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Project Plan for

Hywel Dda – Our Big NHS Change

Formal Consultation Process

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Contents

1. Context

2. Background

3. Scope

4. Consultation Governance and Quality assurance (including governance structure and

project implementation responsibilities

5. Pre-consultation Engagement

6. Option Development process

7. Legal duties and requirements

8. Assessing impact – including equality impact assessment

9. Stakeholder mapping and analysis

10. Development of consultation materials

11. Website

12. Communications and engagement

13. Standards and formats of information

14. Budget and expenditure

15. Risk and assurance

16. Management of consultation responses

17. Consultation analysis

18. Influencing plan

19. Final report

20. Decision making plan

21. Feedback plan

22. Evaluation

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List of appendices

Appendix 1 Scope

Appendix 2 Equality Impact Assessment for consultation plan

Appendix 3 Stakeholder Mapping and Analysis

Appendix 4 Consultation Plan

Appendix 5 Feedback Form

Appendix 6 Risk Register

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1. CONTEXT

1.1 Who are we?

Hywel Dda University Health Board (the Health Board) is your local NHS organisation. We

plan, organise and provide health services for 384,000 people in mid and west Wales. We

manage and pay for the care and treatment that people receive in hospitals, health centres

and surgeries, GPs, dentists, pharmacists, opticians and other places, including within the

community. Every time you use an NHS service in Carmarthenshire, Ceredigion and

Pembrokeshire, you are using a service which we are responsible for.

The Health Board covers the three local authority areas of Carmarthenshire, Ceredigion and

Pembrokeshire and covers a quarter of the landmass of Wales. Hywel Dda is the second

most sparsely populated health board area in Wales. 47.9% of the population in the region

live in Carmarthenshire, 20.7% in Ceredigion and 3 1.4% in Pembrokeshire.

Because we have a very large border with other counties, communities in south Gwynedd,

north Powys and west Glamorgan also rely on our health services.

Our proposals for change could affect everyone in our area, from bumps and babies to older

people and everyone in between, so we are asking you all to tell us what you think. Whether

you are a patient, a carer, a family member, or one of the thousands of people who work for

the Health Board, we want to hear from you.

1.2 Why we need to change We want as many people as possible to live healthier lives for longer.

Doing nothing is not an option if we want to ensure people receive excellent care in the future

in the Hywel Dda area.

Transforming Clinical Services is not only about providing health services that help people to

get well, but about joining up our services around the needs of each person. This should

mean giving children the best start in life, prevention of illnesses and ensuring all of us make

healthier choices as well as quicker recovery if you suffer an illness.

We need a long term plan to support our communities where people are living longer and

surviving serious illnesses, both of which are good news but can result in more physical and

mental health needs. Modern lifestyles are also leading to longer term health conditions such

as diabetes, cancer, respiratory and cardiovascular disease.

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1.3 The purpose of the consultation project plan

This project plan outlines the practical steps we intend to take to ensure that we run a good practice consultation exercise for Transforming Clinical Services. It includes details on how we will manage the process, what we are consulting on and the areas of influence. The consultation will be presented at the Hywel Dda University Health Board Meeting and subject to approval will be formally launched on the 19 April 2018. The consultation period will be 12 weeks and will close on 12 July 2018

2. BACKGROUND

Transforming Clinical Services’ is a programme led by our doctors, nurses and other

healthcare professionals who have worked together to consider how we ensure our health

and care services are safe, sustainable, accessible and kind for our generation, the next

generation to come and beyond.

We want to provide healthcare that is of the highest quality, with excellent outcomes for

patients. This applies to all children and adults in the Hywel Dda area, regardless of gender,

age, disability, ethnicity or sexuality. It also applies equally to people with mental health

problems or a learning disability, as well as people with physical health problems

The difference we want to make for people is to:

prevent people becoming ill where we can, and help people as soon as possible when

they become ill – this is key for us to provide the best healthcare for our population;

be proactive in our support for local people, particularly those living with health issues

and the carers who support them;

provide quick diagnosis so that you can get the treatment you need, if you need it, or

move on with your life;

be as efficient as we can be so that we don’t expect you to travel unnecessarily or wait

too long;

look after you in your own bed unless you need hospital care;

provide care that we would expect for ourselves, our friends and family that is safe and

of a high quality;

be open and honest and learn from what we do well, and when things go wrong;

make best use of the money we have to get the best value from it for our patients;

look after our staff so that they are more able to look after our patients, fully utilising

their skills.

We want everything we do to be ‘safe, sustainable, accessible and kind’ as this is what you

told us was important to you when you receive healthcare. The programme is considering the

opportunities and challenges for the modern NHS, specific to us here in the Hywel Dda area.

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We started the first phase of our work in June 2017 by looking at how well our current

services work and how they might be re-organised.

Since then we have worked closely with our staff, patients, public and a wide range of

partners. This has included a 12 week listening and engagement exercise, ‘The Big

Conversation’, to listen to people’s views before we started to think about any changes that

may be recommended. Our proposals are ambitious. They include big changes to health and

care services in community and hospital settings.

At this stage, the proposals we set out are just that, we have not made any decisions yet

3. SCOPE

The scope of the consultation has been informed by the Transforming Clinical Services Design Steering Group and refined by the Health Board. The scope provides an outline description of the consultation process and includes;

- The context of the consultation - Who we need to consult with - The fixed points (what is not open to influence) - What is open to influence - Options not put forward for consultation - How the consultation process will be managed

The consultation scope has been tested by the Consultation Institute and is in line with good practice. The full consultation scope is included as Appendix 1.

4. CONSULTATION GOVERNANCE AND QUALITY ASSURANCE

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The Health Board has responsibility for the consultation and decision making process. The consultation will be managed by the Transforming Clinical Services Design Steering Group with support from the Options Development Action Group and the Communications and Engagement Group. The Communications and Engagement Group will have responsibility for overseeing the consultation process on a regular basis. The group will manage and oversee the development and implementation of the consultation process and related consultation dialogue activity with the public. The group will include members from the Transforming Clinical Services Design Steering Group, Communications Team, Engagement Team, Equality and Diversity Team and Hywel Dda Community Health Council. The Communications and Engagement Group will meet fortnightly to discuss progress and make any specific changes to the consultation plan as a result of feedback and issues presenting throughout the consultation process. Feedback will be shared with the Options Development Action Group to enable testing of the feedback against the proposed models throughout the consultation. The scope of the Communications and Engagement Group will include:

- Developing the draft project plan and reviewing associated consultation documents for presentation to the Health Board

- Identification and proposing mitigation of risks relating to the consultation - Monitoring of dialogue across the digital and non digital communications and

engagement channels - Monitoring of the effectiveness and feedback from communications and engagement

activities - On-going equality analysis and assurance throughout the consultation - Reviewing arrangements for targeted engagement to ensure that people from groups

with protected characteristics are fully engaged in a way that is accessible - On-going analysis and identification of under-represented stakeholder groups - Targeted engagement to ensure there are opportunities to participate - Participation in the mid-point review - Providing updates to the Transforming Clinical Services Design Steering Group on

progress and arising issues / mitigations to be addressed. This work will be supported by an internal communications and engagement operational group, established to monitor the process, feedback, progress key activities and action / recommend approaches to the Design Steering Group Hywel Dda Community Health Council has been involved throughout the Transforming Clinical Services co-production process and will continue to be involved throughout the consultation process. The consultation process will go through an independent, rigorous assurance process by the Consultation Institute. The Consultation Institute has developed and deployed a tried-and-tested method for the Quality Assurance of public consultations. This quality assurance

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process will include testing and review of the project plan, consultation documentation, the mid-point review, closing date review and a final report to confirm Institute endorsement. All key documents will also be presented to the Hywel Dda University Health Board Public Board

meeting on 19 April 2018.

5. PRE-CONSULTATION ENGAGEMENT

The starting points for our Transforming Clinical Services programme were: listening to the views of local people and patients who have used our healthcare

services, through our engagement exercise ‘The Big Conversation’;

examining our current services in detail with our doctors, nurses and healthcare

professionals to understand:

what currently works well;

the key challenges we face;

what can we learn from successful healthcare systems across the UK and

internationally.

These two parts of our programme, known as Phase 1, were run at the same time and the

messages we were hearing in ‘The Big Conversation’ were being continuously considered by

the groups of staff working on the programme groups to help their thinking as the work

progressed.

‘The Big Conversation’ took place from 20 June 2017 to 15 September 2017. It involved

sharing information about our services and challenges widely to approximately 4,000

interested people and groups. During this time we discussed our work on the Transforming

Clinical Services programme in over 80 different meetings, drop-in sessions, workshops and

other events and activities across Carmarthenshire, Ceredigion and Pembrokeshire. We

asked broad questions about what matters to people and what good healthcare and support

would look like in their view.

The proposals set out in this document have been informed by members of the public in the

following ways:

409 questionnaire responses (including 19 ‘easy read’ responses);

80+ meetings and events;

3 ‘Big Conversation’ engagement events in Carmarthenshire, Ceredigion and

Pembrokeshire that were open to patients, the public, carers, staff, community health

councils local authorities and the third sector;

3 drop-in events for members of the public - one in each county;

14 meetings and drop-in sessions for staff;

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Meetings with the Heath Board’s Stakeholder Reference Group, a group made up of

organisations and interested individuals who work closely with us; the Health Board’s

senior managers; and the Community Health Council (CHC);

Meetings with various organisations within and outside of the local NHS, including staff

groups, county councils, university partners and the Community Health Council;

A Facebook question and answer session;

8 community meetings organised and run by the Mid Wales Health Collaborative;

21 written responses.

There were a number of themes that came through clearly in the engagement responses

during ‘The Big Conversation’:

Travel and access

People told us that they were prepared to consider travelling further if it meant they

would get quicker access to specialist care and their treatment quicker.

You also supported the idea of more services being provided locally to avoid having to

travel long distances, which you are sometimes required to do at the moment

Some people accepted that there is a need for travel given their geographical location.

However, others felt travelling long distances for healthcare services was

unacceptable, with concern over the inadequate public transport networks in rural

areas.

We heard that you would welcome easier access to primary care through longer GP

opening hours and shorter waiting times for appointments.

Quality of care

This covered a variety of areas, but in particular good communication and timeliness,

especially when waiting for appointments or results.

Care closer to home and having the same people support you through all of your care

was important to many people.

Fair and equal access to healthcare was also seen as an indicator of quality.

Where to receive healthcare

We heard a lot of support for care in the community rather than in hospital at nearly

every event we held, with a lot of enthusiasm for hubs in the community or ‘one stop

shops’, where different health and care needs can be dealt with under one roof in the

local community.

Resources

Some people felt that money is wasted on management, paperwork and changing

services. Some also felt that there are too many managers and not enough staff.

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There was a lot of support for more services in the community and having a more

flexible, multi-skilled workforce working in a joined up way with other organisations like

social services or voluntary services.

There was also a willingness to be treated by nurses and non-medical staff (rather than

doctors) for some conditions, although some people raised concerns about staff not

being sufficiently trained.

The people we spoke to recognise that the public would need to be educated and

informed in order to understand new roles such as physician associates and advanced

nurses.

Some of the general hospital environments (Glangwili Hospital in particular) were

considered not fit for purpose now, let alone for the future.

People also highlighted that unpaid carers are a vital resource and more should be

done to support them.

Joined-up services

A large number of people felt that services would be much more joined up if there was

one electronic patient record to allow different healthcare professionals to access notes

quickly to understand what had happened with a patient. However, people wanted

reassurance that this would be secure with a good back-up system.

6. OPTIONS DEVELOPMENT PROCESS

We have taken an open and engaging approach to the development of our proposals, inviting

a wide range of people – staff, partners and groups that work alongside us - to challenge our

thinking and be involved in designing our proposals. This is fairly unusual but we’ve taken this

approach to develop this consultation together at every stage possible, because we believe

that this is how we will design services for the future that will be better for everyone.

We understand this will cause a lot of discussion and speculation in the community as people

want to know right now, in detail, what this might mean for their community-based healthcare

or their local hospital. We have been through a thorough process to narrow down and develop

the options so that we can confidently say to the public ‘these are the proposals we believe to

be viable, safe and offer an improvement to what we already have’.

The proposals we have come up with:

focus on what more can be done to keep people well and improve the health of our

population;

make a commitment to better resource our primary and community care services,

where most patient contact is made;

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make best use of all the available resources in our communities by working together

across organisations and putting more healthcare in the community – from

telemedicine and virtual wards to supporting voluntary sector provision;

change or even replace some of our hospitals and their services.

6.1 How we developed the options

We took everything we learned from our listening and engagement exercises and we worked

with a group of people, including doctors, nurses, therapists and staff, and a wide range of

local interested people and groups including local councils, the CHC, Welsh Ambulance

Service NHS Trust, and the voluntary sector to develop a range of options to redesign our

services.

This process was led by our doctors, nurses and other healthcare professionals. What we

mean by this is that a group of health professionals were brought together to discuss and

propose a wide number of options. In total, 25 options have been developed and considered

during this process. This large number of options was tested across two workshops in

December 2017 and January 2018 with staff and interested people and groups outside of the

NHS, involving over 150 people. During the sessions people were asked to look at the

strengths, weaknesses, opportunities and threats for each of the 25 options. This allowed us

to start ruling out many of the options from what we heard.

6.2 How we narrowed down the options

We took on board all of the feedback and points of view that we heard and, as a result, we

were able to narrow down our options from 25 to nine options to be discussed in greater detail

with our staff and a range of groups and individuals outside of the NHS. In all, we held 26

sessions to test all of the options, speaking to more than 430 staff and other groups,

organisations and individuals.

After we had held all of the sessions we again reviewed the options based on what we had

heard and were able to further reduce the list of options to six.

6.3How we scored the options In order to consider the remaining options in more detail, a set of eight criteria were

developed by a group of staff and members of local groups and organisations who were

completely independent of those tasked with developing and narrowing down the options.

The starting point for developing the criteria was what we heard during the first phase of our

work, and in particular findings from ‘The Big Conversation’. For example we heard a lot of

support for more joined up care in the community so knew that integration, and accessibility of

services, would be important criteria for you. You also told us that fair and equal access to

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health care is an important indicator of quality, so we have included quality and safety as one

of our criteria.

The criteria were ranked in order of importance based on what we heard as part of our

ongoing engagement, and following consideration at a number of workshops. Having a range

of people involved with this meant that we were able to consider a variety of views around

what is important.

We then asked a wide group of staff and interested people and groups to apply a score of one

to ten for each of the criteria, against all six remaining options. A total of 126 people took part

in the scoring exercise including doctors, nurses, midwives, therapists, county council

colleagues and voluntary sector representatives.

Once the total scores had been added up we applied a weighting and then we were able to

order the options from highest to lowest based on the total scores given. We used a scoring

tool to do this. Finally, the order of the scoring of the remaining options from highest to lowest

was identified.

The final part of the process was to look at the potential affordability of the options in order to

inform the final decision on which proposals to take forward to this consultation.

6.4 How we made our decision on the final proposals

The criteria setting, scoring and weighting were used as decision-making tools to help to

refine the options, in conjunction with feedback from ‘The Big Conversation’, discussions

around option development, what we heard during the challenge sessions and finally the

financial information about affordability. Whilst doctors, nurses, other healthcare

professionals, the voluntary sector, county councils, the Ambulance Service and a range of

other partners provided input into the development of the options, the Health Board’s team of

senior leaders was the group responsible for making the decision about which options were to

become proposals.

7. LEGAL DUTIES AND REQUIREMENTS

7.1 Equality Act / Public Sector Equality Duties Our duties in relation to equality and diversity are outlined in the Equality Act 2010 (Statutory

Duties) (Wales) Regulations 2011.

The Act aims to ensure and those carrying out a public function consider how we can

positively contribute to a fairer society in our day-to-day activities through paying due regard

to eliminating unlawful discrimination, advancing equality of opportunity and fostering good

relations.

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In order to make this happen, the Regulations place specific duties on the devolved public

sector, including Health Boards in Wales to carry out equality impact assessments.

In the context of this work we are required to assess the impact of our proposals to ensure

that, as far as is practicably possible, the opportunities for promoting equality and human

rights for people with protected characteristics are maximised and any actual or potential

negative impact is eliminated or minimised.

7.2 Mental Capacity Act 2005 The Mental Capacity Act is a law designed to ensure that all people, age 16 and over, are protected and empowered if they lack the capacity to make a decision about their care and treatment.

7.3 Human Rights Act 1998

The Human Rights Act 1998 (the Act or the HRA) sets out the fundamental rights and

freedoms that everyone in the UK is entitled to. It requires all public bodies, including health

boards, to respect and protect your human rights.

7.4 Welsh Language (Wales) Measure 2011 Our duties in relation to the Welsh Language are outlined in the Welsh Language (Wales) Measure 2011. The Act, the current Welsh Language Scheme and subsequent Welsh Language Standards. In line with the new Welsh Language Standards the organisation will be expected to consider, when formulating a new policy, or reviewing or revising an existing policy, what effects, if any (whether positive or adverse), the policy’s formulation or decision would have on— (a) opportunities for persons to use the Welsh language, and (b) treating the Welsh language no less favourably than the English language. When publishing a consultation document which relates to a policy decision, the document must consider, and seek views on, the effects (whether positive or adverse) that the policy’s formulation or decision under consideration would have on (a) opportunities for persons to use the Welsh language, and (b) treating the Welsh language no less favourably than the English language

7.5 Welsh Government Guidance for Engagement and Consultation on Changes to Health Services 2011 Ministerial Guidance (issued in March 2011) makes it clear that there are certain

responsibilities on the Health Board in undertaking consultations of this nature. The process

for consultation requires a two stage process:

- Stage 1 Pre-consultation to engage key stakeholders in exploring issues, developing options and plans

- Stage 2 Formal consultation

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A Health Board is expected to undertake a two stage consultation process where it appears likely that formal consultation should take place. The first stage of this process is for the Health Board to undertake extensive discussions with all key stakeholders, including:

- Stakeholder Reference Group - Health Professions Forum - Partnership Forum - Community Health Council - Local Service Boards - Staff and their representative bodies - Other key partners as appropriate

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. Only when the Health Board is satisfied that the first stage has been properly conducted should it proceed to formal consultation. Following the first stage, 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 Community Health Council agrees. The consultation document must take into account the specific information on what should be included in a consultation document. It is important to include a clear explanation as to how the views expressed will be considered as part of the decision making process. It is best practice to provide an indicative timeline for the decision making process and identify how results will be fed back to those who have been involved in the process.

7.6 Gunning Principles Any consultation should be able to demonstrate that it has taken into account the Gunning principles i.e.:

i. consultation must take place when the proposal is still at a formative stage; ii. sufficient reasons must be put forward for the proposal to allow for intelligent

consideration and response; iii. adequate time must be given for consideration and response; and iv. the product of consultation must be conscientiously taken into account.

7.7 National Health Services (Wales) Act 2006 Section 183 of the National Health Services (Wales) Act 2006 requires LHBs, with regard to services they provide or procure, to involve and consult citizens in:

- planning to provide services for which they are responsible

- developing and considering proposals for changes in the way those services are provided; and

- making decisions that affect how those services operate.

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Section 242 of the National Health Service Act 2006 extends this requirement to NHS Trusts.

7.8 Wellbeing of Future Generations Act 2015 The Well-being of Future Generations (Wales) Act 2015 (the Act) is new legislation which has

at its heart the well-being of future generations, through the establishment of seven national

well-being goals and five ways of working:

A globally responsible Wales – where we look after the Environment and think about other people around the World.

Five Ways of Working

A prosperous Wales – where everyone

has jobs and there is no poverty

A resilient Wales – where we’re prepared

for things like floods

A healthier Wales – where everyone is

healthier and are able to see the doctor when they need to

A more equal Wales – where everyone has an equal chance whatever their background

A Wales of Cohesive Communities – where Communities can live happily together

A Wales of Vibrant Culture and Thriving Welsh Language –

where we have lots of opportunities to do different things and where lots of people can speak Welsh

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7.8 Social Services and Wellbeing (Wales) Act 2014 The Social Services and Well-being (Wales) Act 2014 imposes duties on local authorities, health boards and Welsh Ministers that require them to work to promote the well-being of those who need care and support, or carers who need support. The West Wales Care Partnership has been established under Part 9 of the Social Services and Wellbeing (Wales) Act 2014 with specific duties to promote the integration of community care and support services. Whilst statutory partners comprise Hywel Dda University Health Board, Pembrokeshire County Council, Carmarthenshire County Council, and Ceredigion County Council, membership of the Regional Partnership Board also includes user and carer representation as well as third and independent sectors. Under the legislation the Regional Partnership Board is required to prioritise the integration of services for older people, including dementia; people with learning disabilities; Carers; Family Support Services; and children with complex needs due to disability or illness. The West Wales Care Partnership has prioritised five priorities based around key enablers for building on these foundations and progressing the integration agenda in the region. These are: - Integrated Commissioning - Service integration/ pooled funds, including establishing pooled fund arrangements for

care homes - Information Advice Assistance - Implementation of the Welsh Community Care Information System - Transformation of Mental Health and Learning Disabilities

7.9 Convention on the Rights of the Child (UNCRC) 1989 In November 1989, the United Nations General Assembly unanimously adopted the

Convention on the Rights of the child (UNCRC). In December 1991, the United Kingdom

government signed up to (‘ratified’) the Convention. In line with this the Welsh Assembly

Government has made a commitment to promote and support children and young people’s

participation and to implementing children and young people’s rights to participate as stated in

Article 12.

Article 12 of the convention states that: “Children and young people have a right to participate

in the decision making processes that are relevant their lives and a right to influence the

decisions made in their regard within the family, the school or the community.”

8. ASSESSING IMPACT (INCLUDING EQUALITY IMPACT ASSESSMENT)

In line with S.149 of the Equality Act 2010 (Statutory Duties) (Wales) Regulations 2011 the Health Board must have due regard to the need to:

- Eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited by the Act

- Advance equality of opportunity between people who share a protected characteristic1 and those who do not

1 Protected characteristics are Age, Disability, Gender Reassignment, Marriage and Civil Partnership, Pregnancy and Maternity, Race, Religion and Belief ( including no belief) Sex, Sexual Orientation

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- Foster good relations between people who share a protected characteristic and those who do not

- Equality Impact Assessment requires us to consider how our proposals on transforming clinical services may affect a range of people in different ways and will help us answer the following questions:-

a) Do different groups have different needs, experiences, issues and priorities in

relation to the proposed service changes?

b) Is there potential, or evidence that the proposed changes will promote equality?

c) Is there potential for, or evidence that the proposed changes will affect different

groups differently? Is there evidence of negative impact on any groups of people?

d) If there is evidence of negative impact, what alternatives are available? What

changes are possible?

e) How will we monitor impact following implementation?

The involvement of people from protected groups will be monitored to ensure that views from a range of groups is represented as defined within the Equality Act 2010 (Statutory Duties) (Wales) Regulations 2011. The Health Board is undertaking an Integrated Impact Assessment as part of the process; this is underpinned by an Equality Impact Assessment which will be further informed by findings from our consultation. The equality analysis has to date considered potential impacts that any change to mental health services may have on people from groups with protected characteristics. As part of the consultation process, we will test the potential impacts on people. This will include asking about the perception of how any change to service might have a positive or negative impact on them. The equalities analysis will be reviewed throughout the consultation process by the Communication and Engagement Work-stream and additional engagement will be conducted around this as required To ensure that the Health Board fully meets its duty an Equality Impact Assessment has been conducted on the consultation plan and will be further reviewed as part of the consultation process. The Equality Impact Assessment can be viewed as Appendix 2

9. STAKEHOLDER MAPPING AND ANALYSIS

A detailed stakeholder mapping analysis exercise has been undertaken to ensure that the relevant stakeholders are aware of and have the opportunity to participate in the consultation. A formal consultation will commence following approval by Board and will be delivered in accordance with the guidance for engagement and consultation on changes to health services. Throughout the consultation process we will need to ensure due regard is given to the general and specific equality duties for public sector organisations in Wales, and the requirement to engage with representatives of protected groups in assessing the potential impact of proposals on these groups.

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We need to understand the views of the following groups on the proposals: We need to understand the views of particular groups in relation to Hywel Dda – Our Big NHS

Change proposals in more depth:

Patients, their families and carers.

Patients, their families and carers with particular emphasis on those with protected characteristics including older people, people with disabilities.

Community and interest groups representing patients, carers and their families.

Community and interest groups representing patients, carers and their families with particular emphasis on those with protected characteristics.

Older and frail people living in rural and isolated areas such as west Pembrokeshire, east and north Carmarthenshire and south Ceredigion

Older people living in the urban areas to the east of Carmarthenshire including Llanelli and Ammanford

Women with high risk pregnancies living in east Carmarthenshire

Paediatric patients living in east Carmarthenshire

Men living in rural areas

Primary care contractors

Professional bodies concerned particularly with the delivery of these services.

Health Board staff We need to understand the views of particular groups in relation to Transforming Clinical Services proposals in more depth We need to understand views on proposals for change in these services so that the Board can decide on the best way to deliver a service that is safe, sustainable, accessible and kind: Stakeholder mapping will include a focus on disadvantaged, marginalised and minority groups and communities via local community and voluntary sector groups and networks to make sure that those seldom heard groups have the opportunity to have their say in decisions that affect them. See Appendix 3 for stakeholder mapping document.

10. DEVELOPMENT OF CONSULTATION MATERIALS

A full consultation document has been developed which details: - The background to the consultation and vision for change - The need to change - Our proposals for change - Rationale for the proposed model and areas of influence - How people can participate in the consultation and give their views

The full consultation document will be available in hard copy and electronic format. To make the consultation as accessible as possible we will provide the executive summary in the form of an animation, the design of which accommodates the inclusion of text for Welsh, English, Polish and other languages as required as well as space for BSL. A transcript of the video including descriptors will be available for easy access for people with visual impairment.

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The animation will be available online and can easily be copied onto DVD or memory stick for circulation to members of our community who may not be digitally active. A frequently asked questions (FAQ) document will be available online (hard copy available on request). This will be a live document and be updated with questions and responses throughout the consultation. Technical documents will be available online, providing the information on the engagement process, background information as to how and why the consultation options have been developed as such. These will include:

- pre-consultation outputs, summary and report - options development process, including those excluded and the rationale for this - case for change - relevant document from e.g. NICE / Royal College / Deanery etc - other information to inform the decision making process / to demonstrate the options

have been thought through and can be implemented We are taking this approach to ensure participants have enough information to give informed consideration to the areas of influence. This will also ensure that the consultation meets the standards set out in the Gunning Principles described in legal duties and requirements section of this document. The feedback and materials will be reviewed as part of the work of the Communications and Engagement Group.

11. COMMUNICATION AND ENGAGEMENT

The consultation objectives are:

- To describe and explain the potential models for future health services in Hywel Dda - To understand the impacts that have been identified and identify any other impacts of

our proposals that have not been identified - To seek people’s views on the models, including the range of services/ activities and

contact methods of services as set out in the proposals - To inform and provide opportunities for a diverse range of people (inclusive of staff,

service users, carers, our partners, stakeholders and the general public) to share their views about how the models have been developed and generate specific discourse on elements of our implementation to help influence the final direction.

- To identify additional ideas to develop the final model and manage the implementation of proposals

- To ensure that the consultation process maximises community engagement and complies with legal requirements and duties

A variety of communication and engagement activities will be used to ensure that the consultation is fully accessible to the population of Carmarthenshire, Ceredigion and

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Pembrokeshire. This activity is detailed in the consultation plan in Appendix 4. The consultation plan will have many activities scheduled for the first half of the consultation, this will provide us with the opportunity to review feedback and opinions and target the engagement activities in the most effective way for the second half of the consultation. We will raise awareness of the consultation through a range of digital and non-digital methods. We will utilise our existing stakeholder databases, staff, Siarad Iechyd / Talking Health involvement scheme and partners networks to raise awareness of the consultation. In addition to this we will utilise community venues and a wide range of healthcare settings to ensure information is available and accessible. We will support our organisational leaders to encourage staff and patient / carer participation in the consultation through the use of briefing sessions and briefing packs to ensure our staff are supported and informed to share messages consistently and record and share feedback promptly. We will look to make best use of our website, with the consultation document, technical documents as well as additional supporting materials including frequently asked questions, press releases etc. We will use social media and develop additional materials such as animation and short videos to share information about the consultation and target seldom heard audiences, including those of working age. Feedback will be received in a variety of different formats, respondents will be able to:

- complete surveys electronically or in hard copy - telephone and leave their views - write a letter - send an email - participate in a Facebook event - attend a drop in session - share their views as part of an existing group / meeting - comment on health board posts / tweets / videos on social media

When gathering feedback from meetings, or one-to-one discussions, the representative from the Options Development Action Group will be asked to complete a feedback form and this will be recorded with other submissions on the submission database. An example of the feedback form is included as Appendix 5.

12. STANDARDS AND FORMATS OF INFORMATION

All information produced as part of the consultation will be written in a language that can be understood by members of the public. Technical phrases and acronyms will be avoided and information will be produced in other formats as required to reflect the needs of the diverse population served by Hywel Dda University Health Board.

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13. BUDGET AND EXPENDITURE

The Health Board has committed resources to the consultation process. This has included:

Activity Estimated Cost

Independent analysis and assurance 114,000

Design, production, translation and distribution of materials 50,000

Events and advertising 20,000

Staffing and support 81,000

TOTAL 265,000

14. RISK AND ASSURANCE

Risk and risk mitigation will be managed by the Transforming Clinical Services Design Steering Group and risks relating to the consultation project plan will be identified and regularly reviewed as part of the Communication and Engagement Group meetings. The current risk register is included as Appendix 6.

15. MANAGEMENT OF CONSULTATION RESPONSES

Consultation responses will come into the organisation in many forms and through various different routes. A database will be set up by the Public and Patient Engagement Team to log responses and feedback gathered from meetings. The team will regularly update the database. Electronic versions will be saved as evidence and paper copies will be scanned so we have an electronic record of all responses received. We will share these regularly with Opinion Research Services (ORS) a company we have commissioned to undertake the independent analysis of consultation responses. Electronic questionnaires will be completed by individual respondents online and any paper questionnaires received will be input onto the electronic survey system. Opinion Research Services (ORS) will undertake a quantitative analysis of the survey to provide demographics and preferences of options in addition to qualitative analysis of the open ended questions. Drop in events and focus groups will provide an opportunity to develop in-depth qualitative analysis of why people hold certain views on proposals. Written responses, feedback from meetings etc will be reviewed as part of the qualitative analysis. Analysis of the responses on social media campaign will be included and considered as part of the qualitative and quantitative analysis process.

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16. CONSULTATION ANALYSIS

The consultation activity will result in quantitative and qualitative feedback and data. It is essential that the data and feedback is subject to robust, in-depth analysis. This will inform the decision-making of the Health Board around the potential changes to health services. To ensure an open and transparent method of analysis an external provider, with expertise in this area Opinion Research Services (ORS) has been commissioned to undertake the data analysis and provide a report for consideration by the Health Board.

17. EVALUATION / ANALYSIS PLAN

The Options Development Action Group and the Communications and Engagement Group will meet regularly throughout the consultation period to review feedback, themes and monitor the progress of the consultation in line with the consultation plan. This will enable the consultation to have a level of flexibility to adapt our activities and respond to what we are hearing. The consultation period will come to and end on the 12th July 2018 and independent analysis of feedback will be undertaken between the 15 July and the 10 August 2018. Following this we will receive a feedback report During the week of the 12 August we will be testing the feedback report and “what we have heard” with key stakeholders and challenge groups. The report will be shared with the Community Health Council for consideration as part of their role in reviewing and formulating an official response to the consultation. Responses from these sessions in addition to the feedback report itself will be used to inform the output report. This will include an overview of the consultation, along with the data analysis, feedback and will call out how this has been used to inform the process of developing recommendations for consideration by the Health Board as part of its decision-making process. A decision will be made at the Health Board meeting in September. Following the decision at Board, information will be sent out to stakeholders to advise of the decision and how the full detail can be accessed. We will use innovative ways to share information on social media, ensure our website is up to date and liaise with the local media to ensure there are press releases and up to date information available for the local media.

18. INFLUENCING PLAN

The Options Development Action Group and the Communications and Engagement Group will meet regularly throughout the consultation period to review feedback, themes and monitor the progress of the consultation in line with the consultation plan. This will enable the consultation to have a level of flexibility to adapt our activities and respond to what we are hearing.

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During the week of the 12 August we will be testing the feedback report and “what we have heard” with key stakeholders and challenge groups. The report will be shared with the Community Health Council for consideration as part of their role in reviewing and formulating an official response to the consultation. Following the decision that is made by the Health Board in September, an implementation phase will commence and integral to this will be the principles of co-design and co-production. The opportunity to influence the delivery of the model will continue throughout this process.

19. FINAL REPORT

A full feedback report will be produced by the independent analysis company ORS. This will include an overview of the consultation, along with the data analysis, feedback and will call out how this has been used to inform the process of developing recommendations for consideration by the Health Board as part of its decision-making process. The report will be shared with the Community Health Council for consideration as part of their role in reviewing and formulating an official response to the consultation. The feedback report, output report and decision will be made available and widely distributed to enable stakeholders to see how their feedback has been taken into account and how the final decision was made.

20. DECISION MAKING PLAN

The key decision points within this process are:

- 19 April 2018 – the Board will make the decision whether or not the consultation will proceed based on the proposals and information presented

- 27 September 2018 – the Board will review the feedback and the output report, consider the proposals and information presented and make a decision on the recommendations

21. FEEDBACK PLAN

The draft feedback report will be available by the 10 August. The feedback report will be tested with key stakeholders and challenge groups to ensure it reflects what we have heard throughout the consultation. Following the testing of the feedback, the output report will be developed and both these documents will be presented to Board in September. Once Board has made the decision, this, together with the links for the feedback and output report will be circulated to the original circulation list used to inform individuals, groups and organisations of the consultation. This will be supplemented by anyone who has requested to be added to our circulation list. We will ensure our website is up to date with the relevant information and documentation and we will also share this across our social media platforms in innovative forms.

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We will liaise with our local media to ensure there are opportunities for press releases, interviews etc to ensure the information is available in our local media.

22. EVALUATION

Evaluation will be on-going throughout the consultation period, led and overseen by the Communication and Engagement Group. Once the consultation has closed, a further, full evaluation of the consultation, including development and implementation, will be conducted. The results of the evaluation will be shared with the Transforming Clinical Services Design Steering Group, the Community Health Council and the wider health board to ensure lessons learned will be taken forward to inform future projects.