National Assembly for Wales

Bore da, good morning, and welcome to the Petitions Committee. We have no apologies or substitutions this morning. Janet Finch-Saunders and Leanne Wood are a little late, but they should join us shortly.

Item 2 on the agenda is new petitions and the first of these is 'Tackling school bullying'. The petition was submitted by the BlowforBradley Campaign, having collected 1,463 signatures. An initial response to the petition was received from the Minister for Education on 7 January. I will declare here that I have met with the petitioners prior to this petition being submitted.

Under the points for discussion, the Welsh Government's response says that it expects schools to adopt a zero-tolerance approach to all forms of bullying and that the school behaviour policy at every school in Wales is subject to a legal duty to ensure that any form of bullying is dealt with effectively. However, I think that the concern of the petitioners is the implementation and the enforcement of polices for schools, and I will note now that in Estyn inspections, bullying is one of the items which is looked at, and it does appear that some schools are, in fact, not describing bullying incidents as such, but are simply describing them as 'incidents'. So, there is obviously a lack of implementation by all schools in the procedures at this moment, and the petitioner is asking if there can be any form of legal framework to make sure that schools do comply with all the recommendations and the policies put in place by the Welsh Government. Do you have any comments?

Yes. I think there's a lot of dissatisfaction with parents who contact me about this issue, and it blights lives, really. So, I'm glad there's a public consultation. I think maybe it would be good to wait for the outcome of that and then act upon that.

Yes, fine. I think we ought to mention that, obviously, there are some legal proceedings ongoing with a particular case that sponsored this particular petition, so I believe that we ought to deal with it only in broad terms, as such.

I think we've got to deal with it in broad terms because I don't think one incident in one school is the total of bullying in Wales. If only that was so, then we wouldn't be discussing this today. We've had further comments from the petitioner. Can we send them on to the Minister, asking for her response? And I just think that the advantage of this is that it is bringing the problems of bullying in schools to the fore. 

Yes. I think that's absolutely right and although we're not referring to the specific, I know the petition was, of course, the result of a particularly tragic incident of bullying. So, the possible actions are that the committee could write to the Minister for Education to provide the further comments from the petitioner, to ask her to provide an assessment of the sufficiency of current legal duties in relation to preventing and tackling bullying in school, and for an update on the outcomes of the public consultation on anti-bullying guidance, when this is available. And we ought to ask, I believe, for a timeline with regard to that consultation as well. Are we happy with that?

Happy with that, yes.

Yes, thanks, Chair.

Okay. We move on to the next new petition, which is to 'Call on the Welsh Government to provide free sanitary products to all women in low income households'. This petition was submitted by Malpas Women's Institute, having collected 141 signatures. I think it's fair to say that the Welsh Government has taken a proactive line with regard to this, and an initial response to the petition was received from the Deputy Minister and Chief Whip on 17 January. They mention here that the Government has allocated over £1 million over the following three years in grant funding to local authorities to help tackle period poverty. I don't think they've gone as far as they have in England, in that they are providing free sanitary products to all necessary recipients. Do you have any comments on that?

My comment is: yes, they should. But I think that the Welsh Government is supportive, and Jane Hutt personally is incredibly supportive of this, and I would probably go along with the action of seeing what the petitioners' response to the Deputy Minister's reply is. But I think that our success would be getting the petitioners and the Deputy Minister to talk to each other without doing it through the prism of us, and I think that if we can write to them and we can write, perhaps, to the Minister and ask the Minister if the Minister will meet with these petitioners—. I think there's a meeting of minds and I think that we can do some useful things, but one of the most useful things we can ever do is to get the petitioners and the person making the decisions talking to each other.

Fine, okay. Do you have anything to add to that, Neil?

I would agree with everything Mike has said there.

Okay. The committee could await the views of the petitioners on the response provided by the Deputy Minister and Chief Whip before considering whether to take further action on the petition. But following that, as Mike has proposed, we could ask the Minister to meet with the petitioners.

Okay, item 3 is updates to previous petitions. The first of these is 'Gender Pay Gap Reporting'. The petition was submitted by Estelle Hart and was first considered by the committee in October 2018, having collected 56 signatures. The committee last considered the petition on 13 November 2018, and agreed to write back to the then leader of the house to seek an update on any developments since her previous letter on 6 September. A response was received from the Cabinet Minister and Chief Whip on 17 January, and the petitioner was informed that the petition would be discussed, but had not provided further comments when the papers were finalised. Do we have any comments to add?

Well, perhaps I ought to say I know the petitioner, as do many other people here. I think we just wait for the petitioner's response.

Yes. I think it would be good to maybe have more detail as well, in terms of pay gap in terms of age brackets as well: 20 to 30, 30 to 40, and so on. I think that would be useful.

Yes. So, the committee could await a response from the petitioner to the latest information provided by the Deputy Minister before considering further action. Are we happy with that?

The following two items are grouped together. The first of the petitions is 'Child and Adolescent Eating Disorder Service'. The petition was submitted by Helen Missen and was first considered in July 2012, having collected 246 signatures. The second petition was by Keira Marlow, 'Eating Disorder Unit in Wales', and was first considered in October 2013, having collected 526 signatures. 

We'll just take a moment to welcome Janet Finch-Saunders—

Hi. I'm sorry I'm late.

—to the committee. At this moment, we are considering two petitions together: 'Child and Adolescent Eating Disorder Service', page 7, and 'Eating Disorder Unit in Wales'. We're considering both of these together.

Obviously, these petitions have been under consideration for a considerable period of time, having been transferred by the fourth Assembly Petitions Committee. However, the Minister has provided an update on the review that was had. It was received by officials on 30 November and it's now being considered. The Government needs to respond formally to the review, following a focused consultation with the NHS. So, the possible action is the committee could continue to keep a watching brief until the Welsh Government formally responds to the independent review carried out by Dr Jacinta Tan. Are we happy to—

Can I propose—?

We're all happy with that. 

In all the time that this has been going on, I haven't see one iota of change, so, I was really glad when the Government did commission Dr Jacinta Tan to do this. But let's hope her work isn't just, sort of, kicking the ball into the long grass again. We need to see some outcomes from any recommendations that she's made. 

Yes, absolutely.

So, I'll move on to the next petition, which is 'Pembrokeshire says NO!! To the closure of Withybush A&E!' This petition was submitted by Myles Bamford-Lewis, and was first considered in July 2018, having collected 40,045 signatures. The committee last considered the petition on 27 November and agreed to write to the Hywel Dda health board. A response was received from the health board on 18 January. We could look at the points: the health board confirms that there is no intention to remove services from Withybush hospital prior to a new hospital being opened, and I think this was the main concern of the petitioners in that there is a proposed new hospital and they were very worried—. I welcome Leanne Wood to the Petitions Committee. 

Sorry I'm late, Chair. It was a late train again. 

We're considering—. I'll give Leanne just a few minutes to settle and get the papers together. 

On this note, I did think at the beginning, especially as we had so many, 40,000, that we were, at one point, going to book this in for a debate because I know they say one thing, but it seems just bizarre to me that 40,000 have got the wrong end of the stick on this. I know that Paul Davies has spoken about the withdrawal of services, as with many other areas—

Page 10, it is, Leanne. We're considering—

—it's almost like just putting this down and then—

—petition 3.4, which is the 'Pembrokeshire says NO!! To the closure of Withybush A&E!' I'm sorry. 

Just, if I can, Chair, to recap on a little bit of the background to this. As you say, the petition has a significant number of signatures, the largest we've received, certainly, during the Fifth Assembly. The committee did refer the petition for debate, and it was debated in October, I believe, and, so, since that time, the committee has engaged in further correspondence with Hywel Dda health board, most recently to seek reassurances that no services would be moved out of Withybush hospital before a new hospital—which is planned or in the early planning stages—would be opened. So, that's the correspondence that's being received here today. I think the other difficulty that the committee has had since the debate is we haven't been able to receive any further contributions from the petitioner. So— 

So, maybe they've—

The alternative option potentially proposed here is that other people who have written to the committee or wrote to the committee in the early stages of this consideration may themselves have views to put in, which could compensate for the lack of contributions received from the petitioner.

Yes. How disappointing to get such a big petition and then not follow through. Maybe there's some illnesses.

Can I ask a question? Is there a facility to put a petition on a 'freeze' so that it doesn't—? You know, 40,000 signatures is an awful lot, isn't it? If there's some way of holding that there just in case we need to come back to it in the future—. But I can't see what further action we can take now at this stage without the petitioners—

Yes. We'll just take a watching brief on it, then. That's right, Leanne. 

That can be done, can it? 

We can make a decision to do that. Do we want to consider the fact that we could write to the people who proactively contacted the clerking team at the time? Yes. Okay, in the meantime. And we could also write to Hywel Dda Community Health Council to seek their reflections on the plans outlined by the health board and the future health services for Pembrokeshire. Yes? Okay. Fine.

We'll move on now to the next petition, and it's 'End the unfairness and discrimination in the financial support for victims of the contaminated blood scandals who were infected in Wales'. The petition was submitted by the Contaminated Whole Blood UK Group, and was first considered by the committee in September 2018, having collected 159 signatures. The committee last considered the petition on 27 November and agreed to write back to the Minister for Health and Social Services to repeat the request for an indication of the likely timescales for determining and communicating scheme benefits for the Wales infected blood support scheme.

Government officials and the Wales infected blood support scheme are continuing to review the current discretionary payments framework, but whilst this work is ongoing, the Minister is not able to offer a clear answer. Do we have any comments on this?

Well, I think we have to wait for the review of the scheme, but I think the petitioners' frustration about the amount of time being taken on this is a fair point, isn't it? Is there anything we can do in terms of urging them to be a bit more speedy with the review?

Right. I've made a note here. The possible action is that the committee could await a further update from the Minister for Health and Social Services in relation to the review of the scheme benefits and discretionary payment framework before considering the petition further, but as Leanne has pointed out, there ought to be a timeline with regard to that, and we thought that we would give them until after the Easter recess, which is two months, which should give them plenty of time to have that review, and we should then take action if that review isn't coming forward.

Yes, I'm happy with that.

Yes. Are we quite happy to do that? Right.

The next petition to consider is 'All men in Wales should have access through the NHS to the best possible diagnostic tests for prostate cancer'. This petition was submitted by Stuart Davies and was first considered by the committee in December 2018, having collected 6,345 signatures. We are just looking at this because we make a note that a debate for this has been set for 6 March, so we will have a debate on this. But just as background, the committee considered the petition for the first time on 11 December. A Plenary debate on the petition is scheduled now for 6 March, and a response from the Minister was received on 29 January. We ought to note that the Minister states:

'Health boards do need to await the final guidance to determine exactly what local changes are needed.'

Isn't it sad, though, that this petition has ended up here at all in terms of the cost for this particular scan? I believe it costs £360 as a trade rate to the NHS, and yet to the average member of the public they've got to pay about £900, and if they don't have this scan—you know, diagnosis is determined. People are having to pay for it to get it.

I think very much the difficulty is not so much the equipment as the people who are able to operate the scan and to be trained up in order to—

We're talking basic diagnostics.

—do this, because this is a deep scan; it's different to a normal scanning technique, so I think that's one of the problems—

Yes, but in terms of diagnostics, we're way behind England on this particular one, and it's unfair on men to be—. Well, I think it's appalling, so I look forward to that debate and holding the Cabinet Secretary—well, Minister now, isn't it—to account.

Yes, well, hopefully, that's what the debate will do. The committee could note the information provided by the Minister for Health and Social Services and the petitioner and consider the petition again following the Plenary debate on 6 March. Are we all happy with that? Or is there any other action that you'd like to take in the meantime? I don't think any of us—

Nothing—

We'll come back after the debate. Hopefully, that will resolve matters.

The health Minister just seems to be buck-passing again, 'It's the health board—.' He's the Minister and he should take a lead on this. These kinds of things are not discussed as widely as they should be. For example, there's an annual test men can take, a blood test, to spot things really early on. I didn't know that until I met a constituent suffering from prostate cancer.

Okay. Obviously, Members will have their opportunity to bring all these matters up in the debate, so can we move on now to the next petition, which is 'End the Exotic Pet Trade in Wales'? This petition was submitted by David Sedley and was first considered in March 2017, having collected 222 signatures. The committee last considered the petition on 15 January and agreed to ask for a briefing on the differences between regulations on the sale of exotic pets in Wales and in England. Regulations made by Department for Environment, Food and Rural Affairs in 2018 include a new licensing system relating to the selling of pets, but it does appear that Wales is still only implementing provisions under the Pet Animals Act 1951, which still, of course, remain in force. Do you have any comments regarding that?

I think it's important that we write back to the Minister. I have very strong views on exotic pets, and I'm not quite sure why some people want some of these things, which are not suitable for our habitat—and the difficulties of some of them escaping, the fact that it's bad for the animal to be kept in conditions that are very unusual compared to their normal habitat. I think we write back and ask the Minister how she intends to get to the same place as England is now. I feel very strongly about this, and I think the problem we've got is an awful lot of things that date back pre internet are dealing with things that are different. I would guess, in 1951, if somebody wanted to buy an exotic pet, they went to a pet shop. Today, if somebody wants to buy an exotic pet, they type in 'exotic pet' online and they get them from anywhere in the world rather than from local pet shops. So, I think it's important we go back to the Minister, asking how we manage to get to the same place as England. Because it's going to cause cross-border problems. If we allow pets of a certain type to be sold in Wales that aren't available in England, all somebody in Chester does is cross the road.

Yes. I think it's worth reiterating the fact that, obviously, when we were looking at that previously, it has been pointed out to us that exotic pets include fish, and that would have, if it was a blanket ban on all exotic pets, which included fish, then, obviously, that would have a devastating effect on many of the businesses. But it does seem as if this divergence in the licensing and regulatory regime is encouraging people, perhaps, to purchase their pets from Wales because they're not allowed to purchase them in England. So, I think we have to have some clarity as to as and when they're going to implement the—

I was just going to say it's up to the Welsh Government to define what they mean by an exotic pet. They could do that in whatever Act they pass so that, if they didn't want to include certain fish—they could decide non-endangered fish are not classed as exotic, if that's what they wanted to do. So, I don't think there's any difficulty with what the old classification is and what we have now.

Right. Okay. So, the committee could write to the Minister for Environment, Energy and Rural Affairs to ask whether she considers that the divergence between licensing and the regulatory regimes in Wales and England poses risks to animal welfare in Wales, particularly in relation to the exotic pet trade and whether she intends to consider the merits of adopting some or all of the various policy changes made in England by the Animal Welfare (Licensing of Activities Involving Animals) (England) Regulations 2018. Are we happy to do that?

Yes.

If we can move on to the next petition, 'Save the trees and ground in Roath Mill and Roath Brook Gardens before it's too late', this was submitted by Tamsin Davies and was first considered by the committee in February 2018, having collected 8,700 signatures.

The committee last discussed the petition on 27 November, when it took evidence from Natural Resources Wales and agreed to seek an update from the petitioners and NRW following the proposed meeting between the parties involved. The correspondence was received from NRW on 29 January. NRW wrote to the committee on 29 January to inform Members that NRW’s board has agreed to reassess the third phase of the Roath flood scheme as a stand-alone project, which I believe was one of the main reasons for bringing the petition to us. NRW is committed to working with the community to reassess the options with a view to reapplying to the Welsh Government funding at a later date.

Do we have—?

I think they've seen a lot of movement considering, at the very beginning of this process, they were being told what they were asking for was impossible. So, things have moved a long way. Whether they are entirely happy—perhaps we could ask them before finally closing this petition. But I think in that correspondence we should say, 'Well done for a successful campaign', really. 

Yes. Okay. Neil, you've been very much involved with this.

Yes. I'd ask them what they think and maybe just park it. I'd be loath to close it at the minute. 

Okay. Yes. Fine. Okay. So the possible actions: committee could seek the views of the campaign group on the latest developments before considering whether it can take any further action on the petition, or we could—in the light of the decision by NRW's board to reassess the third phase of the scheme as a stand-alone project and to find a suitable solution, the committee may wish to close the petition. Are we happy to close the petition at this point, or just write to the—?

I would write to them. I wouldn't close it yet.

Seek their views first.

Sorry?

Seek their views first.

Seek their views first, yes. Okay. And of course we could make a note with regard to NRW as to the length of the reassessment, the timeline that they're going to take. Are we happy on that?

Yes.

Yes. Fine.

Okay, we move on to the next petition, which is 'Fair Funding for Neath Port Talbot County Borough Council and all other Local Authorities'. This petition was submitted by Unison Neath Port Talbot and was first considered by the committee in October 2018, having collected 225 signatures. The committee considered the petition last on 23 October when Members agreed to share details of the petition with other committee Chairs, where appropriate, ahead of their budget scrutiny sessions. A response was received from the Cabinet Secretary for Finance on 18 November 2018. It does appear that there's very little we could do with regard to this because all these budgets have now been finalised. So, in light of the fact the Welsh Government's final budget for 2019-20 was agreed by the Assembly on 15 January 2019, and was scrutinised by the Finance Committee and subject committees, there's little further action that can be taken by the Petitions Committee at this point. So, are we happy to close this petition?

I think we have to close it. There's nothing we can do apart from close it, but it doesn't mean they can't bring back a similar petition next year, when next year's budget is being considered. 

Yes. I think Graeme's made the point that this may well recur on each of the budgets, once they've been proposed. 

Right, we move on to the 'Port Talbot Community Against the Super Prison'. This petition was submitted by the Port Talbot Super Prison Protest Group and was first considered in November 2017, having collected 8,791 signatures. The committee last considered the petition on 1 May 2018 and agreed to request a response from the petitioners to the announcements by the Welsh Government on justice policy and the indication that the prison was on hold. However, I think it's moved on from there in that the UK prisons Minister confirmed to the Welsh Affairs Select Committee that the proposal to build a prison on the site had been withdrawn. So, in light of the recent developments, which demonstrate that the proposals to build a new prison in Baglan are not going ahead, the committee could close the petition and congratulate the petitioners on the success of their campaign.

I think we ought to congratulate the Roath Park petitioners as well. I missed that. 

Of course, yes.

Again, this is a successful campaign that has got the result that they wanted, but there is going to be consideration of further sites for another superprison, so I don't think the issue is going to have gone away completely, and we may see another petition in the future when another site is identified. But I think we should congratulate the petitioners and say, 'Well done'.

Yes, I think so. Okay.  

Right. That ends the review of the petitions, so item 4 is a motion under Standing Order 17.42 to resolve to exclude the public from item 5. Are Members agreed? Fine. 

Bore da, good morning and welcome to the Petitions Committee. Thank you for coming along and agreeing to have this witness session with us. Would you like to introduce yourselves prior to us taking the session?

My name's Deryk Cundy.

And?

From the Save our Services at Prince Philip Action Network committee, basically, for Prince Philip Hospital.

Okay. Thank you.

My name's John Prosser. I'm the secretary of SOSPPAN. I'm from Llanelli.

Good morning, sir. I'm Louvain Roberts. I'm chair of SOSPPAN. Thank you for having us this morning.

Okay. Again, welcome to all of you. As you know, the evidence session will include us questioning you on certain matters, so you will be questioned by each of the Members in turn. Could I open the questioning by saying: could the petitioners expand on their concerns about how Hywel Dda health board's future hospitals model might impact on patients and their families?

Is it okay if I give you a little bit of a background and an introduction and then we can go on from there? We'd like to thank you for allowing us and the residents of Llanelli to present our case to you. Save our Services Prince Philip Action Network, SOSPPAN, is a non-political campaign group with one sole aim—all we want to do is maintain the services of our hospital so that over 100,000 people can access them easily, safely and in a timely manner. We can show how Hywel Dda had made promises to the patients of Llanelli and Carmarthenshire only to cynically break them and to remove services that we were promised were safe. Downgrades became the norm. Hywel Dda proposals are based on a number of assumptions that don't appear to be costed, practical or safe, and we've seen no risk assessments for any of their plans. Community hubs such as a wellness centre are, at the moment, in doubt, but there's no alternative plan should those changes be needed.

Public consultations were managed to get the health board the result they wanted. They've used a grading system, which meant that a number of consultations were disregarded. In the 2017 consultation of the health board, they only printed 5,000 copies for a population of 185,000. It was only at our insistence that the final number distributed was over 20,000. We were actually responsible for distributing over 5,000 of those. We had to ask the directors to act on complaints we were receiving from health workers within the hospital, who were being coached by their managers on what responses to give in the last consultation, and their comments were being vetted by their managers. We're told they plan to remove some services from PP8, but replace them with others. However, history doesn't give us much confidence.

Hywel Dda have admitted that they're concerned that residents from Llanelli will self-present themselves to Swansea hospital. I was recently ill myself, and I went to straight to Morriston because it's 12 miles to Morriston from my house. The new hospital that they plan is 40 miles away.

We've asked if we can have a voice on the health board to represent the local residents. To date, we've requested it at every meeting and although we have dialogue, it's always driven by SOSPPAN.

We ask the Petitions Committee to take notice of the 13,000 local residents who signed our petition, and pass this for debate. Thank you for your time for reading it and allowing us to come.  

Okay. John, thank you very much for that comprehensive background to this petition, and can I now specifically ask that question again so you could answer it? So, could the petitioner expand on the concerns about how Hywel Dda health board's future hospitals model might impact on patients and their families?  

Yes, I can. 

Okay, Louvain—yes, by all means. 

As chair of SOSPPAN and with a nursing background—I'm a district nurse midwife and I was 10 years on the community health council—my concern at the moment, again, is no impact assessment, and no actual dialogue with ambulances. There are only very few ambulances at the moment; I've spoken to the ambulance people as well. The air ambulance can't actually fly in the night. They couldn't have commented because they cover the whole of Wales; they couldn't have commented just on Llanelli. Because we're on the borderline of ABMU, and we have 40 miles to travel. There's very poor infrastructure there at the moment. People are elderly, and austerity kicks in as well. And also, within the proposals, it is all centred around community. If the Delta Lakes actually falls, where's the community going to go, and where's the community hub going to be? Because they have one in the Antioch at the moment, and it started off with three outlets there—leg ulcer clinic, phlebotomy clinic and the pain clinic. To date, the leg ulcer clinic has been closed, and so has the pain clinic been closed, and the phlebotomy is down to three days from five. That's just the start at the moment.

They've also mentioned as well within the consultation—I was speaking to them in Carmarthenshire—I think we've had a—[Inaudible.] As a midwife, I've got great concerns—it's 40 miles to an acute hospital. There's very poor infrastructure for ambulances and air ambulance, and anybody in labour—the ladies around the table will know—anything can happen in the first, second or third stages of labour, and you haven't got an acute hospital near. So, my concerns are around that as well.

And some of the issues—if you've read the proposal, actually, there's no padding in it. It's very much limited to what they say they're going to do. It's very poor—I think it's poor to let you know information-wise to make a favourite choice on. That's my concern. 

Thank you, Louvain. I will mention that there are several questions that we'll be asking you, so you may have opportunities to expand on what you've said further with the further questioning. Deryk, did you want to make some comments on that first question? 

Basically, what's happening is our services are being moved further and further west. Llanelli, or PPH, was a major hospital. It had an A&E only a few years ago, and gradually those services have actually been moved to Carmarthen. That's been done, in some respects, by stealth, just because they say it's safe or unsafe, and so a lot of our population are having to travel 19 miles now to actually access the services anyway. These proposals are actually saying that that facility will actually go further west again, so that will be 40 miles away for most people. That might seem not too bad, but if you're travelling there via ambulance, it's a far further way to go. For visitors, it's almost impossible. Public transport just cannot facilitate somebody trying to visit someone. Even now, to go to Carmarthen, it's a day trip, effectively, because you go by bus and this type of thing. It's not easy at all.

So, really, our services are just basically being whittled away, bit by bit. We actually are the biggest population in Carmarthenshire—Llanelli and that whole area, the Gwendraeth and the Amman Valleys—and there are 100,000 people there who are basically losing their services to the west. We could go to Swansea, but if we do go to Swansea, we're going to overburden Swansea, and we need the right level of agreements there, if it's going to happen. As John was saying, he's been in hospital recently and it took him—you were 36 hours on the trolley, I believe, waiting. He had heart surgery. So, it is really, really pushed now. So, it's important that we keep our services at the very least, but, preferably, increase our services. That's what we'd prefer to do. 

Okay. Leanne. 

Thank you. You mentioned some services specifically—you mentioned the pain clinic and a couple of other services—but can you tell us which services you're most concerned about? I know that you've said that there's been a downgrading over time, but given what we've got now, can you tell us what you're most concerned about in the future, and whether or not those concerns are shared by the wider community as well, please?

Speaking for myself and my committee, yes, I have concerns, because they are mentioning as well that there's a business plan for endoscopy at the moment from Prince Philip, and they only have two theatres there. When those two theatres close, that means orthopaedic will go and your day surgery will go. Now, that's very much up in the air. They've been through this business case for the last two years, I believe, and it's on hold again. So, my concerns are about that as well there. There's always a grey area—is it going to happen or isn't it going to happen, but I can see it happening. Also, the fact is as well that when you've got no theatre there, that does impact on your acute medical unit, because doctors can see a patient who may come in for heart, but land up at surgical, and there's a problem with no—. IT beds will go, and your high-dependency beds will go because there are no theatres there. So, therefore, there's always a knock-on effect. 

They also—[Interruption.] Sorry. 

Can I just mention that, obviously, if one of you answers the question and you feel that it's adequate, there's no need for all of you to answer. But if you feel that you would like to add to it, as I'm sure you do, John, you can add to whatever your colleagues have been saying. Are you happy with that?

Yes, thank you, Chair. 

Okay, fine. Thank you. 

In our meeting with our health board, Steve Moore expressed that they're considering, or very, very seriously considering closing the mental health unit that we have in Llanelli and then replacing it with something else. They want that particular space for something. But it is a very, very heavily used facility for the people of—. As I said, we have 100,000 people there, and, again, moving it miles and miles away may not be the right solution for that particular type of patient. 

Yes, I can see your point there. 

Because they say different things to different people. If they've got us there, they say one thing to us and a different thing—. Community health say they're not moving mental health services at all, yet they've said to us that assessment won't be there. It's either in-patient or assessment; one or the other will be going. So, I don't really know what to believe, so I can't give a definitive answer. 

Okay, thank you. Thank you very much. 

Okay. Neil. 

Before I come to the question that I was thinking of: 40 miles—what are the roads like? What's the journey time outside peak and in peak time?

Probably about an hour, an hour and a half. They're not good roads. The motorway finishes at Pont Abraham. You have a dual carriageway then that goes as far as St Clears. You've already—. That dual carriageway goes through Cross Hands, it goes through Carmarthen town centre, and then, after that, you're on very poor A roads. The Morriston Hospital is 12 miles on the M4, and it's a straight road, and you can do it really, really quickly. During the consultation, when we met with the health board, we questioned them about visitors and about how we did it, and Steve Moore very, very flippantly told us, 'We'll build a railway station.' And I, with another hat on, as a member of Friends of Llanelli Train Station, have been working with Network Rail for a new railway station in Llanelli—I know how long that takes, and the money and everything that's involved, but he was, 'We'll build a new railway station', and that's minuted in the meeting that we had with them. 

Could I add to that? 

Sorry. 

It's perfectly okay. I think it's important to realise that, actually, Hywel Dda also acknowledge, or they're making these changes, and in their documentation, it actually says:

'Our doctors think our proposals will make a lot of things better but it might be difficult for some people to get to the services, especially if they do not have much money or a car.'

Now, in my opinion, and I'm a local county councillor, I think that's an absolutely appalling statement to make. The NHS was supposed to be free at the point of delivery, and people are supposed to be able to access it easily. And if we can't access it easily, it doesn't matter how good the service is, it's not fit for purpose. So, to actually acknowledge that in their proposal, to me, seems absolutely outrageous, and I think that it's something that everybody, as politicians, would be concerned about, really.

Do you think the health board has been sufficiently open and transparent?

Truthfully, no. Their proposals, as you've seen in front of you as well, are very limited, because it's all about community. They have based it on these hubs, and it doesn't say actually what's going to go in the hubs. What my concern is as well is how the GPs are going to come on board. The GPs are a business in their own right—what incentive is Hywel Dda going to bring to get the GPs on board for these communities? And they also get difficulty, Hywel Dda, recruiting GPs at the moment—they have everywhere, but more so in Hywel Dda, because it covers right down to the bottom of Withybush, and people won't go there. So, I don't think they have been, to answer your question—personally.

Just out of interest as well, you said about comments being vetted by managers—do you have evidence of that?

During the consultation, it came up. We were doing weekly—well, twice-weekly—stalls, and we did various campaigns, to get people to sign the petition, and other events that we were running. And members of staff came. We actually tackled the health board on it, and they were horrified—their word—that it was happening, but they didn't ever deny that it was happening. But more than one—it was into the scores of people—were coming to us, on Thursdays and Saturdays, saying, 'My manager is telling me what I have to put in to the consultation', or 'I'm filling the consultation in, and then my manager has to see it before I can send it.' They were asking us for paper copies—that's one of the reasons—because they were frightened to fill them in at work, because it was being dictated to them what they should put in.

Any action taken against the board?

We reported it, and we never had anything back. There was never any comment. He told us that he would look into it—that the board would look into it—but we never had any comment back. But they never denied it either.

Thank you very much. Janet.

As petitioners, do you feel that the patient voice has been adequately taken into account during the consultation process and development of the plan's service change? Because I get the impression that you feel very much left behind, that this has not taken—. I believe, in all reality, our health boards do have to evolve, and they have to change, and they have to—. But just in this day and age, with modern technology, I can't understand why they can't take people with them, so that you're fully informed, you're fully aware of the benefits of them doing the changes, and that it's not all bad news. And I think the two have become a little bit clouded, really, by the mere processes that some health boards take.

We're realists, we understand that A&E is never going to come back to Llanelli—that's gone, and we have a different unit. These guys—because they've been on the committee much longer—can explain that the people of Llanelli are really worried now, because we went through this exercise 11 years ago, when we were told it's a once-in-a-lifetime change, and now, 11 years later, we're having a once-in-a-lifetime change. But the history will tell you that they will tell you one thing and do something else.

But also, they haven't got the elderly along with them at all, because they encourage and they're trying to make Llanelli—. It's not an industrial town any more, it's now where people come down and retire, so you've got a lot more elderly people there. Austerity kicks in, and John and I are in the most deprived ward—we're in the Glanymor ward, the most deprived ward in Wales. And, of course, technology isn't there, so they couldn't go online and see all this, and if we hadn't given it out to them, and spoken to them, in the consultations, they wouldn't have known what was going on at all.

I do sympathise, because, in my own area, I've seen services eroded. And we see—there's almost a plan put in place on how to erode those services, but they're saying, 'Oh, numbers are down, so we're going to have to take this service away.' But, really, I feel quite sorry that you've been kept in the dark, really.

I think the thing that's actually quite remarkable is that this is, if you like, the second tranche of cuts. It was only five years ago, with the previous major campaign—the SOSPPAN campaign—where we actually had 30,000 signatures in Llanelli. We came to judicial review and actually went to Front of House, if you remember. The Front of House has been very successful. We're concerned that that's not necessarily being supported by GPs. Our other big area of worry is a lack of GPs—we haven't got them. We haven't got the surgeries—we're losing them. And it's an integrated solution: you can't just have a hospital without your GPs and vice versa. We don't necessary have all of the GPs to do the out-of-hours service at the hospital. So, we're looking at community hubs. But, again, where we thought we had an understanding of what the community hubs were going to be, recently they said, 'Oh we're going to reconsult on this locally', and that seems really strange to us. So, having this 30,000-signatures petition really shows an awful lot of upset, but people have sort of said, 'Come on, we did 30,000, before we went on marches; we did this and we did that, and what have we got for it? They're coming back in five years' time', and people are losing faith in the system, let alone anything else.

Clearly, the health Minister for Wales has the health boards, technically, running themselves. This falls within the Welsh Government mandate of delivering a health service in Wales. What would you like the Welsh Government Minister to do in this regard? If you could ask him to help in any way, what would it be?

The complete proposals put in with Hywel Dda—it's the Denmark model, where they've got all of these hubs that go around and everything? I don't think it actually goes within the Welsh model, and especially with Llanelli and areas around—I don't think it fits into that model at all. They need to look at this. The footfall to Llanelli hospital says it all, because without Llanelli numbers—. And I know I'm putting my cards on the table, and perhaps I shouldn't say this openly, but I'm putting my cards on the table: without Llanelli footfall, they wouldn't have a business case.

Right. What would you want the Welsh Government Minister to do in this regard?

This particular solution is a limited solution. What we've said is that, within that solution—. I don't know if you've read any of this, but B+ was the best bet for us. But, actually, I think it's a lot more than that; we need to get integrated—GPs and the hospitals. That needs to be done a lot better than they are. Should we be looking at actually changing the way we pay our GPs—?

So, would you like the Welsh Government Minister to review the processes that—?

Yes, absolutely.

And to work more closely with Swansea. Because we're so close, we should have some sort of collaboration, because, at the moment, people go from Llanelli into Swansea and it's very expensive for Hywel Dda because it's a different health board. There should be closer collaboration between the two and more integration. We've always said, right from the start, that we're willing to sit down and help and point them in the right direction. We're not there banging the drum and saying, 'Everything's got to stay'. We need it to be joined-up and working, and that it works for everybody, including the health board.

Okay. Thank you.

Okay. Leanne.

I just wonder—I think I've got an idea of what you're going to say here—how far you're reassured really by the health board's expressed commitment to continuous engagement? You did say—what did you say—that people are losing faith in the system. I know from previous experiences as well that the consultation process is a bit meaningless because they guide you in a particular direction. What confidence do you have that the health board are going to listen to local populations, clinicians, carers and patients in the further development of their plans?

I think they're paying lip service to it, Leanne. I think, really and truly, they want their business plan to go through. They engage with the community health council. I spoke to them yesterday, and they've asked the same questions of them that I've said to you as well. They have a different version again, because they wanted things to go through. So, really, I am not that confident that they engage very well or that they tell the truth to all areas. That's my own personal view, mind—it's nobody else's personal view. It's my personal view.

Okay. Thank you.

I think they tell us what they think we want to hear and then remove the services they want to remove. They have a history of doing this. It's not something we're making up. The history shows this, and when Deryk's made the pack for us, he's documented all of the different things where they tell us, 'That's safe', and then within a year they say, 'Nobody's using it', and it's gone. They tell us, 'Oh, it's not safe to have it there now; we're going to move it'.

I don't think they listen. I don't think they really understand. I don't think people who are younger, if you like, tend to understand how difficult it is for an older person to go and visit the hospital in the first place. I don't think they understand that vulnerable people don't have the money to have their own car. It's a long way—19 miles is a long way, 40 miles is impossible. 

If I can just go slightly a bit off track just to give you another example of that, when I was discharged, it was 1.15 a.m. I was lucky—somebody was there with a car. If you have no car, how do you get home? As Louvain said, we live in a very deprived ward. How would they get home? Taxi fares—it's only 19 miles now; imagine if it was 40 miles. It's a horrendous cost for people to be paying. 

And you don't think that point specifically is being listened to, do you, or understood by people who've got cars?

Categorically 'no'.

We do keep banging on about transport. Transport is so key. John was saying about the taxi. Getting a taxi at 2.15 a.m.—there are cases where you've got 80-year-olds being discharged at that time in the morning and charging them £70 to get home. That is a lot of money for somebody who's got a fixed income and of that age. It's wrong anyway. We shouldn't be doing that.

And you get answers like, 'We'll build a railway station.' 

Can I just start off by saying I represent Swansea East, and Morriston hospital is a mile away from where I live, so I know Morriston very well. We've got a transport system from Singleton to Morriston—a bus that joins the two. I take it that transport is much more difficult in the area you're talking about. 

Yes, you're right.

I also note there's meant to be an ARCH project, which means that hospitals in ABMU are supposed to work much more closely with those in Hywel Dda, especially those to the east of Hywel Dda. Because, as you said, Morriston and Singleton are not difficult for people with their own transport to get to. With public transport, it's possible to get into the centre of Swansea and out. It's a two-bus journey, but it's not impossible.

You're right. Glanymor ward, which John and I work in, is about 50 minutes to the hospital. It's three buses they have to catch—changes.

The point I'm trying to get at is, shouldn't Hywel Dda be looking, certainly for the eastern part of it, to work more closely with those hospitals that are in ABMU? The other question I've got is—this is my belief and you might not agree with it—that Hywel Dda is trying to deal with too wide a geographical area with too many distinct hospitals. I talked to somebody—it might have been one of you, so apologies if it was—who said somebody had an eye problem and they were sent to Bronglais and they were living in Llanelli. The best eye hospital in that part of Wales is Singleton, but they had to go to Bronglais, which is, from Llanelli, driving a car, under good conditions, an hour and 45 minutes.

From there, they came back to Prince Philip, and from there they went to Singleton. 

It's this idea that it's got to be what's best for the patient. Shouldn't more be done in order to see Prince Philip hospital as part of the south-west urban area, rather than seeing it as part of the south-west Wales rural area? I was in Llanelli at the weekend. I know how difficult it is travelling through Carmarthen at times—welcome to the traffic jam. Despite the bypass, you have those lights at the bottom that you queue at.

You're right. They are looking at the service level agreement. What I didn't mention as well was that, with the wellness centre that's going to be in ABMU, I feel sometimes it's going into privatisation. It'll go over to privatisation. Also, as well, they're looking at—Leanne mentioned it as well—what services would go. It's 40 miles away where the new acute hospital is going to go. The antenatal is done in Llanelli for Singleton. For Morriston, it's going to go to Morriston—the babies are going to go there, then that will go. That means the choice for mothers is to go to ABMU to have your baby and then you go to antenatal in ABMU not in Hywel Dda. That's the type of thing that they pull the plug on all the time, and that, I think, is very wrong.

My final question: do you think Hywel Dda are looking at Llanelli as an urban area that has got urban area needs, rather than looking at it as part of a predominantly rural and small-town health board, which is most of what they're dealing with?

I think what's actually happening is they're looking at the numbers—it's the solution they're coming up with which fits the whole of the area they're trying to cover. And Llanelli is totally different to Carmarthen, Newcastle Emlyn, Withybush or Haverfordwest—it's a different set-up altogether. And as you were saying, that whole urban area, taking Swansea and Llanelli, it's a huge area and, actually, it seems to make sense to use all the hospitals in that area.

And Hendy and Pontarddulais run into each other, don't they?

Exactly, and that would go to Morriston, wouldn't it?

And from the Amman valley, it's easier to get to Morriston than sometimes to get to Llanelli, never mind to try and get to—. Especially if you take the back road from Ammanford across to Morriston, over the mountain—. Good in summer; not very good in winter. But you've got that quick road there. It's quicker to get there than it is to Llanelli.

Llanelli was in West Glamorgan—we were in the West Glamorgan health authority until we changed over. And I'm sorry to say this, but I feel the services, in my opinion—nobody else's opinion—as a district nurse midwife, the services have gone down the pan since then.

If you look in the pack, there are, actually, measurements between the hospitals—you've actually got, from the various areas in Llanelli to Carmarthen, to Morriston and across to where the proposed hospital is meant to be.

I'll stop there.

It's just a really quick one, going back to the staff being told what to write and being vetted. It's almost a 'yes' or 'no'. Do you think that's akin to intimidation?

Yes.

Okay, thank you.

Yes.

Do members of the committee have anything else that they'd like to question or comment on with regard to this?

Okay. Can I thank you all very much for your comprehensive answers to our questions? Is there anything else that any of you, briefly, might want to add, that we haven't covered with regard to the questions?

No, I think we really dealt with it. We'd really like to thank you for your time and—

Okay. We do thank you for coming and being witnesses to the committee. To explain, a copy of the transcript will be sent to check for any factual details that you may want to alter or feel they're not quite correct. Are you happy to do that? 

Absolutely. Thank you very much for having us. Thank you.

Diolch yn fawr.

Okay. I propose, in accordance with Standing Order 17.42 that the committee resolves to meet in private for the remainder of today's meeting. Are we agreed with that? Fine, thank you.