“Each Community Health Council must – (a) represent the interests in the health service of the public in its district, and (b) perform such other functions as may be conferred on it by regulations under paragraph 2.”
“It is the duty of each Council to scrutinise the operation of the health service in its district, to make recommendations for the improvement of that service and to advise relevant Local Health Boards… of such matters relating to the operation of the health service within its district as the Council thinks fit.”
“4. … It is not necessary to consult formally on every change that is required. Some changes can be taken forward as a result of effective engagement and widespread agreement. 5. However, in cases where substantial change or an issue requiring consultation is identified, the NHS should use a two-stage process where extensive discussion with citizens, staff, staff representative and professional bodies, stakeholders, third sector and partner organisations is followed by a focused formal consultation on any fully evaluated proposals emerging from the extensive discussion phase. Note for readers on terminology: Although the words ‘involve and consult’ appear together frequently in the legislation, the question of when formal consultation is required needs further explanation and this is provided later in the document. This document uses the terms ‘engagement/engage’ to mean the continuous involvement of, or informal consultation or discussions with citizens, staff, staff representative and professional bodies, stakeholders, third sector and partner organisations regarding plans or changes. The terms ‘consultation/consult’ are used to describe the more formal, focused consultation which is to be employed if substantial or controversial changes are under consideration.”
“31. There may be some cases where, exceptionally, the view is taken that a more formal consultation is required. A key issue to be determined as to whether formal consultation is required is whether the change is substantial or not…. 32. Where is appears likely that a formal consultation could take place, it is proposed in future that this should be conducted on a two stage basis. The first stage is for NHS organisations to undertake extensive discussion with all the key stakeholders, to include: • the Stakeholders Reference Group • the Professional Forum • the Partnership Forum • the Community Health Council • the Local Service Board • staff and their representative bodies • other key partners as appropriate 33. The purpose of these discussions will be to explore all the issues, to refine the options and to decide and agree on which questions will be set out in the consultation. Only when it is satisfied that this first stage has been properly conducted, should be NHS organisation proceed to formal consultation. 34. Following the first stage described above, a formal consultation period of a minimum of 6 weeks should be sufficient in most cases if the issues have already been fully explored during the first stage and if the CHC agrees. 35. A number of issues should be considered right at the start, because they will impact on decisions to be taken at various stages throughout the formal consultation process. These include: • … • who should be consulted, on what and how? • … • what evaluation of the consultation is going to be undertaken, and how? • when to complete a full equality impact assessment • what is the timetable for both involvement and consultation process • what is the impact on associated services? • … 37. Consultation documents should: • … • show which options were considered during the engagement phase – the NHS needs to ensure that, if a preferred option is specified, this will not be seen as a ‘fait accompli’;…” • the Stakeholders Reference Group • the Professional Forum • the Partnership Forum • the Community Health Council • the Local Service Board • staff and their representative bodies • other key partners as appropriate • … • who should be consulted, on what and how? • … • what evaluation of the consultation is going to be undertaken, and how? • when to complete a full equality impact assessment • what is the timetable for both involvement and consultation process • what is the impact on associated services? • … • … • show which options were considered during the engagement phase – the NHS needs to ensure that, if a preferred option is specified, this will not be seen as a ‘fait accompli’;…”
“We have been working closely with our clinicians to look at the potential options we may have for our services. We are now at a stage where we believe this work, if shared more widely, will help shape the options we put forward for consultation in the future. The purpose of the next few weeks is for us to listen to what you have to say. We will openly share the work we have done so far, listen to any concerns and take into consideration any alternative suggestions. We need to be absolutely clear that no decisions have been reached either in terms of future services or in terms of the options we will ultimately consult on. … Once the listening period is completed, we will analyse the information we have received and this will influence the options we put forward for formal consultation.”
“Once we have completed the consultation process we want to assure you that we will have a robust process of implementing any changes. An Implementation Board will be formed with a chair person independent of the Health Board. This board will be responsible for overseeing and providing scrutiny on the change process.”
“On too many occasions, patients have gone to [PPH] in an emergency and required urgent transfer. This is not a safe situation so we need to ensure that everyone is aware of the services available at the hospital. … None of our emergency departments comply with the College of Emergency Medicine Guidelines and the only way that this can be achieved in Hywel Dda Health Board is to have a single emergency department. We accept this is not practical in view of our geography and we recognise the need to provide a full emergency department in each county.”
“Once we have completed the consultation process we want to assure you that we will have a robust process of implementing any changes. An implementation board will be formed with a chairperson independent of the Health Board. Tis board will be responsible for overseeing and providing scrutiny on the change process… Before any change is made the board will need to be sure that the infrastructure is in place to support the change and the alternative service is in place.”
“1.8 By running such an extensive listening and engagement process in advance of formulating and consulting on its eventual draft proposals, the [LHB] has recognised the importance of giving the public and stakeholders the opportunity to influence the evolution of its thinking at a very early stage. The process has been conscientious and proportional to the importance and controversiality of the issues: in our opinion, the [LHB] has sought to be open, accessible and fair to those wishing to express their views. 1.9 There have been some understandable criticisms of some aspects of the questionnaires used, but the listening and engagement process overall has been substantial and open – particularly in explaining the Board’s initial thinking, listening to so many responses through a wide range of routes, and in extending the consultation period to enable more people to share their views.”
“In advance of the listening and engagement exercise each potential option was measured and scored against these criteria, with only those clinically safe and operationally deliverable Options being put forward for consultation.”
“Option A:… [PPH] will no longer have an emergency medical admission unit but will provide a nurse-led Local Accident Centre for minor accidents. Option B: … [PPH] will have an emergency medical admission unit and will also provide a nurse-led Local Accident Centre for minor accidents.”
“• Consultant-led obstetric services will continue to be provided in Bronglais, Glangwili and Withybush Hospitals. • We will continue to have paediatric assessment units in Bronglais, Glangwili and Withybush Hospitals. • Bronglais and Withybush Hospitals will continue to have short stay paediatric units open all day every day.”
“As a research practice with wide-raging experience of controversial statutory consultations across the UK, ORS is able to certify that both the listening and engagement and formal consultation processes undertaken by [the LHB] have been both intensive and extensive. Overall, there is no doubt that both exercises have been conscientious, competent and comprehensive in eliciting the opinions of stakeholders and many members of the public.”
“The Assessing for Impact exercise articulated the demography and socio-economic make up of the [LHB] area. The responses received through the consultation process highlighted potential equality impacts that will need to address in the implementation phase. These include: … Potential Negative Impacts • For any additional transfers, increased travel times with potential impact on the elderly disabled, young people and families and low income households • Staff relocation with potential to affect staff from different equality strands. The [LHB] is committed to mitigating the potential negative impact by providing care in the community and in primary care whenever possible and by providing tangible solutions to improving transport.”
“An initial equality impact assessment has identified the following positive and negative impacts. Further detailed assessment will be made as part of the implementation process. … Potential negative impacts • Increased travelling distances depending on location – financial implications • Family separation and potential adverse consequences • Single parent families and impact on other dependents • Staff relocation with potential to affect staff from different equality strands Every effort will be made to mitigate the potential negative impacts. Families will be supported if they have to deliver their baby in a hospital that is not the nearest one to where they live.”
“8.7 The Board is asked to approve Continued work towards the implementation of Option B so that there is: • 24/7 Emergency Departments co-located with purpose-built clinical decision and assessment facilities at Bronglais, Glangwili and Withybush Hospitals; and • To adopt the terminology that will be standardised across Wales. The final decision is yet to be made but to note that it is likely that services that are not full Emergency Departments will be called Urgent Care Centres. At [PPH] a clinically led group has started to explore the unscheduled care services needed in primary care and at the hospital, and in particular a reshaping of ‘front door’ services. The Board is asked to approve for this clinically led group to continue and to: • Deliver an integrated service through a new model of secondary and community care. This will involve doctor supported, primarily nurse delivered services but will sit within an integrated model of GPs, pharmacists, paramedical and community services teams; • Deliver a 24/7 emergency medical assessment and admission service; and • Use this work to inform service delivery models at other sites within the Health Board. 8.8 The recommendation is the same as the original proposal for Bronglais, Glangwili and Withybush Hospitals, which means that emergency departments will be retained. For [PPH], the concerns of the public and the clinicians have been recognised and the recommendation is now broader and approves a clinically led group to re-design the unscheduled care services for the hospital and the community. The recommendation supports a doctor supported, nurse delivered service, but as a part of a new model of secondary and community care within an integrated service that will include a 24/7 medical assessment and admission service.”
“Mr Wales commented that this has been a particularly difficult issue for the CHC particularly around training rotas and sustainability, however they would wish to retain the status quo and for there to be equal provision across the 3 sites [i.e. Glangwili, Bronglais and Withybush]. In terms of the Level 2 neonatal service, a good deal of support has been received for developing this at Withybush Hospital which the board should take into consideration, particularly given the accessibility of Singleton Hospital [in Swansea] from Carmarthen, and concerns over knock on effects to paediatric cover at Withybush…”
“Dr Kloer confirmed the intention to retain paediatric and obstetric services in Withybush… regardless of the outcome of consultation…”
“… a number of the healthcare configurations are deemed unacceptable and not in the best interests of patients and the public, particularly: • Women’s and children’s, neonatal, SCBUs, obstetrics and paediatric services • the A&E service at [PPH]…”
“In light of these concerns [the CHC] remains unable to endorse the proposals given the (as yet unresolved) potential risks which are described in more detail within the report.”
“Our alternative model would therefore suggest that such an urgent care centre at PPH would be staffed by a fully trained GP (with experience in A&E) or by a doctor with relevant skills.” ii) The CHC said they “did not support the development of a neonatal Level 2 unit at [Glangwili], but instead recommends a greater working relationship with [Morriston]”
“I propose to make a determination on the proposals which the [CHC] has stated it cannot support as set out in its referral, as follows: Neonatal Services – specifically in relation to Glangwili and Withybush Hospitals. A&E Services at [PPH].”
“The [CHC] also reported its dissatisfaction with the consultation process undertaken by the [LHB]. The vast majority of the [CHC’s] referral relates to the [LHB’s] consultation with the wider pubic and other bodies, as opposed to its consultation with the [CHC], and would not therefore appear to be within the scope of Regulation 27(7) of the [2010 Regulations]. If the [CHC] is seeking to report on the [LHB’s] engagement with the [CHC], you may wish to refine this particular element of the report and resubmit it to me as soon as possible…. Although the [CHC’s] report on the [LHB’s] consultation with the wider public is outside the remit of the Regulations and therefore not something on which I shall make a determination. Once the current round of consultations across Wales has been completed, I do intend to commission a ‘lessons learned’ review of the different consultation exercises and will ensure that your views are considered as part of that process”
“In addition we enclose some further information regarding what we perceive to have been significant shortcomings in the listening and engagement and consultation processes between this CHC and the… LHB. We send this in the knowledge that you will be separately commissioning a report upon ‘lessons learned’ upon the consultation of the current round of consultations across South Wales and we hope that this will be meaningful in this latter regard; we are not asking you to investigate this particular aspect at this time unless you should so wish, nor to reopen the consultation process.”
“Newborn needs can be accommodated, without need for a neonatal unit, if a low-risk maternity service provided through a midwifery-led unit, is accompanied by emergency medical obstetric cover, staff trained in newborn resuscitation and stabilisation, and clearly defined pathways for in-utero and postnatal transfers… From a neonatal perspective centralisation of consultant maternity services in a single centre in Hywel Dda would provide improved patient throughput. Enable centralisation of neonatal services, facilitate stable and improved staffing, maintenance of staff skills, more efficient resource utilisation, and would benefit infant care and outcomes. ”
“In addition, the [LHB] is required to carry out an analysis of the need for, and an implementation plan for the provision of, improved neonatal transport services to support the changes in neonatal care at any of the Hospitals.”
“I was telephoned by the then Vice-Chair of the Board Janet Hawes on30 July 2010 , shortly after the document had been leaked. It had been obtained by the press in Pembrokeshire and contacts passed on a copy to me. Janet Hawes told me it was a mistake, and that it should not have been released, and that the board intended to work further on the document. She did not refute any of the contents of the document or imply that the information in the document was incorrect, but rather gave the impression that it had been released prematurely. The particularly unusual feature was that it is one of the very few, if not the only time that the Health Board proactively contacted me to speak to me about this issue.”
“9. … The draft 2010 Document was an initial draft prepared by the [LHB]. It was never finalised and no concluded view had been reached by the [LHB] that the models outlined in the draft 2010 Document were the solutions that should be adopted. 10. Before the draft 2010 Document could be considered by the Board of the [LHB], it was leaked without knowledge, consent or authority of the[LHB] in early August 2010…. The draft 2010 Document was widely distributed by persons unknown at this time with its purpose misinterpreted and misrepresented. 11. It must be remembered that Health Boards have to plan and look at potential models for the future and the draft 2010 Document was precisely that. The key purposes of the draft 2010 Document were to: 11.1 inform early discussions with the Welsh Government in relation to future funding; and 11.2 provide a starting point for discussions with the [LHB’s] clinicians on how we could deliver safe, sustainable, high quality services within the constraints of limited resources, four hospital sites and significant recruitment issues. 12. The draft 2010 Document set out what the potential configuration of services would look like if the [LHB] was to adopt a Royal College standards driven model for all services. It highlighted a number of areas where significant service reconfiguration would be required if such a standards model was to be adopted. The document highlighted what the implications for the [LHB] would be in order to meet the various Royal College standards.”
“Once we have completed the consultation process we want to assure you that we will have a robust process of implementing any changes. An Implementation Board will be formed with a chair person independent of the Health Board. This board will be responsible for overseeing and providing scrutiny on the change process.”
“Once we have completed the consultation process we want to assure you that we will have a robust process of implementing any changes. An implementation board will be formed with a chairperson independent of the Health Board. The board will be responsible for overseeing and providing scrutiny on the change process… Before any change is made the board will need to be sure that the infrastructure is in place to support the change and the alternative service is in place.”
“The concept of ‘due regard’ requires the court to ensure there has been a proper and conscientious focus on the statutory criteria, but if that is done, the court cannot interfere with the decision simply because it would have given greater weight to the equality implications of the decision than did the decision-maker. In short, the decision-maker must be clear precisely what the equality implications are when he puts them in the balance, and he must recognise the desirability of achieving them, but ultimately it is for him to decide what weight they should be given in the light of all relevant factors.”
“… [T]he specific criticism of the analysis relating to transport… has substance only inasmuch as it points out that transport was a problem to which no detailed solution had been formulated. However, as I have already mentioned, the general solution had been identified and it was appreciated both that the details had to be ‘firmed up’ and that the needs of each specific case would be the subject of an assessment in the normal way. The defendant clearly considered the transport issue. It was not bound to take the view that supposed transport difficulties were a determinative objection to its proposals.”
“In addition to assessing health needs, the impacts of proposed changes on those protected specifically by theEquality Act 2010 should be considered. The CHC accepts that the LHB has sought guidance from both the NHS Centre for Equality and Human Rights and the Consultation Institute on this topic. The CHC also accepts that impacts have been explored and that appraisal of such impacts will continue throughout the implementation phases. As such we make no accusations that the LHB has fallen short of any statutory duties relating to the Act ”
“Although the [CHC’s] report on the [LHB’s] consultation with the wider public is outside the remit of the Regulations and therefore not something on which I shall make a determination.”
“In my judgment [CREEDNZ Inc v Governor General[1981] 1 NZLR 172 ] (via the decision in In re Findlay[1985] AC 318 ) does not only support the proposition that where a statute conferring discretionary power provides no lexicon of the matters to be treated as relevant by the decision-maker, then it is for the decision-maker and not the court to conclude what is relevant subject only to Wednesbury review. By extension it gives authority also for a different but closely related proposition, namely that it is for the decision-maker and not the court, subject again to Wednesbury review, to decide upon the manner and intensity of inquiry to be undertaken into any relevant factor accepted or demonstrated as such.”
“… [T]he [CHC’s] report on the [LHB’s] consultation with the wider public is outside the remit of the Regulations and therefore not something on which I shall make a determination.” ”