We now move to the short debate, and if Members who are leaving could do so quietly, I will call the short debate in a few moments’ time.

The short debate, therefore: Huw Irranca-Davies to speak on the topic that he has chosen. Huw Irranca-Davies

Diolch, Llywydd. In opening this debate, could I just point out that I’ve agreed for Suzy Davies to speak in it, and Dai Lloyd also? So, in opening this debate I’m putting a request to the Cabinet Secretary this evening for his help in resolving a long-running issue affecting primary care in Llanharan, Brynna and the surrounding area. The request isn’t made lightly. I’d prefer not to do it. It’s made out of some frustration after the continuing efforts of concerned local residents and community activists, community and county councillors, myself and others, to find a way forward over the last 18 months, and I’ve personally invested a significant amount of my time and that of my office team to find progress, and I know that councillors like Geraint Hopkins and Roger Turner, community councillors like Chris Parker and others have worked diligently behind the scenes as well.

The Deputy Presiding Officer took the Chair.

A brief history of this matter would be of help. Around 18 months ago there was a sudden and unexpected change to the service provided to Llanharan and Brynna residents by the local Pencoed Medical Centre. There had long been a so-called satellite GP branch surgery provided in Llanharan and Brynna under contract by the Pencoed Medical Centre, which the residents would say is no substitute for a medical centre of their own serving the ever-expanding communities of the Llanharan area. It did at least provide a reasonable and appreciated service for those elderly and other patients who did not have their own transport or for whom public transport was difficult or along with taxis too expensive, or those who were time constrained through work or other commitments. I should also point out, by the way, that this is no criticism of the clinicians and the other staff at Pencoed Medical Centre, and the care they surely, of course, want to provide to all their patients wherever they reside. This is a criticism of the structures and the funding steams that seem to get in the way of seamless patient care, not least when, as in this situation, the patients and the practice fall into two different health authority areas.

But those changes 18 months ago brought in a noticeable and instantly noticed reduction in the hours of GP provision in this branch satellite service. The change, as I say, was sudden, and unexpected. Many patients were taken by surprise. Understandably, many residents were deeply concerned at what seemed like a shock withdrawal, or at least a significant diminution of services to those who did not find it easy to travel to Pencoed. A public meeting was organised in response to these concerns. Well over 100 people attended that meeting and—I don’t use some kind of Trump inauguration exaggeration here—the corridors were lined with people trying to hear what was being said within. In addition to local residents present, there were councillors and community councillors, regional and local Assembly Members, the Member of Parliament, Chris Elmore, representatives of the Pencoed Medical Centre, ABMU, the community health councils and others. But this was no lynch mob; they were trying to get the facts of what was happening and what was clear then and is clear now is that the administrative border that separates ABMU and Cwm Taf is a real and pressing issue. Perhaps the recent proposal that the eastern side of ABMU and Cwm Taf health authorities be merged may help resolve this issue, but we can’t wait forever.

The Pencoed Medical Centre sits within the ABMU region and patient funding is through ABMU, yet, through historic service patterns, whilst the majority of the patients in Pencoed go to either the Pencoed medical practice or to the other neighbouring one, a significant proportion of its patients—in fact, the majority, I understand, of those patients at the Pencoed Medical Centre—fall within the Llanharan and Brynna areas, which lie within the Cwm Taf catchment. You can see the cross-border problems that arise with funding flows.

Pencoed Medical Centre, in reducing its service, is simply working to the detail of its contract—no more, no less. A health board cannot insist that they provide a certain service. The financial incentives need to be aligned with patient needs and, to be fair to Pencoed Medical Centre, there is a logic to the argument they put that investing in enhancing the service provided at Pencoed is better for all patients who can attend there—who can attend there. But those branch surgeries in Llanharan and Brynna have long satisfied the requirements of older and less mobile individuals who find it simply difficult to attend the Pencoed Medical Centre through constraints of cost, health, transport or time.

Over the last year, I’ve spoken with the medical centre and I’ve suggested to ABMU that they offer the medical centre some additional funding that could help in the short term to restore, or partially restore, the original level of service to Llanharan and Brynna branch surgeries. It would go a long way, Minister, to soothing the continuing discontent. So, I would be really grateful for the Cabinet Secretary’s assistance in seeking clarifications on the reasons why the original service at Llanharan and Brynna, or something like it, cannot be restored to assuage those current concerns, especially if additional support has been offered by ABMU, as I understand may indeed be the case. I fully understand that the discussions between a private medical practice and a health board can be delicate, that some commercial confidences must be protected, but I do believe that local people, including those who attended the original meeting, deserve a frank report on what efforts have been made by ABMU and the Pencoed medical practice to respond to their concerns. I think people would be, frankly, disappointed if it were found that support had been offered that could restore the service and alleviate those concerns, and that such support had been declined for whatever reason.

Before I turn to the larger strategic issue, let me just strengthen the case in two significant ways, knowing that evidence-based policy is good policy indeed and that the Cabinet Secretary would support that. I was delighted that the community health councils, at our instigation, got together to look at the issues of patient satisfaction among those who attended the Llanharan surgery and the Brynna surgery—fascinating what they found. I have to say that, overall, the patient satisfaction with the Pencoed surgery was 65 per cent—those who said that they were satisfied to some extent or another. But 65 per cent of those who attended the Llanharan and Brynna surgeries were dissatisfied. It’s quite fascinating. The majority of patients—65 per cent—generally happy with the overall experience that they received from the practice overall, but 65 per cent attending the Llanharan branch surgery were dissatisfied with opening times. The majority of people in the Llanharan area, it says in the report, are unhappy with the opening times; they saw it as inequitable. It caused particular difficulties, the community health council was told, for working people and those who needed to collect prescriptions. Few patients reported travelling to the further surgery, however, when they did this, it had an impact on travel arrangements. More people needed to secure lifts from friends or family or community transport, and some had to rely on taxi services. And people expressed frustration about what I referred to before, about the care pathways associated with being registered with an ABMU practice. These comments were made by patients across the practice footprint, who felt it would be more convenient to streamline the process that was currently causing problems.

And they made recommendations, Cabinet Secretary. They identified a need for rejigging the appointment system, and that is going on at the moment. It’s causing some issues with settling in, but there is a change going on at the moment with the practice. But, they said the practice may wish to look again at the provision offered at the Llanharan branch surgery, to ensure that services are organised to best meet the needs of the population, and this might include providing some later appointments. That is what used to happen. That’s why people can’t get there anymore. The practice may wish to explore alternative ways for Llanharan patients to access prescriptions, possibly by working with local pharmacies, instead of going all the way to Pencoed, and so on. And Cwm Taf UHB should consider if boundaries of nearby practices could be extended to offer residents in the Llanharan area a choice of accessing a Cwm Taf practice. They made specific recommendations. It would be great to see if we could act on those.

But, let me go further, because the other aspect is the massive growth in the population of the Llanharan and Brynna area. In the 10 years from 2005 to 2015, the Llanharan ward grew by 14 per cent in homes—450 additional homes. In the Brynna ward, it grew by 17 per cent with an additional 657 homes over that 10-year period. Overall, over 1,100 new homes in a 10-year period in Llanharan. But, that’s not all. If we actually look ahead at what is going to happen in future, we can see that the adopted local development plan for Rhondda Cynon Taf proposes a strategic development site at Llanharan for around 2,000 more houses. I’m not decrying this; it’s a popular destination. This is a commuter area with a well-serviced railway station, with a bypass thanks to good decisions by a Labour local authority and Labour Ministers to work together to provide it. It’s making it more attractive—2,000 more houses. The same development plan allocates a site in Brynna for 200 more houses. This is growing like Topsy and we need to actually match that up with the provision.

So, in addition to seeking the Cabinet Secretary’s assistance in seeking clarification on why the original service could not be restored in some shape or form, let’s look at that bigger issue. It’s clear that it’s not simply a perceived but a real and lived difference in the experience of patients in Llanharan and those in Pencoed, and I want an equitable service, a good service for everybody. I don’t want to diminish what’s going on in Pencoed, I want to raise the standards in Llanharan and Brynna. I want them all to receive a great service and I’m sure the medical practice that services the area would want exactly the same. It’s not currently happening.

So, that second piece of evidence to do with the growth in homes leads me to my second point. Llanharan is a great community. It’s going through great transformation once again. It used to be pre-industrial, rural Glamorganshire, then it expanded massively through the industrial revolution, through rail and through collieries and then through open cast, and now we’re looking, with the advent of new rail links and new road links, to take it into a new era as well. It’s a popular growing place along the south Wales seaboard. It’s going to grow rapidly.

So, I’m pleased, over the last 18 months, Cabinet Secretary, that the leaders of Cwm Taf health authority and Rhondda Cynon Taf council have been willing to engage in exploratory discussions aimed at resolving the underlying primary care needs of this community. Local councillors like Geraint Hopkins and Roger Turner have played their part too, alongside community councillors. We’ve all been exploring whether there is a will to work in partnership to create a new primary care facility, fit for this century, that would service the needs of this growing population as well as the adjoining communities.

And we can tantalisingly imagine the possible model for primary care provision fit for the future in Llanharan and the area. Elements of it can be seen already in brilliant examples like the Gilfach Goch medical centre in the Ogmore constituency, and the many others that have been devolved in partnership with Welsh Government, local authorities, health authorities, GPs and clusters working together. It could involve, for example, teaching practice for GPs and allied professions. It could bring together the relevant services in one place for that community, with midwives and district nurses, dieticians and chiropractors—a range of professionals beyond the old-style, much loved, but so last century GP practice—with a knowledgeable onsite pharmacist who could advise on regular ailments and prescribe, thereby freeing up the precious time of the GP. And all of this, Cabinet Secretary, as you support, helping to keep people healthy longer in their lives and closer to home, without having to resort to emergency or acute care in a hospital bed. Who knows? Perhaps even on a site, with the help of Rhondda Cynon Taf, combining modern elderly care facilities too.

Cabinet Secretary, this has been your mission as Welsh Government itself to transform the style of primary care and of social care, keeping people healthier closer to their homes, reducing the over-reliance on GPs, utilising more effectively allied health professionals, breaking down the barriers between health and social care without costly structural changes. You’ve been doing this transformation elsewhere. I’ve seen it, I’ve seen the positive health outcomes. It is transformative; it transforms people’s lives. So, Cabinet Secretary, people in Llanharan are ready to have that transformation.

So, could I ask: to resolve the immediate issues, could the Cabinet Secretary help facilitate a meeting with ABMU and Pencoed Medical Centre to see whether a way can be found to resolve the disparity in dissatisfaction with patient experience between those who reside in Llanharan and Brynna and those who reside in Pencoed? I want them all to receive a great service. Secondly, could you help play a part in facilitating a meeting with ABMU and Cwm Taf health boards, Rhondda Cynon Taf and other potential partners, to examine those options for the development of new facilities? A medical centre, by the way, is already included in the strategic development site, so let’s fast-track these discussions. This would help resolve, in a meaningful way, the underlying issues linked to the massive housing and population growth in the area. If he could agree to assist us in getting progress on these matters and breaking the logjam, I know that would be appreciated by all in the local community, including those who are watching from the gallery today, and I look forward to others’ contributions.

Thank you very much. You indicated two people. They’ve got something like 45 seconds between them to respond to the debate, so it’ll be a challenge. Let’s see how we go. Suzy Davies.

First of all, thank you for the hard work that you’ve done on this as well, and also for highlighting why CHCs are so important to our local communities. There’s been some difficulty in getting a new public meeting together to update the community on this, partly because of the unwillingness of representatives of the practice to attend, but the reasons they give for their unwillingness to attend are quite interesting. The first is that they haven’t heard from the steering group that was talked about—it’s got to be at least a year ago now—to help smooth the way on this, but secondly and more importantly is that they haven’t heard from ABMU. This is a health board that’s already had some difficulties dealing with surgery issues in Porthcawl, and if they’re not even prepared to engage now with you, hopefully, on this, then there are serious questions for me about how willing they’re going to be to engage in GP cluster conversations, which are going to be critical to the vision we all have for the future.

Well done. Dai Lloyd.

Thank you. Just briefly, I work in a branch surgery in Penclawdd, which is several miles from the home—mission control—in Gowerton surgery, but it’s expensive, premises wise. Premises budget needs to be looked at. It’s also quite extravagant in terms of staffing and IT technology. None of that is insurmountable, particularly in view of new housing; it just needs organisation and a go-to attitude, but it requires money, organisation and political drive.

Thank you very much, and I call on the Cabinet Secretary for Health, Well-being and Sport, Vaughan Gething, to reply to the debate.

Thank you, Deputy Presiding Officer, and thank you to Huw Davies for another opportunity to speak today in the Chamber, but in particular for using today’s short debate to highlight the importance of accessing high- quality primary care services.

Our local healthcare services account for more than 90 per cent of people’s contact with the healthcare system here in Wales. Of all the points that were made today, it’s been really interesting that so much of it has focused on the hospital-based part of that system and yet the great majority—as I said, over 90 per cent—of people’s interaction takes place in our local healthcare service. And I certainly want our local healthcare service in Wales not just to be based on the principles of prudent healthcare as a mainstay of a sustainable health and care system that is generally able to respond to the changing needs of our population, but I share what you say as well: I want every single community across our country to have not just high-quality healthcare locally, but actually to have good access to it, to have really great care and to understand what that looks like. And in many parts of the country, that will look different to the system that has served us well up to this point in time, because I recognise the stress and the pressures that we frequently discuss in this place over the future of our local healthcare service, and in particular GPs as significant, if you like, leading parts of our local healthcare system, because we recognise that local healthcare is changing, and it needs to.

There are so many drivers that we frequently rehearse in this Chamber and otherwise, but we want it to deliver more care closer to home, with a more preventative approach: so, the idea of treating illness, moving beyond that to actually how you prevent ill health, and having a much wider team of people. That’s why our national primary care plan sets out key actions to improve local health, and that includes developing a more integrated, multi-professional workforce that collaborates at a very local level to meet people’s needs at, or close to, home, and recognises that much more care could and should take place in people’s own homes. I’m really pleased that you mentioned in your own contribution the reality that we want to keep people out of hospital. There’s much more that we could and should do.

I think that, sometimes, this sounds like a bit of a platitude, saying, ‘This is the course we want to do’, and then we go back, as politicians, to talking about hospitals again. If we can’t get this right, as we discussed in the parliamentary review, there’s a really difficult future ahead for the whole service. And, increasingly, though, we are seeing health boards collaborating with GP practices and other local service providers. Some of this is already happening, with pharmacists, community-based nurses, therapists, dentists, optometrists, mental health teams, social workers, third sector workers and others, through the 64 primary care clusters we’ve created. That’s to optimise the best use of our available resources and people’s time and expertise and the money we’ve directly provided to each of those clusters to spend on local priorities. Because I recognise that there are significant parts of Wales where they’re struggling to recruit and retain GPs. We talked about that earlier, in the Health and Social Care Committee’s report—not just the measures we’re taking on—[Inaudible.]—and others, but cluster working is a really important part of what we want to do to keep great local healthcare. That should lead, and is already leading, to greater collaboration between GP practices—they didn’t always talk to each other, frankly; so, it’s between the practices, not just within them—as they identify new ways of organising themselves and making effective use of their available resources.

Our national programme of Pacesetters has been really interesting in helping to identify more sustainable ways of working and providing services, like the federation of GP practices that is moving to the same place in the Bridgend locality, and the social enterprise in southern Powys, the Red Kite social enterprise. And that’s been so interesting, because that’s drawn together GP practices that previously did not talk to each other, and they were not friends of each other, and, now, they wouldn’t have it any other way. They’ve got a different way of working with each other, the way that people actually access the service, and they’ve just taken on board a GP service in Presteigne—where the previous GP practice was handing back its contract, they’ve taken that on. So, there is an appetite amongst the profession to work differently, because more practices are seeing the advantages of coming together to provide a better environment to work in for staff in the service, but also a better platform to deliver great local healthcare with and for the public.

I think this is where it comes back to how the national programmes can look at the challenges that you raise, because a significant part of the concern that is being taken up at the national Pacesetter programme is access. It’s a common concern about the ability either to get an appointment or to get a convenient and local appointment. Much of what you say is about access to local care. From that model, that new way of working with Pacesetters, much of it focuses on how you have a triage system, whether it’s on the phone or online or whether it’s nurse or GP-led, but a way to actually try and direct people to the right part of care. That could be going to see a GP; that could be having advice you can deal with at home; it could be going to the pharmacy; it could be coming in to see a physiotherapist or a different healthcare professional. And what we’ve seen in significant parts of that is that it actually speeds up access to see a healthcare professional, and it actually helps people to get directed to the right part of the service, so GPs don’t get overloaded with people they don’t need to see and, potentially, they don’t get to see people that they really could and should see, and I know this is an issue that the Member opposite has recognised in his own working practice well, about how you make the very best use of GP time. Now, more anticipatory care, to be designed to keep people at home rather than being admitted to hospital, and that’s where we’ve seen the development of the virtual ward-type models around the country as well—.

Now, the other part I just wanted to focus on before I go from the national to the local is the common element service in the way of pharmacy, because, again, you mentioned the point about could pharmacy be an option for people to get a service more locally. Actually, Cwm Taf have been really go-ahead on this in the way they’ve gone out after the Choose Pharmacy service. So, we currently have over 350 pharmacies in the country offering the service; 75 of them are in Cwm Taf. One of the pilots was in the Cwm Taf area, in Aberdare, and it was really interesting how the local GP practice recognised that it had helped them to manage the numbers of people coming through the door, and not just the numbers, but the appropriateness of people coming through the door as well. And people actually trusted their pharmacist. They had a private room to go and see them, they’re registered healthcare professionals, and it’s been enabled and empowered by access to a version of the GP records. There’s something about the safety. And, interestingly, Cwm Taf have told me that they think that the Choose Pharmacy service has helped to eliminate handwriting mistakes in scripts to be delivered as well, so there’s actually a significant benefit from a safety point of view as well. Now, in March, that service will be available to at least 400—certainly more than half—of the pharmacies in Wales, and we want to see genuine national coverage of this service.

It’s National Eye Care Week, but I won’t go on to talk about optometry because I do want to address directly the points you made about the local issue. And this comes on the back of an issue that other parts of the country recognise: population growth—current and planned population growth—that we know is going to happen, and you referred to Llanharan and Brynna being areas that are well connected from a transport point of view. The challenge is how we design so that services reflect what we currently have and will have, as opposed to waiting for those services to be overloaded.

And there’s something about the future of those services as well, and recognising that we want to work with independent contractors. So, we’d like to work with the current independent contractors to provide really good, high-quality care. And I do recognise what you say about the fact that this practice has invested in Pencoed. So, they haven’t been afraid to invest, and invested in one of those sites. And I also reflect on and recognise the comments that the CHC made on the potential that, if they can’t get somewhere where they think local residents want them to be, they may want to ask Cwm Taf to see if one of their other providers would want to come and open a list in the Llanharan and Brynna area. I think that means there’s a greater imperative to want to have a local conversation where—[Inaudible.]—there’s a different alternative.

That’s where I go back to the point to address the concern or the question that you raised about the offer of investment, and it partly deals with Suzy Davies’s concern about ABM as well, because my understanding is that the Abertawe Bro Morgannwg University Local Health Board did offer some investment for services to stay in the Llanharan and Brynna area. I don’t know why that hasn’t been taken up, but I am happy to ask if that previous offer from the Abertawe Bro Morgannwg health board area can still be on the table as part of an open conversation.

The final point, which I guess is your main ask from me, is whether I am prepared to use my good offices, to use one of those phrases, to try and engineer a conversation with relevant stakeholders. And I think it’s really important that you mentioned the local authority, because, to be fair to Rhondda Cynon Taf local authority, in other parts of their footprint they’ve been really helpful about making use of not just their ability to access capital in a different way, but also look at the estate that they have as well, to see if there’s an opportunity to try and re-engineer primary care with them as a partner—not just deliver what we currently have, but come up with a different way of doing it. I’ll happily take an intervention if I’m allowed, and then I’m going to finish.

I thank the Cabinet Secretary for taking this intervention, and he makes a very valid point. This isn’t—and, in fact, I would want to make sure that the existing Pencoed Medical Centre was part of this conversation, but there are good examples with Rhondda Cynon Taf. The proposal they’re looking at in Mountain Ash at the moment is very much a partnership between the local authority, looking to identify sites, together with the health board, looking to identify could they do this as an all-singing, all-dancing, and teaching practice sort of thing. It’s that partnership model that we want, but the difficulty I have, and this is why I’m asking you today, is actually getting all those people to come together. And I do understand, I would say to the Cabinet Secretary, that Pencoed Medical Centre have had their fingers burnt once on this before. They’ve been led up this thing, and I think they might be slightly reluctant. So, any help you can give to actually facilitate sitting down with trusted people around the table to say, ‘Let’s discuss this. How do we resolve this?’—. Because I know that there is a will from partners, from the health board, and from the authority and others to do this; we just need all players at the table.

And that’s the final point to finish on. I am happy to say that, yes, I am prepared to invest some time to try and get people to sit around the same table at the same time. So, both health boards, yourself, and any other local representatives that could and should be involved—. And, of course, to make sure that Pencoed are part of the conversation. So, a conversation with them and with their public, as opposed to a conversation about them, is what I’d like to see engineered, and I hope that all those people do take up the opportunity to do that to have some clarity for the local public about what the future holds, as everyone recognises there’ll be more people in this part of Wales, not fewer, in the future.

Thank you very much. That brings today’s proceedings to a close. Thank you.