Hywel Dda Health Board Your Health Your Future Statutory Consultation on the Reconfiguration of Healthcare Services Carol Evans, Assistant Director of Corporate Services, Hywel Dda LHB Dale Hall, MD, ORS

Process that was reasonable, proportionate, inclusive Adopt best practice wherever possible, and Meet the legal requirements of the Gunning Principles and the All-Wales Guidance on Engagement Consultation on Changes to Health Services What were we aiming to achieve?

The Guidance for Engagement and Consultation on Changes to Health Services EH/ML/0161/11 The Guidance describes a two stage consultation process Stage 1 -The first stage of this process was for the Health Board to undertake extensive discussions with all key stakeholders, (The purpose of these discussions is to explore all the issues, to refine the options and to decide and agree on which questions will be set out in the consultation ) Stage 2 – formal consultation formal consultation process (minimum 6 weeks) Consultation plan Assurance statement for consultation documents (para 37 ) – 16 points Post consultation phase

The Consultation plan Board approved detailed stakeholder analysis targets set to maximise reach opportunities multi-faceted range of engagement techniques employed to reach people across a wide geographical area communications and new media techniques seldom heard groups Weekly task and finish group to monitor plan (with CHC involvement) Mid-way review with CHC and ORS TCI compliance assessment

5 Hywel Dda Health Board’s Clinical Services Strategy OUTPUTS 10 clinically led workshops SWOT analysis of main clinical areas (called Programme Groups) Development of Right Care, Right Place, Right Time Strategy OUTPUTS Clinical Think Tanks Exploring the issues Clinically identifying potential solutions and options for future services across Hywel Dda Health Board OUTPUTS Two Day workshop -120 clinicians, nurses, therapists, GPs and partners to identify key service change options and evaluation criteria Option appraisal criteria approved Clinical Programme Groups to develop options and clinical pathways for service delivery in each area OUTPUTS Clinical refinement of high level options Key internal & external stakeholder engagement 12 week public listening and engagement – Your Health, Your Future Independent analysis of feedback Clinical workshops for options appraisal and site selection OUTPUTS 12 week public consultation Your Health, Your Future: Consulting Our Communities Reply to consultation responses from community Independent analysis of feedback to inform decision- making October - AprilMayDec - AprilAugust - OctoberMay - September Clinical Workshops Clinical Think Tanks Phase 1: Clinical Engagement Phase 2: Pre Consultation Listening & Engagement Phase 3: Consultation Phase 4: Post Consultation Oct - Dec Phase 5: Implement Jan onwards OUTPUTS Reflect on feedback Publish responses Produce Activity report Produce final report based on all clinical evidence and feedback Approve final recommendati ons OUTPUTS Establish Implementation Board Establish Strategic Health Groups Establish Improvement Academy Design implementation programme Implement “quick wins”

Compliance with Gunning Principles Consultation must take place when a proposal is at a formative stage The principle is that the decision maker – the Health Board – cannot consult on a decision that has already been made  extensive clinical and stakeholder engagement from May 2010 to December 2011  Listening and engagement –Dec 2011 –April 2012  The final consultation questions were areas of service change which remained open to influence.

Compliance with Gunning Principles Sufficient reason must be put forward for the proposal to allow for intelligent consideration and response Consultees should be made aware of the basis on which a proposal for consultation has been considered and will be considered  a comprehensive consultation document, supported by a suite of technical documents  Health Board also provided a range of opportunities for staff, the public and key stakeholders to meet with Directors and senior managers to discuss the consultation proposals in detail  The consultation document was provided in a range of different formats

Compliance with Gunning Principles Adequate time must be given for consideration and response There is no legally defined timescale for a consultation but the period allocated must be proportionate to the matters under consultation. All Wales Guidance requires a minimum of 6 weeks  Health Board agreed to extend this time frame to twelve weeks to maximise all opportunities for people to feed back their views.  Analysis of the submissions to ORS demonstrated returns across the population and indicates that people were aware of the consultation and had opportunities to contribute

Compliance with Gunning Principles The product of consultation must be taken conscientiously taken in to account sets out the need for conscientious consideration of the output from the consultation. If this stage is not completed properly, the Health Board could be accused of already having made its mind up or failing to give due consideration to the issues raised.  Internal process of evaluating all direct submissions –overseen by the Director of Public Health  ORS independent evaluation  Sharing of all submissions with the CHC  Publication of all responses received

CONSULTATION ELEMENTS QUAL ACTIVITIES QUANT ACTIVITIES “POPULAR” ACTIVITIES Focus groups Forums Submissions Open Q Household Survey Q Petitions Public meetings ORS analysis Board Decisions

Main Consultations 1

Main Consultations 2

OPEN QUESTIONNAIRE RESPONSES PER 1K POPULATION

RESPONDENT PROFILES: LOCAL AUTHORITY

PLANNED CARE – Orthopaedics Location for Orthopaedic Centre of Excellence for Carmarthenshire and Pembrokeshire Household Survey Base: All respondents (560) 80% of respondents answered this question Open Questionnaire Base: All respondents (3470) 78% of respondents answered this question

HOUSEHOLD SURVEY Vs OPEN QUESTIONNAIRE WOMEN AND CHILDRENS SERVICES Paediatric HDU, Level 2 Neonatal Unit and Complex Obstetric Unit Inpatient paediatric services in the South Household Survey 72% Glangwili 28% Withybush 71% Glangwili 29% Withybush 76% answered the question79% answered the question Open Question- naire 45% Glangwili 55% Withybush 45% Glangwili 55% Withybush 73% answered the question75% answered the question Please indicate where you would prefer the service to be located …

WOMEN AND CHILDREN’S SERVICES Where should Paediatric High Dependency Unit, Level 2 Neonatal Unit and Complex Obstetric Unit be located? <1 98 2

Carol Evans Assistant Director of Corporate Services Hywel Dda Health Board Dale Hall Managing Director ORS