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00:00Three updates to previous petitions. So, 3.1.1350 is to reopen Devy Ward at Towing Hospital,
00:10which is in Dwyfor Merioneth in North Wales. So, this is submitted by Jane Eleanor Sutton
00:19and Barrowclough, and there were a total of 5,528 signatures. So, this goes back to June
00:3223, response to the original. 11th of September, petition was, 23, petition was considered
00:39for the first time. So, lots of correspondence, but not a lot happening. Luke, could I bring
00:49you in on this, your experience of this?
00:52Luke Davies AM Yeah, I mean, this has come to Committee
00:56about five times now, from what I gather. I wouldn't mind a bit of steer or some thoughts
01:02from other Members on where we take this, because obviously we keep writing to the relevant
01:08people. We get the same answers back, the sort of assurances that they want to do this,
01:14that they want to move things forward, but then we're still 18 months down the line,
01:18nothing's happened. One thing that comes to mind, obviously, is that we contact local
01:24Members, because I think the pressure needs to be put on in the Chamber, perhaps, but
01:28I've no doubt local Members are already aware of that. In terms of what we can do as a Committee,
01:34we could, of course, write again, you know, for the up-to-date time now, but I think we
01:41need to go a bit beyond just writing letters at this point. So, I would appreciate some
01:45steer from fellow Committee Members, and maybe I'm unfairly looking to one in particular.
01:52We've experience in this matter. It's very useful.
01:56But then you develop the property, you know, and I definitely see it as being great.
02:00I think that's a prime example of that, I think.
02:05I think there's something clearly wrong here. There's something clearly wrong on a communication
02:13level, if nothing else, and a respect level for what we are asking and not receiving appropriate
02:22responses, you know. So, just on those points alone, I don't think we should leave this at
02:30all. I think we need to write again and challenge them as to why they don't feel it's appropriate
02:36to respond.
02:37I think I spoke to this on the fourth time, and I think we agreed that we would write
02:43a final letter, and we really thought that that would be it, but to be in the same position,
02:49you know, months afterwards.
02:51The question for me is, how do we as a Committee spend our time in the right way?
02:57We can, of course, write again, but if we're going to get the same answer back, well,
03:00we don't want the worst Committee time, nor the petitioner's time.
03:03Maybe this is cue von Gethin.
03:08But there's a question here, not just about our time, but also about the answers that
03:12are being provided. The Health Board say they want to recruit staff, and they had some staff
03:17who then moved on. So, actually, this is about recruitment and retention and the model
03:24of care, and if you can't recruit staff to go into that model of care, then it doesn't
03:29matter how many letters we write.
03:31If the staff won't stay to provide the service, you don't have a service, or even worse, you
03:36have an unsafe service that people think they should be able to rely on, and it doesn't
03:39provide the outcomes of care that any of us would want for our families, let alone our
03:43constituents.
03:45There is something about, not just, you know, I've read the letters from the Chief Exec,
03:50Carol Shiller, but previous Chief Exec of Powys, used to providing different and changing
03:56models of care to a rural community, and understands the difficulty and the challenge, and how
04:01you get people to buy into that, both locally, the population, and staff as well.
04:05What I haven't really seen is an explanation of, not just here's what we've done to try
04:10to recruit staff, but what I think the challenges are in getting staff, and whether they actually
04:15need to change the model of care, or actually, whether the health board want to sit up front
04:19and say, we don't think we can provide that service there.
04:22We'd ideally like to, but given the current state of recruitment and retention, we can't
04:27do that.
04:28And the challenge always is, if we say, just put more money at it, well, that money will
04:32need to come from somewhere else, and then members in different parties will stand up
04:36in the chamber and say, why, oh why, is this health board spending lots of money?
04:40And actually, you often end up spending money, because you're providing a model of care
04:45that actually costs more than you'd want it to.
04:47And it's not straightforward.
04:49The easiest thing is for us to say, just make it happen.
04:52But that won't necessarily change anything.
04:55So I think a question around, what is the current model?
05:00Is it simply about needing more staff to go and work and everything, and the model of
05:03care itself is fundamentally the right one?
05:06Or is this actually something where this type of care isn't going to be made available in
05:10the same way?
05:13And look, it's the easiest thing in the world to demand a bigger, bolder, and brighter
05:17recruitment campaign.
05:21But if the staff don't want to go there, it doesn't matter.
05:25And you know, we recruit lots of nurses internationally, and we train lots of nurses.
05:30Our rates of not just getting people into nurse training, but keeping them there, compared
05:35to England in particular, is much better.
05:38And the reason I England in particular, is that's where most of the cross-border flow
05:41goes.
05:42There's no point pretending that actually we could go and grab nurses from Scotland.
05:46That's not a helpful comparator.
05:48And because the English system is actually looking for more staff itself, you don't have
05:53stability across the England and Wales part of it.
05:57And that means that we catch a cold as well.
05:59So there is something there about what we're trying to do and deliver, the test we're asking
06:04the health board to meet, and whether actually it's one that they can realistically meet
06:09or not.
06:10It's not very comfortable, but it's a much more honest way of dealing with it.
06:13I think you hit on the head there, and it's about honesty and clarity.
06:20And what upsets people is because they don't see a light at the end of the tunnel.
06:25They don't know what the milestones that need to be breached, or what the barriers
06:29are in the way of getting where they are now.
06:31People generally are very reasonable if they understand the facts.
06:34They recognise things might not happen overnight, but need to know what journey the health board's
06:39on to get to where it needs to be.
06:41And I think that's half of the trouble.
06:43People get so frustrated about things, there's no clarity.
06:47And I think that applies to health boards, it applies to government, it applies to local
06:51government.
06:52We just expect people to believe us.
06:55And sometimes we need to lay it out and explain, well, actually, you know, well, I remember
07:00my own health, my own chief executive telling me one day, when we were talking about social
07:04care and the unmet need in mum's year of 2,000 hours a week, he said, Peter, you've
07:09given me £30 million tomorrow, I couldn't solve the problem because I can't get the
07:14staff.
07:15So that was really easy to comprehend.
07:17I think Peter's point is important there, and it follows on from Paul's point, is the
07:22health board is not in a unique position.
07:25Attraction or retention is an issue across the board in many other professions, too.
07:31You speak to legal firms in these areas, and there's a huge issue with attracting and
07:37then training, and then after training, retaining staff.
07:41So I agree with Vaughan's comment about the honesty and just the rationale behind it would
07:49make things much easier for people, and following Peter's point, much more palatable for the
07:57petitioner and others.
07:59The other part is how the service used to be provided here and where it's currently
08:05being provided and how.
08:07Because, you know, it's not as if people who currently go there are being left at the
08:12door or in tents.
08:14So a service that used to be provided on this ward, where and how is that being reallocated,
08:21and what is the stability and the quality of that care that's being provided, and is
08:26there a long-term plan that is realistic to recruit staff into this model of care and
08:31to keep them there on a longer-term basis?
08:34Okay.
08:36But it appears to me there seems to be a desire to keep this still going here, where, you
08:42know, they've tried to recruit, struggled to retain.
08:46I heard, I was on another committee where I think the Welsh Audit Office did a review
08:52of Betsy, and there was discussions about the survey of staff, and they said they thought
08:58they had a good response from staff, but actually the response rate was really quite low.
09:02So, you know, it's expanding this a bit further, but it's really important regarding
09:09retention.
09:10And, you know, when I talk to people in that area, and they say we need to have more jobs
09:16in the area, when we talk about jobs, they expect, oh, we need industry to employ people
09:20in businesses, but health, public services, it goes back to that, this is, these are jobs.
09:26These are jobs in the local community that need, you know, you need to have investment
09:30in.
09:31We've got the new medical school being built in Bangor, so that's, but that's looking at
09:38GPs, isn't it?
09:39But we do have Bangor that recruits allied health professionals and nurses, so it would
09:48be interesting to see how many places there are there, and how they're getting on with
09:54recruitment and retaining and training there.
09:58And if more could be done regarding offering more places, that's something we could ask
10:04the health board.
10:08And then we have these new staff, safe levels of staffing now, don't we, that have been
10:15introduced as well, so, which is, you know, important, but when you're struggling to recruit
10:23as well, it's.
10:25So I'd check all those things, but I am able to recruit and retain the right number of
10:30staff, and a mix of training your own staff, that's not just in nurse, therapist and doctor
10:40training, and it's a really good thing that, and there's been the first intake this autumn
10:44in Bangor for the new medical school.
10:46Yep.
10:47But it's, you're still going to need to recruit nationally and internationally, and that takes
10:53money, and you've got to have a way and a service that people find attractive to want
10:58to buy into, and also someone they want to live as well.
11:02And actually there are lots of people who just won't want to live in this part of Wales,
11:06that's because they'd rather be in a city.
11:09There are other people though, who would possibly want to live in a part of Wales like this,
11:14because they want what you can get for life, and so there is something there about the
11:18job and the model of care, but it's also about all the rest of it as well.
11:21So the provision that used to exist, where and how is that being provided, what's the
11:28feedback from people who are now receiving that care somewhere else, and then if the
11:33health board want to do this, is it they're thinking that there is a sustainable model
11:37of care, and they just basically need to keep going until they get the staff, or do they
11:42think that actually this model of care needs to change to be sustainable?
11:47You know, I think we have spent a lot of time in Wales running campaigns around health
11:51care that are almost about a sense of loss for a place if a service doesn't exist, whereas
11:58actually if the quality care being provided isn't the sort of quality that we would want
12:04to receive ourselves, why are we fighting for poor care that is local?
12:10And you then get all the tension of how far you need to travel for really good care that's
12:13sustainable as well.
12:15But it's an honest engagement with the challenges we have, and I can't see in the health board's
12:19correspondence whether they're saying it's just about recruitment, whether it's more
12:23than that, and I think that would be helpful to know.
12:26Part of the response is when, you know, you're asking where are they providing alternative,
12:31it says here health board increased work in the community, enabling patients to be cared
12:37for at home as where possible, but for a small number of patients needing more intensive
12:42care, additional beds at Dolgellau have been made available.
12:47Sorry, the reason I asked my point, Chair, sorry, is that, and when I read that part,
12:52I know the petitioner came back and said we don't agree that these are small numbers.
12:57Well, how large are the numbers?
12:59How many people a year still require inpatient care that would otherwise have gone to tow-in,
13:03and how many people are getting their care in a community-based model of care?
13:08And the reason I think it's important to understand that is, if you're seeing more
13:11of the people who have previously been in a hospital or been in tow-in three years ago,
13:16well, let's take it five years ago, pre-pandemic, well, how many of those people now have their
13:22needs met in a different way?
13:23Because most people that get community-based care are much happier with it.
13:28But actually, the numbers of inpatients that are still required, what are those numbers?
13:34Are they adequately provided for?
13:35Are we talking about 10 people a month or 100 people a month?
13:39The difference between the two is quite important.
13:41And we don't get that from the correspondence.
13:43That's why I think asking about the model of care is important.
13:47Because it could be that the community-based care deals with 10% of the previous need.
13:51It could be it deals with 70%.
13:53And that changes everything about what's then sustainable.
13:56And again, I think Peter's point, if you were to say to the public, not as we're doing more of
14:01this, but if you're saying a large percentage of people who have previously gone there now
14:06receive their care in the community.
14:09And that almost always leads to better outcomes as well, actually.
14:12Well, I feel like because we're a petitioning committee, we're discussing the merits of
14:17trying to deliver health service as well.
14:22So this has been submitted by somebody who feels the need to have Taryn opened again,
14:34working again.
14:35It seems that there is a desire there.
14:38But so we need to respond to the petition in particular and get some targeted real responses
14:49back from the health board as to for her to have a reality of, do they really intend going
15:00forward to reopen it?
15:02And what are they doing regarding retention?
15:08I think they had two nurses working there.
15:11Retention was difficult.
15:13So how have they dealt with that retention of staff?
15:15How are they working with their staff going forward?
15:20And just regarding what courses are available locally for nurses being offered at Bangor
15:29as well, or generally locally?
15:33It's just a suggestion, and it might be rubbish.
15:39So if it is, just say.
15:41But when we are writing to whoever on this particular point now, is it not worth seeing
15:50if the chair of the health committee will also sign that letter, so it's a joint letter,
15:54to give it a bit more weight and give it a bit more prominence as well in terms of this
16:00isn't just something that we are dealing with, but the health committee is beginning
16:04to take an interest as well.
16:06I don't know if that will have an effect.
16:08Yes, we could ask.
16:12Recruitment and retention in rural areas, especially North Wales, is such a big issue.
16:16Many people will, as we mentioned, work in Cardiff's one of the big city centres.
16:23And transport is more of an issue, isn't it, in rural areas as well?
16:27So we've discussed it many times, haven't we, recruitment and retention in rural North Wales?
16:33This is such a specific issue, the health committee may not want to get involved.
16:37They may be more interested in the more strategic point around recruiting and retaining the
16:42right number of staff in the health service and all the different factors that go into it,
16:45including its relation with social care and how community-based models work.
16:49But that's a much bigger topic, isn't it?
16:51This is, on a micro level, what is happening here.
16:57Okay, is there anything else?
16:59Are you okay going forward?
17:00You've got enough there to work on.
17:06Yeah, so again, I'd just like to thank the petitioner.
17:11And we'll follow up those actions.
17:13So 3.2.