Wales of protest
Is public consultation on reorganising Welsh health services a sham? The public - and some in the NHS - think so.
It is becoming something of an annual event. At this time of year, the citizens of Powys take to the streets and protest about Dyfed Powys health authority.
Last year, they protested about its plans to close community hospitals in the face of a pounds13.5m deficit. This year, they are protesting about trust reconfiguration.
More than 600 people packed an HA meeting at Carmarthen leisure centre last week to try to persuade it to back plans that would retain a community- led trust in Powys.
But after a lively debate, the board endorsed the recommendations of a project board set up four months ago. It will now tell Welsh health minister Win Griffiths that there should be just two trusts in Dyfed Powys, one for acute and one for community services, or three trusts, based on geographical areas.
The decision led Brecon and Radnorshire MP Richard Livsey to tell The Western Mail: 'They decided what they had already agreed on and took no notice of what anyone said.
'It's more like a Stalinist praesidium than a representative body, and we will make strong representations to the minister about this.'
Mr Livsey can make representations. But as HA chief executive Peter Stansbie points out: 'All health authorities in Wales are going through this process.
'It is a move designed to improve the quality of hospital and community care by establishing a more effective and efficient structure of NHS trusts. Ministers would like to see pounds5m to pounds10m saved in this way.'
HAs have spent the winter looking at options for trust reconfiguration and testing them against Welsh Office criteria issued last year.
The criteria say, for example, that plans should increase the 'seamlessness' of service for patients, take account of new staffing and training requirements, increase openness and 'reduce management overheads'.
HAs were given until 1 February to come up with proposals, and encouraged to send one option to the Welsh Office.
Ministers will discuss the options this spring, public consultation will go on through June, July and August, final decisions will be made in October, and the new trusts will go live on 1 April next year.
The Association of Welsh Community Health Councils is already wondering where public views really fit into this relentless timetable.
'By the time you get to public consultation, if you are down to one option, then everything has actually been decided,' says chief officer Sue Wilshere.
AWCHC's confidence in the Welsh Office's commitment to public participation has not been bolstered by the three-month public consultation on proposals to create an all-Wales ambulance trust that ended last week.
It was triggered by an independent report, endorsed by a policy advisory group of ambulance trust chairs and chief executives, which concluded that the 'best way forward' for ambulance services was either a single trust or three trusts serving north, central and south east Wales.
But after the report went to the Welsh Office last year, only the 'super trust' option went to public consultation.
'For consultation to be genuine it must take place when proposals are at a formative stage,' says Ms Wilshere.
'The two exercises together raise major questions about the value of such exercises... To call it public consultation is ridiculous.'
Mr Griffiths has insisted that 'no decision will be taken on (the ambulance trust) proposals until the results are known'.
But few in Wales doubt that a single ambulance trust will be in place on 1 April - especially since adverts for non-executive directors were placed in December.
Even so, enthusiasm for one is not overwhelming. Gwent HA unexpectedly announced on 27 January that it 'could not support the proposal'.
North Wales HA board secretary John Roberts told the Journal: 'We are very happy with our existing service, but... we are willing for these plans to go forward if safeguards are put in place.'
The safeguards North Wales HA wants include protection for local management, transparent financial accounting, the preservation of current levels of service and 'regional identity'. Wales' other HAs have asked for similar safeguards.
Unison, which also believes an all-Wales trust is a fait accompli, has raised concerns about its financial viability, since it will be expected to absorb the pounds1.5m debt left by South East Wales Ambulance trust and make pounds3m savings in five years.
And a last-ditch battle to save the integrated ambulance service run by Pembrokeshire and Derwen trust is still being fought by, among others, two Labour MPs, local consultants, the CHC and the trust board.
Meanwhile, the trust merger programme proceeds amid warnings from the Welsh Institute for Health and Social Care and the NHS Confederation in Wales that it could cost rather than save money because of redundancy payments.
There is also weariness among managers, even when they see benefits in the final outcome.
Gwent HA's reconfiguration project group reported: 'The preference to maintain the status quo, at least in the short term, pending the implications of the white paper and the Welsh Assembly, was apparent across all organisations and all areas of Gwent.'
Gwent HA has told the Welsh Office its preferred option is a single, combined trust, although there is 'substantial minority support' for combined trusts serving north and south Gwent.
There is scope for Powys-like protest in its decision since the project group reports 'opposition from the local trust, GPs and local councillors'.
North Wales HA has decided to recommend three integrated trusts to the Welsh Office.
Iechyd Morgannwg HA has recommended that two integrated trusts should be created to serve the east and west of its area. Bro Taf HA was unable to reach a decision on reconfiguring trusts in the north of its area at a meeting this week. However, it agreed there should be one acute and one community trust in south Bro Taf although it would like to see an integrated trust in the long term.