Wrthi'n llwytho
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Resolved: (i) to confirm that it had read, understood and taken into account the work that was required on a continual basis to meet the expectations and improve hospital flow in North Wales; (ii) that the Lead Member and officers take note of the Committee’s observations on the work undertaken to date through the North Wales Regional Partnership Board to address the recommendations; and (iii) that a further Information Report on the progress made in delivering the combined organisational action plan in response to the Audit Wales recommendations be circulated to Committee members when available. At this juncture the Committee adjourned for a comfort break at 12.55pm and reconvened at 1pm.
Resolved: to communicate to the Project Team and Cabinet - (i) that having considered the report and received the presentation summarising the detailed design stage, attached at Appendix A to the report, emphasised that its desire was similar to that of local residents to have a replacement bridge built to connect both communities and ease travel between them. Nevertheless, based on the expert engineering and risk management advice received the delivery of this project did not seem viable as its construction would likely pose significant risk to critical infrastructure in the area which supplies water for circa 85,000 homes; (ii) acknowledging the impact the loss of the bridge had on local communities and their residents that the Council should make every effort to reduce the impact on connectivity between the communities affected by improving other local transport links and highway routes in the area; and (iii) to confirm that, as part of its consideration of this matter, it had read, understood and taken account of the Well-being Impact Assessment, Appendix B to the report.
Resolved: subject to the above, to confirm its programme of future work as set out in Appendix 1 to the report.
None tendered.
Councillor Kelly Clewett declared a personal interest in business item 5, ‘Urgent and Emergency Care: Flow Out of Hospital – North Wales Region’ in her capacity as an employee of Betsi Cadwaladr University Health Board (BCUHB), as a Community Resource Team Lead – Community Resource Team.
No items of an urgent nature had been drawn to the attention of the Chair, or the Scrutiny Coordinator, prior to the commencement of the meeting. At this juncture the Chair informed members that as a result of the formation of the new Denbighshire Independent Alliance political group there had been a change in the Council’s political balance. A consequential effect of the change in political balance was the composition of the Committee’s membership. This had resulted in Councillor Bobby Feeley leaving the Committee and being replaced by Councillor Merfyn Parry. The Chair thanked Councillor Feeley for her valuable contribution to the Committee’s work and welcomed Councillor Parry to his first meeting.
The minutes of the Partnerships Scrutiny Committee meeting held on 13 February 2025 were submitted were submitted. The Committee: Resolved: that the minutes of the Partnerships Scrutiny Committee’s meeting held on 13 February 2025 be approved as a correct record of the proceedings. Matters arising page 9, ‘Royal Alexandra Hospital (RAH) Development – responding to an enquiry the Corporate Director: Social Services and Education confirmed that the procurement stage of the delivery plan had slipped slightly due to technical matters, but work was on-going with a view to concluding this stage in the near future. Despite this, other matters had progressed satisfactorily i.e. discussions relating to car parking and arrangements for decanting staff ahead of the redevelopment. A further progress report was scheduled for presentation to the Committee at its September 2025 meeting.
Y penderfyniad fel y'i cofnodwyd
Resolved: (i) to confirm that it had read, understood and taken into account the work that was required on a continual basis to meet the expectations and improve hospital flow in North Wales; (ii) that the Lead Member and officers take note of the Committee’s observations on the work undertaken to date through the North Wales Regional Partnership Board to address the recommendations; and (iii) that a further Information Report on the progress made in delivering the combined organisational action plan in response to the Audit Wales recommendations be circulated to Committee members when available. At this juncture the Committee adjourned for a comfort break at 12.55pm and reconvened at 1pm.
The Lead Member for Health and Social Care and the Corporate Director: Social Services & Education (CDSSE), alongside the Acting Assistant Director – Care Homes Support and Continuing Health Care Commissioning and Director of Public Health (BCUHB), presented the Urgent and Emergency Care: Flow out of Hospital – North Wales Region report (previously circulated).The aim of the report was to provide an updated account/information to partners regarding the associated work undertaken since the first publication of the Audit Wales report and combined organisational response in September 2024. The Committee were informed that overall, it was found that whilst partners understood and showed a commitment to improving patient flow out of the hospital, performance remained extremely challenging with adverse effects on patient experience and care. Partners continued to work both individually and collaboratively to set and implement clear guidance, mitigate the challenges posed by reduced capacity and increased complexity of care, and ensure the impact of activities was continually monitored, challenged, and maximised. The original report found that the extent of discharge delays in North Wales had grown significantly in recent years. Between April 2023 and February 2024, each month, there were, on average, 334 medically fit patients whose discharge was delayed, with completion of assessments the leading cause for delay. For the year up to and including February 2024, the total number of bed days lost to delayed discharges was 71,871, with a full-year cost equivalent of £39.202 million. The consequent impact on patient flow within hospitals and the urgent and emergency care system was significant, with waiting times in emergency departments and ambulance handovers falling well short of national targets. In February 2024, there were over 8,000 lost ambulance hours because of handover delays, and the average wait within the Health Board’s emergency departments was around 8.5 hours. Difficulties with discharge also impacted the ability of partner organisations to meet some patients' needs effectively, especially in the west of the region, where a significant proportion of patients were placed in temporary accommodation post-hospital discharge. Members drew attention to several areas within the report and discussed the following further – • whether the continual negative press/media coverage received by the Health Board contributed to the difficulties encountered in recruiting staff at all levels, thus impacting the flow in and out of the hospital. Officers responded that negative press coverage was an issue. However, it had no impact on staffing, and the staffing levels were acceptable in all disciplines other than mental health, which was still proving challenging to hire staff. • the steps being taken to ensure that vulnerable patients were not discharged home in the middle of the night with no one to receive them when they arrived. What support was made available to them to make sure they fully understood when and how to take their medication etc and whether any follow-up visits were scheduled. Responding officers acknowledged there were issues with the discharge process and agreed with members that vulnerable people should not be discharged in the middle of the night. BCUHB officers emphasised that vulnerable patients should not be discharged in the middle of the night and without support. If this was happening it should be reported as an incident. The Health Board held hourly discharge data, which was closely monitored, and worked closely with the community health team to ensure follow-ups were being carried out. • The Health Board had recently finalised its hospital discharge policy win cooperation with the local authority and other stakeholders. • whether communication channels were sufficiently effective to ensure that patients deemed medically fit for discharge were provided with proper support to aid their discharge. Officers clarified that a lot of work and communication was carried out with patients on discharge. They were provided with leaflets containing all relevant information and contact details. There was ongoing work to improve the information sharing between organisations and improving communication throughout. Further work was being undertaken in a bid to streamline the discharge process through the introduction of an electronic process. In addition, Optimal Flow Facilitators had now been employed with a view to improving patient flow in and out of hospital. At present all three Optimal Flow Facilitators were focussing their work at improving the flow in and out of Ysbyty Glan Clwyd. Regarding support and carers, officers clarified that they strived to provide local care for residents, and the use of micro providers assisted with this. • the Regional Integration Fund (RIF) monies and queried whether officers believed the funding would continue beyond 2027. Officers informed the Committee that they were continuously discussing the RIF monies and potential funding post-2027 with the Welsh Government (WG). • the report was a regional overview and was not solely focused on Denbighshire. Its findings and recommendations along with the progress in delivering the identified actions were discussed at the North Wales Regional Partnership Board (NWRPB). It had initially been presented to the Governance and Audit Committee which suggested the report be brought to scrutiny. The delay in its presentation to Scrutiny was due to the democratic process of the report being sighted by the relevant bodies before being discussed at the current meeting. • ‘RIF slippage monies’ would accrue when a role was vacant and had not been filled for some time. Whilst the post was vacant the funding would be reallocated where required. • Officers clarified that each organisation on the NWRPB contributed towards the work of delivering the action plan. • With regards to delayed discharges Members were advised that these usually entailed complex needs which required multidisciplinary team meetings to fully assess the individual’s care needs. Delay codes were being reviewed nationwide with a view to simplifying the procedure. • A member of the Single Point of Access (SPoA) team was now located at the hospital with a view to co-ordinating service enquiries more effectively. • With regards to sickness absence levels officers reassured members that there had been a slight increase in sickness absences. However, when working in health or social care, unlike other sectors, people could not work when suffering with sickness bugs, colds etc. due to the risk of passing them on to vulnerable clients, this caused short-term illness statistics to increase. • Members raised concerns about the lack of local knowledge from secondary care providers, as many agency workers did not know the local area and could not locate people appropriately. Other concerns were the IT systems used by the health and social care sector the perceived lack of synergy between them. Officers advised that there were ongoing meetings with WG, which aimed to focus more on community-based care, and there was ongoing work to get the IT systems working better together. • Confirmation was provided that work was underway to streamline pharmacy services in a bid to improve the discharge process. • Officers confirmed that partnership working arrangements were strong and positive, neither partner was blaming each other. It was the media that was attempting to create divisions. The NWRPB was working to improve the service provided regionally, with cooperation and joint working. This approach at times required some compromises, but it was realising its objectives. • Advised that in order to enable residents to live fulfilling lives there was a need to reframe the narrative and move the focus from a hospital centric system to a community care one. This required a shift to a preventative and early intervention approach in primary and community care. • Confirmation was provided that regular maintenance plans were in place for critical and specialist equipment at the hospitals. • The Committee agreed that it would be prudent to have a follow-up information report on the action plan as soon as possible. At the conclusion of a comprehensive discussion the Committee: Resolved: (i) to confirm that it had read, understood and taken into account the work that was required on a continual basis to meet the expectations and improve hospital flow in North Wales; (ii) that the Lead Member and officers take note of the Committee’s observations on the work undertaken to date through the North Wales Regional Partnership Board to address the recommendations; and (iii) that a further Information Report on the progress made in delivering the combined organisational action plan in response to the Audit Wales recommendations be circulated to Committee members when available. At this juncture the Committee adjourned for a comfort break at 12.55pm and reconvened at 1pm.
Y penderfyniad fel y'i cofnodwyd
Resolved: to communicate to the Project Team and Cabinet - (i) that having considered the report and received the presentation summarising the detailed design stage, attached at Appendix A to the report, emphasised that its desire was similar to that of local residents to have a replacement bridge built to connect both communities and ease travel between them. Nevertheless, based on the expert engineering and risk management advice received the delivery of this project did not seem viable as its construction would likely pose significant risk to critical infrastructure in the area which supplies water for circa 85,000 homes; (ii) acknowledging the impact the loss of the bridge had on local communities and their residents that the Council should make every effort to reduce the impact on connectivity between the communities affected by improving other local transport links and highway routes in the area; and (iii) to confirm that, as part of its consideration of this matter, it had read, understood and taken account of the Well-being Impact Assessment, Appendix B to the report.
The Lead Member for Environment & Transport alongside the Corporate Director: Environment & Economy, the Head of Highways & Environmental Services, the Risk & Asset Manager and the Senior Engineer - Bridges & Construction presented the Committee with a report (previously circulated) updating members on the Pont Llannerch project. Due to the complexities involved with this specific subject the Head of Highways & Environmental Services guided members through the report's contents. He also welcomed Dŵr Cymru Welsh Water’s Head of Water Production to the meeting to answer the Committee’s questions on their operations in the bridge’s vicinity and how any proposals may impact on those operations. Following the collapse of Pont Llannerch during Storm Christoph in January 2021, Highways & Environmental Services has been working on a project to build a replacement bridge. The project was split into three stages: Optioneering, Detailed Design, and Construction. It had now reached the end of the Detailed Design stage. The detailed design stage had been complicated and lengthy and has raised significant challenges. The main challenge being the consideration of the foundations required for a new bridge. This discussion had been complicated because Pont Llannerch was located above a freshwater aquifer, which was within a layer of weathered sandstone, and because Dŵr Cymru Welsh Water (DCWW) had a freshwater abstraction site situated directly next to where the old bridge was located. This aquifer and freshwater abstraction site provided water to around 85,000 homes in the region, therefore, the freshwater aquifer and water abstraction assets were extremely important to many DCWW customers. Consequently, the Council would need to ensure that it did not compromise these assets when building a new bridge. A preferred design using raft foundations had been chosen because raft foundations worked by distributing the load over large areas of ground. However, significant risks still existed because construction would require sheet piling – essentially drilling into the rock below where the foundations would sit. This drilling created a risk of compromising the assets. Provisional ground investigations at the pioneering stage determined that this weathered sandstone sat between 12 and 36 metres below ground level and extended as far upstream as Ruthin. Further ground investigations during the detailed design stage showed the water level to be as close as 10 metres beneath ground level. There was a standard for assessing the predicted scour depth of a bridge, and this showed that all 10m of the riverbed gravel in this location would likely erode in the future. Therefore, to protect a new bridge and to ensure it was not undermined, the newly constructed sheet pile curtain containing the new raft foundation would need to be drilled/driven into the area beneath where the foundations were placed, and this would penetrate the weathered section of sandstone in which the aquifer sits. Drilling into the aquifer could potentially compromise water quality at the DCWW abstraction point at Llannerch Park. Compromising the site would present a risk of supply loss to 85,000 DCWW customers. The project team had been working closely with DCWW throughout the Detailed Design Stage, and the DCWW view was that all risk assessments had failed to provide suitable evidence that the drilling work would not introduce risk to this critical asset. DCWW has stated that drilling into the aquifer would ultimately create a pathway for the risk of water supply contamination, compromising the aquifer local to the abstraction point could lead to several factors related to risk and safeguarding for their customers. An introduction of significant risk associated with the water supply had the potential to introduce a public health risk with wide-reaching consequences. DCWW has also stated that rectifying an issue created by drilling into the ground would not be straightforward and would be extremely costly to resolve. DCWW had also indicated that it may not even be feasible to repair it if a physical pathway was driven into the aquifer. For these reasons, DCWW had assessed the bridge's construction to be a high-risk activity. Members were also guided through a technical presentation illustrating further details regarding the project's design stage and all of the proposed designs for the bridge. Responding to Members questions the Lead Member, Officers and DCWW’s representative – • clarified that due to the existence of the aquifer building a bridge of any size to accommodate vehicle traffic was not feasible without risk. • confirmed that the concerns were not solely confined to the weight capacity of the bridge but to the potential velocity and power of the flood waters running underneath the bridge. Due to these factors, a strong foundation would be needed regardless of the size and weight capacity of the bridge, it was the foundations that would cause risk for the aquifer. • confirmed that the Council had a 10-year bridge maintenance plan in place with a view to safeguarding such structures. As part of this plan restrictions had been placed on the stone bridge over the River Clwyd in to Rhuddlan. However, this bridge was built on a rock foundation, which was not the same as the Llannerch bridge. • confirmed that the potential impact on the aquifer had not been fully assessed until the detailed design stage. • advised that it was hard to quantify the impact of the loss of the bridge on local communities, however, roughly 1,600 vehicles were thought to use the road daily before the bridge was swept away. • confirmed that the Council had strived to carry out as much correspondence with residents as possible throughout the whole design process for a potential replacement structure. • emphasised that they fully understood the value the bridge had to residents and the potential of erecting a temporary bridge had been explored, but the risks would remain the same as it would for a permanent structure as both would require strong foundations. The crux of the problem was the foundation and the potential risks that posed to the aquifer. • confirmed that it would not be possible to erect a replacement bridge either a few miles up or downstream because the issue would remain as the aquifer ran along approximately 22km below the riverbed. • highlighted the advice received from the Council’s insurers (paragraph 10 in the covering report) if it proceeded to build a replacement bridge which resulted in damage caused to the aquifer. • provided assurances that, with a view to improving connectivity between the communities effected, improvement work on the current diversion routes was being considered with funding from the Welsh Government. The Committee, following a comprehensive discussion: Resolved: to communicate to the Project Team and Cabinet - (i) that having considered the report and received the presentation summarising the detailed design stage, attached at Appendix A to the report, emphasised that its desire was similar to that of local residents to have a replacement bridge built to connect both communities and ease travel between them. Nevertheless, based on the expert engineering and risk management advice received the delivery of this project did not seem viable as its construction would likely pose significant risk to critical infrastructure in the area which supplies water for circa 85,000 homes; (ii) acknowledging the impact the loss of the bridge had on local communities and their residents that the Council should make every effort to reduce the impact on connectivity between the communities affected by improving other local transport links and highway routes in the area; and (iii) to confirm that, as part of its consideration of this matter, it had read, understood and taken account of the Well-being Impact Assessment, Appendix B to the report.
Y penderfyniad fel y'i cofnodwyd
Resolved: subject to the above, to confirm its programme of future work as set out in Appendix 1 to the report.
The Scrutiny Co-ordinator introduced the report and appendices (previously circulated), which sought the Committee to review its future work programme. Members were informed that there were not any substantial changes to the work programme; there was one item scheduled for the May meeting, which was the Household Waste Recycling Centres. Enquires could be made to see if the North Wales Economic Ambition Board Annual Report 2024/25 would be available to be presented at the next meeting. Members agreed that enquires be made to this effect. Members were advised that the next Scrutiny Chairs and Vice-Chairs Group (SCVCG) meeting was scheduled to be held on 28 April 2025. Their attention was drawn to Appendix 2, which contained the Members’ Scrutiny Proposal form. This form required completion and return if members had any topics, they wished to be considered for inclusion on a future scrutiny committee forward work programme. The Committee: The Committee: Resolved: subject to the above, to confirm its programme of future work as set out in Appendix 1 to the report.
None. Meeting concluded at 1.25pm.
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