6. What guidance is provided by the Welsh Government to health boards regarding engaging with the public about changes to services? OAQ53344

The Welsh Government has issued national guidance to NHS Wales on engagement and consultation when they're considering making changes to health services. I expect them to take full account of the guidance and involve stakeholders—including, of course, the public—fully when proposing any changes.

The Betsi Cadwaladr health board is about to discuss far-reaching changes to the way in which some services are provided across north Wales. The changes include the provision of urology services on two sites rather than three, and the movement of stroke services from two sites and orthopaedics from two sites. So, I’m sure you’d agree that the health board needs to be entirely transparent with the public when major changes such as these are being discussed. Unfortunately, they are trying to introduce the changes through the back door. Will you ensure that there is thorough consultation and that detailed impact assessments are carried out before any final decisions are taken?

I don't think I'd quite accept the characterisation that these are changes trying to be introduced through the back door. On the three areas that you've talked about—on neurology and orthopaedics, there's big pressure on the numbers going through our system and our ability to meet those. That is partly about the rise in demand—for example, in neurology, in having the right equipment and right people recruited into those services to make them robust, and in orthopaedics, where it isn't just about having a more efficient way of delivering more operations, it's actually about which centres should you have operations taking place in, what do you have done, and then, also, what do you need to do in terms of those people who may not need an operation in the first place. In all of those areas, there is a need to talk to staff and the public about what is potentially there. I know that the draft proposals that have gone to the board are exactly that: they're draft. No final decisions have been made and I do expect there to be full and proper consultation.

On stroke services, though, there's been a long-running conversation and the leading voice with and for patients, the Stroke Association, are very clear that they want the health service in Wales and across the rest of the country to make real progress on hyperacute units—a smaller number of admitting centres with better outcomes for staff. Actually, the clinical lead for stroke services in Wales, based in Bronglais, is really clear that the number of our services where actually people are admitted for stroke needs to change as well to deliver better care. Now, that's a conversation that clinicians need to have and agree, but it's also a conversation they need to have with the public about what they're proposing and why as part of that proper engagement with the public. That is my expectation, not just in north Wales but across the whole service.  

Could I ask the Minister, in terms of guidance, are we in any way hamstrung by the constraints that are on health boards in terms of consultations? Before Christmas, Abertawe Bro Morgannwg University Local Health Board went out to consultation on an issue around Maesteg hospital. It wasn't framed as 'the future of Maesteg hospital; how we can look at the long-term future of it, what we can do on reconfiguration of services'. It was big up on the overhead projector on Maesteg town hall with a couple of hundred people watching it: 'Closure of day hospital', which many people, by the way, conflated with the closure of the hospital itself rather than the day unit and the respite care provided. They've paused that because of the overwhelming objections to the proposals going forward and they're going to come back and reconsult. But one of the things they say to me is they're limited by how they frame that. They have to frame it in terms of closure of a unit as opposed to asking people, 'What would you like to see here to meet the modern needs of Maesteg and the upper Afan valley?' and so on. So, is there a problem with our guidance that is constricting the way in which health boards can go out and actually consult people on what they want to see as the future of their very important local facilities?  

I'm prepared to take on board and take seriously the point the Member is making and look again at the guidance to see if it does have an unintended consequence. But actually, the starting point is that it's important to have a full conversation with the public about what is being proposed: what is the proposal for the future, what does that mean about services now? And to make sure that we don't have an artificial conversation that either makes people more worried about the future of services that are going to be taken away, rather than the future mix of where people get the right care, in the right place, at the right time. So, I'll happily talk with him about the specific example he raised and look to see if there is a need to change the guidance or not, and the balance that health boards need to address to be able to move as quickly as possible, but actually to make sure that there's a speed and a pace that properly engages the public in having a real conversation about what matters to them.