1. Will the First Minister confirm when, after 1 March 2018, the decision to keep emergency vascular services at Ysbyty Gwynedd was reversed? OAQ53524

Diolch. Betsi Cadwaladr University Local Health Board is currently implementing changes to vascular services that were publicly consulted on and agreed in January 2013 as part of its service change programme. There have been no changes made to this decision. We anticipate the service will be operational from 8 April 2019.

I, today, am discussing the process, not the principle, of removing emergency services from Bangor—but the process itself—and how the decision was reached. In the spring of last year, the health board gave its stamp of approval to retaining emergency services in Bangor, and all the GPs in the area received a letter stating this. The board hasn’t reversed this decision, and in numerous statements, unfortunately, it has become apparent that the emergency vascular services are to be removed from Bangor. I’ll ask again, therefore: when was the decision changed? You talk about 2013, but in 2018 there was a change of mind. When was that original decision of 2013 returned to, and can you show me where the record of that is in the board papers?

Diolch, Siân Gwenllian. A paper did go to the board on 1 March 2018, which stated that,

'Patients with diseases of the lower limbs related to the circulation will be managed at both Ysbyty Glan Clwyd and the limb salvage unit at Ysbyty Gwynedd with provision for elective and emergency admissions and in-patient treatments at both sites.' 

I think it's that sentence that has given rise to the confusion. The paper should have made it more explicit that the provision for elective and emergency admissions to Ysbyty Gwynedd related to diabetic foot and non-arterial cases. Arterial cases will go to Ysbyty Glan Clwyd—you're aware of the new centre that's being built there—but those are the complex, specialist cases. That will amount to about 300 cases, and they will go to the new centre.

You ask about the letter that was sent to GPs, and, again, the same letter went with the same wording, and, hence, I'm guessing the same confusion might have been caused. There was no decision to rescind anything. Eighty per cent of vascular services will still take place locally. It will be about 20 per cent of all vascular activity that will occur in the new centre at Ysbyty Glan Clwyd. 

The concern remains about the other problems that patients can suffer, even if they access vascular services, and that the first point of contact is Ysbyty Gwynedd. Last February, the health board told us that emergency vascular services without qualification would remain in the three district general hospitals in north Wales, supported by a petition signed by over 3,000 people, and questions raised in Prime Minister's questions, as well as in this Chamber. What consideration has been given to doing an impact assessment, particularly given the rurality of the population affected, to establish the actual needs of this population if they now have to travel further and if their conditions could expose them to other consequences that may not be available to them unless they can get to Ysbyty Glan Clwyd?

So, as I said in my answer to Siân Gwenllian, 80 per cent of patient care will continue in the other two sites—Wrexham Maelor Hospital and Ysbyty Gwynedd. It will only be the complex cases that go to Ysbyty Glan Clwyd. So, where the new centre has been built, that's attracted consultants and doctors, whom I don't think would have ben attracted to north Wales unless we had that specialist centre. But in cases where it's in patients' interests to be treated for an emergency in either Ysbyty Gwynedd or Wrexham Maelor Hospital, as happens now, there will be a new, robust service, which will allow an on-call vascular specialist to advise and, where appropriate, attend, so the patients could still have the treatment in Ysbyty Gwynedd or Wrexham Maelor Hospital.