look after her. I said that I would care for her myself, but the medical staff were concerned that I would just not be able to manage alone and that without an appropriate timetable of care, she would end up being re-admitted to hospital, which in her condition, was too distressing to contemplate.

The truth is that Ceredigion Social Services, (knowing how strapped they were for resources and how short they were of carers), would have been only too happy to let me take on the role of a single-handed carer, but the medical staff at Bronglais were adamant that it would be unsafe for me to do so, and they were right.

The result was that because adequate care resources were not available, Mum ended up staying on Meurig Ward for six weeks longer than was necessary. She was not alone. It was my experience that 75% of all patients who were in that four-bed unit on that ward were in exactly the same position – with one elderly lady spending a record 12 weeks there.
I have no complaints at all about Meurig Ward and the quality of nursing and medical care was exceptional and if Mum was still here, she would say so too. In the end, thanks to the wonderful Beacon of Hope organisation, we were able to bring Mum home for the last twelve days of her life. But in these straitened circumstances of not having enough carers available, no patient, family, doctor or nurse should have to ‘do battle’ every day to see whether a care package can be put together to release a patient. It is unbelievably cruel and unfair.

For what happened to be the last few weeks of her life, my Mum felt anxious and guilty because of the pressures and stress involved in trying to secure a care package. Despite our best efforts to convince her otherwise, at this most precious time, added to all of her burden, I know that she felt guilty and fearful about how we were going to cope. And for us, it was simply awful; every day my Dad I would visit her and every day we would manage to hold it together until we got to the car park, when we would both break down because powerless to help her, we thought we were letting her down at the very the time when she needed us most. Speaking to other relatives of patients on the ward, it was clear that they and their loved ones were all experiencing exactly the same traumatic emotions and no-one should ever have to go through this.

So when Hywel Dda talk about introducing Virtual Wards as part of their care at home concept without offering any costs or detailed plan forming up part of the equation, it makes me very angry indeed. Never mind ‘virtual’………. Hywel Dda need to get a handle on what happens in the real world.

How inept. How incompetent. Why is this Board still employed when they are clearly not fit for purpose?

Just like me, I know that everyone who came to Penparcau last night had their own personal story to tell about why Bronglais is so important to them and the people they love – such experiences show us very clearly that the changes which are planned by Hywel Dda will only ever result in an unsafe and a dangerous health service for most of the people of Mid Wales.
Whilst Hywel Dda’s plans are apparently clinician-led, last week’s letter to the Health Board, which was signed by 50 out 60 senior medical staff at Bronglais and proclaimed ‘no confidence’ in the Health Board, speaks volumes about what most of our caring, hard-working clinicians really think.

There can be no doubt that the Hywel Dda HB and the Welsh Government Health Minister must surely know by now that it isn’t only a group of so-called ‘rebel’ consultants who have no confidence in them or their plans, but that these thoughts and actions are echoed by the majority of us who live in this part of Mid Wales.

Fight for Bronglais? You bet your life we will.

*ABER – Achub Bronglais Emergency Rescue