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.

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