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Apologies for absence were received from County Borough Councillors P Binning, S J Davies, J Elliott, D Evans, S Evans, D Grehan, H Gronow, K Morgan, M Norris, D Owen-Jones, D Parkin, S Powderhill, M Powell, W Treeby, J Turner, D Williams, T Williams and R Yeo.
In accordance with the Council’s Code of Conduct, the following declarations were made pertaining to the agenda: County Borough Councillor S Morgans – “My daughter is a nurse at the Royal Glamorgan Hospital” County Borough Councillor G Caple – “My son is a doctor and employed by the Local Health Board” County Borough Councillor S Evans – “I work for the Cwm Taf Health Board”. County Borough Councillor K Johnson – “My wife is a nurse for Cwm Taf Morgannwg Health Board” County Borough Councillor S Trask – “My wife is employed by the Welsh NHS” County Borough Councillor M Ashford – “My wife works at the Royal Glamorgan Hospital” County Borough Councillor R Lewis – “I have a close family member who works for the NHS”. County Borough Councillor C Middle – “My sister works for the Cwm Taf Morgannwg Health Board” Note: A declaration of interest was made later in the meeting as follows: County Borough Councillor R Yeo – “My wife works for the NHS”
The Presiding Officer introduced the Cwm Taf Morgannwg Health Board representatives and advised Members that they will be covering items as indicated on the agenda, he acknowledged Members’ concerns regarding the changes with rapid response vehicles but pointed out that these are matters for the Welsh Ambulance Trust. The Presiding Officer advised that any further questions should be addressed to the Cwm Taf University Health Board for a response via the Council’s Democratic Services. The Chairman of the Cwm Taf Morgannwg University Health Board, Mr Emrys Elias introduced himself and five members of the Executive team, Mr P Mears, Chief Executive, Suzanne Hardacre, Director of Midwifery, Gynaecology & Integrated Sexual Health, Sarah Bradley & David Miller Operations Leadership & Medical Leadership for Primary & Community Care and Mr Gethin Hughes, Chief Operating Officer. Through the aid of PowerPoint slides the representatives of the Cwm Taf University presented an overview of key matters under the following headings: • Maternity & Neonatal Services Update • Primary Care Update • Winter Pressures The Leader of the Council thanked members of the Cwm Taf Morgannwg University Health Board for their presentation and virtual attendance at the council meeting. The Leader referred to the Maternity & Neonatal Services update and added that he had valued his many discussions and regular briefings with Mick Giannassi, the Chair of the Independent Maternity Oversight Panel, on the recommendations, progress made and patient feedback. He queried whether the previous short fallings in staffing levels had now improved? He also referred to the three reports by Audit Office Wales on the failings to meet the Health Board’s response targets within the required timescales and the quality of the responses and the Leader asked for an update on this matter. He also requested a further update from the Cwm Taf Morgannwg Health Board on the Neonatal services following the Midwifery review. The Leader raised a query regarding GP Services and particularly what appears to be a postcode lottery across the County Borough in relation to GP appointments. The Leader sought clarification as to how the Health Board is supporting GP practices with the costs of locum Doctors. He reminded Members that the Council has continued to support the Health Board with promotion of its Flu and Covid vaccine programme whilst supporting its own staff with the flu vaccine. He added that the close working relationship between the Cwm Taf Morgannwg Health Board and the Council has continued with regular meetings which will assist to jointly address the winter pressures. The Leader was pleased to see the re-opening of the Minor Injuries Unit within the Cwm Cynon Hospital. He acknowledged the positive work that the Health Board is undertaking to address the backlog of elective surgery and praised their efforts to tackle this problem. Mr Paul Mears responded to the queries raised by the Leader such as the safe staffing levels within the Maternity Services which he described as levels being ‘where they need to be’ with staffing levels being monitored routinely to ensure they are safe. He added that there are challenges with recruitment, but newly qualified midwives trained at the Royal Glamorgan Hospital are remaining in post. Mr Mears advised that much work has been done to improve response times within Maternity Services and where complaints are received they are responded to appropriately and quickly. He added that responses to complaints are shared with other colleagues so that examples of good practice can be recorded. Mr David Miller responded to the query regarding the variation in access to GP services and how the Health Board is looking to avoid a postcode lottery. He added challenges faced by the GP Practices include developing a robust, multi-disciplinary team to ensure they can provide a wrap-around service to accommodate the needs of the population. The key issues for the practices, during times of staff shortages, is to remain flexible to support the most urgent and vulnerable cases and to be very clear in their messaging, which he agreed could be improved. He explained that GP locums form an essential part of GP Practices, however, due to national factors, outside of the Health Board’s control, the market has become a little destabilised. He added that key is to make the GP Practice as attractive as possible in terms of the quality of the premises such as those in Porth or Gilfach, which improves recruitment and retention. The training of qualified doctors into GP Practices, also improves recruitment. The Health Board also uses the Primary Care Support units to support practices in times of difficulty and the Cardiff University Academic Fellowship Scheme, where doctors spend part of their time undertaking research, are also available to work in the GP Practices where necessary. Mr Paul Mears confirmed that the Cwm Taf University Health Board would be happy to attend a future meeting of Full Council to discuss elective surgery waiting lists. Councillor D Wood asked whether there was an impact on attendance at clinics where residents have to travel on public transport across the County Borough and whether the Health Board has considered establishing satellite clinics to support residents? Mr Mears advised that the Outpatient clinics are held in more convenient locations and the UHB is looking to work with transport groups and voluntary organisations to identify opportunities where they can support and signpost patients. When booking appointments with patients, he confirmed that discussions are held with them and NHS staff around transport options and they are keen to work with colleagues in the local authority with regards to this matter. At this stage in the proceedings, the Presiding Officer advised that he would be inviting questions from Members in groups of three. Councillor S Trask referred to the South Wales Programme and asked for an update on the future plans of the Paediatrics Inpatient services at the Royal Glamorgan Hospital and what considerations are being made by the UHB to provide patients, in A&E, with access to food and drinks during their time spent waiting? Councillor D R Bevan asked whether, following the pandemic, it would be more beneficial to declare a winter crisis to jointly address the key issues such as ambulance waiting times and hospital discharges. He also sought a response as to what the Health Board is doing to address recruitment issues in those areas where agency staff are used to backfill and also asked if current staffing levels are safe? Councillor P Evans raised a concern regarding ambulances lined up outside A&E Departments and being used as cubicles to treat patients and she also sought confirmation that patients are receiving the correct care under these circumstances. Mr Mears commented that there are no plans to change the provision of Paediatric Services at the Royal Glamorgan Hospital. With regards to the catering concern, it was confirmed that regular catering is available throughout the waiting rooms and vending machines are also available and provide hot and cold beverages. In addition, comfort rounds are undertaken to provide food, to those waiting in line. It was confirmed that there are regular meetings between the Health Board and the three local authorities and a winter summit meeting with the local authority will also be held shortly. Mr Mears thanked the local authority for its involvement and support of the Health Board, particularly the ideas coming forward where support can be provided. He added that it is a collective effort between the Health Board, the Ambulance Service and the local authorities and the frequent forums are beneficial to consider matters across the whole organisation. The Cwm Taf University Health Board confirmed that efforts are being made to reduce the number of agency staff which is also a national challenge and indeed throughout the whole of the UK. There continues to be a large number of staff/nurse vacancies across many services. The Health Board is working actively on the recruitment process and in collaboration with the University of South Wales. Recently over 100 overseas nurses were recruited through the overseas recruitment programme and although this was helpful there is a need to retain the nurses that are already in post and as much effort is spent on the retention of staff as recruitment. Mr Gethin Hughes provided an update on the Ambulance queues and delays and commented that the outflow is from A&E departments which is driven by the ability to discharge patients in a safe and timely way to reduce the delays. When patients are held in ambulances they are seen by doctors and if they need scans they are removed from the ambulance into the hospital where they receive the full range of care. He added that 50% of admissions into Intensive Care are directly from A&E departments and the challenge is to assess which patients are a priority. Mr Hughes acknowledged that with the delays comes a risk to the community and the ability of the ambulance to respond to other calls, but he assured Members that the ambulances are released to respond to red calls. Councillor W Lewis commented on her recent good experience at the Minor Injuries Unit which she visited instead of going to A&E. She also asked that despite Maternity Services being out of special measures, what is being put in place to ensure systems continue to improve and there isn’t a repeat of previous issues? Councillor R Williams asked what is the projected impact of Covid and seasonal flu this Winter in addition to the Covid backlogs already in place? Councillor L Tomkinson asked that with the increase in energy prices and inflation expected to remain above 10%, what plans are being put in place to make efficiencies while maintaining services to a level expected by residents? Mr Paul Mears confirmed that despite Maternity Services coming out of special measures, the Health Board is continually looking at ways to improve the services within that area. Ms Hardacre commented that the Health Board has embedded a quality improvement approach to its learning which is driven by data and working closely with Welsh Government as part of the Neonatal support programme to ensure that services within CTM and across Wales are safe. In terms of assurance, the Maternity Services regularly report its performance to the HB’s Quality & Safety Committee and reporting regularly to Welsh Government’s IQPD performance. Mr Mears confirmed that plans are in place, should Covid numbers rise, such as reverting to screening patients through the front door and the Health Board is working with Welsh Government to identify any trends or changes in Covid activity and monitoring is ongoing. In terms of cost efficiencies, Mr Mears commented that energy cost pressures and their impact are huge for the Health Board, like all NHS organisations, and they already have a significant plan in place to manage efficiencies. Early indications are that next year will be more challenging and the Chief Executive advised that it will be important to provide safe, good quality services for residents whilst ensuring that the Health Board can deal with the financial challenges before it. He advised that 70% of its costs are associated with its work force. He added that a key priority is the workforce, without it to fill the gaps and having to use temporary and agency staff can impact on those safe and good quality services. In conclusion, Mr Mears commented that part of the efficiency programme is looking how things can be done differently and efficiently which is part of the existing programme. Councillor R Davis asked about the winter pressures, particularly around what preparations are taking place locally to manage them? Councillor J Brencher wished to thank all the Health Board staff for their work despite the challenges they face. She commented that cancer targets are not being met currently and patients are not receiving treatment within the recommended timescales. She added that in view of the huge concern amongst GP’s and residents, is there any strategic plan to tackle this in a different way, through private services? Councillor Brencher also commented that A&E was closed recently with patients being advised to visit their GP’s, which pushed them towards breaking point. She asked whether in hindsight it may have been more beneficial for those patients to have been sent to another Hospital. Councillor G O Jones asked what impact is the cost-of-living crisis having on the demand on staff and services? The Chief Executive, Mr Mears commented that in order to manage demand pressures at a local level, the Health Board is looking to give as much access to the GP Practices as possible, to prevent residents from presenting themselves to A&E. He added that it is also useful to remind local residents (and this is where Elected Members can support) that other alternatives exist such as the urgent Primary Care centre in the Rhondda or patients undertaking self-care or seeking advice from their local pharmacy although he added that it is important to ensure residents are choosing well and having access to the right service to accommodate their needs. Mr Gethin Hughes responded to the issue of cancer targets, he advised that the targets are not where they should be and that this is driven by a significant increase in the number of cancer referrals. He added that the Health Board is treating more cancer patients than before. He confirmed that the Health Board is on course to ensure that 75% of all patients are diagnosed and treated within 62 days and there has been a significant reduction in the numbers of patients who have been waiting for a significant period of time. The primary focus is to get the cancer diagnostics and treatment service back to a minimum target of 75% this year and to 85% the following year, which is in line with NHS Wales requirements. Mr Hughes advised of two innovative one-stop clinics, the new One Stop Breast Unit which will be opening in January 2023 on the Royal Glamorgan site, for any patient who is referred on the breast cancer pathway and the one-stop gynaecology site is now live. Mr Mears referred to the A&E closure which happened over two consecutive days, which was due to a power outage on the Royal Glamorgan site. He clarified that arrangements are in place for such incidents and emergency ambulances are diverted to other Hospitals. The fault was resolved quickly, and he acknowledged the offer of support from the Leader of the Council during this time. With regards to the cost-of-living crisis Mr Mears commented that support is in place for NHS staff in a number of ways such as providing advice, signposting and the use of a staff wellbeing service. In terms of patients, he explained that the fuel and energy crisis brings with it the risk of cold homes and he alluded to the associated impact and ailments that this can cause. Mr Miller added that this is an area of particular concern, and one the new President of the Royal College of General Practitioners also shared recently around the impact of cold homes and poor nutrition, particularly amongst frail and elderly patients. Councillor K Johnson asked what is the Health Board doing to support staff morale through this difficult time and to support those hard working and dedicated members of staff in view of the recent events with the Maternity & Neonatal Services? Councillor J Barton praised the work of the Health Board and she commented that the Hospitals are working well following her recent experience as she dealt with long covid. Councillor Barton asked, how much consultation should GP Practices have with their patients and how do patients receive feedback without any consultation? Councillor Barton was concerned that in her own experience, the local GP refuses to speak to patients and refused to meet with her in her capacity as a local Councillor, to discuss issues raised by local residents. Councillor S Emmanuel referred to the GP services in the North of the County Borough and asked does the Health Board intend to communicate with patients and to reassure them that they will have access to the services? Ms Hardacre responded to the query regarding staff morale within the Maternity Services and described some of the support available for staff. With each report launched the Health Board held an engagement session with staff, to allow them a safe space to attend and talk both on Teams and a face-to-face meeting. She added that the best attended meeting came following the launch of the recent and latest report on the 7th November which boosted morale. A culture engagement wellbeing plan has been launched which involves close working with trade unions partners where many events are held with senior leaders and drop-in sessions. The Clinical Psychologist within the Health Board also regularly attends the engagement sessions. The ‘Caring for You Wellbeing Action Plan’ with the Royal College of Midwives has recently been launched, and there is engagement with all other team members to ensure that it is all inclusive and provides support for all members of the multi-professional team across the Service. With regards to the question posed by Councillor Emmanuel, Mr Miller offered assurance that GP’s and their staff are resilient and have been flexible in their response and approach to the Pandemic and will continue to do so. He agreed that more needs to be done in terms of their communication with residents but as demonstrated within the earlier presentation, the access tile will track their progress or highlight those areas that need to be improved. He added that, as with his own practice, any resident who raises concern following a consultation will be invited to form part of a patient participation group to help assist future developments. In conclusion, the Leader of the Council thanked the representatives of the Health Board for their attendance and advised that an invitation to the Welsh Ambulance Service would be extended to attend a Full Council meeting in the New Year. He also suggested that the representatives from the Cwm Taf Morgannwg University Health Board return to a future meeting of Full Council in the Spring. The Presiding Officer reminded Members that any outstanding questions can be sent to the Council’s Democratic Services who will forward them to the Cwm Taf University Health Board for their written response.
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