Agenda item

The Committee received a presentation from Hywel Dda University Health Board which focused on proposed investment in their Estate.

The Executive Director of Strategic Development and Operational Planning at Hywel Dda University Health Board explained that Hywel Dda served a population of around 385,000 across three Counties of West Wales, covering a very large geographical area; the population was noted to not be dissimilar to other Health Boards in terms of size, however it was spread out across an extensive rural area. Due to this, it was noted that there were transport and travel challenges that needed to be addressed. Members were informed that South West Wales did not have a central large town or city to build these services around; this was a key point in terms of the legacy of the configuration of health services that had been inherited, coming into the formation of the Health Board.

Following on from the above, it was stated that the Health Board had a configuration of services that dated back to the 1950s/1960s; a lot of problems and challenges had emerged over the past 20 years as a result of that, including financial challenges and service sustainability and fragility. It was explained that this meant that some services have had to cease or centralise into one location, and some of the other service areas that were continued were on the brink of this. The Committee was informed that this was the background to the development of the ‘Healthier Mid and West Wales Strategy’, which was intended to set a longer term direction for sustainable health services for Mid and West Wales.

It was highlighted that one of the significant challenges going forwarded was the need for investment into the various estates; in particular Glangwili General Hospital and Withybush General Hospital, however investment was needed across all hospitals. It was noted that 40% of Hywel Dda’s estate was over 50 years old; this emphasised the need for investment in these estates and their facilities

Another significant challenge noted was around workforce and the sustainability of the model that was currently being delivered. The Health Board confirmed that they had progressively witnessed an aging population and increase in demand; the older model of care was no longer fit for the modern demands and pressures. It was mentioned that the Strategy set out a shift towards keeping people well, prevention and self-care, with much lower proportions of ill health being managed in acute settings.

In order to support the Strategy and its infrastructure implications, Members were informed that the Health Board had identified there was a need to make some improvements to the facilities that were currently in place. It was noted that over the past few years work had started to develop a network of community facilities; new integrated facilities had been developed in Ceredigion, Aberaeron, and there were plans to develop similar facilities across all key towns and population areas within the Health Board’s region.

In addition to the above, it was highlighted that there needed to be a change in the way in which Glangwili General Hospital and Withybush General Hospital function, and the need to establish a range of community hospital services to meet needs; there will also need to be relatively minor changes to Prince Philip General Hospital and Bronglais Hospital in terms of service configuration, which would be required to make them sustainable for the long term.

The presentation detailed the short, medium and long term community infrastructure development plans which the Health Board were in the process of developing, some of which had been previously mentioned and others that were in the pipeline; over the next five to seven years, Officers within the organisation will be developing these facilities in the highlighted areas, and work with Local Authorities to ensure that a suitable service model was developed and in place for those towns and localities. Also detailed within the presentation was a draft example of what the integrated community network could look like; each integrated community network will differ, as they will need to be designed to fit the local population needs.

The current opportunity for South West Wales, in bringing investment into the area, was highlighted by the Health Board; West Wales, from a health perspective, had been under invested in over the past 30-40 years, and this opportunity could assist in rectifying this issue. It was explained that there was significant capital investment associated with the plans set out in the presentation; if this capital could be secured from Welsh Government, it will bring opportunities to local communities in many areas such as education, supply chains, town centre development and training and employment. Members were informed that one of the objectives through this work was to leave a lasting legacy for the local populations, and to ensure that the investment will be put back into the hands of the local businesses and communities.

The Committee was informed of the current position of the new urgent and planned care hospital; the following points were raised:

·        The hospital will have around 500 beds - this was much larger than the current facilities in place, however compares to a medium sized hospital of UK standards.

·        Alongside the physical health hospital, there will also be a mental health facility, a range of diagnostics and other support services.

·        The development will use principles of a biophilic design which looks at opportunities to use nature, and interaction with nature, to support rehabilitation and treatment as part of the health care offering – this will equally support staff and the local population with a building that is much more focused on using good design, to bring the environment and hospital as one.

·        The timelines were demanding for what was intended to be achieved, as currently the aim was to implement the changes, including the development of the new hospital, by 2029 – there may be changes and alterations to the timeline going forward.

·        The Heath Board had submitted the programme business case to Welsh Government and it had gone through their usual processes – feedback had been received, which included that Welsh Government would like to work with the Health Board further on a clinical piece of work on the model, and support the development of a strategic outline case, which will be the next step of this process.

·        The land selection for the new hospital was underway – the public process of identifying land had been completed, with 11 sites considered and then shortlisted down to five (one in Narberth, two in Whitland and two in St Clears). It was added that over the last six months, four work streams were undertaken to evaluate the sites, including public representation on the technical site appraisal; the detail of which was taken to a Board meeting in August, which resulted in narrowing the sites down to three (two in Whitland and 1 in St Clears). It was agreed at this point to go to public consultation on the three sites before any further decisions were made.

The importance of transport was highlighted; in all discussions with the public, one of the key questions that came up repeatability was in regards to the plan for transport for South West Wales, and how it was going to impact the delivery of services. It was noted that the public were naturally concerned about travelling long distances to receive the services, especially given some of issues around public transport; there will be opportunity for the Health Board to work with South West Wales Corporate Joint Committee, and Transport for Wales, to look at what that transport offering could be and what could be done over the next 10 years to support that.

A discussion took place in relation to the next steps, highlighting the current position of the programme business case, and that the Health Board were currently in discussions with Welsh Government on how to progress it forward; as well as the continuing plan to develop the community facilities which forms part of the Strategy and the programme business case.

The Executive Director of Strategic Development and Operational Planning concluded that the work that was undertaken between 2017 and 2018, which was a long term, fundamental review of health care and the way in which health care services were delivered, resulted in the ‘Healthier Mid and West Wales’ Strategy being formed. Alongside the health benefits of this, it was stated there were other opportunities for West Wales in a much wider sense; long-term benefits for jobs, the economy, education and training, and transport. Members were informed that the Health Board were eager to work the Corporate Joint Committee as this develops further.

Reference was made to the timescales, and when further progress would be reported back to those affected by this work; it was important to involve all members in that discussion. It was noted that the strategy was originally developed in 2018, and the programme business case was submitted in February of this year; the response from Welsh Government was only just received in September, which has caused slight shift in the timeline. It was added that the Health Board were also required to develop a Statement of Case (SOC) which might also have an impact; the timeline will be received as a result of these factors.

Further to the above, it was noted that Welsh Government were committed to the clinical model review and would be supporting the Heath Board with the funding of the strategic outline case; these were the first proactive and positive steps that had been received from Welsh Government in respect of the plan. Whilst the Heath Board were not quite where they intended to be in terms of having a PBC endorsed, it was stated that they were encouraged by the fact that Welsh Government were recognising the case for change and working with them on the next steps. The exact timings for each of these elements could not be provided just yet, however it was noted that the Heath Board were looking to carry out the clinical review in the spring of 2023; and complete the SOC, subject to how much detail Welsh Government would require, in time for summer 2023. It was added that this would then align with the conclusion of the consultation, which could enable the Health Board to compile this work together, including additional work on the land selection for the new hospital; and hopefully, next summer be able to clearly set out the next steps and timelines.

In regards to engaging with those affected and involved in the work being carried out, it was explained that the Health Board were currently engaging with as many people as possible including liaising with multiple Town Councils; it was important to engage with the public early on, especially as they will form part of the consultation process. Members were informed of the intentions of the Health board which included making this work a live, ongoing discussion, with all stakeholders and anyone who had an interest in it; conversations were being had with many people, such as construction industries which formed to be very useful and positive.

Members raised their concerns in regards to staffing and transportation for the new hospital development. It was expressed that these factors were challenges for the Health Board to overcome; Officers from the Health Board had spent the last few months meeting with all Community Councils, Pembrokeshire County Borough Council, attending Scrutiny Committees and meeting with those involved in the Save Withybush Campaign in order to discuss these matters.

It was explained that the Health Board were carrying out various actions in regards to staffing matters; Hywel Dda had the biggest apprenticeships program in the UK in relation to nurses, had brought 100 overseas nurses in this year, and were doing everything possible to advertise for jobs.

The Committee were reassured that the Health Board did not intend to lessen the services in the other two hospitals in advance of the new hospital being built; however, some of these services were currently very fragile, and it was only by the dedication and good will of the employees that these were being maintained. It was added that the only way out of the current difficulties was to provide the new hospital development; aside from the health benefits, it will be a great opportunity for many other areas such as the construction industry and the foundational economy.

In relation to the two hospitals that were left in the area, it was confirmed that they will still be running; however, they will be focusing on rehabilitation, convalescence, and enabling patients to leave the hospital in order for them to be cared for close to home and their relatives, which will allow employees to deliver the more specialist care. Members were informed that 70% of people who go to Accident and Emergency (A&E) were minor injuries; this will remain the same in Withybush hospital with a 24/7 General Practitioners (GP) led unit, which was noted to be really successful and embraced by the population. The importance of the integrated health and care centres in the local areas across West Wales was highlighted, particularly so people don’t have to travel further than needed.

The Committee expressed the need for services to stay at these hospitals until the new hospital is built. The Health Board assured Members that this was the intention, and that there were no plans to reduce the services in the current hospitals in advance; some elements were out of the Health Board’s control, however they were doing everything possible to maintain the hospitals and the services that they delivered. 

Members reflected on the current issues surrounding GP surgeries, and the need to keep the local hubs satisfactory manned in order for the new concept to work effectively. It was also queried if the Health Board had completed any survey work to identify any other issues aside from transport, and if the staff could be obtained in order to run the required services. The Health Board confirmed that there were other issues to resolve aside from transportation; this included housing, particularly in Pembrokeshire. As previously mentioned, Hywel Dda had brought in 100 overseas nurse this year, however were finding it difficult to provide housing for them in Pembrokeshire; many were being houses in Carmarthenshire. Reference was made to the importance of working together with other sectors, and look into building affordable housing or providing nurses accommodation closer to the hospital; the Health Board were in discussions with Carmarthenshire regarding certain sites, and the future of Glangwili General Hospital, as there may be some excess land that could be utilised for housing purposes.

In regards to GP surgeries, it was highlighted that due to the Health Board covering such a large geographical area, there was a very mixed picture in terms of their current positions. It was noted that a number of people had visited the integrated health and care hubs, and recognised that the impact on the morale, working conditions and the multi-disciplinary work was really attractive to staff. The Health Board were continuing their work in regards to GP recruitment; however, highlighted that workforce was a challenge for all public sector organisations, and all job types within the service. It was acknowledged that the new strategy and plan will not solve all of the current issues, however would be helpful in trying to deal with them. The Committee were informed of the importance of the need to provide better facilities to attract people into the service, and enhance the range of services that could be provided locally.

A further discussion took place in regards to the biophilic design concept of the new hospital; there was a scheme currently being undertaken in Swansea, which was providing a lot of learning and research in terms of the health benefits of the biophilic concept. It was added that there were no end to the opportunities and areas to explore within this concept.