An Integrated Service & Estates Strategy For ... - Health in Wales

An Integrated Service & Estates Strategy For
Conwy and Denbighshire NHS Trust
Community, Mental Health and Learning
Disabilities Services
Part of the Integrated Strategy for
Conwy and Denbighshire NHS Trust
Conwy Local Health Board
Denbighshire Local Health Board
4th draft
March 2005

Contents
1 Executive Summary ………………………………………………. 2
1.1 The Nature of the Strategy ………………………………………… 2
1.2 Methodology ………………………………………………………… 2
1.3 The Strategy ………………………………………………………… 3
2 Introduction ………………………………………………………… 7
2.1 An Integrated Strategy …………………………………………… 7
2.2 A Service-led Strategy ……………………………………………… 8
2.3 The Scope of the Strategy …………………………………………. 8
2.4 Methodology ………………………………………………………… 8
3 Current Services and Estate …………………………………….. 9
3.1 Service Profile ………………………………………………………. 9
3.1.1 Community Services ………………………………………………... 9
3.1.2 Mental Health & Learning Disability Services …………………… 10
3.1.3 Family Services ……………………………………………………. 11
3.1.4 Community Dental Services ………………………………………. 12
3.2 Strategic Estates Review ………………………………………….. 13
3.2.1 Scope ………………………………………………………………… 13
3.2.2 Overview …………………………………………………………….. 13
3.2.3 Conwy & Denbighshire NHS Trust ……………………………….. 14
3.2.4 Conwy LHB ………………………………………………………….. 16
3.2.5 Denbighshire LHB …………………………………………………... 17
3.2.6 Summary Performance Indicators ………………………………… 18
3.2.7 Backlog Maintenance ………………………………………………. 21
4 Service Vision ……………………………………………………… 22
4.1 Policy Context ……………………………………………………….. 22
4.2 Service Specific Issues …………………………………………….. 27
4.2.1 Conwy & Denbighshire LHBs ……………………………………… 30
4.2.2 Conwy & Denbighshire Councils & Other Agencies ……………. 31
4.3 Principles ……………………………………………………………. 32
5 Demand & Capacity Modelling …………………………………. 34
6 Strategic Direction ……………………………………………….. 35
6.1 Introduction ………………………………………………………….. 35
6.2 Structure ……………………………………………………………... 35
6.3 Integration of Services through Community Hospitals, Primary 36
Care Resource Centres & Primary Care Centres ………………..
6.4 Localities ……………………………………………………………... 37
6.4.1 Conwy ………………………………………………………………... 38
6.4.2 Denbighshire ………………………………………………………… 39
6.4.3 Central Services …………………………………………………….. 40
7 Project & Action Plan 42
References 45
Appendices: Connection Groups Notes (Appendix 1) 47
List of Participants (Appendix 2) 52

1 Executive Summary
1.1 The Nature of the Strategy
This document outlines the service and estates strategy of the community,
mental health and learning disabilities services provided by the Conwy and
Denbighshire NHS Trust. It forms part of a much broader integrated strategy
for health and social care. As part of the same process, and therefore
sharing the same strategic vision, the primary care estates strategies of
Conwy and Denbighshire Local Health Boards (LHBs) are currently being
completed. The process has also incorporated the views of local
government and other key stakeholders to ensure that a whole system view
has been taken of service and estates issues. In terms of the Trust’s services
it builds on the first strategic document, produced in 2003, which outlined the
strategic issues for the Trust as a whole but focused primarily on the
strategic resolution of those issues which related to acute services and
facilities.
It is fundamental to the health community’s approach that this strategy is
service-led, with the aim of providing the highest quality healthcare to
patients in the most appropriate physical environment. Strategic estate
solutions deriving from projected changes in the scale and nature of services
required by the local population. The focus is on outlining the principles
underlying the modern delivery of care, applying these to local circumstances
and establishing what physical environment is required to support them. The
strategy also takes a realistic view of the future availability of resources, both
capital and revenue, to support development and change.
This document outlines a broad strategic direction for community, mental
health and learning disabilities services. It is not intended to provide a
detailed blueprint of the future of each individual service. The outcome of the
strategy is a clear, timetabled action plan. This action plan consists of a
series of projects, either locality or service-based, which will produce specific
proposals and business cases for the modernisation of services.
1.2 Methodology
The strategy has been developed on an inclusive basis, with the involvement
of: the staff of the Trust and other health, social care, voluntary and
independent agencies; service users; and the public. Relevant national and
local policy documents have been analysed, and a review carried out of
primary, community, mental health and learning disability services in other
parts of the UK. An analysis has also been undertaken of local estates and
activity data. The programme board, which has overseen the development
of the strategy, is made up of representatives of the Conwy & Denbighshire
2

NHS Trust, and the Conwy, Denbighshire and Flintshire Local Health
Boards.
1.3 The Strategy
The strategy incorporates a set of clear principles, following a review of
national policies and an exploration of local issues. The key ones are as
follows:
• A strong emphasis on integrated working - both between professionals
within the same organisation, and between different organisations
working in health, local government, and the voluntary and independent
sectors
• The development of shared facilities, to support the development of
integration
• The potential for strategic shifts of activity from acute to primary and
community settings and care at home
• An evidence-based approach, building upon models which have been
implemented successfully elsewhere.
There is a particular emphasis on the development of integrated premises in
the form of Primary Care Centres (PCCs), Primary Care Resource Centres
(PCRCs) and Community Hospitals. These vary in scale and the range of
services provided, from PCCs with a relatively narrow range of facilities at
one extreme to large Community Hospitals at the other.
The strategy applies these broad principles and models to a series of
localities in Conwy and Denbighshire and to more centralised community,
mental health and learning disability services and facilities. The localities are
outlined in the enclosed map (Figure 13). The result is a series of specific
actions and projects, some of which will result in business cases for the
development of new or enhanced services and facilities. The projects
outlined in the action plan will be developed with the full involvement of the
public, as required in the National Assembly for Wales guidance “Shaping
Services Locally”. This action plan is summarised in the following table:
3

Conwy + Denbighshire NHS Trust
‘Localities’
Bangor
Llanfairfechan
1
Llandudno
Colwyn
Bay Abergele
2
Llanrwst
5
3
4
Prestatyn
Rhyl
10 11
1
St Asaph
2
Denbigh
Holywell
1
2
3
4
5
1
2
3
Penmaenmawr, Llanfairfechan, Conwy,
Henryd, Llandudno Junction
Deganwy, Llandudno, Craig -y-Don,
Penrhyn Bay Liverpool
Rhos on Sea, Colwyn Bay,
Old Birkenhead
Colwyn, Mochdre
Kinmel Bay, Towyn, Llanddulas, Abergele
Rural Area
‘natural’ extension to area 4
Rhyl + Prestatyn
St. Asaph, Denbigh + Ruthin
The South
Ruthin
3
Corwen
Wrexham
Llangollen

Locality /
No
Service
1 Conwy
Locality 1
2 Conwy
Locality 1
3 Conwy
Localities 2 & 3
4 Conwy
Localities 2 & 3
5 Conwy
Localities 2 & 3
6 Conwy
Localities 2 & 3
7 Conwy
Locality 4
8 Conwy
Locality 5
9 Denbighshire
Locality 1 and
Conwy
Locality 4
Description of Project or Action
Complete the development of the primary
care resource centre at Llanfairfechan
Agree the future use of the Llanfairfechan
health centre, including consideration of
the business case to develop dental
services
Complete the review of Llandudno and
Colwyn Bay hospitals, exploring what
opportunities exist for better integration of
community services
Develop a service and estates plan for
these localities, following the outcome of
the hospital review
Reach conclusions on the potential for a
joint estate development with the
Ryssledene practice
Reach conclusions on the potential for a
joint estate development with Social
Services in Llandudno
Reach conclusions on the potential to colocate
services with Social Services in
Abergele
Develop plans for the integration of
services in a new build in Llanrwst
Review the future provision of services in
Rhyl and the surrounding area, Kinmel
Bay, Abergele and Towyn - including the
future of the Royal Alexandra Hospital
Agency /
Agencies
GPs; LHB; C&D
Trust; Conwy
Social Services
C&D Trust; Conwy
LHB
Conwy LHB,
NWWT, C&D Trust
Conwy Local
Government
C&D Trust; Conwy
LHB
C&D Trust; GPs,
Conwy LHB,
Conwy Social
Services
C&D Trust, Conwy
Social Services
C&D Trust, Conwy
Social Services
GPs, Conwy LHB,
C&D Trust, Conwy
Social Services
Conwy LHB,
Denbighshire LHB,
C&D Trust
Executive Lead
Director of Planning,
C&D Trust
Director of Planning,
C&D Trust
Chief Executive,
Conwy LHB
Chief Executive,
Conwy LHB
Director of Planning,
C&D Trust
Director of Planning,
C&D Trust
Director of Planning,
C&D Trust
Chief Executive,
Conwy LHB
Chief Executive,
Conwy LHB
Date for
Completion
Sept 2005
Sept 2005
Dec 2005
To be agreed,
dependant on
the outcome of
[3] above
May 2005
May 2005
May 2005
Sept 2005
Sept 2005
4

No
Locality /
Service
10 Denbighshire
Locality 1
11 Denbighshire
Locality 2
12 Denbighshire
Locality 3
13 Mental Health
Acute Services
14 Older People’s
Mental Health
Services
Description of Project or Action
Review the future provision of services in
Prestatyn, including the potential to
develop the extra care housing model,
and conclude on the future of Prestatyn
Hospital
Develop plans to extend the use of
Denbigh and Ruthin Community Hospitals
to facilitate greater integration
Undertake a strategic review for the
locality including Llangollen hospital, the
clinic and mental health facilities in
Llangollen, and the Corwen Health
Centre.
Undertake a formal option appraisal on
the way forward for acute inpatient
provision
Complete a review of the use of inpatient
provision at Bodnant, Bryn Hesketh, Glan
Traeth and Tawelfan and development of
an action plan
Agency /
Agencies
Denbighshire LHB,
C&D Trust,
Denbighshire
Social Services
Denbighshire LHB,
C&D Trust
Denbighshire LHB,
C&D Trust,
Wrexham LHB,
North East Wales
Trust
C&D Trust,
Denbighshire LHB
C&D Trust
Executive Lead
Chief Executive,
Denbighshire LHB
Director of
Operations, C&D
Trust
Chief Executive, C&D
Trust
Director of Nursing,
C&D Trust
Director of Nursing,
C&D Trust
Date for
Completion
Sept 2005
Sept 2005
Sept 2005
March 2006
April 2006
15 Learning
Disabilities
16 Child Health &
Child and Adult
Mental Health
Services
(CAMHS)
Develop specific plans for the creation of
services linked to the closure of the Bryny-Neuadd
facility
Explore the costs and location options for
the development of a central base or
bases
17 CAMHS Explore the estate implications of the
expansion in tier 2 and 3 services
envisaged in the CAMHS action plan
C&D Trust,
Resettlement
Project Board
C&D Trust
C&D Trust, Conwy
LHB
Director of Nursing,
C&D Trust
Director of Nursing,
C&D Trust
Director of Nursing,
C&D Trust
April 2005
March 2006
March 2006
5

No
Locality /
Service
Description of Project or Action
18 CAMHS Agree the strategic way forward for the
future of CAMHS Tier 4 for North Wales,
services currently provided at Cedar
Court
19 Child Health Work jointly with Education on plans for
the creation of a Child Development
Centre in Conwy, and the replacement of
the existing Child Development Centre in
Denbighshire
20 Outpatient Undertake a strategic review of
Services outpatients, including the future scale and
21 Demand and
capacity
modelling
location of services
Complete the development of a demand
and capacity model, to inform the scale of
developments required by Locality
Agency /
Agencies
HCW, C&D Trust,
NEWT, NWWT,
Conwy LHB
C&D Trust, Conwy
County Council,
Denbighshire
County Council
C&D Trust
C&D trust
Executive Lead
Director of Nursing,
C&D Trust
Director of Capital
Developments and
Major Projects, C&D
Trust
Director of Planning,
C&D Trust
Director of Planning,
C&D Trust
Date for
Completion
August 2005
Sept 2005
June 2005
June 2005
Progress against the actions outlined in this table will be monitored by the Service and Estates Programme Board.
6

2 Introduction
2.1 An Integrated Strategy
This document outlines the service and estates strategy of the community,
mental health and learning disabilities services provided by the Conwy and
Denbighshire NHS Trust. It forms part of a much broader integrated
strategy, in line with The Review of Health and Social Care in Wales
recommendation that:
“Local Estates strategies…should be whole system, covering all health
and social facilities, irrespective of ownership” [Wanless,D. (2003), The
Review of Health & Social Care in Wales, Welsh Assembly Government,
p.78].
In terms of the Trust’s services this is the second iteration (cycle) of the
strategy. The first document, produced in 2003, outlined the strategic issues
for the Trust as a whole but focused primarily on the strategic resolution of
those issues which related to acute services and facilities. This was due to
the urgent need to address health and safety issues related to asbestos at
Glan Clwyd. The strategy resulted in a Strategic Outline Case (SOC) to
modernise acute services, which is currently deferred by the Assembly
pending the outcome of the North Wales Planning Forum (NWPF) review of
secondary services across North Wales.
This document further develops the strategic direction outlined in the acute
plan to incorporate the totality of the Trust’s services. As part of the same
process, and therefore sharing the same strategic vision, the primary care
estates strategies of Conwy and Denbighshire Local Health Boards (LHBs)
are being produced. The process has also incorporated the views of local
government and other key stakeholders to ensure that a whole system view
has been taken.
Following the completion of the LHB primary care estates strategies a
consolidated summary document will be produced, incorporating the acute,
community, mental health and learning disability services of the Trust, and
primary care in Conwy and Denbighshire. The acute element of this
document will be amended as appropriate to reflect the progress made by
the secondary care review.
7

2.2 A Service-led Strategy
It is fundamental to the health community’s approach that this strategy is
service-led, with strategic estate solutions deriving from projected changes in
the scale and nature of services required by the local population. The focus
is on outlining the principles underlying the modern delivery of care, applying
these to local circumstances and establishing what physical environment is
required to support them. The strategy also takes a realistic view of the
future availability of resources, both capital and revenue, to support
development and change.
2.3 The Scope of the Strategy
This document outlines a broad strategic direction for community, mental
health and learning disabilities services. It is not intended to provide a
detailed blueprint of the future of each individual service. The outcome of the
strategy is a clear, timetabled action plan. This action plan consists of a
series of projects, either locality or service-based, which will produce specific
proposals and business cases for the modernisation of services.
2.4 Methodology
The strategy has been developed on an inclusive basis. Interviews have
been held with key staff within the Trust, LHBs and other agencies. A series
of models of care workshops have been held involving both professional and
non-professional stakeholders. Relevant national and local policy
documents have been analysed, and a review carried out of primary,
community, mental health and learning disability services in other parts of the
UK. An analysis has also been undertaken of local estates and activity data.
The programme board, which has overseen the development of the strategy,
is made up of representatives of the Conwy & Denbighshire NHS Trust, and
the Conwy Denbighshire and Flintshire Local Health Boards.
Public and patient involvement has been an integral part of the development
of the strategy from the outset, as required in Shaping Health Services
Locally: ‘Guidance for involving and consulting on changes to health
services’ [Welsh Assembly Government (2004), Welsh Health Circular
(2004) 84]. This has been achieved through attendance at joint workshops
with professionals, and through two workshops held with members of the
Trust’s Connections group. Notes of the comments made by the
Connections groups are enclosed as Appendix 1. It is important that the
nature of this involvement is clearly understood. Consultation and discussion
has been about the broad principles outlined in this strategy. It has not
involved discussions about individual localities and premises. This will be
undertaken as part of the individual projects arising from this strategy, as part
of the process of identifying options for service and estate change.
A list of participants in this process is included as Appendix 2.
8

3 Current Services and Estate
3.1 Service Profile
This section briefly describes the services which are covered by this strategy.
3.1.1 Community Services
The Trust offers a broad range of community hospital and community nursing
services. The community division also hosts palliative care, and family
planning and continence services.
a. Community Hospitals
There are 6 Community Hospitals with a total of 206 inpatient beds, 141 of
which are managed by General Practitioners and the remaining 65 are
managed by consultant physicians. The network of community hospitals
across Conwy & Denbighshire offer a range of services in addition to
inpatient care. For example; physiotherapy, occupational therapy, speech
therapy, podiatry services, child health, radiology, minor injuries, phlebotomy,
screening services, audiology and orthoptists. Consultant-led outpatient
clinics take place in many community hospitals from a variety of surgical,
medical and mental health specialties.
b. Community Nursing
District Nursing Services are divided into two teams, one covering Conwy,
and the other covering Denbighshire. The service makes approximately
180,000 patient contacts per year.
The District Nursing Service operates from bases within clinics, health
centres, GP practices and community hospitals. The service addresses
patients’ health and nursing needs in their own homes and in residential
care, whilst also providing advice to nursing homes. Clinic sessions are also
run where it is felt that patients might be more appropriately treated in a clinic
setting – for instance, leg ulcer clinics. The nurses work within the wider
primary health care teams.
Community nursing services also provide evening nursing services in some
areas.
9

c. Palliative Care Nursing
The Palliative Care Nursing Service is an integrated service, encompassing
both acute and community care, with staff based in the North Wales Cancer
Centre and at the various bases within the community. Maintaining links
across North Wales and also with the hospices are vital to the service. The
Lymphoedema Service also comes under the remit of Palliative Care, noncancer
patients are also seen by the service.
d. Family Planning Services
The Family Planning service covers both Conwy and Denbighshire Trust and
North East Wales Trust. Clinics are provided in numerous locations, which
enables improved access for patients. Many of the staff work on a sessional
basis and also have employment elsewhere, either within the Trust or with
neighbouring Trusts.
3.1.2 Mental Health & Learning Disability Services
The services delivered by the division are spread across three areas; adult
mental health, older people’s mental health and learning disability services.
Overall the division offers inpatient, daycare, outpatient and community
nursing services.
For adult and elderly patients requiring acute admission, the Ablett Unit
offers a 54 bed inpatient facility and also offers; group therapy, social skills,
anxiety management, assertion, self awareness, relaxation, leave groups,
goal planning, creative writing, arts and crafts, exercise, keep fit, problem
solving, discussions, computer skills, gardening, social groups and cookery.
The unit treats approximately 700 inpatients per year.
a. Adult Mental Health
For adult mental health services five community based mental health teams
offer community mental health nursing, both in the client’s home and in a
health facility, outpatient clinics, walk-in facilities, crisis intervention services,
group therapy (for example, for anxiety and self confidence building).
b. Older People’s Mental Health
For clients over the age of 65, five community based teams offer older
people’s mental health services. The services offered cover inpatient stays,
day hospital services, assessments and re-assessments, day care and a
community psychiatric nursing service.
Combined, both adult and older people’s mental health daycare services
record over 20,000 attendances per year and community mental health
nurses report approximately 34,000 patient contacts.
10

c. Learning Disability Services
The service delivers specialist learning disability services across the adult
age ranges. The service also offers support to carers. The service is
responsible for learning disability consultant and nursing provision. Services
provided to children with learning disabilities include; specialist psychology,
speech and language therapy, physiotherapy and occupational therapy.
Learning Disability Services are based on social services sites. The
headquarters is based on the Denbigh Infirmary site. The Conwy Team
office is based at Glan y Don in Colwyn Bay and the Denbighshire Team are
based at the Henllan Centre, Denbigh.
3.1.3 Family Services
The services covered by this section outline those family services which are
delivered in the community.
a. Child & Adolescent Mental Health
The Child & Adolescent Mental Health service (CAMHS) offers a range of
services from advice and support to inpatient residential accommodation for
patients across Conwy & Denbighshire. The service also supports the
families of children with mental health difficulties. CAMHS teams offer
assessment, treatment, outpatient, day care, therapy and residential
accommodation (referred to as Tier IV) for ten residents at Cedar Court in
Colwyn Bay.
b. Community Paediatrics
Community paediatricians’ work across Conwy & Denbighshire and
community hospitals. They provide assessment and management of children
and young people with neurodevelopmental difficulties, working closely with
education and social services. They are involved with adoption and fostering
in addition to child protection services. The child health department
schedules immunisations both in the General Practice and at school,
arranging vision and hearing screening and medical examinations.
c. Community Nursing – Health Visitors
Health visitors work across the community from a variety of locations
including GP practices, clinics and community hospitals. They provide
support to families and usually work with young children. Health visitors
promote mental, physical and social wellbeing, providing health checks and
advice.
11

d. Community Nursing – Young Person’s Health Advisor
Young Person’s Health Advisors (formerly known as school nurses)
implement screening programmes, immunisation programmes and medicals
for school age children across Conwy & Denbighshire.
e. Children’s Learning Disabilities
The Learning Disabilities Department is for school-age children with learning
disabilities and who mainly attend special schools in Conwy & Denbighshire.
Children can be seen in schools, clinics or at their own home.
f. Children’s Special Needs
The Special Needs Department is responsible for all children who attend
special schools, and for children in mainstream schools who have significant
special needs, in the Conwy & Denbighshire locality. Administration is
undertaken for case conferences, children who are under the care of Social
Services and for Assessment clinics.
3.1.4 Community Dental Services
The Conwy & Denbighshire Trust provides the Community Dental Service for
the whole of North Wales. The remit of the Service is set out in Welsh Office
Circular WHC(89)28, which is still extant.
A hub and spoke model is already in operation and the intention is to develop
this across North Wales. There are 45 surgeries providing care at 26
locations. Additionally there are 7 mobile units (5 drivable and 2 towable). A
number of large (three pus surgeries) strategically placed centres are
required with smaller satellite clinics and mobile clinics servicing areas of
need. The larger centre will provide some secondary care services, eg
sedation, orthodontics, dento-alveolar surgery etc, as well as the core
services identified in WHC(89)28. Some smaller centre may also provide
some secondary care services depending upon the skills of the clinicians
available.
The policy context for the service is set by “Routes to Reform” and the Welsh
Assembly Government draft Circular “NHS – Role of the Community Dental
Service in Wales” with further guidance expected.
Given that the direction of this service is currently under review by the
Assembly, this iteration of the Trust’s will not address further the specific
strategic requirements of the Dental service. This work is being undertaken
by the Dental Directorate, and will be fully integrated into the overall strategy.
12

3.2 Strategic Estates Review
3.2.1 Scope
The Estates Review undertaken in the development of the strategy
encompasses:
• A service-led approach
• A sound understanding of existing estate constraints and opportunities
• Performance analysis of the existing estate
• Development of broad options to deliver the service vision
The review of the Trust’s existing Community, Mental Health, Learning
disability and Primary Care premises is based substantially on Conwy &
Denbighshire NHS Trust’s 6 facet survey 2003, revised February 2004
This has been supplemented with visits to a sample of Trust sites. The
analysis below has been derived from a comprehensive estates database
covering all properties.
3.2.2 Overview
The total property holding of the Conwy & Denbighshire NHS Trust is 35
properties. In addition services are provided from a number of other
properties, shared either on leasehold or via more informal arrangements.
Figures 1 and 2 illustrate all community, mental health, learning disability
and CAMHS properties for Conwy and Denbighshire Hospitals NHS Trust.
These are listed with reference numbers in Table 1 (note that the table
excludes acute sites and residences).
Figure 3 illustrates non-freehold properties from which the Trust provides
community mental health and learning disability services. These are listed
with reference numbers in Table 2.
Figures 4 and 5 illustrate all GP properties within Conwy and Denbighshire
LHBs respectively. These are listed with reference numbers in Tables 3 and
4.
Figure 6 shows social services properties for Conwy and Denbighshire;
These are detailed in Tables 5 and 6.
13

Table 1
Property List: Conwy & Denbighshire NHS Trust
ref no property use dept/directorate
1 Abergele Clinic Clinic Clinic
2 Abergele Hospital Acute Hospital
3 Ablett Unit Inpatient ward & day care centre Mental health
4 Argyll Road Clinic Clinic Clinic
5 Brodnant EMI Unit Inpatient ward & day care centre Mental health
6 Bryn Hesketh EMI Hospital Inpatient ward & day care centre Mental health
7 Cedar Court CAMS inpateint
8 Colwyn Bay Hospital Community hospital
9 Corwen Health Centre Health centre Health centre
10 Denbigh Community Hospital Community hospital
11 Fforddlas Clinic Clinic Clinic
12 Glan Clwyd Hospital Acute Hospital
13 Glan Traeth EMI Day Hospital Day hospital Day hospital
14 Hafod MHRC Resource centre Resource centre
15 HM Stanley Acute Hospital
16 Llanfairfechan Health Centre Health centre Health centre
17 Llangollen Health Centre Health centre Health centre
18 Llangollen Hospital Community hospital
19 Llanrswt Clinic Clinic Clinic
20 Nant-Y-Glyn RC Resource centre Resource centre
21 Oakleigh Llangollen MHRC MHRC
22 Prestatyn Clinic Clinic Clinic
23 Rhuddlan Childrens Centre Childrens centre Childrens centre
24 Rhuddlan Health centre Health centre Health centre
25 Roslin MHRC Resource centre Resource centre
26 Royal Alexandra Hospital Community hospital
27 Ruthin Clinic Clinic Clinic
28 Ruthin Hospital Community hospital
29 St Asaph Health Centre Health centre Health centre
30 Tim Dyfryn MHRC Mental health resource centre Mental health resource centre
31 Prestatyn Hospital Community hospital
32 Maes Derw Clinic Clinic Clinic
33 Trefeirron MHDC Day Centre Mental health
34 Child and Family Services Mental health Mental health
35 Ty Marchaen, Ruthin Rehabilitation Unit Rehabilitation Unit

Conwy + Denbighshire NHS Trust
All Properties
Llanfairfechan
16
Bangor
Llandudno
Prestatyn
Rhyl
Colwyn
22
25
Bay
Abergele
14 26
13
5
31
4
11
34
24
32 1
12
23
3
29
15
St Asaph
Holywell
clinic + HC
Birkenhead
Liverpool
community hospital
mental health
children
acute
Llanrwst
19
33 30
10
Denbigh
27
Ruthin
28
9
6 8 2 7 20 21
Corwen
18
17
Llangollen
Wrexham

Conwy + Denbighshire NHS Trust
Mental Health Properties
Llandudno
Colwyn Bay
25
6
5
Llanfairfechan
Abergele
20
3
3
Holywell
Bangor
St Asaph
14
Rhyl
13
Prestatyn
AMI : CMHT base
AMI : day centre
Birkenhead
Liverpool
AMI: inpatient unit
EMH: community base
EMH: inpatient unit
EMH: day hospital
LDS : base
Llanrwst
33
30
10
10
Denbigh
35
35
Ruthin
Corwen
21
Llangollen
Wrexham

Conwy + Denbighshire NHS Trust
Non-Freehold Clinics
Liverpool
Llanfairfechan
Bangor
Llandudno
Colwyn
113 107
Bay
Abergele
106
112
105
103
108
101
104
Prestatyn
Rhyl
St Asaph
Holywell
Birkenhead
Llanrwst
Denbigh
110
Ruthin
109
111
Corwen
Wrexham
Llangollen

Table 2
Property List
Non-freeholding clinics
101 Bodelwyddan Clinic
103 Kinmel Bay Clinic
104 Llansannan Health Centre
105 Llysfaen Clinic
106 Mochdre Clinic
107 Rhos-on-Sea Clinic
108 Tan y Marian Clinic
109 Cerrigydrudion Clinic
110 Plas Meddyg
111 Wrexham Health Centre
112 Colwyn Bay Clinic
113 Ysbyty Cyffredinol, Llandudno

Conwy LHB
All Properties
Llanfairfechan
27
16
Bangor
Prestatyn
15
Llandudno
Rhyl
14
13 2
Abergele
33
5
6
12
Colwyn
7 26
8
9 24
18 1
Bay19
28 11
29
10
30
36
31
25
St Asaph
32
34
35
17
Denbigh
Llanrwst
3
Ruthin
20
22
Holywell
main surgery
branch or outlying
in health centre
Birkenhead
4
Corwen
23
Llangollen

Table 3
Conwy LHB : List of GP Premises
GP surgery name
Postcode
1-The Surgery-Kinmel Avenue Abergele Conwy LL22 7LP
2-The Medical Centre-Plas Penrhyn Penrhyn Bay Llandudno LL30 3EU
3-Meddygfa-Betws y Coed Conwy Conwy LL24 0BB
4-Meddygfa-Cerrigydrudion Nr Corwen Conwy LL21 9UB
5-Tyn-y-Coed Surgery-61 Conwy Road Colwyn Bay Conwy LL29 7LG
6-Kinmel Bay Medical Centre-The Square Kinmel Bay Rhyl LL18 5AU
7-Rysseldene Surgery-98 Conway Road Colwyn Bay Conwy LL29 7LE
8-Rhoslan-4 Pwllycrochan Avenue Colwyn Bay Conwy LL29 7DA
9-Llys Meddyg-23 Castle Street Conwy Conwy LL32 8AY
10-Meddygfa Gyffin-Woodlands Gyffin Conwy LL32 8LT
11-Fairhaven-Abergele Road Bodelwyddan LL32 8LT
12-158 Conwy Road-Llandudno Junction Llandudno Conwy LL31 9DU
13-Mostyn House Medical Practice Llandudno Conwy LL30 1YL
14-West Shore Surgery-9 Bryniau Road Llandudno Conwy LL30 2BL
15-7 South Parade-Llandudno Conwy Conwy LL30 2LN
16-The Health Centre-Village Road Llanfairfechan Conwy LL33 0NH
17-The Surgery-Scotland Street Llanrwst Conwy LL26 0AL
18-Cadwgan Surgery-11 Bodelwyddan Avenue Old Colwyn Colwyn Bay LL29 9NP
19-16 Wynn Avenue-Old Colwyn Colwyn Bay Colwyn Bay LL29 9RF
20-Pentrefoelas-Pentrefoelas Betws y Coed LL24 0LE
21-Penybont-Ysbyty Ifan Ysbyty Ifan LL24 0LE
22-The Surgery-Penmachno Penmachno LL24 0YA
23-Festrir Capel-Betws Gwerfil Goch Betws Gwerfil LL21 9PE
24-Medical Centre-York Road Deganwy Conwy LL32 8AT
25-Glasfryn-Llanfairtalhaearn
Llanfairtalhaear LL33 0NH
26-Maes Gwyn-Towyn Road Towyn LL22 9ER
27-Llys Meddyg-Paradise Road Penmaenmawr Conwy Ll34 6AS
28-Llys Aled Surgery-Towyn Road Towyn Conwy LL22 9ER
29-Nant Mor-Towyn Towyn LL22 9ER
30-The Surgery-Llanrwst Road Glan Conwy LL28 5SR
31-Bodreinallt-Castle Street Conwy Conwy LL32 8AT
32-Cartrefle-Egwysbach Colwyn Bay LL32
33-Lonfa-Glyn y Marl Road Llandudno Conwy LL31 9NS
34-Maes Creiniog-Llansannan
Llansannan
35-The Old School-Llangemyw
Llangemyw
36-The Village Hall-Betws yn Rhos
Betws yn Rhos
Estates information from Welsh Health Estatestn.xlsconway list25/02/2004

Denbighshire LHB
All Properties
Llanfairfechan
Bangor
Llandudno
Abergele
Colwyn
Bay
Prestatyn
Rhyl
14
10
11 7
8
21
25
24
13
6
23 18 20
9
17
Holywell
22
St Asaph
19
main surgery
branch or outlying
in health centre
Birkenhead
Llanrwst
34
5
2
3
4
Denbigh
16
Ruthin
15
27
1
26
Corwen
Llangollen

Denbighshire LHB: List of GP Premises
GP Surgery Name
Postcode
9 Dr Barnsley & Partners - Quarry House High Street Dyserth LL18 6AB BRANCH
6 Fforddellan Centre - Dyserth Road Ffordellan Rhyl LL18 4HZ BRANCH (11)
21 Fford Elan - 43 Fford Elan Dyserth Road Rhyl LL18 4HZ BRANCH (14)
19 Llys Meddyg - North Street Caerwys Flintshire CH7 5AW BRANCH (2)
22 St Asaph Health Centre St Asaph Denbighshire BRANCH (2)
24 Vale Road Rhyl Rhyl Denbighshire BRANCH (25)
18 The Surgery - Main Road Ffynnongroew Holywell CH8 9SL BRANCH (7)
23 Meliden Community Centre - Prestatyn Prestatyn Denbighshire BRANCH (7)
1 The Health Centre - Green Lane Corwen Denbighshire LL21 0DN MAIN
2 Beech House Surgery - 69 Vales Street Denbigh Denbighshire LL16 3AU MAIN
3 Berllan Surgery - 24 Vale Street Denbigh Denbighshire LL16 3BL MAIN
4 Middle Lane Surgery - Middle Lane Denbigh Denbighshire LL16 3UW MAIN
5 Bronffynnon Surgery - 24 Bridge Street Denbigh Denbighshire LL16 3TH MAIN
7 Central Surgery - Ffordd Pendyffryn Prestatyn Denbighshire LL19 9DH MAIN
10 Kings House Surgery - Kings Avenue Rhyl Denbighshire LL18 1LT MAIN
11 Clarence House - 14 Russell Road Rhyl Denbighshire LL18 3BY MAIN
13 Madryn House Surgery - 6 Madryn Avenue Rhyl Denbighshire LL18 4RS MAIN
14 Lakeside Medical Centre - Wellington Road Rhyl Denbighshire LL18 1LR MAIN
15 The Clinic - Mount Street Ruthin Denbighshire LL15 1BG MAIN
16 Plas Meddyg - Station Road Ruthin Denbighshire LL15 1BP MAIN
17 Pen-y-Bont Surgery - the Roe St Asaph Denbighshire LL17 0LU MAIN
20 The Medical Centre - The Medical Centre Rhuddlan LL18 2UE MAIN
25 Park House Surgery - Nant Hall Road Prestatyn Denbighshire LL19 9LN MAIN
8 The Surgery - Jubilee Community Centre Seabank Drive Denbighshire LL19 7PP MAIN BEING RE-PROVIDED
26 Church Hall - Llanarmom Denbighshire
27 Village Hall - Llandegla Denbighshire
34 The Surgery Llansannan BRANCH (5)

Conwy + Denbighshire NHS Trust
Social Services Properties
Liverpool
Llanfairfechan
209
203
213
205 210
Llandudno
Colwyn
211
Bay
Abergele
214
202
206
201
208
207
212
320
313
305
309
319
314
304
204
317
303
Prestatyn
Rhyl
308
Bangor
St Asaph
Holywell
Birkenhead
Llanrwst
301
316
307
311
Denbigh
318
310 306
Ruthin
315
Corwen
312
302
Wrexham
Llangollen

Table 5
Property references: Conwy Social Services
ref no property use / address user
201 Operational Base, Bron y Nant provider unit
202 OP/PDSI, 94 Conwy Road purchasing unit
203 Daytime Opportunities, County Wide provider unit
204 Internally provided residential, county wide provider unit
205 Day Centres, Older People, County Wide provider unit
206 Residential Units, County Wide children & family services
207 Building Maintenance housing service
208 Head Office housing service
209 Area Office: Llandudno housing service
210 Area Office: Conwy housing service
211 Area Office: Colwyn Bay housing service
212 Careline Contact Centre housing service
213 Operational Base, Builder Street Directorate Central Services
214 Ersdkine House, 74 Conwy Road Learning Disabilities

Table 6
Property references: Denbighshire Social Services
ref no property name / address property type
301 Henllan Social Services
302 Llangollen (Hospital Social Work) Social Services
303 Rhuddlan (Children's Centre) Social Services
304 Rhyl (Children's Resource Centre) Social Services
305 Rhyl (Morfa Hall) Social Services
306 Ruthin Social Services
307 Denbigh (Dolwen) Day Centres for Older People
308 Prestatyn (Llys Nant) Day Centres for Older People
309 Rhyl (Hafan Deg) Day Centres for Older People
310 Ruthin (Awelon) Day Centres for Older People
311 Denbigh (Team Dyffryn Clywd) Mental Illness Services
312 Llangollen (Oakley) Mental Illness Services
313 Rhyl (Fron Fraith) Mental Illness Services
314 Rhyl (St Winifred's) Mental Illness Services
315 Corwen (Cysgod y Gaer) Residential Homes for Older People
as 307 Denbigh (Dolwen) Residential Homes for Older People
as 308 Prestatyn (Llys Nant) Residential Homes for Older People
as 310 Ruthin (Awelon) Residential Homes for Older People

An analysis of relevant independent sector properties in Conwy and
Denbighshire, which may offer co-location opportunities in implementation of
the strategy, will be undertaken as part of the next phase of the development
of the strategy.
3.2.3 Conwy and Denbighshire NHS Trust
a. Community Hospital services are provided from the following sites (see
Figure 1).
Colwyn Bay Hospital accommodates 42 GP led beds as well as a wide
range of support services including outpatient facilities, nurse led minor
injuries, palliative care, x-ray, therapy service support for inpatients and
outpatients and acts as a host for the Acquired Brain Injury team. The
hospital is also a base for community district nursing staff. The new
outpatient department was completed in 1999.
Denbigh Infirmary is the main site for provision of services in Denbigh and
is a well used, busy site offering 50 GP led beds. The Infirmary services are
well supported by the community and local GPs, and the site offers a nurse
led minor injuries service and x-ray diagnostic testing. It is a strong centre
for local patient care. A 1992 Development Control plan initiated an
extensive programme of improvements including a 3 bedded Macmillan Unit
and nurse team base. Adjacent to the Infirmary is Denbigh Clinic, which
offers a range of complementary services.
Llangollen Hospital is located on a main road into Llangollen. The
buildings are old and access is not ideal. The lack of car parking space
adjacent to the hospital is a problem and accessibility to and within the
buildings is poor. Dating from around 1875, the hospital currently
accommodates 18 GP beds with a small outpatient service and minor
casualty unit.
Prestatyn Community Hospital is located on the outskirts of Prestatyn town
in a residential area and was adapted from a pair of semi-detached houses.
It is in a hilly location and there is no public transport route. Car parking is
extremely limited. The 12 GP led in-patient beds are located on the first floor
of the premises. The location of the hospital makes the replication of a full
range of community hospital services an unlikely proposition. Hospital
facilities are described as congested and there is perceived to be little scope
for additional service provision.
Royal Alexandra Hospital, Rhyl (RAH). The RAH is a large Victorian
hospital building close to the sea front with hospital services provided on 3
floors. There are 24 GP led beds and 29 beds managed by consultant
medical staff. Other services include x ray and physiotherapy. The building
is also a base for community district nursing, health visitor, administrative
and senior management staff. Post 1960 additions include the existing
outpatients department, which is a sub-standard, limited life building.
14

Ruthin Hospital predates 1948 but was considerably extended in the early
1980’s to provide 48 GP beds and a range of support facilities including; x
ray, a nurse led minor injuries service, podiatry, outpatient therapy clinics
and a limited outpatients department. Recent developments include an
upgraded Day Hospital and Occupational Therapy facilities.
b. Health Centres and Clinics are located at: –
• Abergele
• Argyll Road, Llandudno
• Corwen
• Fforddlas, Rhyl
• Llanfairfechan
• Llangollen
• Llanwrst Clinic
• Maes Derw, Llandudno
• Prestatyn
• Rhuddlan Health Centre
• Ruthin
• St Asaph
In addition, community services are provided from a number of other nonfreehold
premises which are detailed in Figure 3 and Table 2.
c. Mental Health Services (Figure 2) are provided from: –
• Ablett Unit – Adult Mental Illness (AMI) acute inpatients
• Ablett Unit – Elderly Mental Health (EMH) acute inpatients
• Community Mental Health Team bases at:: –
• Tim Dyffryn, Denbigh
• Roslin Mental Health Resource Centre (MHRC), Llandudno
• Nant-y-Glyn, Colwyn Bay
• Oakleigh MHRC, Llangollen
• Hafod MHRC, Rhyl
• AMI Rehabilitation Unit at Ruthin (Tan y Castell)
• EMH inpatients / day care and assessment and community bases at:: -
• Bodnant Ward, Llandudno Hospital
• Bryn Hesketh, Colwyn Bay
• Glan Traeth, Rhyl
• Ruthin Hospital (limited inpatient and day provision)
• Adult Mental Health Day Centre at Trefeirion, Denbigh
The shortcomings of the Ablett Unit, which dates from 1995, are highlighted
in Section 4.2 ( c ).
15

The Bryn Hesketh EMH Unit was completed at the same time as the Ablett
Unit and provides 16 EMI beds and 20 day patient places.
Glan Traeth EMH, Rhyl is located next to RAH and was formerly a purpose
built inpatient unit for blind people and was adapted in 1991.
Bodnant EMH Unit in Llandudno provides 16 inpatient beds and 12 day
patient places.
Learning Disability Services are based at social services sites with the
exception of the headquarters which is based at Denbigh Infirmary.
Social Services properties for Conwy and Denbighshire councils are noted in
Tables 5 and 6 and on the map in Figure 6. The data for Conwy Borough
Council are taken from Asset Management Planning Services Blueprints
2002. For Denbighshire County Council the data are taken from
Denbighshire County Councils Service Asset Management Plan for Personal
Services report 2003-04.
Child Health and CAMHS Services are provided from the following
properties managed by the division –
• Cedar Court Adolescent Residential Unit, Colwyn Bay (leased)
• Rhuddlan Children’s Centre
• Lawnside Child and Family Centre, Rhyl
• Residential Block 12 YGC (Genetic services)
• Argyl Road Health Centre, Llandudno
• Child Health Department, Colwyn Bay Hospital
• Kinmel Bay Health Clinic
Cedar Court at Colwyn Bay was converted in 1997 from a former nursing
home and provides residential care for 12 children and adolescents and
others on a day-care basis. The lease will expire in 2008.
Services are also provided in a number of other settings including GP
practices and the accommodation is of variable appropriateness for
children’s services.
3.2.4 Conwy LHB
Figure 4 illustrates all GP properties within Conwy LHB. These are listed with
reference numbers in Table 3 and comprise: -
• 19 main surgeries
• 17 branch or outlying surgeries
for 70 GPs in total.
16

As noted above the analyses which follow are based upon information from
the All Wales survey of GP premises carried out in 2002 and will require local
verification to clarify any changes to the estate since that date.
Figure 7 indicates the numbers of GPs per practice for the main surgeries
(branch and outlying surgeries are excluded). Medium sized practices of 4 –
6 GPs are predominant with a large practice of 8 GPs based in Colwyn Bay.
Primary care is provided from: –
• 35 premises most of which are owned by GPs
• 7480m 2 of accommodation varying in size from 26m 2 – 600m 2
• an area totalling 11,000 sq hectares
• £746k total backlog maintenance (identified through 2002 survey)
• Average area per GP of 107 m 2 compared to Red Book allowances of
110 m 2
A third of premises have other occupants and 4 of the properties are listed
buildings. Just 8 of these properties were purpose built surgeries
Further details are provided in the Conwy LHB primary care estates strategy,
which has been produced as part of the same process as this strategy.
3.2.5 Denbighshire LHB
Figure 5 illustrates all GP practices within Denbighshire LHB. These are
listed with reference numbers in Table 4 and comprise: –
• 16 main surgeries
• 10 branch or outlying surgeries for 53 GPs in total
(Note that the map also shows no 34, a branch surgery of the Denbighshire
Bronffynon practice, which is located in Conwy).
4 practices have surgeries located in Health Centres owned by Conwy and
Denbighshire NHS Trust at: –
• Corwen Health Centre
• St Asaph Health Centre
• Rhuddlan Health Centre
• Mount Street Clinic, Ruthin
Again, this information is based on the All Wales Survey of GP practices
2002, supplemented with RKW internet searches and will require local
verification to identify any changes to the estate since that date. The Park
House practice, Prestatyn (25) was established in November 2003 and was
not included in the premises survey database, details and assessments for
this property have been provided by the LHB.
17

Conwy LHB
GP Numbers
Llanfairfechan
27
16
Bangor
Prestatyn
15
Llandudno
Rhyl
14
13 2
Abergele
33
5
6
12
Colwyn
7 26
8
9 24
18 1
Bay19
28 11
29
10
30
36
31
25
St Asaph
32
34
35
17
Denbigh
Llanrwst
3
Ruthin
20
22
Nos. of GPs (main surgery)
Birkenhead
Holywell
1
2-3
4-6
>6
4
Corwen
23
Llangollen

Denbighshire LHB
GP Numbers
Llanfairfechan
Bangor
Llandudno
Abergele
Colwyn
Bay
Prestatyn
Rhyl
14
10
11 7
8
21
25
24
13
6
23 18 20
9
17
Holywell
22
St Asaph
19
Nos. of GPs (main surgery)
Birkenhead
1
2-3
4-6
>6
Llanrwst
34
5
2
3
4
Denbigh
16
Ruthin
15
27
1
26
Corwen
Llangollen

Figure 8 indicates the numbers of GPs per practice for main surgeries
(branch and outlying surgeries are excluded). Of the 16 main practices, 9 are
small practices with 1 – 3 GPs, there are 2 large practices at Clarence
House, Rhyl (8 GPs) and Central Surgery, Prestatyn (9 GPs).
Primary care is provided from: –
• 26 premises most of which are owned by GPs
• 6520m 2 of accommodation varying in size from 80m 2 – 720m 2
• Occupying 19,500 sq hectares of land (tbc)
• £258K total backlog maintenance
• Average area per GP across all properties of 118m 2 compared to Red
Book allowances of 110m 2 per GP
The medical centre in Rhuddlan is part of a larger development including the
Child Development Centre and Library. Two surgeries in Ruthin are occupied
by the LHB and two properties in Denbigh are listed buildings.
Further details are provided in the Denbighshire LHB primary care estates
strategy, which has been produced as part of the same process as this
strategy.
3.2.6 Summary Performance Indicators
As part of the Strategy estates databases have been compiled for the Trust
and each LHB recording their respective properties’ performance in terms
of:-
• Physical condition
• Statutory compliance
• Backlog maintenance
• Building age
• Functional suitability
• Space availability
• Estates related running cost
From these analyses a framework has been developed to identify properties
which are comparatively poor performers in their current use and may be
candidates for: –
• Priority investment
• Disposal
• Alternative or intensified use
The framework considers size, physical environment, access and
adaptability to band properties into best, mid-range and worst performers. It
is emphasised that these criteria are estates related and it will be appropriate
to consider whether there may be other factors, for example the strategic
location of a property, which would mitigate poor scores.
18

In the scoring exercise the criteria have been given equal weightings, and
scored on 1 (poor) – 3 (good) scale. The outcome of this exercise is
summarised in Figure 9, which indicates the best, middle and lower scoring
facilities.
Community hospitals (see Figure 9) have been scored against 8 criteria: –
• Access
• Space Availability
• Bed Capacity
• Physical Condition
• Quality
• Functional Suitability
• Expandability
• DDA Compliance
Three of the criteria: –
• Expandability
• Space Availability
• Bed Capacity
are indicators of flexibility within the existing estate to adapt to service
reconfiguration and new models of care in the future. Bed capacity has also
been included in the light of the NHS Wales Policy Statement that community
hospitals with fewer than 30 beds are unlikely to be viable or cost effective.
Prestatyn and Llangollen hospitals ranked lowest. Both hospitals are small in
area and have limited bed capacity at 12 beds and 18 beds respectively. In
addition Prestatyn Hospital is not easily accessible. Llangollen Hospital
scores low on physical condition, quality and DDA compliance.
The Royal Alexandra in Rhyl scores low on this issue and on functional
suitability. Against this the site is very accessible, it is a large hospital in
terms of space availability and bed capacity and could be adapted or
expanded to accommodate new service models.
Clinics and health centres have been scored against similar criteria with
the exception of bed capacity which is not applicable. Also, a measure of
estates performance has recently been introduced by Welsh Health Estates
which refers to the patient’s experience of the physical environment.
GP premises have been ranked against similar criteria to clinics with the
exception of quality since this information was not available for LHB
properties.
19

Community
Hospitals Health
Centres and Clinics
(Freehold)
Access
Space availability
Bed Availability
Physical
condition
Quality
Functional
suitability
Expanability
DDA
Llangollen HC
-
-
Colwyn Bay Hospital
- - -
-
Denbigh
-
- - - -
Argyll Road clinic -
- - - - -
Ruthin clinic - - -
- - -
Ruthin Hospital - -
- - - - -
St Asaph HC
- -
Ffordlas clinic
- - -
Prestatyn clinic
- - -
Royal Alexandra Hosp
Maes Derw clinic - - - - -
Rhuddlan HC - - -
Llanwrst clinic -
Corwen HC - -
Prestatyn Hospital - -
Llangollen Hospital - - -
Abergele clinic - -
Llanfairfechan HC - -
-
clinic hit list.xlscombined25/02/200414:29

Health Centres and Clinics
The top 4 performing facilities are: –
• Llangollen Health Centre
• Argyll Road Clinic
• Ruthin Clinic
• St Asaph Clinic
At the bottom of the table are –
• Corwen Clinic
• Abergele Clinic
• Llanfairfechan Health Centre
Figure 9 provides a consolidated ranking for all community premises
including Community Hospitals and Clinics.
Conwy LHB (Figure 10 refers)
Scoring low against all criteria were the following 3 outlying properties: –
• Penybont, Ysbyty Ifan
• Pentrefoelas, Pentrefoelas
• The Village Hall, Betws-y-Coed
With a further 2 scoring poorly against 5 criteria: –
• Lys Aled Surgery, Towyn
• The Surgery, Kinmel Avenue, Abergele
Of the LHBs 35 premises, 12 scored low against 4 out of the 6 criteria and
only on, The Medical Centre, Plas Penrhyn, score good or satisfactory
against all criteria.
Denbighshire LHB (Figure 11 refers)
Eight premises score good or satisfactory against all criteria with 6 of these
scoring highly against 3 or more criteria: –
• Park House Surgery, Prestatyn
• Lakeside Medical Centre, Rhyl
• Plas Meddyg, Ruthin
• Fforddellan Centre, Dyserth Road
• Central Surgery, Prestatyn
• Berllan Surgery, Denbigh
Just 1 surgery, the surgery at Main Road, Fynnongroew, scored low on 3
criteria
20

Conwy LHB GP surgeries
Access
Space
Availability
Physical
Condition
Functional
suitability
Expanability
DDA
2-The Medical Centre-Plas Penrhyn
- - -
18-Cadwgan Surgery-11 Bodelwyddan Avenue
- -
7-Rysseldene Surgery-98 Conway Road -
- - -
10-Meddygfa Gyffin-Woodlands - - -
4-Meddygfa-Cerrigydrudion
8-Rhoslan-4 Pwllycrochan Avenue
16-The Health Centre-Village Road
13-Mostyn House Medical Practice-Mostyn Broadway -
22-The Surgery-Penmachno
25-Glasfryn-Llanfairtalhaearn
- - -
- -
- -
-
- -
- -
3-Meddygfa-Betws y Coed - -
-
33-Lonfa-Glyn y Marl Road - - -
5-Tyn-y-Coed Surgery-61 Conwy Road - - -
31-Bodreinallt-Castle Street
- - -
23-Festrir Capel-Betws Gwerfil Goch - -
30-The Surgery-Llanrwst Road - -
24-Medical Centre-York Road
- -
9-Llys Meddyg-23 Castle Street - - -
32-Cartrefle-Egwysbach - - -
34-Maes Creiniog-Llansannan
-
15-7 South Parade-Llandudno -
27-Llys Meddyg-Paradise Road -
29-Nant Mor-Towyn -
35-The Old School-Llangemyw
-
12-158 Conwy Road-Llandudno Junction - -
11-Fairhaven-Abergele Road - -
26-Maes Gwyn-Towyn Road - -
17-The Surgery-Scotland Street - -
14-West Shore Surgery-9 Bryniau Road - -
19-16 Wynn Avenue-Old Colwyn - -
28-Llys Aled Surgery-Towyn Road
1-The Surgery-Kinmel Avenue -
21-Penybont-Ysbyty Ifan
20-Pentrefoelas-Pentrefoelas
36-The Village Hall-Betws yn Rhos

Denbighshire LHB GP surgeries
Access
Space
Availability
Physical
Condition
Functional
suitability
Expanability
DDA
25-Park House Surgery, Nant Hall Road, Prestatyn
14-Lakeside Medical Centre-Wellington Road
-
16-Plas Meddyg-Station Road
-
-
6-Fforddellan Centre-Dyserth Road
-
-
7-Central Surgery-Ffordd Pendyffryn
- - -
3-Berllan Surgery-24 Vale Street - - -
17-Pen-y-Bont Surgery-The Roe - - - -
11-Clarence House-14 Russell Road
- -
10-Kings House Surgery-Kings Avenue
- -
20-The Medical Centre-The Medical Centre
- -
1-The Health Centre-Green Lane -
- -
5-Bronffynnon Surgery-24 Bridge Street - - - -
21-Fford Elan-43 Fford Elan -
-
- -
15-The Clinic-Mount Street - - - -
2-Beech House Surgery-69 Vale Street - - - -
4-Middle Lane Surgery-Middle Lane
- -
8-The Surgery-Jubilee Community Centre
- -
9-Dr Barnsley & Partners-Quarry House - -
19-Llys Meddyg-North Street - - -
18-The Surgery-Main Road - -
- -
6-Kinmel Bay Medical Centre-The Square - - - -
13-Madryn House Surgery-6 Madryn Avenue - - - -
Estates information from Welsh Health Estatestnhit list6/3/20048:04 AM

Table 7
Conwy & Denbighshire NHS Trust : Backlog Maintenance 2004
Property
Building
area (GIA
sqm)
Physical
Condition
£
Statutory
Condition
£
Energy £ Site Total
£
Site £
per sqm
COMMUNITY HOSPITAL
Colwyn Bay Hosp 5,254 235,590 205,963 44,063 485,616 92
Denbigh Com Hosp 3,244 378,508 101,363 22,620 502,491 155
Llangollen Hosp 894 599,200 105,113 15,000 719,313 805
Prestatyn Hospital 1,076 54,370 45,300 50,000 149,670 139
Royal Alexandra Hosp 6,646 2,149,099 487,600 522,876 3,159,575 475
Ruthin Hosp 2,378 514,825 31,725 15,000 561,550 236
CLINICS & HEALTH CENTRES
Abergele Clinic 426 125,110 24,075 5,981 155,166 364
Argyll Road Clinic 716 45,000 9,300 7,108 61,408 86
Corwen Health Centre 261 82,500 4,388 3,353 90,241 346
Fforddlas Clinic 164 3,280 2,200 1,682 7,162 44
Llanfairfechan Health Centre 300 77,200 5,775 4,414 87,389 291
Llangollen Health Centre 579 68,740 6,325 4,834 79,899 138
Llanrwst Clinic 240 7,000 3,538 2,704 13,241 55
Maes Derw Clinic 225 60,500 2,625 2,006 65,131 289
Prestatyn Clinic 301 34,040 8,563 2,723 45,325 151
Rhuddlan Health Centre & Childrens 161 63,063 9,913 4,328 77,303 480
Ruthin Clinic 429 26,855 5,688 4,347 36,890 86
St Asaph Health Centre 263 28,900 3,650 2,790 35,340 134
MENTAL HEALTH INCL CHILDREN
Ablett Unit 3,412 165,300 0 36,105 201,405 59
Bodnant EMI Unit 1,810 195,970 59,375 17,293 272,638 151
Bryn Hesketh EMI Hospital 1,165 30,165 35,450 11,809 77,424 66
Cedar Court 700 0 33,875 5,255 39,130 56
Child & Family Services, Lawnside 203 11,045 3,013 2,303 16,360 81
Glan Treath Ward & Day Hosp 1,176 115,270 14,425 0 129,695 110
Hafod MHRC 925 41,800 10,663 8,150 60,612 66
Nant-Y-Glyn RC 922 68,830 10,425 7,968 87,223 95
Oakleigh Llangollen 475 40,000 10,275 7,853 58,128 122
Roslin MHRC 572 80,710 6,950 5,312 92,972 163
Tim Dyfryn MHRC 327 8,175 8,675 3,382 20,232 62
Trefeirion MHDC 471 15,935 4,313 3,296 23,544 50
35,715 5,326,980 1,260,538 824,554 7,412,071 208
Community Hospitals 19,492 3,931,592 977,063 669,559 5,578,214 286
Health Centres and Clinics 4,065 622,188 86,038 46,270 754,496 186
Mental Health including Children 12,158 773,200 197,438 108,725 1,079,362 89
35,715 5,326,980 1,260,538 824,554 7,412,071 208
Table 9.xlsSummary 200425/02/2004

3.2.7 Backlog Maintenance
Table 7 summarises the total Backlog Maintenance liability for the Trust and
LHB properties. It should be noted that the figures represent the costs of
restoring buildings to good physical condition and functional suitability for
their current use and as such may be regarded as the cost of a do-minimum
option.
21

4 Service Vision
4.1 Policy Context
The service and estate strategy has been developed with explicit reference
to key national and local policy initiatives. The major ones are as follows:
The Review of Health and Social Care in Wales (the Wanless Review)
Reporting in July 2003, the review highlighted a growing demand for health
services due to unhealthy lifestyles, increasing numbers of people not
receiving social services after assessment, and long hospital waiting lists.
The review recommended policies to create greater public awareness, and a
greater role for primary and social care to: relieve pressure on the acute
sector; address delayed transfers of care; and secure seamless provision. It
also emphasised the desirability of evidence-based and costed policies,
supported by clear financial strategies in which money flows reflect need and
reward good practice. New and more robust workforce planning with better
training and retention, and a focus on the long-term, was seen as crucial to
sustainable health and social care. The need was also identified for an
overhaul of information systems to improve timeliness and coverage and
major investment in estates. The Review emphasised that strong
performance management against a programme of realistic – short, medium
and long-term goals was required to achieve the necessary change.
The Welsh Assembly Government response to the Wanless Review (A
Framework of NHS Policies to Inform the Production of Local Action Plans in
Wales) issued in December 2003, emphasises the importance of the
following: -
• Integrated whole systems approaches built upon care pathways
• The provision of safe services as locally as possible (not vice versa, a reiteration
of the principle set out in Access and Excellence [NHS Wales
Corporate Strategy (2000), Access and Excellence – Acute Services in
Wales, Welsh Assembly Government])
• Explicit statements about which services are to be provided by whom
and at what level
• Blurred divisions between sectors
• Full patient and public engagement in the development and
implementation of new care models
• The potential for strategic shifts of activity from acute to primary /
community settings and care at home
• Refocusing the roles of community hospitals which are unlikely to be
viable if smaller than 30 beds
• Primary care resource centres providing an extended range of services
• Rural health networks to ensure equity of access to health and social
care
22

Health, Social Care and Well-being Strategies
Welsh Assembly Government guidance identifies the following key features
of successful health, social care and well-being strategies: –
• An integrated and multi-disciplinary partnership between NHS and local
authorities
• Local Authority and Local Health Board jointly responsible for needs
assessment and strategy formulation and implementation
• Local Health Boards and NHS Trusts under a statutory duty to involve
patients and the public in planning and decision making processes
• An integrated approach to local authority and NHS strategic planning for
carers and carers services
• Underpinned by comprehensive health and well being needs
assessment
• Addressing a full range of issues affecting health and well-being
• Action to improve health and reduce health inequalities as an equal
priority to effective and efficient health care services
• Identifying areas for tackling health inequalities
• Addressing public health agenda at local level
• Supporting implementation of the Community Strategy and other local
strategies and frameworks
• Developing the prevention role of local authority services and health
services
• The basis for the commissioning strategy for NHS services and local
authority health related services
• Strategic context for annual operational planning
• Joint planning, review and performance management
The Health, Social Care and Wellbeing strategies of Conwy, Denbighshire
and Flintshire contain the following key elements which are relevant to this
strategy:
• Conwy
Conwy’s strategy aims to ensure prompt access to health, social care and
well-being services. The strategy also encourages innovative approaches to
the delivery of services. It specifically identifies the development of capacity
in primary and community care as a key objective. The strategy also
highlights planned primary health & social care centres within the county as
examples of good practice.
• Denbighshire
The aims of Denbighshire’s strategy are to improve the quality of and access
to NHS, local government, voluntary and private sector services across
Denbighshire.
A key theme from Denbighshire’s HSCWB strategy is that services should be
seamless from the patient’s perspective whilst being both effective and
efficient. In order to achieve this the strategy specifies that services should
23

e integrated, community based and multi-agency in their approach to coordinating
the care of patients in Denbighshire. The strategy states that:
• Services should provided which are safe and effective as locally as
possible
• Acute, intermediate and primary care and social care services need to
work closer together
• A greater proportion of service delivery needs to occur in primary and
community settings
• Flintshire
Flintshire’s strategy emphasises that effective, appropriate and accessible
services should be available to meet the current and continuing health and
social care needs of the population. The strategy aims to move care away
from institutionalised settings into the community, in order to improve access
to services for patients.
Improving Health in Wales – The Future of Primary Care
The high level objectives set out in Improving Health in Wales – The Future of
Primary Care include: –
• Reversal of the relative under-development of primary care in Wales
over the past 20 years
• Reduction in list sizes and nurse triage to enable doctors to spend more
time with patients
• Well developed primary care teams, working closely with public health,
health promotion and secondary / tertiary services
• Development of primary care resource centres and new models
including salaried GPs and nurse practitioner based services
• Easier access to services for patients in a variety of settings
• Improved primary care information, information technology and
communication systems
• A variety of contractual options to facilitate flexibility
Investing in General Practice [Department of Health (2003) – The New
General Medical Services Contract] – detailed implementation of the new
contract, which aims to secure objectives described above, has been taking
place in parallel with the development of this strategy. Of particular relevance
are the following likely changes –
• Greater flexibility for practices to determine the range of services they
wish to provide
• Rewards for delivering clinical and organisational quality
• Modernisation of practice infrastructure including premises and IT
• Allocation of resources on a more equitable basis, allowing practice
flexibility
24

Transforming Health and Social Care in Wales (Audit Commission, April
2004)
This report by the Audit commission followed from the Wanless review. The
report reiterates the unsustainable state of health & social care services in
Wales currently. The report focuses on the national levers for change and
the barriers to success in implementing the Wanless vision of future services.
In order to aid the implementation of the Wanless review, the Audit
Commission's report highlighted the steps which need to be taken by the
Assembly (both the centre in Cardiff and the regional offices), Trusts, LHBs
and LAs. The report also contributes to the discussion by detailing which of
the Wanless recommendations can be implemented immediately, and which
are more long term.
The National Service Frameworks and Cancer Standard for specific
services have also been taken into account.
Mental Health
Many of the key policy drivers outlined above clearly relate to all services,
including mental health. In addition the following national policy initiatives
are of specific relevance to mental health and learning disabilities:
• Compliance with the recommendations and subsequent review of the
Audit Commission (2002) “Losing Time” report on services to older
people with mental health problems. Key recommendations from the
review are as follows:
• There needs to be a greater focus on early diagnosis
• There needs to be an increased emphasis on the planning,
commissioning and monitoring of these services
• Joint working arrangements need to be encouraged to ensure a
whole systems approach
• Workforce issues need to be addressed nationally and locally
• There must be meaningful engagement of Carers
• Commissioners and providers to develop inpatient environments
appropriate to need
• The statutory sector should work alongside such agencies as Care
Standards Inspectorate Wales to support the training and
development needs for those staff working in the independent sector
• Compliance with the strategic imperatives of the Adult Mental Health
Strategy, as follows:
• The closure of the Victorian institutions
• Increased availability of Psychotherapy services
• The strengthening of Advocacy services
• Appropriate and timely assessment and care planning
• The development of a good interface between primary care, criminal
justice, District General Hospitals, and drugs and alcohol services
25

• The establishment of a multidisciplinary group to oversee
implementation
• Adherence to the key actions outlined in the National Service Framework
for Adult Mental Health. These are currently under review, but are likely
to include:
• Promoting Social Inclusion
• User and Carer empowerment
• An emphasis on normal daily life
• The development of equitable and accessible services
• Commissioning effective services
• Delivering effective services
• The development of client assessments and care pathways
• The development of a skilled workforce
• Enabling Mental Health Services achieve the necessary infrastructure in
preparation for the new Mental Health Act (likely to come into force in
2007) and the Mental Incapacity Bill. It is likely that this will result in:
• Increased demand for beds from the criminal justice system
• Increased levels of Mental Health Act Tribunal activity
• Increased compulsory treatment of individuals in the community
• Adherence to the key actions outlined in the soon to be published “Older
Peoples National Services Framework”
For Child Health and Child and Adolescent Mental Health (CAMHs) the
following national policy initiatives are of particular relevance:
Everybody’s Business [Welsh Assembly Government (2001), Child and
Adolescent Mental Health Services] is a strategic plan for Child and
Adolescent Mental Health Services (CAMHS) in Wales which echoes many
of the principles set out in the Adult Mental Health Services NSF and other
policy initiatives. Specific objectives include: –
• To establish child-centred services which take into account the views of
young people and families
• To build child protection measures into all services at every stage and
throughout every service
• To consider the problems of ethnic minority children and young people
• To link to Government programmes on social inclusion, substance
misuse and reduction in offending with particular emphasis on reduction
of violence.
26

4.2 Service-Specific Issues
In developing the service and estate strategy issues related to specific
service areas have been identified. These are summarised below.
a. Learning Disability Services
Key issues in the future direction for the provision of services for people with
learning disabilities include –
• Ensuring a person centred approach in the planning and delivery of
services
• The development of care pathways integrated with primary care
• Access to appropriate facilities in primary and community health settings
and local authority settings (which current properties may not be able to
provide – see Section 5.1 regarding potential of Primary Care and
Primary Care Resource Centres)
• A single point of access to the service
• Ensuring that people with Learning Disabilities have equal access to
general health and social services
• Full involvement of, and advocacy for, service users
• Re-provision of services and, where appropriate, facilities currently
located at Bryn- y-Neuadd
• The desire to develop locally available specialist services including –
• Autism
• Challenging behaviour – six-bedded assessment and treatment units
to be developed at Bryn y Neuadd and Mold
b. Child Health and Child and Adolescent Mental Health Services
Key issues include: –
• Development of a centralised administrative base for The Child Health
and Child & Adolescent Mental Health Services with space for meeting
rooms, close links with Therapy Services (possible Audiological support
and Equipment storage) in addition to providing some clinical space
• Service developments following the recent appointment of two new
consultants
• A long term solution for the services currently provided at Cedar Court
the lease for which expires in 2008.
• Appropriate provision for adolescents requiring acute admission could be
associated with, but distinct from, the Ablett Unit with the potential also to
accommodate younger patients currently admitted to adult wards
• Lack of office and staff base accommodation, in particular at Cedar
Court, Argyll Road and Lawnside
• Child development centres proposed in joint projects with respective
education and social services departments and voluntary sector in Rhyl
and Llandudno. Potential for future reuse of the existing CDC in
Rhuddlan to be explored
27

• Possible relocation of medical examination suite (currently in non-child
specific accommodation in Colwyn Bay) to appropriate site on
Conwy/Denbighshire borders with input from respective social services
departments. Possible co-location with proposed central administrative
base
• Primary Mental Health Workers - a rapidly growing group of
professionals who work in non-hospital locations, which include primary
care settings where sessional access to appropriate accommodation is
required. Administrative bases for these workers to be co-located with
CAMHS specialists at the proposed central location
• Children’s services – potential policy vacuum without Welsh equivalent
of English Green Paper?
• Children’s Trust model while unlikely to develop formally in Wales is in
part reflected by the integration of services within the Directorate
• The absence of a child development centre within Conwy
• Potential of extended school models
• The growth of Clinical Genetics – in both its adult and child related
aspects.
Proposed models of care for Child Health and Child and Adolescent
Mental Health services are shown in Figure 12.
Developments within CAMHS are taking place within the context of
current SAFF targets with Conwy LHB taking lead responsibility.
c. Mental Health Services – Adults
Adult Mental Health services considered in the development of this strategy
include both those provided from the Ablett Acute Unit, located on the Glan
Clwyd Hospital site and those in Community and Primary Care settings.
The Ablett Unit is based upon an outmoded concept, known as the “ward
annexe model”, which assumed that inpatients would undertake substantial
amounts of daytime activity away from the ward. This is inappropriate given
the current levels of acuity and occupancy levels in the Unit and assumes the
availability of therapy and activity areas elsewhere. As a consequence the
inpatient units are poorly provided for day time activity and there is
inadequate space for consultations. The 10 bed units are regarded as too
small for effective staff deployment and attempts to manage units in pairs are
hindered by the cross-corridor layout. While one is designated for extra care
it does not provide the space or facilities which current guidance and good
practice requires for a psychiatric intensive care unit.
In addition to the issues of internal functional suitability, the Ablett Unit is
subject to the pressures of its DGH location. These include limited access to
external space and the impact on environmental quality of site intensification.
The service has also noted operational difficulties associated with sharing
infrastructure and services within the Acute hospital. A detailed analysis of
the Ablett Unit’s suitability has been prepared to support a business case for
its possible reconfiguration or re-provision.
28

CAMHS
Future Model of Care
Tier 1
Tier 1
Conwy
Denbigh
Tier 2/3
SSVs
Schools
SSVs
Schools
Tier 4
Proposed
GPs
GPs
Llanrwst
Clinic
Llandudno
Clinic
Admin
Training
Denbigh
Clinic
Rhyl
Clinic
Tier 4
Ynys Mon
Gwynedd
Flintshire
Tier 2/3
Milieu Unit
Cedar Court
Acute Unit
YGC
Rapid response
Enhanced
paed/ adol outreach

Given Denbighshire’s high acute admission rate, relative to the rest of Wales,
the business case will review longer-term demand and capacity requirements
in the context of alternatives to acute admission. Thus developments such
as assertive outreach (see below) have the potential to reduce admissions
and/or support earlier discharge but may also detect currently unmet need.
Since the development of primary and community services is currently
underway it will be possible to monitor their net impact upon acute capacity
requirements and determine the size of any future reprovision accordingly.
Other issues for the Adult Mental Health service include: -
• The suitability / capacity of the Community Mental Health Team (CMHT)
bases to accommodate NSF driven developments such as assertive
outreach, crisis intervention and home treatment and the extra demand
for community-based treatment orders
• The potential to develop virtual CMHT bases
• The requirement for the further development of CPN bases in Primary
Care settings to improve service integration
• Potential future service developments as follows:
• Supportive outreach
• Crisis intervention
• Home treatment
• Move-on, low secure facilities
• The need to review the current dependence on the independent sector
for the provision of continuing care
• The impact of the integration of health and social services within the
Mental Health Partnership (which formally takes effect from July 2005).
d. Older People’s Mental Health Services
Inpatient services for elderly mental health patients are provided in the Ablett
Unit (as well as at Bodnant Ward, Bryn Hesketh and Glan Traeth – see also
Section 3.2.3) such that the functional suitability issues referred to above
apply here also.
Other issues include: -
• Ensuring a continuum from assessment to long-term care through the
development of integrated care pathways
• Rebalancing services towards a more condition specific focus (e.g.
functional/organic) for both inpatient and day cares
• Swift access to and from Primary Care which may be affected by
Primary Care premises and CMHT base capacity
• The need for rapid access to domiciliary services to avoid hospital
admission
• The potential for further integration of health and social services
following the adult Mental Health Services Partnership model
• The shortage of independent sector provision
29

• The absence of EMH facilities in South Denbighshire highlighted by a
recent needs assessment
e. Community Hospitals and Services
Factors affecting the current use and future potential of community hospitals
include a distribution of capacity and functions reflecting a historical pattern
rather than a direct response to local needs. The capacity of Community
Hospitals is further affected by the system of admission rights for GPs which
limits the flexibility with which beds can be used. An alternative medical
staffing model is being piloted at Colwyn Bay Hospital and at Denbigh, which
may offer the potential for more flexible and intensive use of Community
Hospital beds in the future. Quantification of future community hospital bed
requirements and their location, incorporating potential enhanced support to
the acute sector via admission prevention and earlier discharge is underway
as part of the demand and capacity modelling (see Section 5).
Other issues include: –
• Variable provision of rehabilitation services which are seen as key to
maximising the potential of community hospitals
• Future provision and location of day services
• Variability of provision for respite care
• Equity of access to ultrasound services
• Further development of the role of Nurse Practitioners and the
introduction of nurse-led services where appropriate
• Better use of IT to assist in acute – community hospital transfers
• The future of hospitals smaller than 30 beds (Prestatyn and Llangollen),
suggested by the Wanless guidance as a minimum for viability.
• Development of a robust and sustainable clinical management model
building upon pilot projects at Colwyn Bay and Denbigh
Table 9 highlights current service profiles in community hospitals. Estates
related issues concerning community hospitals are discussed in Section 4.
4.2.1 Conwy and Denbighshire LHBs
A fuller exploration of the key issues facing the LHBs will be included in their
primary care estates strategies. This section briefly outlines the major issues
relevant to the health and social care system in general, and Trust services
in particular.
Issues common to the two LHBs include: –
• The impact of the new GMS contract in terms of increased service
provision
• The future model for out of hours cover as LHBs assume responsibility
for this service under the new contract
30

Table 8
Core services
Colwyn Bay
Royal Allexandra
Rhyl
inpatients
30 beds • •
rapid response teams
•
hospital at home teams
•
social services base • • •
active rehabilitation eg stroke unit
therapies • • • • •
elderly day care • •
IP & DP palliative care services
•
minor injuries • • • •
radiology • • • •
other diagnostics • •
community dental services
•
outpatient services • • • •
Extended services
maternity services
mental health IP and DPs
•
Macmillan nursing • • •
specialist community teams eg ABI •
primary care services • •
specialist community nursing • •
Prestatyn
Denbigh Infirmary
RuthinHospital
Llangollen
community hospitals - range of services.xlsSheet125/02/2004

• Security and safety in general and the specific requirement for safe and
secure locations where GPs can see patients with a history of violence
• The challenge of developing practice specialisation in particular areas
such as diabetes care while retaining the best features of the traditional
patient-GP relationship
Conwy- specific issues include:–
• The limited capacity of existing premises to accommodate service
developments such as nurse-led clinics
• The integration of primary care teams, Trust staff and social services in
three Health and Social Care pilot projects (Abergele, Llanrwst and
Llanfairfechan see section 4),
• The need to agree the future role of branch surgeries and outlying
consultation facilities
Denbighshire-specific issues include:–
• The potential for co-location of primary care services with Extra Care
Housing developments planned by Denbighshire County Council
• A relatively high proportion of single-handed GPs
• High rates of referral by GPs to hospital services
• The potential of radical models, such as the Rhyl Going Forward Project,
to address areas of deprivation
4.2.2 Conwy and Denbighshire Councils and Other
Agencies
Representatives of Conwy and Denbighshire social services departments
were interviewed and attended model of care workshops. These discussions
confirmed a shared objective for greater integration and co-location of
services where appropriate. The Adult Mental Health and Social Care
partnership is one model of how successful integration may occur. The
health and social care pilots being pursued in Llanfairfechan, Llanrwst and
Abergele are further practical examples of the development of integration,
facilitated by shared premises.
The strategy outlined in Section 6, and the action plan in section 7, will take
full account of the opportunities for joint development with social services
and other elements of council services. The roles of the voluntary and
independent sectors in each locality will also be fully considered.
31

4.3 Principles
As outlined in section 2.4, the strategy has been developed through a
combination of reviews of the national policies and local issues described in
section 4.1, and a series of meetings and workshops involving key
stakeholders. From this work the following set of key principles and policy
directions have been established: -
• A strong emphasis on integrated working - both between professionals
within the same organisation, and between different organisations
working in health, local government, and the voluntary and independent
sectors
• The development of shared facilities, to support the development of
integration
• Active managed care of at-risk well based upon integrated needs
assessment
• Chronic disease management by multi disciplinary teams operating from
community settings supported by GPs with special interests. Early target
areas may include diabetes, cardiology and dermatology with a need for
increased local access to diagnostic services if the model is to succeed
• Models of service which reinforce a broader definition of health and
contribute to healthy lifestyles
• Multi-agency models with potential to draw upon multiple funding
sources
• Evidence-based approaches, building upon successful models. This
includes the potential to apply local initiatives more widely
• Extended roles, for example for nurses, therapists, social workers and
exploration of the opportunities for staff rotation between sectors
• Market management to minimise uncertainty regarding private/ voluntary
sector capacity, particularly residential/nursing homes
• The development of clear integrated care pathways
• A greater focus upon supporting people in their own homes
• A recognition that what matters most to users is their direct experience in
the receipt of a service experience rather than the organisational model
which delivers it
• Creative approaches to ensuring ease of access including partnerships
with transport agencies
• Services responsive to local circumstances and individual needs, not a
one-size-fits-all model
• Ensuring that localised services are not achieved at the cost of
professional isolation by support to continuing professional development
• A dynamic model incorporating continuing dialogues, within and between
agencies and meaningful public and patient involvement in service
development and implementation.
32

It is recognised that to realize this vision requires addressing the challenges
of: –
• Apparent capital scarcity relative to the likely cost of change across
Wales
• The limitation of existing facilities to accommodate new models of care
• Workforce planning and training
• Possible professional reluctance to relinquish roles
• Approvals procedures and timescales
• Public support for change
• Health and social services differences with regard to charging for
services
• Avoiding acute sector gravitational pull
• Ownership patterns in the primary care sector
• Maintaining a coherent strategic direction amidst unfolding initiatives.
33

5 Demand and Capacity Modelling
A demand and capacity model was developed as part of the first iteration of
the strategy. This model focused primarily on acute services, but included
the potential to transfer work from an acute setting to community and primary
care.
The model is being updated and further developed to incorporate the
following:
• Activity associated with acute episodes of care: in-patient and day-case
based activity, and establishing a model capable of quantifying a
potential shift of some activity into a non acute setting.
• Community based activity: establishing the current and future capacity
requirements to cater for activity occurring in community hospitals, as
well as incorporating the additional activity that will emerge from the
acute model’s transfer of activity to the community hospitals. The model
also identifies the potential to shift community hospital activity out into a
non hospital based environment.
• Out-patient modelling: outlining the capacity requirements for out-patient
based activity in acute and community settings.
This analysis will be completed by June 2005, and will provide a quantitative
basis for the plans and business cases emerging from this strategy’s action
plan.
34

6 Strategic Direction
6.1 Introduction
As stated in Section 2, this document outlines a broad strategic direction for
community and mental health services. It is not intended to provide a
detailed blueprint of the future of each individual service. The main
outcomes are an overall strategic framework and a clear, timetabled action
plan. This action plan consists of a series of projects, which will produce
specific proposals and business cases for the modernisation of services.
The strategy brings together the service principles outlined in Section 4 and
the potential of the estate to support those service principles. The strategy
needs to be flexible in terms of both content and speed of implementation,
given the challenges which are also outlined in section 4, in particular the
uncertainty around the availability of both capital and revenue funding.
6.2 Structure
The strategy is divided into two sections:
1. The strategic direction by locality
2. The strategic direction for specific central services, which are not locality
dependant
Localities
The localities are outlined in figure 13. They are based primarily on
suggestions by the respective Social Services departments of Conwy and
Denbighshire. They match the area partnerships of the latter with the
exception of the boundary between localities 2 and 3. For local government
the boundary between these localities is to the north of Ruthin, whereas in
health terms it is regarded as more meaningful to look at Denbigh and Ruthin
in the same locality. It is important to emphasise that none of the localities
should be regarded as having rigid boundaries, and will be further refined as
proposals are developed.
Central services
The services covered by this strategy will in large part be delivered through
integration within locality based facilities. This explicitly includes mental
health services. However, as outlined in section 4, there are certain
elements of these services which are provided on a centralised basis. This
element of the strategy deals with those services.
35

Conwy + Denbighshire NHS Trust
‘Localities’
Bangor
Llanfairfechan
1
Llandudno
Colwyn
Bay Abergele
2
Llanrwst
5
3
4
Prestatyn
Rhyl
10 11
1
St Asaph
2
Denbigh
Holywell
1
2
3
4
5
1
2
3
Penmaenmawr, Llanfairfechan, Conwy,
Henryd, Llandudno Junction
Deganwy, Llandudno, Craig -y-Don,
Penrhyn Bay Liverpool
Rhos on Sea, Colwyn Bay,
Old Birkenhead
Colwyn, Mochdre
Kinmel Bay, Towyn, Llanddulas, Abergele
Rural Area
‘natural’ extension to area 4
Rhyl + Prestatyn
St. Asaph, Denbigh + Ruthin
The South
Ruthin
3
Corwen
Wrexham
Llangollen

6.3 Integration of Services through
Community Hospitals, Primary Care
Resource Centres and Primary Care
Centres
A key driver in determining future models and service configuration is to
ensure the integration of primary, community mental health and learning
disability services within the local health and social care system, and to
optimise their contribution to alternatives to acute care. As a general
strategic principle the Trust will pursue opportunities to integrate both
services and estates with partner agencies, to improve the seamless delivery
of care. This is consistent with the recommendations of the Wanless review.
Thus proposals have been developed within a consensus emerging from the
workshop and interview process in favour of integrated service provision,
with other health and non-health organisations.
Models such as Primary Care Centres (PCC) and Primary Care Resource
Centres (PCRC) offer such a focus for community, primary and mental health
services together with social services and other non-health agencies.
Generic Community Hospital, PCRC and PCC models are described in
Figure 14. This outlines the range of services that would be expected in
each of these facilities and the approximate capital costs. Examples of
similar models being developed elsewhere in the UK are shown in Figures
15 - 16. Potential advantages of such models include –
• Greater integration of services provided by primary care, the Trust and
social services
• Extension of the range of services available in a particular location with
benefits to patients in terms of convenience
• Support to multi-disciplinary working
• Creation of a larger critical mass allowing cost effective devolution of
expertise and medical technology
• Professional support to staff
These models should be seen as illustrative, capable of flexible application to
meet local needs and continuing re-balancing between acute and primary
care. For example the English NHS Improvement Plan’s emphasis on the
importance of access to diagnostic services suggests that further devolution
may be likely. Therefore Near Patient Testing (NPT) listed here as a
community hospital function may, in some cases, be appropriately provided
in a PCRC or PCC. Indeed Community hospitals, PCRCs and PCCs are
best regarded as points on a continuum rather than as discrete entities.
The NHS Policy framework document for Wales suggests that a PCRC
would serve a population of 50,000 people, which would indicate only 4 such
centres for the population of Conwy and Denbighshire combined. However
there are particular challenges in balancing critical mass and access in rural
and less populated areas which require a more flexible approach.
36

figure 14
Range of potential
services
primary care centre
extended primary care
primary care
resource centre
specialist primary and
community services
community hospital
plus intermediate care
GPs
GPs • • •
HVs • • •
DNs • • •
Community clinics • • •
Social services + voluntary • • •
Pharmacy • • •
Dentistry • • •
Optometry • • •
Specialist primary care
GPSI, CNS • •
hospital outreach • •
minor injuries • •
mental health • • •
Therapies • •
Diagnostics
xray • •
US • •
ECGs • •
NPT
•
audiology
•
Team bases • • •
CMHT • • •
Training and Development • •
Inpatient care
30 beds •
day care
•
Non-clinical support • • •
Area (GIA sqm) 1,450 2,950 5,800
Cost £3.5M £7.2M £17M

Putney Primary Care Centre
Non-clinical Areas
Other Functions
access from
entrance
separate
access
LB Wandsworth
Social Services
Voluntary
Agencies
CAB
Community
Police
Meeting
Rooms
Library Areas
Support
Staff Areas
Common Room &
Kitchen
Showers, Change, WCs
Commercial Opportunities
Creche
Community Cafe
Entrance /
Reception
Main Waiting Area /
Information Area
Pharmacy
separate
access
or from
Main Wait
Other Clinical Areas
Primary Care Suite
Eileen Lecky
Clinic
OPD
Physio
Optician
Dietician
Osteo
Putneymead
Disraeli
Dental
OT
Ultra
Comp.
Therapy
Mental
Health
Alcohol
Balmuir
Shared Areas

Feasibility Business Case 2001
Sutton and Merton PCT

For Conwy LHB the primary care strategy aims for a progressive
achievement of the benefits of co-location without attempting to implement a
standard model. The development currently progressing in Llanfairfechan,
and the one planned in Llanrwst, illustrate the potential for smaller-scale
PCC-type developments in the more rural areas. In Colwyn Bay and
Llandudno the current review of the roles of the hospitals is fundamental to
the strategic development of primary care services and estate in this area.
Conwy LHB’s draft strategy envisages the following: –
• Maintaining the existing 19 main sites (as there are limited opportunities
in the short term to co-locate surgeries in new accommodation outside of
Conwy, Llandudno and Colwyn Bay.)
• Bringing main sites to Physical Condition B standard as a minimum and
ensuring statutory standards compliance.
• Reviewing the role, suitability and functionality of branch surgeries and
outlying consultation facilities. For those that need to be maintained,
bringing them up to Physical Condition B standard and to ensure
statutory standards compliance.
Denbighshire LHB has a relatively high quality primary care estate. It has
concluded that networked or virtual models, using separate premises in close
proximity to work on a health and social care campus rather than larger scale
facilities, will be more appropriate in most instances. However, while the
overall average area per GP across Denbighshire exceeds the Red Book
recommendations, there are variations by practice and locality. It is also
recognised that Red Book standards pre-date current developments in
primary care, in particular the move towards enhanced service delivery from
primary care settings under the new contract which is central to this strategy.
The strategy therefore envisages the retention of existing good quality
practice premises augmented by developments sited to provide
accommodation for shared use by local practices and other PCC/PCRC
functions.
6.4 Localities
The proposed strategic way forward by locality is described below. There is
considerable variation by locality. At one extreme there are localities where
developments which are currently taking place fully meet the health
community’s strategic intent. At the other extreme, there are localities where
options for development cannot be outlined until the completion of the
secondary care review for North Wales and/or in-depth public and patient
involvement.
37

6.4.1 Conwy
a. Locality 1
• Llanfairfechan – the development of a Primary Care Centre model in a
former nursing home (Plas Menai) is almost complete, re-housing GPs
and C&D Trust community staff from the existing health centre. The
development also includes social services and the voluntary and private
sector, and clearly meets the service and estates goals outlined in this
document.
• Proposals for the expansion of dental services in the vacated space in
the health centre are currently under consideration.
b. Localities 2 and 3
• The future configuration of community mental health and learning
disability services in these areas is inextricably linked to the review of
Llandudno and Colwyn Bay hospitals. This review is currently being
undertaken by Conwy LHB and is due to report later in 2005. The future
of these hospitals will also be affected by the review of secondary care in
North Wales. The date for the completion of this review is yet to be
agreed.
• Pending the outcome of these reviews, opportunities for integration and
co-location will be taken as they arise. At present this includes the
potential for a joint development with the Ryssledene GP practice and
the possibility of a joint development with social services adjacent to the
new GP practice in Craig-y-Don, Llandudno.
• There is the potential to create a Child Development Centre within 1 of
these localities, possibly at Ysgol Gogarth (Llandudno).
c. Locality 4
• The GP practice is planning to relocate to the Business Park in Abergele.
Discussions about full integration of the GP premises with the Trust and
social services have not come to fruition. However the Trust and Social
Services will continue to explore the potential for co-location. This will
include considering the option to move from the existing Abergele clinic
to the business park adjacent to the GP surgery to facilitate future joint
working.
• There may be opportunities to deliver Community hospital and/or
Primary Care Resource Centre facilities to this locality in a joint
development with Denbighshire. This is explained further in
Denbighshire Locality 1 (below).
38

d. Locality 5
• In Llanrwst the Trust will continue to explore the potential development of
integrated premises and services with the GP practice and local
government.
6.4.2 Denbighshire
a. Locality 1
Prestatyn
• Prestatyn hospital has 12 beds, and therefore does not meet the 30-bed
minimum requirement envisaged by the Framework of NHS Policies to
Inform the Production of Local Action Plans. The hospital also rates
poorly from an Estates perspective. There is therefore a requirement to
review the future of this hospital within the context of the Trust’s and
LHB’s overall strategy. A project will be established for this purpose,
including full public and patient involvement in the development of
options as required in Shaping Services Locally.
• There are opportunities for a joint health and social care development
linked to an extra care housing model. A project team has been
established to explore this. This may include options that relate to the
future of Prestatyn Hospital.
Rhyl
• The future of the Royal Alexandra hospital requires an in-depth review in
light of its relatively poor physical condition. A project will be established
for this purpose, including full public and patient involvement in the
development of options as required in Shaping Services Locally. This
review will incorporate the implications of the Rhyl Going Forward
regeneration project, and local government plans to develop extra care
housing. It will also explore the possibility of providing community and
inpatient facilities for Conwy residents from the Abergele, Towyn and
Kinmel Bay area.
b. Locality 2
• Both Denbigh and Ruthin Hospitals are in good condition and well
located to serve their local populations. A project will be established to
review how their use can be extended to facilitate greater integration of
services.
c. Locality 3
• Llangollen hospital has 18 beds, and therefore does not meet the 30-bed
minimum requirement envisaged by the Framework of NHS Policies to
39

Inform the Production of Local Action Plans. The hospital also rates
poorly from an Estates perspective. There is therefore a requirement to
review the future of this hospital. The review will include the strategic
way forward for the entire locality, including the clinic and mental health
facilities in Llangollen and Corwen Health Centre. A project will be
established for this purpose, including full public and patient involvement
in the development of options as required in Shaping Services Locally.
This review will be carried out jointly with Wrexham LHB and the North
East Wales Trust in view of the cross-boundary issues.
6.4.3 Central Services
a. Mental Health – Adult and Older People Acute Services
A separate report has been produced to address the space provision and
suitability issues of the Ablett Unit outlined in Section 3. Options in this
preliminary analysis include:
• Internal reconfiguration to address key issues
• Relocation of all acute mental health services off the YGC site
As also outlined in Section 3, service developments are currently being
introduced that may have an impact on demand for acute inpatient services.
It is important to assess the results of these changes before any strategic
decisions about the scale and location of future provision are made. A
specific piece of work emerging from this strategy is therefore to evaluate
these changes and undertake a formal option appraisal on the way forward
for acute inpatient provision by March 2006.
In terms of older people’s services, there is also a need to review the use of
inpatient provision at Bodnant, Bryn Hesketh, Glan Traeth and Tawelfan.
b. Learning Disabilities
Plans are being developed to increase the range of services provided by,
staffing levels in, Learning Disabilities. This includes enhancements to the
learning disability teams, the development of a challenging behaviour service
and the creation of a crisis prevention and management service. All of
these developments are linked to the planned closure of the Bryn Y Neuadd
Hospital. This will clearly require an increase in the physical estate. Specific
proposals for this are being developed through the project board for the
hospital resettlement project.
c. Child Health and CAMHS
The requirements for a central team base for Child Health and CAMHS have
been scoped in broad terms. Work will be carried out to explore the costs
and options for the location of such a base. This will include the option of
separate bases for the two services.
40

In terms of the inpatient Tier 4 CAMHS services currently carried out at
Cedar Court, there is an urgent need to agree the way forward given that the
lease expires in 2008. This work is being led by Health Commission Wales
as part of a North Wales review of the service. The issue of an acute
admissions unit for mentally ill adolescents is also included in this review.
For tiers 2 and 3 there is also a need to review the estate implications of the
expansion of services envisaged in the CAMHS action plan.
The Trust will continue to work with both Conwy and Denbighshire Local
Education Authorities on plans for Child Development Centres in both
counties. In Denbighshire this would replace the existing facility in Rhuddlan.
In Conwy it would be a new development.
d. Outpatient Services
There is a need to review the balance of outpatient services between acute
and community locations, as well as the total physical space required. This
forms part of the current strategic review of outpatient services, which is due
to report in June 2005.
41

7 Project and Action Plan
The table below summarise the specific actions and projects related to this strategy. Progress against the actions outlined in this
table will be monitored by the Service and Estates Programme Board.
Locality /
No
Service
1 Conwy
Locality 1
2 Conwy
Locality 1
3 Conwy
Localities 2 & 3
4 Conwy
Localities 2 & 3
5 Conwy
Localities 2 & 3
6 Conwy
Localities 2 & 3
Description of Project or Action
Complete the development of the primary
care resource centre at Llanfairfechan
Agree the future use of the Llanfairfechan
health centre, including consideration of
the business case to develop dental
services
Complete the review of Llandudno and
Colwyn Bay hospitals, exploring what
opportunities exist for better integration of
community services
Develop a service and estates plan for
these localities, following the outcome of
the hospital review
Reach conclusions on the potential for a
joint estate development with the
Ryssledene practice
Reach conclusions on the potential for a
joint estate development with Social
Services in Llandudno
Agency /
Agencies
GPs; LHB; C&D
Trust; Conwy
Social Services
C&D Trust; Conwy
LHB
Conwy LHB,
NWWT, C&D Trust
Conwy Local
Government
C&D Trust; Conwy
LHB
C&D Trust; GPs,
Conwy LHB,
Conwy Social
Services
C&D Trust, Conwy
Social Services
Executive Lead
Director of Planning,
C&D Trust
Director of Planning,
C&D Trust
Chief Executive,
Conwy LHB
Chief Executive,
Conwy LHB
Director of Planning,
C&D Trust
Director of Planning,
C&D Trust
Date for
Completion
Sept 2005
Sept 2005
Dec 2005
To be agreed,
dependant on
the outcome of
[3] above
May 2005
May 2005
42

Locality /
No
Service
7 Conwy
Locality 4
8 Conwy
Locality 5
9 Denbighshire
Locality 1 and
Conwy
Locality 4
10 Denbighshire
Locality 1
11 Denbighshire
Locality 2
12 Denbighshire
Locality 3
13 Mental Health
Acute Services
14 Older People’s
Mental Health
Services
Description of Project or Action
Reach conclusions on the potential to colocate
services with Social Services in
Abergele
Develop plans for the integration of
services in a new build in Llanrwst
Review the future provision of services in
Rhyl and the surrounding area, Kimel
Bay, Abergele and Towyn - including the
future of the Royal Alexandra Hospital
Review the future provision of services in
Prestatyn, including the potential to
develop the extra care housing model,
and conclude on the future of Prestatyn
Hospital
Develop plans to extend the use of
Denbigh and Ruthin Community Hospitals
to facilitate greater integration
Undertake a strategic review for the
locality including Llangollen hospital, the
clinic and mental health facilities in
Llangollen, and the Corwen Health
Centre.
Undertake a formal option appraisal on
the way forward for acute inpatient
provision
Complete a review of the use of inpatient
provision at Bodnant, Bryn Hesketh, Glan
Traeth and Tawelfan and development of
an action plan
Agency /
Agencies
C&D Trust, Conwy
Social Services
GPs, Conwy LHB,
C&D Trust, Conwy
Social Services
Conwy LHB,
Denbighshire LHB,
C&D Trust
Denbighshire LHB,
C&D Trust,
Denbighshire
Social Services
Denbighshire LHB,
C&D Trust
Denbighshire LHB,
C&D Trust,
Wrexham LHB,
North East Wales
Trust
C&D Trust,
Denbighshire LHB
C&D Trust
Executive Lead
Director of Planning,
C&D Trust
Chief Executive,
Conwy LHB
Chief Executive,
Conwy LHB
Chief Executive,
Denbighshire LHB
Director of
Operations, C&D
Trust
Chief Executive, C&D
Trust
Director of Nursing,
C&D Trust
Director of Nursing,
C&D Trust
Date for
Completion
May 2005
Sept 2005
Sept 2005
Sept 2005
Sept 2005
Sept 2005
March 2006
April 2006
43

No
Locality /
Service
15 Learning
Disabilities
16 Child Health &
Child and Adult
Mental Health
Services
(CAMHS)
Description of Project or Action
Develop specific plans for the creation of
services linked to the closure of the Bryny-Neuadd
facility
Explore the costs and location options for
the development of a central base or
bases
17 CAMHS Explore the estate implications of the
expansion in tier 2 and 3 services
envisaged in the CAMHS action plan
18 CAMHS Agree the strategic way forward for the
future of CAMHS Tier 4 for North Wales,
services currently provided at Cedar
Court
19 Child Health Work jointly with Education on plans for
the creation of a Child Development
Centre in Conwy, and the replacement of
the existing Child Development Centre in
Denbighshire
20 Outpatient
Services
21 Demand and
capacity
modelling
Undertake a strategic review of
outpatients, including the future scale and
location of services
Complete the development of a demand
and capacity model, to inform the scale of
developments required by Locality
Agency /
Agencies
C&D Trust,
Resettlement
Project Board
C&D Trust
C&D Trust, Conwy
LHB
HCW, C&D Trust,
NEWT, NWWT,
Conwy LHB
C&D Trust, Conwy
County Council,
Denbighshire
County Council
C&D Trust
C&D trust
Executive Lead
Director of Nursing,
C&D Trust
Director of Nursing,
C&D Trust
Director of Nursing,
C&D Trust
Director of Nursing,
C&D Trust
Director of Capital
Developments and
Major Projects, C&D
Trust
Director of Planning,
C&D Trust
Director of Planning,
C&D Trust
Date for
Completion
April 2005
March 2006
March 2006
August 2005
Sept 2005
June 2005
June 2005
44

References
Wanless, D. (2003), The Review of Health & Social Care in Wales, Welsh Assembly
Government, p.78.
Howard, I., Kelly, J., & Walker J. (2003), Conwy & Denbighshire NHS Trust Service &
Estate Strategy, Conwy & Denbighshire NHS Trust.
Welsh Assembly Government (2004), Shaping Health Services Locally: Guidance on
involving and consulting on changes to health services, Welsh Health Circular (2004) 84,
Welsh Assembly Government (2003), A framework of NHS Policies to inform the
Production of Local Action Plans in Wales.
NHS Wales Corporate Strategy (2000), Access and Excellence – Acute Services in
Wales, Welsh Assembly Government
Department of Health (2003) Investing in General Practice – The New General Medical
Services Contract
The Audit Commission (2004), Transforming Health and Social Care in Wales.
Department of Health (2003), Our Inheritance, Our Future: Realising the potential of
genetics in the NHS.
Welsh Assembly Government (2004), Draft National Service Framework for Children,
Young People and Maternity Services.
The Audit Commission (2002), Losing Time: Developing Mental Health Services for
Older People in Wales.
Welsh Assembly Government (2001), Adult Mental Health Services for Wales : Equity,
Empowerment, Effectiveness, Efficiency.
Welsh Assembly Government (2001), Child and Adolescent Mental Health Services:
Everybody’s Business.
45

Appendices
Appendix 1
Notes of comments made by the Connections Group
Appendix 2
List of participants
46

Appendix 1
Conwy & Denbighshire NHS Trust
Connection Workshops
Background
Together with Conwy and Denbighshire Local Health Boards and Conwy and
Denbighshire County Council Social Services Departments, Conwy &
Denbighshire NHS Trust has drawn up an Integrated Services and Estates
Strategy for Mental Health, Community and Primary Care.
The purpose of this wide-ranging and radical strategy was to review existing
mental health, community and primary care services and the need for
modernisation both of these services and the buildings from which they are
provided. In addition, the strategy put forward a number of illustrative examples
of the way in which services could be redesigned to fit them for 21 st century
health care.
Keen to consult with patient and public representatives at a very early stage in the life of
the strategy, Conwy & Denbighshire NHS Trust commissioned M&M Communications
Consultants to run a series of workshops with its Patient and Public Involvement (PPI)
forum, Connection.
M&M hosted workshops on May 25, November 3 and November 24, 2004.
The aims and objectives of the workshops were to:
• clearly outline the purpose of the strategy
47

• describe in lay person’s terms the context in which the strategy is set – i.e.
the national and local reasons for change
• discuss the illustrative examples of models of care highlighted in the strategy
• engage Connection members in debate about those models of care
• seek the views of Connection members on the most effective ways in which
to consult with the general public on the multi-faceted and complex issues with which
the strategy is concerned.
Methodology
We would like to acknowledge the support and advice we received from Ian Howard and
Vicky Russell, the Trust’s Patient Experience Manager, which informed our plans for the
workshops.
We should like to point out that we did not attempt to cover the aspects of the strategy
which dealt with mental health services. There were two reasons for this decision. The
first was that we felt it would be more appropriate to discuss these with service user
representatives. Secondly, the sheer amount of information in the strategy, and the
complexity of the issues, were such that we felt it would not be possible within the
allotted time to do them justice.
It should be noted that we did receive one criticism of this decision, which is referred to
later in this report.
Workshop 1 May 25
This preparatory session was designed with a high degree of interactivity and employed
a number of simple techniques and visual aids through which to convey the central
themes inherent to a clear understanding of the Service and Estates Strategy.
Our aim here was twofold:
• to enhance members’ appreciation of the need for radical change and modernisation
• to seek members’ views on the most effective tools and methods of communication
to be employed when consulting with the general public on the strategy.
It was not our aim in this workshop to deal in any detail with the contents of the strategy,
which was not at that time at an appropriate stage of development.
We also engaged members in table-top exercises which were designed to illustrate
another key point - that when developing services, one configuration or model will not
suit all and that compromise is necessary.
48

Workshop date
Venue
Attendance
Outcome
May 25, 2004
Glan Clywd Hospital
10 Connection members (including Chair Gail Campbell)
Lynn and Richard May, M&M Communications
Consultants
Vicky Russell, Patient Experience Manager
John Kelly, RKW
Delegates appreciated that it was not possible or
appropriate to continue to develop health services in
buildings which were not fit for purpose.
Delegates were asked to grade a range of
communications tools and presentational styles in order
of preference and effectiveness. This provided useful
feedback on each style’s clarity and ease of
understanding indicating that a graphical style worked
well to explain overall concepts but that more detailed
information required textual treatment in lay person’s
terms.
A statistical analysis of the outcome of the workshop is
available in a separate report.
Workshop 2 November 3
Building on the knowledge gleaned from our first workshop about the methods of
communication preferred by Connection members, we delivered a two-part, interactive
workshop on November 3 using a range of visual aids.
In the first part of the workshop, we used display boards to illustrate our presentation on
the key points of the strategy and the illustrative examples contained within it. We read
from a prepared script to ensure that we would be able to deliver precisely the same
information to a second workshop on November 24 for those members unable to attend
the session on November 3.
Delegates were invited in the second part of the session on November 3 to split into
three break-out groups, each with a facilitator who used a series of questions to guide
discussion on key points. Some delegates chose to fill in the questionnaire while others
preferred to express their opinions verbally.
A note was taken of the debate in each discussion group and it is these notes which
have informed our summary of the outcomes of each workshop.
49

Workshop dates November 3
Venue
H M Stanley
Attendance
12 Connection members (including Chair Gail Campbell)
CHC representatives
Vicky Russell
Lynn May, Richard May, Alison Leith – M&M
Ian Howard
Outcome
There was general agreement and approval for the broad
aims and objectives of the strategy in terms of modernising
and developing community and primary care services. In
addition, delegates were not surprised to hear of the poor
condition of many of the Trust’s buildings.
Delegates were particularly interested in new models of care
such as Primary Care Centres and Primary Care Resource
Centres. They also welcomed the Trust’s commitment to
designing and planning services around local needs rather
than designing ‘one size fits all’ solutions.
However, there was wide-spread concern about the possible
closure of community hospitals, particularly those which have
been “paid for by the community”. The majority view was that
it was better to retain them, even if their role were to change
substantially. One delegate articulated the views of others
when she appealed for “plenty of notice” to be given if a
community hospital were to close.
The following bullet points reflect the views expressed by one
or more members of the three break-out groups:
• approval for the principle of integrating health and social
care but concerns about its implementation
• “build on the good things and get rid of the bad”
• general agreement that patients would prefer to be treated
in their own home, wherever possible
• elderly patients should be given time to consider their
options for long term care before being discharged from
hospital
• great interest in extra care housing concept – would like
more information about how this would work
• support for change if it produces better services
• scepticism that health and social care services can work
together effectively
• concern that Social Services are not as committed as the
NHS to the concept of ‘patient and public’ involvement
• the general public will want detailed information about the
way in which any proposals for change would be
implemented in their local area
• important to include minority groups (a small population of
ethnic Chinese people living in Conwy was specifically
50

mentioned) in any public consultation process
• concerns about the financing of the strategy and its cost
effectiveness
• need for recognition of the fact that people living in the
more densely populated coastal strip have differing needs
from the less well-populated rural hinterland
• delegates felt they needed more information about the
way in which the principle of a Primary Care
Centre/Primary Care Resource Centre would be applied in
rural areas
• some delegates were concerned about the possible sale
of community hospitals (it was said by one delegate that
the NHS does not historically have a good record for
achieving the best price for valuable assets)
• opposition to closure of a community hospital
• pleased to hear about the Trust’s commitment to involving
patients and the public in decision making and planning in
relation to mental health community and primary care
services
• the need to ensure the transport infrastructure is capable
of supporting any changes in how and where care is
provided
• desire to be told “in our own language” what is going on
Workshop 3 November 24
This workshop followed the same pattern as workshop 2. It differed only in as far as
there were fewer delegates which meant that the use of the questionnaire to guide
discussion was rendered unnecessary.
Workshop dates November 24
Venue
Glan Clwyd Hospital
Attendance
3 Connection members (including Chair Gail Campbell)
Lynn May, Richard May, Alison Leith – M&M
Ian Howard
Outcome
The key points and concerns expressed by delegates in this
group were broadly similar to the preceding group.
As mentioned earlier in this report, the decision not to include
mental health services in the workshop presentation was
criticised by one delegate.
Lynn May, Communications Director, M&M
Richard May, Managing Director, M&M
December 2004
51

APPENDIX 2
ATTENDEES
Name
Job Title
Alan Benbow Denbighshire Learning Disabilities Forum
Alan Croxford Conwy Social Care & Housing
Alan Hassall Public & Patient Representative
Alan James Social Services Mental Illness, Denbighshire County Council
Alan Lawrie Chief Executive, Denbighshire Local Health Board
Alan Roberts Denbighshire County Council
Alan Smith Project Manager, Conwy Social Care & Housing
Alaw Pierce Team Manager, Learning Disabilities, Denbighshire Social Services
Alec Cherry Public & Patient Representative
Alison Jones Consultant Nurse, Child Health, Conwy & Denbighshire NHS Trust
Alistair Douglas Clinical Director, Adult Medicine, Conwy & Denbighshire NHS Trust
Alun Lewis Non-Executive Director, Conwy & Denbighshire NHS Trust
Alwyn Rowlands The Alzheimer's Society
Andrew Gunnion Chief Executive Officer, Flintshire Local Health Board
Andrew Jones Local Director of Public Health, NPHS/Denbighshire Local Health Board
Angela Jones Head of Community Facilities, Conwy & Denbighshire NHS Trust
Ann Marie Consultant Psychiatrist, Nant y Glyn, Conwy & Denbighshire NHS Trust
Schmidt
Ann
Voluntary Services Council, Conwy
Westmoreland
Avril Taylor Practice Manager, Abergele Surgery
Barbara Jones Practice Manager, Pen y Bont Surgery, St Asaph
Beryl Roberts Public & Patient Representative
Beth Roberts Practice Manager, Pendyffryn Medical Group
Bryn Williams Age Concern
Carole Davies Practice Manager, Madryn House, Rhyl
Carolyn Hinds Clinical Psychologist, CAMHS, Conwy & Denbighshire NHS Trust
Carolyn Clwyd Community Health Council
Theobold
Celia Taylor Speech and Language Therapy Manager Erskine House/Union
Representative
Chris Moor Service Manager Ablett Unit, Conwy & Denbighshire NHS Trust
Chris Phillips Denbighshire Social Services
Chris Rudgley Planning Manager, Conwy & Denbighshire NHS Trust
Chris Sweetnam Member, Conwy East Community Health Council
Chris Wilcock Capital & Property Manager, Conwy & Denbighshire NHS Trust
Claire Lamb CAMHS Consultant, Conwy & Denbighshire NHS Trust
Clive Sparkes Clinical Director, Conwy & Denbighshire NHS Trust
52

Name
Job Title
Colin Peters Service Manager Conwy, Roslyn, Conwy & Denbighshire NHS Trust
Dave Stewart Snr Nurse Manager, Bryn Hesketh, Conwy & Denbighshire NHS Trust
Dave Williams Service Manager, Denbigh Infirmary Clinic, Conwy & Denbighshire NHS
Trust
David Gozzard Medical Director, Conwy & Denbighshire NHS Trust
David Jago Deputy Director of Finance, Conwy & Denbighshire NHS Trust
David Johnson Asst Director Development & Peformance, Denbighshire Local Health
Board
David Scott Conwy Voluntary Services Council
David Stewart Senior Nurse, Elderly Mental Health, Conwy & Denbighshire NHS Trust
David Williams Mental Health Services, Conwy & Denbighshire NHS Trust
Deborah Albrow Community Nurse Learning Disabilities, Conwy & Denbighshire NHS Trust
Diane Windmill Penrhyn Bay Surgery
Dianne Lewis Practice Manager, Rysseldene Surgery
Dilys Percival Head of Therapy Service, Conwy & Denbighshire NHS Trust
Donna Practice Manager, Bronyfynnon Surgery, Denbigh
Thompson
Dr Andrew GP, Bronyfynnon Surgery, Denbigh
Heaton
Dr C H Wright Consultant Radiologist, Conwy & Denbighshire NHS Trust
Dr Caroline
Earys
Head of Learning Disabilities Psychology, Conwy & Denbighshire NHS
Trust
Dr Crowther Consultant, Ablett Unit, Conwy & Denbighshire NHS Trust
Dr E R Coulton GP, Kinmel Bay Surgery,
Dr Gerallt Owen Consultant, Care of the Elderly, Conwy & Denbighshire NHS Trust
Dr Goodwin GP, Madryn House, Rhyl
Dr Jan Consultant Psychiatrist (Conwy) Bryn Y Neuadd
Srinivasan
Dr Keith Owen GP, Rysseldene Surgery
Dr Mary Thomas Family Planning Consultant, Conwy & Denbighshire NHS Trust
Dr Neil Davies Consultant Ablett Unit, Conwy & Denbighshire NHS Trust
Dr P A Britt GP, Llanrwst Surgery
Compton
Dr Peter Gore-
Rees
Consultant, Child & Adolescent Mental Health, Conwy & Denbighshire NHS
Trust
Dr Pritchard GP, Clarence House Surgery
Dr Richard GP, King's House Surgery
Landon
Dr Robert Jones Senior Clinical Psychology Manager Henllan Centre
Dr Tony Roberts Consultant, Conwy & Denbighshire NHS Trust
E M Patel Tyn Y Coed Surgery, Colwyn Bay
Eirwen Godden Denbighshire Voluntary Services Council
Ellen Greer General Manager, Medicine, Cancer & Psychology, Conwy & Denbighshire
NHS Trust
Enid Thomas Practice Manager, Rhoslan Surgery
53

Name
Eva Edwards
Fran Lewis
Job Title
Hospital Manager, Ruthin & Denbigh, Conwy & Denbighshire NHS Trust
Project Manager, Conwy Social Care & Housing
Fran Whitehurst Continence Advisor, Conwy & Denbighshire NHS Trust
Frances Cook
Frank Shirt
G Jones
Head of Psychology, Tim Dyffryn Clywd, Conwy & Denbighshire NHS Trust
Public & Patient Representative
Practice Manager, Llanrwst Surgery
George Johnson Public & Patient Representative
Gerry McDonald Clinical Nurse Manager Learning Disabilities, Conwy & Denbighshire NHS
Trust
Gill Pierce Senior Nurse Ablett Unit, Conwy & Denbighshire NHS Trust
Graham
Alexander
Gren Kershaw
Helen Shand
Helen Young
Head of Capital Projects, Conwy & Denbighshire NHS Trust
Chief Executive, Conwy & Denbighshire NHS Trust
Clinical Nurse Manager, Learning Disabilities, Conwy & Denbighshire NHS
Trust
Director of Nursing Services, Conwy & Denbighshire NHS Trust
Helena Thomas Service Manager, Mental Health & Provider Services Denbighshire Social
Services
Henriette Kerr Locality Manager, Conwy & Denbighshire NHS Trust
Hilary Owen
Hilary Stevens
Iain Mitchell
Ian Bellingham
Ian Howard
Ian Mitchell
Ian Rickard
Ian Walker
Ingrid Howorth
Jan Zsabo
Jane Toffrey
Jane Trowman
Jane
Westmoreland
Jane Williams
Janet Morgan
Jeff Lees
Jill Baker
Jim Brooks
Jo Cotton
Joanna Stapeley
Morris
Deputy General Manager, Mental Health & Learning Disabilities, Conwy &
Denbighshire NHS Trust
Chairman - Conwy & Denbighshire NHS Trust.
Head of Therapies, Conwy & Denbighshire NHS Trust
Executive Director of Operations, Conwy & Denbighshire NHS Trust
Director of Planning, Conwy & Denbighshire NHS Trust
Head of Therapies, Conwy & Denbighshire NHS Trust
Head of Learning Disability & Mental Health Services, Conwy Social Care &
Housing
Manager, Pathology Services, Conwy & Denbighshire NHS Trust
Team Manager, CMHTs South Denbighshire & Rehabilitation Services
Union Representative, UNISON
Occupational Therapist, Conwy & Denbighshire NHS Trust
Hospital Manager, Royal Alexandra Hospital, Conwy & Denbighshire NHS
Trust
Practice Manager
Conwy Social Care & Housing
Conwy Social Care & Housing
Director, MIND
Continence Advisor, Conwy & Denbighshire NHS Trust
Elderly Mental Health Services Manager, Conwy & Denbighshire NHS Trust
Denbighshire Social Services
CPA Coordinator, Royal Alexandra Hospital, Conwy & Denbighshire NHS
Trust
54

Name
Job Title
John Davies Conwy Social Care & Housing
John
Chairman, Conwy East Community Health Council
MacLennan
John Smith Design Unit Manager, Conwy & Denbighshire NHS Trust
John Walker Head of Estates, Conwy & Denbighshire NHS Trust
John Williams Assistant Director of Performance, Conwy Local Health Board
Joy Williams Practice Manager, Dr Kings', Llandudno
Julie Heath Practice Manager, Plas Meddyg Ruthin
Julie Riley General Manager, Women, Children & Family Services, Conwy &
Denbighshire NHS Trust
Julie Winspear Regional PCS Co-ordinator, Welsh Ambulance Trust
Karen Davies Clarence House Surgery, Rhyl
Karen Jowitt CNS Training, Clinical Governance Team, Royal Alexandra Hospital,
Conwy & Denbighshire NHS Trust
Karen Kilcoyn Denbighshire Voluntary Services Council
Kathleen
Anderson
Public & Patient Representative, Denbighshire Access & 500, Denbighshire
Disability Forum
Kay Hemsley Corporate Services Manager, Conwy & Denbighshire NHS Trust
Keith Watson Senior Education Officer, Denbighshire County Council
Ken Granger Public & Patient Representative
Leighton Capital Projects Officer, Conwy & Denbighshire NHS Trust
Downing
Lilian Hughes North Denbighshire Survivors Network Representative
Linda Jones Penrhyn Bay Surgery
Linda Nicholson Assistant General Manager, Women, Children & Family Services, Conwy &
Denbighshire NHS Trust
Liz Baines Clinical Nurse Specialist, Medical Genetics, Conwy & Denbighshire NHS
Trust
Liz Fletcher Senior Nurse Child Health, Conwy & Denbighshire NHS Trust
Liz Morgan General Manager, Community Services, Conwy & Denbighshire NHS Trust
Lynn Prior Community Service Manager, Conwy & Denbighshire NHS Trust
Lynne Edge Health & Safety Officer, Conwy & Denbighshire NHS Trust
Mair Dempster-
Jones
Assistant Director of Performance, Secondary Care, Denbighshire Local
Health Board
Margaret Chair, Denbighshire Community Health Council
Meddley
Mark Andrews General Manager, Surgery & Anaesthesia, Conwy & Denbighshire NHS
Trust
Mark Sykes Director of Human Resources, Conwy & Denbighshire NHS Trust
Maureen Asst Director for Community Services, Flintshire Social Services
Mullaney
Maureen Hospital Manager, Llangollen, Conwy & Denbighshire NHS Trust
Whittam
Meinir Williams Conwy Local Health Board
Michaela Swales Deputy Head of Child Clinical Psychology, Conwy & Denbighshire NHS
Trust
Mike Goodwin Director of Capital Developments and Major Projects, Conwy &
55

Name
Job Title
Denbighshire NHS Trust
Mrs Sue Dawson Practice Manager, King's House Surgery
Myfanwy Allam
Neil Stevens
Nick Wilson
Nigel Morris
Norma Davies
Pat Mowday
Learning Disabilities, Conwy Social Care & Housing
Director of Finance, Conwy Local Health Board
Director of Performance & Developments, Conwy Local Health Board
Director of Finance, Conwy & Denbighshire NHS Trust
Administrative Manager, Ablett Unit, Conwy & Denbighshire NHS Trust
Age Concern
Pat Youds Operations Manager, Radiology Services, Conwy & Denbighshire NHS
Trust
Pauline Edwards Occupational Therapist, Conwy & Denbighshire NHS Trust
Pauline Pritchard Practice Manager, Betws y Coed
Peter Dutton
Peter Fowler
Practice Manager, Kinmel Bay Surgery
Learning Disabilities Manager, Denbighshire Social Services
Peter Stutchfield Clinical Director, Child & Adolescent Health, Conwy & Denbighshire NHS
Trust
Phil Stanley Regional PCS Liaison Services Manager, Welsh Ambulance Trust
Phil Walker
Rachel Shaw
Conwy East Community Health Council
Head of Paediatric Nursing, Conwy & Denbighshire NHS Trust
Reena Cartmell Assistant Directory Nursing, Conwy & Denbighshire NHS Trust
Rich Gillett
Planning & Performance Officer, Conwy & Denbighshire NHS Trust
Richard Corney Head of Psychology, Conwy & Denbighshire NHS Trust
Robin Holden
Rose Jones
Roz J Slater
Russell Jones
Sally Baxter
Sally Ellis
Sandra Payne
General Manager, Mental Health & Learning Disabilities, Conwy &
Denbighshire NHS Trust
Practice Nurse, Clarence House Surgery, Rhyl
Tyn Y Coed Surgery, Colwyn Bay
Liaison Nurse Manager Ablett, Conwy & Denbighshire NHS Trust
Director of Development and Performance Management, Denbighshire
Local Health Board
Corporate Director Personal Services, Denbighshire Social Services
Regional Director of Public Health, NPHS
Sandra Clinical Director, Dental Services, Conwy & Denbighshire NHS Trust
Sandham
Sefton Brennan Assistant Practice Manager, Abergele Surgery
Shelagh Hughes Practice Manager, Cadwgan Surgery, Colwyn Bay
Shirley Cox
Sian Owen
Sonia Carey
Stef Greenway
Steve Riley
Sue Kirkby
Non-Executive Director, Conwy & Denbighshire NHS Trust
Community Learning Disabilities Nurse, Henllan Centre, Conwy &
Denbighshire NHS Trust
Practice Manager - Clarence House
Senior Nurse, Care of the Elderly, Conwy & Denbighshire NHS Trust
Snr Nurse, Adolescent Services, Conwy & Denbighshire NHS Trust
Community Midwifery Manager, Conwy & Denbighshire NHS Trust
56

Name
T Gywn-Jones
Tom Shea
Val Klimack
Vicky Russell
Wyn Thomas
Wynn Lloyd
Yvette Dowell
Job Title
Conwy West Community Health Council (nominated by Age Concern)
Palliative Care Nurse Manager, Conwy & Denbighshire NHS Trust
Community Consultant Paediatrician Conwy & Denbighshire NHS Trust
PPI Facilitator, Conwy & Denbighshire NHS Trust
Chief Executive Officer, Conwy Local Health Board
General Practitioner
Assistant General Manager, Community Services, Conwy & Denbighshire
NHS Trust
57