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SUMMARY REPORT ABM University Health Board
Health Board Date: 27
th November 2014 Agenda item: 7 (ii)
Subject Integrated Medium Term Plan (IMTP)
Prepared by Karen Pearman, Acting Assistant Director of Strategy
David Osborne, Programme Manager
Approved by Siân Harrop-Griffiths, Executive Director of
Strategy
Presented by
Siân Harrop-Griffiths, Executive Director of Strategy
Purpose
This report requests the Health Board: 1. To receive and
consider progress against delivery of 2014/15
IMTP. 2. To note Welsh Government (WG) expectations in line with
the
2015/16 NHS Planning Framework. 3. To note the proposed Health
Board process to refresh the
2014/17 IMTP in line with WG timescales. 4. To receive an update
on progress in refreshing the 2015/18
IMTP.
Decision x Approval X Information
Other
Corporate Objectives Excellent
Population Health
Excellent Population Outcomes
Sustainable & Accessible
Service Strong
Partnerships Excellent
People Effective
Governance
X X X X X X
Executive Summary
A six monthly review of the Integrated Medium Term Plan (IMTP)
has been completed and this report provides progress against each
of the Strategic Change Programmes and highlights the Programme
Plans for the remainder of the year. It also outlines the 2015/16
IMTP refresh process in line with the 2015/16 NHS Planning
Framework. The 2015/16 NHS Planning Framework was published on the
31st October 2014 which provides guidance on the development of the
2015/16 Health Board IMTP. This report summarises the Welsh
Government process for the planning and development cycle,
timescales for the completion of the Health Board IMTP and a
framework to consider, against which, Welsh Government will test
plans submitted in January 2015. This report also outlines the
Health Board’s internal process and proposed governance
arrangements; and provides an overview of where we are in the
planning and development cycle.
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Key Recommendations 1. To receive and consider progress against
delivery of 2014/15 IMTP. 2. To note Welsh Government (WG)
expectations in line with the 2015/16 NHS
Planning Framework. 3. Consider and agree the proposed Health
Board process to refresh the 2014/17 IMTP
in line with WG timescales. 4. To note update on progress in
refreshing the 2015/18 IMTP.
Corporate Impact Assessment Financial Implications There are no
specific resource impacts in preparing this report
but delivery of the measures within the report could release
resource and increase quality of care.
Quality and Safety The Report link to the following standards: -
• 1 – Governance and accountability framework. • 6 – participating
in quality improvement initiatives • 7 – Safe and clinically
effective care.
Risk n/a Legal Implications n/a
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MAIN REPORT ABM University Health Board Health Board
Date: 27th November 2014 Agenda item: 7(ii)
Subject Integrated Medium Term Plan (IMTP) Prepared by Karen
Pearman, Acting Assistant Director of Strategy
Approved by Siân Harrop-Griffiths, Executive Director of
Strategy
Presented by Siân Harrop-Griffiths, Executive Director of
Strategy
1. PURPOSE This report requests that the Health Board:
1. Receives and considers progress against delivery of 2014/15
IMTP; 2. Notes Welsh Government (WG) expectations in line with the
2015/16 NHS Planning
Framework; 3. Notes the proposed Health Board process to refresh
the 2014/17 IMTP in line with
WG timescales; and 4. Receives an update on progress in
refreshing the 2015/18 IMTP.
2. BACKGROUND Abertawe Bro Morgannwg University Health Board’s
Integrated Medium Term Plan (IMTP) for April 2014 to March 2017
sets out our plan to fulfil our civic duty, both as a commissioner
and provider of services, to meet local health needs. This includes
our responsibilities to deliver high quality effective and
efficient services and as a major employer and contributor to the
local health economy. Our IMTP sets down how, over the next three
years, we aim to improve the health of our population, the quality
and safety of the services we provide, to meet Tier 1 standards and
meet additional demand on the NHS through new ways of working and
new models of care. The IMTP sets out how we will change for the
better over the next three years. The Strategic Change Programmes
are key delivery vehicles for how the Health Board will create high
quality, safe and sustainable services, achieving both national and
local performance standards, using robust monitoring arrangements
and effective governance systems. Each Programme has been
specifically designed to support the delivery of our Health Board
strategy, with focused membership and engagement throughout the
organisation. The success of the Strategic Change Programmes is
critical to meeting the aims of the next 3 years.
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The seven key Strategic Change Programmes set out within the
IMTP are:
Changing for the Better Clinical Service Programme
Unscheduled Careand Patient Flow Programme
Commissioning Development Programme
Surgical Pathway Efficiency Programme
Patient Experience Programme
Patient Safety Programme
Effective Use of Information Systemsand Technology Programme
Seven Key Strategic Change
Programmes
Enabling Programme
Enabling Programme
Quality Programmes
Service Change
Programmes
. 3. 2014/15 Plan A summary of the 2014/15 IMTP has been
prepared and is attached at Appendix 1. This document summarises
the key themes and priorities in the IMTP, and will be made widely
available through our internet and intranet as a much more
accessible document for the public, staff and stakeholders. The
focus of this paper is to update the Board on progress against the
7 Strategic Change Programmes. The Board will be aware that the
Programmes are complex and contain several projects within each. A
detailed 6 month review report setting out the progress of the
seven programmes is attached as Appendix 2. This sets out in a
level of detail the considerable activity and service change that
has been implemented across the UHB in the first six months of the
year to support delivery of the UHB’s Strategic Change Programmes.
It also identifies that there are areas of risk in terms of full
delivery of plans and outcomes. The plans to implement the
Programmes are currently being reviewed to confirm their
deliverability and expected outcomes; this will inform the
development of next year’s IMTP. Progress against the IMTP is
reported to the Board and its sub committees through a variety of
routes throughout the year. Performance against the target measures
within the overall IMTP, is covered by the routinely reported
integrated performance report for the Health Board. For the
November 2014 Health Board meeting this is attached as report 7(i).
The position statement on the financial performance of the IMTP is
included in the papers as report 7 (iii).
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4. 2015/16 NHS PLANNING FRAMEWORK The 2015/16 Planning Framework
was published on the 31st October 2014. The following section
summarises the planning and delivery cycle, and the timetable for
the 2015/16 IMTP. 4.1 The Planning Cycle The planning cycle is
designed to ensure that the development or refresh of an IMTP does
not become an annual “one off” event but is a dynamic activity,
embedded into the way the Health Board conducts and manages its
business and critically delivers improved outcomes for populations
and communities. Figure 1 below demonstrates the three key
components of the cycle: • Plan Development • Plan Approval • Plan
Delivery, Monitoring and Escalation These three main components of
the cycle provide the structure of the 2015/16 NHS Planning
Framework: Figure 1: Planning and Delivery Cycle
Planning & Delivery
Cycle
Scrutiny & Assurance
Cycle
RefreshPlanning
Framework issued
Diagnostic &
Engagment Phase
IMTPs recalibrate
d
Board Scrutiny & Approval
National Scrutiny & Approval
Escalation Options
Delivery & local
assurance
Integrated Monitoring
Escalation Options
Plan Developement
Plan Approval
Plan Delivery & Monitoring
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The 2015/16 NHS Planning Framework was published on the 31st
October 2014 by Welsh Government. Following feedback from Health
Boards the guidance has been strengthened in the following
ways;
• National planning requirements have been clarified, with a
focus on defining success and setting out expectations of the
IMTPs;
• Clear policy imperatives for strengthening primary and
community care, embedding prudent healthcare and reducing health
inequalities have been added;
• Decision making and approval responsibilities have been made
clear; and the steps that will be taken to strengthen the planning
profession across NHS Wales have been identified.
As outlined in the framework, the submission of the final draft
2015/16 IMTP to Welsh Government is required by 30th January 2015,
and will be submitted to the Board on 29th January 2015 for
approval. Board members will be given the opportunity to see and
comment on the draft prior to submission to the formal Board
meeting. 4.2 Timetable (2015/16 Integrated Medium Term Plans)
2015/16 IMTPs must be submitted by 30th January 2015. The final
draft plan will need to be approved by the Health Board prior to
submission to Welsh Government. The timetable for the development,
scrutiny and approval of the 2015/16 Integrated Medium Term Plan is
provided in Table 1 overleaf:
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Table 1
Action Date WG NHS
Pl
an D
evel
opm
ent
Integrated Planning Framework developed between Welsh Government
and NHS
June – October 2014 √ √
Integrated Planning Framework issued to NHS October 2014 √ NHS
organisations develop 2015/16 Integrated Medium Term Plans in
accordance with Integrated Planning Framework
October 2014 – January 2015 √
Indicative budgets and financial assumptions to NHS
organisations
October 2014 √
Financial Allocation letters issued to Health Boards and
Trusts
December 2014
√
Welsh Government sponsored peer review – draft organisational
plans ready for sharing
December 2014 √
Pl
an A
ppro
val
NHS Organisations’ Boards approve “Final Draft” versions of
Integrated Medium Term Plan
January 2015 √
NHS organisations submit the ‘Final Draft’ Board-approved plans
to Welsh Government
31 January 2015 √
Welsh Government scrutiny process February – March 2015 √ Boards
respond to feedback from scrutiny process and amend Plans
accordingly. Boards then approve these final versions
Prior to 31st March 2015 √
Pl
an D
eliv
ery
Delivery agreements for approved IMTPs April – May 2015 √
Integrated Delivery Board Meeting (WG internal) Monthly √ Quality
& Delivery Meetings (WG and NHS) Bi – monthly or
monthly(dependent on escalation levels
√ √
Joint Executive Team Meetings Six monthly √ √ Quarterly Planning
Review Meetings June 2015
September 2015 December 2015 Feb/March 2016
√ √
4.3 Framework for the Development of the IMTP Figure 2 provides
the strategic context for the development of 2015/16 IMTPs. The
Health Board is not required to structure the plan around the
diagram; rather it provides a framework, against which Welsh
Government will test plans submitted in January 2015. It will
heavily influence the Welsh Government’s approach to assessment and
therefore must be considered in developing this year’s IMTP.
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Figure 2: Framework for the Development of the IMTP
FRAMEWORK OF NATIONAL PLANNING REQUIREMENTS
CENTRAL ORGANISING PRINCIPLES
golden threads running through entire planning process, they are
values and principles that must underpin plans in
the Welsh NHS
ENABLERS
the key resources and assets that will allow a plan to be
delivered
SYSTEM SHIFTS relate to the development of new ways of doing
things rather than doing things
better within existing models. They should be evident through
all aspects of
the plan
PATHWAYS whilst there are many, often designed to
respond to local circumstances, the advent of national
programmes for
unscheduled and planned care have and continue to set common
requirements that must be evident in all organisations
SPECIFIC NEEDS the diagnostic stage will identify
particular populations with a higher level of, or different,
needs from services.
Meeting those needs will be common to all services across the
NHS and
therefore reflected in national plans
Prudent Healthcare
Quality and Safety
Prevention & Health Improvement
Strengthening primary and community care
Integrated Care and Partnership Working
Service Change
Unscheduled Care
Planned Care
Children, Young People and Maternity
Delivery Plans
Older People
Mental Health
Workforce and OD
Estate and
Infrastructure
Revenue Innovation Research
Health Inequalities
Outc
omes
and
Deli
very
Fra
mew
ork
IMT
4.4 Peer Review Process Welsh Government has appointed the Good
Governance Institute to help support and facilitate this exercise,
which will run in December 2014. The proposal is for 3 clusters of
Local Health Board to peer review each others’ plans, together with
a day facilitated by the Good Governance Institute in December to
support the provision of feedback. In order to achieve these
timescales, this means the Health Board will need to submit draft
plans to the Good Governance Institute by the middle of December.
5. HEALTH BOARD IMTP PROCESS FOR 2015/18 The objectives of the IMTP
refresh are:
• To maintain focus on delivering our priorities; • To refresh
the 2014/17 IMTP as follows:
a. Provide a position statement against year 1 of the 2014/17
IMTP b. Agree year 2 delivery plan;
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c. Identify year 4 developments; d. Ensure commitments given
during last year’s IMTP process about
improvements in 2015/16 are delivered; e. To ensure the document
reflects the 2015/16 NHS Planning Framework.
The document will be re-drafted in the context of:
• Organisational change; • Revised Quality Improvement Strategy
(incorporating Action after Andrews); • Outcomes from the Values
work; • Updated Joint Strategic Needs Assessment; • Learning from
the Patient Safety and Experience Programmes during 2014. • 2014/15
being a transition year as new Strategic Planning and
Commissioning
Boards are developed; • Ministerial Priorities:
o Prudent Health Care o Primary and Community Care o Supply and
Demand Balance o Workforce Planning
• Any new national drivers eg. o New Social Services and
Wellbeing (Wales) Act 2014; o Future Generations Bill o NHS
Outcomes and Delivery Framework.
It must be noted that the document is a refresh not a rewrite
and it is planned to retain sections on life courses, strategic
vision and aims. Sections 1 to 4 and 9 and 10 will be updated in
line with the above. Sections 5 to 8 will be reviewed in line with
updated Directorate and Locality plans and the NHS planning
framework. Where are we?
• IMTP Refresh Group established July 2014. • IMTP refresh
template issued to Directorates and Localities in August 2014. •
IMTP Sharepoint site set up at the beginning of October to share
relevant information
(Link:
http://brosps:8081/sites/Finance/CorpDir/Planning/IMTP/default.aspx)
• Mid-year performance reviews with Directorates and Localities
held in October 2014
to share initial thoughts; • Draft plans will be received by the
21st November 2014. • Draft plan to be populated by the 16th
December 2014 in preparation for the peer
review. • Final draft to be completed by the 31st December 2014
for presentation to January
Board meeting. 6. RECOMMENDATIONS The Board is requested to:
1. To receive and consider progress against delivery of 2014/15
IMTP; 2. To note Welsh Government (WG) expectations in line with
the 2015/16 NHS
Planning Framework;
http://brosps:8081/sites/Finance/CorpDir/Planning/IMTP/default.aspx
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3. Consider and agree the proposed Health Board process to
refresh the 2014/17 IMTP in line with WG timescales; and
4. To note update on progress in refreshing the 2015/18
IMTP.
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Appendix 1
3 Year INTEGRATED PLAN
3) COMMISSIONING PLANS
2) ORGANISATIONAL STRATEGY
Local resource and delivery
proposals and plans
Community Networks, Localities, Clinical Directorates,
Service
Improvement Team
Process & forum to be decided
Board, Executive Team, Clinical Assurance Group, Commissioning
Boards, C4B Team,
WBP Board
Commissioning plans to deliver system change
Strategy to deliver vision,
priorities, outcomes
CITIZENS &
PARTNERS
1) ORGANISATIONAL VISION & PRIORITIES
10 year STRATEGIC PLAN
1 year OPERATIONAL PLANNING
Vision, Aims, Priorities,
Outcomes, Values
Workforce, IT, Capital, Finance, Implementation
6) INFRASTRUCTURE PLAN NING
5) BUSINESS CASE PRIORITISATION LOCAL PLAN AUTHORISATION
4) LOCAL DELIVERY PLANS BUSINESS CASES
MONITORING & PERFORMANCE MANAGEMENT: Outcomes, Quality,
Targets, Delivery Plans, Activity/Cost
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APPENDIX 1
ABERTAWE BROMORGANNWG UNIVERSITY HEALTH BOARD Strategic Change
Programmes IMTP 6 Month Review 2014/15
1.0 Introduction This report provides an update on the 7
Strategic Change Programmes detailed in the IMTP. These programmes
are: - 1. Changing for the Better 2. Commissioning Development 3.
Patient Experience 4. Patient Safety 5. Effective Information
Systems and Use of Technology 6. Surgical Pathway 7. Patient
Flow
2.0 Changing for the Better Programme The 9 Projects within the
programme are:
• C4B Staying Healthy Project • C4B Community Services Project •
C4B Rapid Access Services Project • C4B Pre Hospital Services
Project • C4B Hospital Services Project • C4B Women, Children and
Families Project • C4B Trauma Centre Development Project • C4B
Outpatient Modernisation Project • C4B Elective Procedures in
Primary and Community Care 2.1. Changing for the Better Staying
Healthy Project The Staying Healthy Project has adopted a life
course approach and aims to reduce health inequalities observed in
our most vulnerable and disadvantaged communities. Progress The
Smoking Cessation Project has been significantly progressed,
supporting the Health Board towards achieving the Tier 1 target. A
thorough prioritisation exercise was undertaken which resulted in
38 Community Pharmacies (out of 125 across ABM) being selected, to
run a Level 3 stop smoking service. The commitment made within the
IMTP was aimed at 23 Community Pharmacies, with the Executive Team
agreeing to an extension of the commitment. Training and
accreditation for the Level 3 services commences in September 2014,
with a view to having a proportion of the pharmacies up and running
by 1st October (this also co-incides with the Stoptober campaign,
for which there are several local events and activities planned to
create publicity and demand for this service).
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In addition to local service developments, the Project has
developed a local marketing campaign, ‘Start Here’, to drive up
demand for these services. In order to tailor this campaign to our
most deprived communities, the Project has liaised with Communities
First teams throughout the development of the campaign. Planning is
also progressing with the hospital-based smoking cessation service,
during September; the Integrated Pharmacy and Medicines Management
Directorate has been selected to host and manage the service with a
view to being operational by the end of the year. Following an
obesity needs assessment that was recently completed for the ABM
area, an adult weight management business case has also been
developed, to be ratified by the Staying Healthy Project Board,
followed by C4B Programme Board and C4B Delivery Board in Oct/Nov.
Scoping work has also begun on developing a children & young
people’s weight management business case.
2.2. C4B Community Services Project The Community Services
Project is centred on delivering improved services for Frail Older
People and those with Dementia. This is a joint project between
Western Bay and Changing for the Better. A Joint Commitment was
agreed by all four partner organisations in September 2013. The
first priority was to start with Intermediate Care and then phase
into development of wider proimary and community services. Progress
Intermediate Care The Intermediate Care programme has been rolled
out across the three locality areas following investment of the
£7.8m investment from Welsh Government in 14/15. 140 permanent
staff members are being recruited through a comprehensive
recruitment campaign started in the summer – this is nearing
completion, with 80% of staff recruited, against a re-profiled
position which reflects slippage. An Intermediate Care
implementation manager commenced in August 2014. The initial focus
of the post is to develop a consistent infrastructure to support
the operational leads with the delivery of Intermediate Care across
the region. In addition, the Project has commissioned Whole System
Partnership (WSP) to establish a performance framework for
Intermediate Care implementation. A provider has been commissioned
to advise on the Section 33 and Pooled Fund arrangements for the
Western Bay Programme including the Intermediate Care business
case. Detailed financial arrangements across the four partner
organisations are being remodelled. These arrangements are planned
to be in place by March 2015. WSP prepared the Quarter 1 reporting
on Intermediate Care fund expenditure for Welsh Government. Given
the lead in time for commencement of posts being recruited, the
expenditure against the fund was under profile for quarter 1; any
slippage has been re-profiled into subsequent quarters as well as
proposals directed into other initiatives in line with the
Intermediate Care investment themes. Any redirection of slippage
will require the approval of the Programme Board.
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Managed Care Closer to Home Executives from both Health and
Social Care took part in the initial scoping of this work in August
2014 and have requested that the work of Abertawe Bro Morgannwg
University (ABMU) Community Networks merge to form a comprehensive
programme of work to develop primary and community care across
Western Bay. The initiative has secured some minor investment
through the Regional Collaborative fund and executives has asked to
commission external support from the Better Care Fund in England in
order to scope this significant work programme. Older People’s
Mental Health (OPMH) There are historical issues in designing a
service model for OPMH across the four organisations with complex
issues between the physical frail and specialist mental health
diagnoses. A considerable amount of work has been undertaken to
model service for memory assessment and management. A planning
session with Psychiatrists, Acute Physicians, Nurses, therapists,
social workers, the third sector and managers took place on
September 2nd 2014 to try to establish an integrated model for
delivering services across western bay. A detailed options
appraisal is now being put together based on the discussions and
issues raised at the session for submitting to Programme Board for
discussion and decision.
Frailty Model Work has begun to design a frailty model for
community services by March 2015, spanning primary, community and
hospital care. A symposium is being planned for the winter which
will invite academics and experts in the field of frailty in order
to agree the definition of frailty and start to tackle the issues
relating to the management of these service users, e.g. generalist
v specialist. Detailed preparatory work to prepare for that, which
builds the practical side of managing frail older people, is
happening in the meantime, e.g. comparison of the various indices
we use to assess frail older people which then provide inconsistent
care packages. Community Resilience In support of the strategic aim
around older people keeping well and supported in the community,
the project has been working with Welsh Government and Third Sector
to develop a proposal on innovative ways of adopting social finance
into mainstream service delivery. The proposal is currently at the
funding stage and a ‘proof of concept’ bid has been submitted to
the Primary and Community Care fund. The proposal focuses on using
time credits to address loneliness in isolated communities in order
to stop the exacerbation of these vulnerable people to more complex
care packages and hospital admissions. 2.3. C4B Rapid Access
Services Project The overall objective is to provide a model for
rapid access services in each of the localities in ABMU that are
specialty specific and proactively provide a range of rapid
interventions. These are split into three distinct areas Rapid
access to assessment and treatment (initially through development
of an ambulatory unit at Singleton), rapid access to specialist
advice (GP to specialist advice lines) and rapid access to
diagnostics (radiology) Progress
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There has been a delay in implementing the ambulatory unit (ward
10 expansions) in Singleton and the rapid access radiology services
across all localities due to the situation with availability of
capital investment and lack of agreement on investment by
Localities, as agreed to in the Integrated Medium Term Plan.
Discussions with Localities have taken place through August and
September in order to agree operational delivery arrangements as
well as clarification of the investment requirements. A number of
solutions are currently being finalised for discussion in
individual localities and then C4B Delivery Board Ambulatory Care
Following Programme Board endorsement of the Ambulatory Care model
and way forward, discussions have taken place with the Ambulatory
Emergency Care Network (part of the NHS Improvement Agency in
England) to establish a cohort for ABMU. The network has come back
with a number of options which are being discussed within key
groups. As a result of the meetings in August and September the
locality have agreed the model for the ambulatory unit in
Singleton. A working Group has been established consisting of the
Rapid Access Project leads and key members of Swansea Locality. The
purpose of the Group is to operationalise the cold site ambulatory
unit, forming immediate, medium and long term options, dependant on
the infrastructure and investment dependencies. Specialist advice
for GPs Through initial planning work, the Rapid Access project has
attracted interest from the NHS Wales Informatics Service (NWIS) to
begin a pilot in ABMU with regards the use of the Welsh Clinical
Communication Gateway (WCCG) as a mechanism for establishing
specialist advice lines between GPs and specialists. NWIS have
established test versions of the Scottish version of WCCG for ABMU
ICT programmers to begin development work ahead of piloting with GP
practices and specialties in the autumn. Good progress has been
made with the development of specialist advice governance
structures and discussions with Rheumatology, Gastro-enerology,
Cardiology and MCAS. Rapid Access to Diagnostics Following sign up
to the radiology models, the localities requested further
information in the summer. The Clinical Support Services
Directorate has collated detailed analysis of access to radiology,
the detail of which is to be shared with Directorates and
Localities towards agreement of the benefits of the Project,
efficiency gains and investments required for delivery. An extended
pilot is being considered to increase the understanding of the
improvements that can be realised through the Project. 2.4. C4B Pre
Hospital Services Project The aim of this project is to develop and
strengthen services, with the Welsh Ambulance Service and other
partners, to provide alternatives to the public / patients arriving
unnecessarily at the Emergency Department and within Primary Care.
Progress Frequent attendees The Project is piloting work that
identifies a numbers of frequent attendees at the Emergency
department who are then contacted by the third sector (Red Cross)
who work with them closely for a 12 week period on a behaviour
change programme.
Public Education
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The project is focused on continuing to inform the public of
what unscheduled care services are available and when they should
be appropriately accessed. This is being progressed through the
“Choose Well Campaign” a priority of this Campaign is to
communicate and engage with ABMU staff on the Key messages.
Direct Access This project will be working with Specialities to
develop Direct Access Pathways for Patients from the Community and
Patients who WAST are conveying. This work is closely linked to the
developments of an acute hub. Alcohol Treatment Centre (ATC) - The
“Help Point” will open on 20th September 2014 ready for Freshers
Fortnight, this has a focus on reducing inappropriate attendences
to the emergency department, and a significant role in reducing
vulnerablity in the nighttime economy through creating an
accessible safe haven Care Home Conveyance- The project continues
to have a significant focus on Care Home Conveyances and, through a
range of actions, aims to see the number of conveyances (currently
4000+ per year in ABMU) reduce over the next 6 months. The project
will continue to oversee the “Choose Well” campaign, through
September, working with Welsh Government on planning to develop the
brand. 2.5. C4B Hospital Services Project The purpose of this
project is to establish and improve the coordination of services
within hospitals (serving our Health Board Area) into a ‘network’
of hospitals serving the health care needs of the population of
Swansea, Neath Port Talbot and Bridgend and wider region.
Progress
Medical Workforce The recruitment of the additional medical
workforce has commenced, however, the full recruitment scheduled
within the IMTP is subject to the resultant savings being
operational deliverable, and these are currently in development.
Detailed work is ongoing to describe the specialty service models
for each of the specialties once worforce are in place. All of the
speciality plans are in line with the C4B principles and supports
the implementation of the appropriate Welsh Government Delivery
Plans. Surgical Strategy – Swansea & Neath Port Talbot (NPT) As
the next step in developing a medium term surgical strategy which
outlines how / where surgical procedures should be delivered at the
3 main Hospitals in Swansea and NPT the Project Team have completed
the data analysis of each surgical procedure, by site, age, bed
stay etc. A group from Corporate Planning, Information, &
Finance are sourcing an appropriate modelling tool which will be an
essential resource in progressing the development of a strategy.
Oncology & Haematology The Oncology & Haematology group has
two primary aims: firstly to develop an interim plan for the
Management of Acute Oncology & Haematology following the
proposed co-location of acute inpatient medicine at Morriston. A
plan has been developed and during August 2014, clinicians have
used a retrospective audit to test and inform the plan.
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Following discussions with Swansea University a proposal has
been received by the Project Team. The proposal from the University
is to model the future demand for Cancer Services over the next 10
/ 20 years. This will be important information for the Cancer
Commissioning Board once established, and will inform the
priorities for service development in coming years. Relocation of
Therapies and Ward space Work will continue during August and
September with the Physiotherapy, Occupational Therapy and SALT
service regarding the relocation of their services from the 2 ward
template currently utilised by their services in Morriston. All
services have identified and described the service that is required
to remain on the main hospital site and the outpatient service
which could be provided in different locations. Work is underway to
identify options for where the inpatient service could be
alternatively based. 2.6. C4B Women, Children and Families Project
The objective is to transfer maternity, obstetric, neonatal and
in-patient gynaecology services from Singleton Hospital to
Morriston Hospital, when capital funding allows. The actual
delivery of this will be beyond the current 3 year plan. Progress
An audit has been undertaken within Paediatric Assessment Unit
(PAU), Morriston, to better understand attendances at the unit. The
data was then discussed with key personnel, in order to determine
the best way in ensuring that where it is safe to do so, children
are managed within the community. The next steps are to circulate
some of the key findings to GP’s along with guidelines on how to
manage particular conditions that wouldn’t necessarily require an
admission or PAU attendance. An educational programme is also being
considered in order to better equip GP’s with the skills required
to care for children. Site visits have been undertaken to the
Serennu Centre, Newport and the Kaleidoscope Centre, Lewisham, to
explore local integrated models for children with disabilities
(additional needs). Both centres provide examples of co-located
services which provide a one-stop shop approach for families, where
care is better co-ordinated both in terms of assessments and the
planning and evaluation of care and interventions. It should be
noted that co-location is considered to have provided the basis for
improved working relationships and greater co-ordination, however
there are still systems and processes under development that will
enable a more stream-lined approach to assessment and care
planning. Following on from the site visits, a workshop was held on
18th July 2014 with partners, looking at ways in which the Project
can improve services for children with disabilities in Neath Port
Talbot. A draft specification has been put together (this is due to
be taken to WC&F Project Board and Think Families Board in
September 2014), with a view to then creating a delivery plan for
how this can be put into place. A further workshop was held on 27th
August 2014, again with partners across ABMU, but looking at some
of the broader challenges facing Children & Young People’s
services (services discussed at the workshop included CAMHS,
Continuing Care and Looked After Children). The output of the
workshop has been prepared for a meeting with the Western Bay
Programme Director and key individuals to discuss plans for
improving services for children & young people by utilising a
partnership approach.
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The project had a follow-up engagement session with the Youth
Councils for NPT, Swansea and Bridgend on 12th July, in order to
briefly update them on the Programme’s progress to date and to
obtain their views on particular work that is underway in respect
of the Women, Children & Families Project and also the Staying
Healthy Project (for example smoking cessation and weight
management schemes). 2.7. C4B Trauma Centre Development Project
This project will support the implementation of the output from the
South Wales Trauma Network Collaborative. A gap analysis of
appropriate services, against the national standards for Major
Trauma, has been completed. The gap analysis identified a number of
areas that will require development including:
• Major Trauma Rehabilitation – ability to meet the requirement
for a rehab prescription
within 72hrs and the additional rehab that is required. • The
requirement to establish a system / service for the coordination of
care for patients
with complex major trauma, once the patient leaves intensive
therapy unit (ITU). • Ability to provide 24/7 major trauma lead.
Progess A meeting of the South Wales Major Trauma Network Project
took place on 11th September 2014. From ABMU, 8 clinicians
represent their services on the Clinical Reference Group including
2 Clinicians who represent the Emergency Medical Retrieval &
Transfer Service. In early September the post of Clinical Lead for
Major Trauma was advertised to all ABMU Consultants, interviews are
to be held on 16th October 2014. 2.8. C4B Outpatient Modernisation
Project The scope of this project is to: - • National Benchmarking
(look at other areas that may have had successes and failures
in increasing collaboration and reducing demand on traditional
outpatients and learn from these.)
• Look at innovative ways to provide the core benefits of an
outpatient attendance in the patient’s home.
• Intelligence on medical training requirements (i.e. does this
negatively affect the way we plan to undertake outpatients in the
future in terms of learning opportunities)
• Effectiveness of booking systems and alternatives approaches
used elsewhere • Effectiveness of our communication back to
referrer or GP via electronic transmission.
Could we discharge more and offer "See on Symptom" access? Can
we improve communication in terms of e-advice?
• Why do we bring so many patients to a hospital clinic and what
are the alternatives that have been proven effective in other areas
/ countries.
• What is the quality of information sharing both referral in
and appointment summary etc? Are we sending the patient appropriate
accurate information? What IT/hardware is available to help with
this?
• Are we getting the best use out of our consultant time
(sessional use, and could we consider virtual clinics or rapid
access email advice for GPs etc)?
• Patient pathways and how do these need to change to modernize
our service?
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Progress Several pilot initiatives are underway which include: •
ENT telephone and email advice line (commenced August 2014); •
Dermatology digital images in primary care (proposed pilot from
October 2014); • Epilepsy email advice line; • Mental Health Care
Home Virtual Clinic; • Parkinson’s Disease telephone follow up; •
Digital images for early identification of oral cancers
In addition the following are being reviewed for the next phase:
• electronic outpatient booking system to allow patients to more
easily book and
rearrange appointments; • improved communication with patients
to ensure patients are notified in a timely and
appropriate manner; • systems are in place to ensure that all
patients have a clinically appropriate
appointment date for follow up. 2.9. C4B Elective Procedures in
Primary and Community Care Minor surgical procedures identified as
suitable will be carried out in a primary/community care setting in
order to provide a better service to patients and address capacity
issues within current secondary care services. Progress The
intitial phase of the project has focussed on vasectomies. A
comprehensive procurement exercise has been completed; two
Community Networks (one in Swansea and one in Bridgend) have been
commissioned to provide 250 cases per annum (per Network) across
the ABMU area.
3.0 Commissioning Development Programme The Commissioning
Development Programme has a specific commissioning development
project within it which aims to further improve health board
planning and delivery of services on the basis of population health
need, evidence of clinical effectiveness, value for money and
demonstrable improvements in population health outcomes. The key
workstreams establised by the Programme to focus on the delivery of
the aims and objectives are: • Joint Strategic Needs Assessment •
Planning and Commissioning Frameworks and Commissioning Boards •
Communication and Workforce Development • Improving Clinical
Engagement in Commissioning • Improving use of Data for
Commissioning Progress Significant progress has been made across
each of the work streams. Meetings on the Joint Strategic Needs
Assessment have taken place with the Western Bay Programme Team and
plans are being developed for production of a JSNA and an annual
refresh process to inform IMTP refresh which incorporates the
implications of the new Social Services and Well Being (Wales) Act
2014. Planning and Commissioning Framework - a series of engagement
and discussions have taken place across a number of forums both
internally and with the Western Bay. A
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partnership with Swansea University, Public Health and ABMU is
driving forward the creation of several Changing for the Better
Commissioning Boards, including terms of reference, governance and
incorporation of an approach to allocative efficiency; Programme
Budget Marginal Analysis. It is the intention of the PBMA exercise
to support the health board in delivering a discrete piece of work
based on a defined budget area which delivers improved quality and
patient outcomes for the same investment level. The first
Commissioning Board is due to convene in November 2014 with a
further two in March 2015 and three more by Summer 2015. A review
of the Unscheduled Care Board has been undertaken to inform the
development of the unscheduled care commissioning board. Terms of
Reference along with Operating guidance for the commissioning
boards has been produced. The staff engagement approach is
continuing to build, the commissioning boards will be clinically
led and have strong out of hospital clinical representation as part
of this, work to develop links with the community network leads is
also underway. The Workforce and OD lead is currently working on a
communications approach to improve awareness and understanding for
staff of the programmes work. The programme is working very closely
with the changing for the better team, planning department and
finance team to ensure that existing skills and capacity are
aligned with commissioning programme plans where possible and
appropriate. The support of data and information for use in
commissioning has mapped current system capability and capacity to
meet the organisational requirements. Joint collaboration with
Swansea University and the Informatics service has completed its
first phase on the use of the SAIL database, with the second phase
scheduled to be completed September 2014. A Prudent Health Care
Unit partnership proposal between the health board, public health
Wales and Swansea University is currently under review.
4.0. Patient Experience Programme The Programme’s overarching
vision is one of: Being a listening organisation – knowing how well
we are doing – Learning from Experience Progress “You Tell Us” has
been agreed as the overarching Patient Feedback Brand, co-
ordinating the benefits delivered by the Programme. SNAP and DATIX
have been procured which will provide a Ward to Board patient
experience electronic analysis and reporting platform. Timescales
for implementation areas follows:
• DATIX web Project is on track for 1st December 2014. • The
SNAP Project responded to a shared roll out with Welsh Government
of the “I
Want Great Care” patient feedback system, which is a 4 month
pilot on the NPT site which commenced 15th October 2014;
Work is also underway with the University of Swansea to scope
wider integrated reporting and the link to longer term health
outcomes integration with the Secure Anonymised Information Linkage
(SAIL) database.
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The Friends and Family Test has been fully implemented across
all clinical areas within Princess of Wales site. The roll out to
Neath Port Talbot is planned, but dependent on Private Finance
Initiative (PFI) approvals. The formation of a single Health Board
wide Volunteer service is on target. The Patient Feedback Team
structure has been developed, with staff consultation commenced.
The Patient Reported Outcome Measures (PROMs) Project has been
deferred to the autumn of 2014, to prioritise the roll out of the
SNAP patient experience system. The initial focus of the PROMs is
intenedd to be for Trauma and Orthopaedics. There has been a
redevelopment of the Health Board’s Intra and Inter-net “You Tell
Us” patient feedback sites, led by the SNAP Project Manager with
support from the Communications department.
5.0 Patient Safety Programme The overarching vision set for the
programme is to ensure: Continuous improvement in patient safety,
creating confidence in our services Progress In recognition of the
need to put quality (of which safety is an integral part) at the
heart of everything we do, a Quality Strategy is being developed by
the Medical Director and Director of Nursing & Patient
Experience. An initial draft of the strategy has been discussed at
the Quality and Safety Committee where it was confirmed that the
Committee was content with the focus and progress of the strategy.
The strategy will be discussed at the C4B Delivery Board in
December.
To support the implementation of the strategy an Integrated
Quality Programme, incorporating key priorities from the Patient
Safety and Patient Experience Programmes, actions from the AQuA
(internally commissioned quality review) and Andrews (Trusted to
Care) reports and learning from mortality reviews will be
developed, and incorporated into the 2015-8 IMTP.
As part of the development of the Quality Strategy, an assurance
framework will be put in place that will clarify the outcomes and
benefits for our patients and public as well as the mechanisms for
measuring and monitoring their delivery.
The Health Board’s safety priorities have been reviewed drawing
on lessons learned from patient experience and external reviews.
The Patient Safety agenda will be re-launched as part of the
Integrated Quality Programme and IMTP for 2015-8.
It is important to note that whilst the structured Patient
Safety Programme has not progressed as well as expected improvement
work has progressed in a number of key areas. The Quality &
Safety Committee receive regular progress reports on these work
programmes.
To support the identification of potential Hospital Acquired
Thrombosis (HAT) cases and learning the lessons, Welsh Government
had mandated that monthly incidences are reported quarterly, with
each case being investigated to determine whether it was avoidable
and what lessons can be learned. A dashboard has been built to
support this, where each case is treated as a critical incident and
forwarded to the relevant Clinical Director. This demonstrates the
linkage of the Patient Safety and Experience
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Programmes. 1000 Lives Improvement sponsored HAT Steering Group
continues to raise awareness within the Health Board, other
external organisations and the public.
Embedding Universal Mortality Reviews into practice has been a
success. Three of the four main hospitals consistently review all
their deaths and the fourth has now reached 90% compliance. The
initial focus was on inpatient deaths on acute sites, this has now
expanded to include Maesteg Community Hospital. To broaden the
scope of mortality reviews and increase the opportunities for
learning a pilot is being undertaken in three GP practices, one in
each Locality, to review deaths that have occurred within 30 days
of discharge from hospital. In-depth Stage 2 reviews that follow on
from a sample of UMRs have highlighted a number of themes that have
informed the review of safety priorities such as inconsistent
recognition and response when a patient’s condition deteriorates.
With support from the 1000 Lives Improvement Team the Health Board
is working to promote and embed early recognition and intervention
e.g. the Sepsis Care Bundle. A review of training provision,
effectiveness and prioritisation is underway, covering the
Resuscitation Training Team and “Last days of life – the Health
Board’s End of Life delivery plan”.
Primary Care indicators are being refined, to provide assurance
on quality and safety and encourage peer review. Compliance with
care bundles and the documents used are under review to ensure
effectiveness and efficiency.
In order to achieve the Tier 1 target of a reduction in C.
difficile infection and improvements in antimicrobial stewardship /
Proton Pump Inhibitor prescribing across ABM. A business case is
nearing conclusion to develop a Programme Team, to undertake the
following:
• Comprehensive, regular and consistent analysis of practices
progress, including in-practice audits for the poorer performing
practices.
• Enhanced surveillance of C. difficile ribotype. • Targeted
interventions based on data from Heat Mapping software •
Multidisciplinary prescribing reviews • Education and awareness
sessions with GPs and non medical prescribers • Develop and
co-ordinate a network of GP antimicrobial prescribing champions •
Improve access to the Primary Care Antimicrobial guidelines. •
Develop a visible ongoing Health Board wide campaign to raise
awareness of
the dangers of inappropriate antibiotic use and associated
antibiotic resistance, building on the existing ‘Big Fight’
campaign.
6.0 Effective Information Systems and Use of Technology The aim
of the informatics strategy is to provide clinical staff with an
electronic, patient-centred view of information in order to support
high quality care. This information needs to be up-to-date,
accurate, and available wherever care is being delivered, with
reduced variation in IT systems. Progress The Informatics Strategic
Outline Programme (SOP) has been submitted to Welsh Government, and
been approved by the Capital Investment Board (CIB) in September
2015. The Strategic Outline Programme has been developed by
Informatics and Finance to establish an innovative investment
strategy, maximising the utilisation of sources of funding. This
has been supported by individual Business Cases to establish funds
for key
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projects in the areas of unscheduled care and surgical pathways.
Funding requirements include:
• Procurement and implementation of the National Emergency
Department system; • Hardware to support the rollout of the ABMU
Clinical Portal and the TOMS Theatre
system across Swansea; • Hardware and resources to take forward
the implementation of Microsoft SharePoint, to
support and streamline clinical and administrative processes
across the organisation
A bid was put forward for the Welsh Government Health
Technologies Fund to provide improvements to community and social
care services through the use of technology. The bid was based on
joint working between the Health Board and the 3 local authorities,
with plans to also utilise Western Bay revenue funds.
Unfortunately, ABMU were not successful, the requirements will now
be taken forward under the Strategic Outline Programme.
Informatics, Finance and Planning secured an additional £500k of
discretionary capital, to further the investment in technology,
enhancing the infrastructure for our services. Additional
discretionary capital is being pursued to extend the investment and
improvement opportunity.
Progress on the deliverables set out above is as follows:
Digitising the Health Record – The submission of a business case
to procure and implement a scanning solution has been recommended
by Welsh Government, following a scoping session with WG Business
Case scrutiniser. The plan is to take forward the implementation in
15/16
Document Management System (DMS) - The new Document Management
System (DMS) for creating and managing clinic letters has been
rolled out to all sites. The DMS solution enables secretaries to
continue using Microsoft Word, but ensures that all letters are
stored centrally against the patient record, enabling them to be
easily retrieved at a later point. Existing letters currently
stored inconsistently across multiple locations can also be
uploaded to form part of a central patient record. The only areas
that are not part of this first phase are Mental Health, Learning
Disabilities and Sexual Health. Further work will be required to
understand the needs of these services, given the sensitivity of
the information that they hold.
ABMU Clinical Portal - On 7th July 2014, the ABMU Clinical
Portal was rolled out to the Swansea hospitals. This implementation
built upon the launch of the ABMU Clinical Portal on 1st July in
the Bridgend and Neath Port Talbot Hospitals. This now provides
staff with the ability to:
Maintain real time admission lists across the organisation Plan
discharges more effectively using estimated discharge and medically
fit dates Improve the quality and timeliness of discharge
communication by providing junior
doctors, pharmacy staff and consultants with one standard
solution for completing discharge summaries.
Seamlessly view electronic pathology results
The ABMU Clinical Portal Clinician View, providing a patient
electronic document via the Clinical Portal is progressing well,
with development started on the infrastructure commenced.
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ePrescribing – A business case is currently being prepared to
identify the benefits of taking forward ePrescribing in both
Outpatients and Inpatients settings.
eReferrals – ABMU is now receiving approximately 80% of GP
referrals electronically. The next step is to conduct a pilot of
electronic prioritisation by Consultants in Urology and Dermatology
in the Princess of Wales during December/January.
ED System - Ministerial approval is required for the Emergency
Department Clinical Information Management System (EDCIMS)
following a preferred supplier being chosen. Meanwhile, ED
departments are working through their business processes in
readiness to go “paperless” when the new system is introduced.
Finance Colleagues are meeting with the Medical Director,
Informatics Directorate and NHS Wales Informatics Service (NWIS) to
evaluate the contractual and funding options open to the Health
Board and NWIS in progressing this matter.
Theatre System (TOMS) - The rollout of TOMS to Swansea will
include the electronic capture of the Theatre Care Plans and WHO
Checklists, and is due to go live in November 2014. The rollout
requires capital investment. The requirements of this investment
need to be described in a business case, specifically setting down
the benefits of the required investments. This has been
communicated to the Directorates and Project Management. On the
basis this is provided, a funding solution is being sourced with
Planning and Finance.
Pathology - The implementation of the National Laboratory
Information Management System (LIMS) is scheduled for January
through to March 2015. Financial resources have been made available
to accelerate the implementation of the Pathology Directorate
Analyser procurement to meet ABMU Health Board obligations in the
LIMS Project.
Radiology – The PACS Project has received clinical signed off,
with a 2 phase approach, implementation at Neath and Bridgend
during early 2015, followed by replacement at Swansea by December
2015.
New Morriston Outpatients - The “Outpatient Flow System- in
touch with health” implementation plan is on schedule for patients
to self register upon arrival in the new outpatient department.
Patient Experience Feedback System (SNAP) – The implementation
of the SNAP system is being piloted during October 2014.
Digital Dashboards (Qlikview) - The latest version of the
Patient Flow dashboard went live on 26th September 2014. This
version continues to improve dashboard functionality to aide
Service Improvement using FISH methodology and now includes “vitals
charts” at Hospital, Ward and ED levels along with further
improvements in functionality when viewing charts. The screen shot
below show the ED Vitals chart for Morriston Hospital. The first
version of the Surgical Pathways dashboard will be available from
early October 2014. Issue with theatres data has delayed the
implementation of this dashboard and it is planned that the first
version will be released for UAT prior to the next Surgical
Pathways Programme Board on 15th October. This will provide a
weekly view for users of Theatre information. This will expand to
include RTT/waiting list/FUNB profiles for waiting list
management.
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7.0 Surgical Pathway Programme In December 2012 our Health Board
instigated a Surgical Pathway Efficiency Programme, in recognition
of the opportunities that existed to improve patient experience and
maximise the utilisation of theatres across the Health Board. The
latter was based on an external consultancy review by CAPITA in
2012. Progress Efficient Standard Operating Procedures for Whole
Pathway • Implementing and auditing use of the WHO checklist is
underway • Actions following Medical Director’s letter on WHO
Checklist are in place, taken
forward by a WHO checklist flag on the system, auditing
compliance in theatres, and reported on Datex
• Index of Theatre Services Department Standard Operating
Procedures reviewed and circulated
• Site based Surgical Pathway User Groups established • Desk top
standardised process for cancellation of theatres and backfill in
place
Right Workforce and Right Working Patterns • Bottom up work
commenced to agree the theatre timetable for 2014/15 to meet
the RTT targets for the year • Good progress is being made on
estimating the workforce capacity needed to
run Morriston theatres over a 50 weeks, 48 weeks and 46 weeks,
matched against current budget staffing levels
• Good response to current theatre vacancies with the potential
to appoint over 20 registered and 10 non registered nurses
dependent on funding available
• New anaesthetic rota system in place together with changes to
Consultant Anaesthetic job plans
• Good progress against plan being made with Pre Operative
Assessment. Plan covers space and move to HVS; IT systems;
Workforce and Financial Plan.
Beds and Equipment Available when Needed
• Cardiothoracic hold twice daily ward board rounds to
coordinate and optimise patient flow across the pathway
• Weekly Morriston Surgical Pathway User meetings are to start
following the example of the cardiothoracic weekly capacity
planning meeting to review theatre lists with all specialties and
anaesthetists
Fit Patients
• Anaesthetic component of Enhanced Recovery After Surgery
(ERAS) pathway for Hip and Knee replacement at Morriston is being
reviewed.
• Work started to widen ERAS to include some foot & ankle
procedures led by clinicians within the MSK Foot and Ankle
sub-specialty group
• Gynaecology and Plastic Surgery are starting discussions on
ERAS good practice principals
• Supporting the ERAS pathway for vascular services additional
therapies input has been invested to undertake a 1 year pilot to
improve patients post operative recovery and rehabilitation
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• Morriston Pre-Operative Assessment (POA) Team transferred to
Clinical Support Services as part of a planned incremental
development of POA, the appointment of a senior nurse and the move
to a new build in early 2015
• Three Consultant Anaesthetists appointed to commence POA
sessions in September 2014
• POA IT system specification and demonstration been written and
developed • Work continues on improving the availability of case
notes and data collection to
inform the Day of Surgical Admission (DOSA)
In addition to the above: The Surgical Pathway Programme had
been established to build upon the findings and recommendations by
CAPITA, which described a number of efficiency gains that could be
made in theatre utilisation, specifically improved start and finish
times. The progress of this work has been discussed at the
Programme Board; however, it has been limited pending the support
of the Service Improvement Team. Women & Child Health has
appointed a fixed term Surgical Pathway Coordinator to focus on the
efficiency and effectiveness of the gynaecology pathway in
Singleton Hospital. From August the Coordinator will be joined by a
new consultant with a job plan that includes lead for surgical
pathway improvements. A particular focus for Surgery is on
improving the pathway for patients with peripheral vascular
disease, organised by a multi disciplinary group and using patient
stories. Small tests of change are being implemented using A3
problem solving improvement process, such as providing a dedicated
wheelchair stock for the ward. In addition, Public Health Wales
have facilitated a joint piece of work between ABMU and Hywel Dda
to establish the baseline demand for this service and a joint
workshop with Hywel Dda on 21st July held to review and improve the
high level pathway from a network basis, which concluded with a
joint set of actions. In Musculoskeletal Services the current focus
is on data collection. Consultants are leading a review to identify
every procedure currently carried out in all our hospitals from an
orthopaedic and spinal perspective. The purpose is to understand
exactly what we could potentially do on each site and what we would
need in terms of infrastructure and workforce to deliver. Also a
prospective data collection based on a set of criteria looking at
delays in trauma care and impact on elective capacity, started in
July by Professor Nick Rich, Swansea University. For Regional
Services work on understanding the patient pathway through plastic
surgery started 7th July 2014. Data captured on the system has
already highlighted significant level of late starts on the
registrar day case list and levels of early finishes on consultant
lists. Work is underway on the diagnostic undertaken to understand
the patient journey through Plastic Surgery and where improvements
need to be made. Also using procedure time data to improve
efficiency of theatre time In Cardiothoracic Surgery the focus has
been on building the team, leadership and encouraging front line
staff to make changes to help improve patients care. The whole
directorate has undertaken ‘Human Factors’ training, which has led
to an improvement programme for Theatres. For example, the Cardiac
Theatres Team is hold ‘team briefings’ every morning prior to the
commencement of the theatre lists, which has improved list
start
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times. External evaluation was extremely positive and
improvements to address the feedback are being made. For Theatres
it was reported that the Singleton Efficiency Group were focusing
on a standardised process for cancellation of theatres including
circulating and agreeing backfill theatres; data; and improving
flow through Ward 2. NPT continue to look at validating their
theatre data and work on understanding the workforce needed to
match theatre capacity and demand is progressing. The Albatross
Benchmarking system, with the support of the Programme, identified
a planned reduction in beds, through improved length of stay as a
result of the measures introduced by the Programme. The planned
reductions were based on a “peer group”, which was comprised of
organisations of similar size which perform better than ABMU Health
Board, but weren’t the top performers. Work is being progressed to
identify the deliverable opportunity, with the reductions due to
commence in 2015/16. Albatross has also been used to identify
efficiency gains in “time on table”. The benchmarking work whilst
shared with Directorates as an opportunity, it has limited
integration into operational plans.
8.0 Patient Flow Programme The focus for this year is on two key
components:
• implementing the recommendations from the Finnamore Report
produced in December
2013, in relation to ‘Front door’ emergency developments at both
the Princess of Wales and Morriston.
• rolling out the Patient Flow Programme to ensure that capacity
is effectively managed through efficient operational processes, 7
day working and appropriate staffing.
Progress
Improving the Flow • Weekly ‘Big Room’ standing meetings are
held on the Morriston, Neath Port Talbot and
Princess of Wales sites focusing on unscheduled care flow of the
frail older patient • Healthcare colleagues from Denmark and
Scotland visited the Princess of Wales
Hospital in September to demonstrate the work of the National
Flow Programme by looking at our work to improve flow in ED and
flow for frail older patients on the medical wards.
• In Morriston the ‘Big Room’ has redefined its high level A3
problem solving process to focus on ensuring frail older patients
receive the right assessment and care plan following arrival at the
‘front door’. A high level current state process map has been
completed and work is currently underway collecting data and
undertaking value stream mapping to understand the problem. This
will be used with existing knowledge and where we want to be to
decide on the improvements we need to make and test the changes
out.
• A further ‘Big Room’ for the flow of all patients through
Morriston ED started in September, reorganising the work already
underway as part of the Finnamore’s report
• Morriston Radiology undertaking A3 problem solving looking at
the flow to Radiology when in ED
• The Princess of Wales Hospital is looking at improving flow in
ED, senior decision making in Acute Medical Unit, and flow on the
medical wards. PoWH Big Room also
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undertaking a mapping exercise on the process for referring
patients in Bridgend for social services to support discharge from
the acute hospital.
• Continue to be actively engaged with the 1000 Lives + Patient
Flow collaborative - ABMU acknowledged nationally as having made
the most progress in understanding our system and giving staff the
skills and support to make changes for improvement.
• Visit by Kate Silvester from the Health Foundation on 17th
June to Morriston and the Princess of Wales and delivered
‘information for measurement’ coaching session. Key messages from
her visit were: 1. Every patient must have a clinical plan
documented on admission which
indicates the physiological and physical goals for the patient.
Patients with ongoing medical needs must have care plans for their
management in primary care/care homes etc
2. The 4 VITALS charts (demand, activity, Work in progress (WIP)
and Lead time) are the key measurements of analysing our systems
flow
• Alex Howells presented at the National Learning set on 19th
June with key staff and the Health Minister in attendance. Our ‘Big
Room’ progress was also on display.
Developing capacity and capability • 8 clinicians attended the
National Clinician Workshops on 2nd & 3rd July, led by Kate
Silvester with Dr Sarah Spencer, ABMU Consultant, presenting •
34 staff have completed the Foundations of Improvement Science in
Healthcare
(FISH) with a 32 in progress, which continues to increase. • Two
staff are undertaking the Improvement Science Practitioner (ISP)
level with further
3 to start • Two further internal 2 day Patient Flow workshops
have taken place in June/July, one
each for Swansea and Bridgend, facilitated by 1000 Lives +
Patient Flow team. 50 plus clinical and managerial staff have
participated in these 2 day workshops which supports them to put
the FISH training into practice.
• A patient flow resource section is available on the
information portal with data dashboard, relevant documents, videos
and templates. This is useful for those directly involved in
delivery.
• Latest figures (18 August) show over 1,581 ABMU staff are
holders of Bronze Improving Quality Together (IQT) with nearly 400
in the process of completing the training.
9.0 Programme Risks and Issues The following table provides the
risk status of delivery across key risk categories for each of the
Programmes/Projects.
Programme/ Project
Investment Delivery)
Saving Delivery
Environment Strategic Timescale Benefit Measure
Operational plans for delivery are in place
Operational plans for delivery are in place
Capital, Equipment & Interdependencies are achievable
Strategy is understood and owned by Dir/Loc
Programme/ Project will meet IMTP Timescale
Measures and Monitoring is established
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Programme/ Project
Investment Delivery)
Saving Delivery
Environment Strategic Timescale Benefit Measure
C4B Staying Healthy
Acceptable Low Low Low Acceptable Significant
C4B Community Services
High High Low Low Significant Significant
C4B Rapid Access Services
High High Significant Acceptable Significant Significant
C4B Pre Hospital Services
Significant High Low Low Significant Significant
C4B Hospital Services
Significant High High Low Significant Significant
C4B Women, Children & Families
Acceptable Low Low Low Low Significant
C4B Trauma Centre Development
Acceptable Low Low Low Low Significant
C4B Outpatient Modernisation
Acceptable High Low Low Significant Significant
C4B Elective Procedures
N/A N/A Low Low Low Significant
Commissioning Development Programme
Acceptable Low Low Low Acceptable Significant
Patient Experience
Low Low High Low Significant Significant
Patient Safety Significant High Low High High Significant
Effective Information Systems
Significant Low High Low Significant Significant
Surgical Pathway
Significant High Low High High Significant
Patient Flow Low Low Low Acceptable Acceptable Significant
The individual risks and issues are held by the respective
Programmes; the key themes are summarised below.
Revenue Funding – Each of the Strategic Change Programmes has
identified a number of investments, the initiation of these
investments is determined by the Health Board. As previously
described, the total investment required at the outset of the IMTP
was £5.7m which needed to be prioritised into £4m, predicated upon
£2m planned savings. Robust
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operational plans for delivery of the £2m planned savings are
not in place at present. This has resulted in a restricted amount
of investments being initiated. In the absence of robust savings
plans, the investments will continue to be held, limiting the
progress of the Programmes, impacting on the timeframe for
delivery.
Mitigation – The Strategic Change Programmes in collaboration
with the operational services are continuing to create robust plans
for investments and savings delivery, inclusive of recruitment
schedules, and specific areas and timing for efficiency gains such
as planned bed reductions.
Availability of Capital Funding – Due to the limited amount of
funding available, the Programmes dependent on capital are
restricted in the progress that can be made. These include
infrastructure changes (Changing for the Better Hospital Services,
Women, Children & Families and Rapid Access Projects) and
equipment (Patient Experience and Effective Information Systems and
Use of Technology). Sources other than discretionary Capital
funding are being sourced to create opportunities for
progression.
Mitigation – Finance, Planning and Informatics are pursuing
sources of funding to increase the opportunities for capital
investment. Where there is limited capital funding the Health Board
and Executive Team will be required to prioritise this funding, in
line with Strategic Change Programmes readiness and strategic
priorities.
Planned Bed Reductions - A paper has been produced for a
September 2014 meeting of the Annual Planning Implementation Group
(APIG) which describes the operational status for plans to deliver
the bed reductions identified within the IMTP. The paper described
that whilst plans are in development they are limited plans at
present. The majority of savings identified for Strategic Change
Programmes are based on bed reductions and release of the
associated funding. As the plans become more robust, the initiation
of investments becomes available. The paper focuses on bed
reductions, however, the status of operational delivery plans holds
true for each of the savings.
Mitigation – APIG will oversee the delivery of operational
plans, with validation of the robustness. These plans continue to
be developed collaboratively with the Strategic Change Programmes
and Services.
Governance – The role of the Health Board and required reporting
arrangements is presently under review. The frequency of reporting
has been raised as a concern, with a suggested bi-monthly or
quarterly provision to the Delivery Board, enabling the time
allocated for discussion of each Strategic Change Programme to be
increasingly effective. These discussions could be expanded in
terms of progress, escalation of risks and issues, and funding
requirements.
Mitigation – The role of the Health Board and supporting
governance arrangements are presently under review by the Executive
Team. In addition the establishment of Board Sub Committees for
specific elements of Health Board performance may also provide some
opportunities to strengthen governance.
Workforce – The availability of the required workforce has been
raised as a consideration, for example General Practitioners
availability (Changing for the Better Hospital Services),
Informatics staffing, and the scale of Nursing and Support Workers
(Changing for the Better Community Services). The development of
the IMTP for future years will need to further consider workforce
availability when planning.
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Mitigation – The working Group for the development of the IMTP
for 2015/18 has workforce representation, with the delivery plans
submitted by Localities and Directorates to be assessed in
recruitment considerations.
Engagement – Across the Strategic Change Programmes there is a
variance in the knowledge, adoption and ownership of the Programmes
by the Health Board. This includes the transition from strategic
planning to operational delivery, for example bed closures. The
first six months of 2014/15 has seen a marked increase in this
transition, however, further engagement and ownership is required
for the delivery of the IMTP.
Mitigation – The Health Board, APIG, Strategic Change
Programmes, Directorates and Localities continue to engage and
ensure ownership of the strategic transition to operational
delivery.
Culture – The newly established Service Improvement Team, which
will support the progress of the Surgical Pathway and Patient Flow
Programmes, will drive a changing culture of improvement measures
and science. This requires the culture of the organisation to
respond to a new understanding of performance management.
Organisational support for the Patient Safety and Patient
Experience Programmes in promoting a culture of timely management
and intervention, evolving from a monitoring perspective.
Mitigation – The newly established Service Improvement Team will
continue to drive the improvement culture.
Benefit Measures – Whilst there are clear benefits targeted by
the Strategic Change Programmes, the mechanisms for measurement and
monitoring vary in their strength and consideration. To determine
the success and realisation of the service changes which are
introduced, effective systems and appropriate measures are
required, with reporting aligned to the performance reporting of
the Health Board.
Mitigation – Planning, Finance, Informatics and Strategic Change
Programme leads continue to consider and build these mechanisms and
measures, such as bed reductions and patient experience feedback
and actions. Each Strategic Change Programme is required to give
further focus on the benefit measures, such as improved outcomes
for patients. This is an essential requirement for the success of
the Strategic Change Programme initiatives.
10.0 Conclusion and Next Steps Whilst progress has been made in
a number of areas, the delivery of planned savings is critically at
risk. Operational plans are continuing to be developed, however, at
present they are limited. In the absence of robust savings plans,
the investment for both current and future years is unable to move
forward. The completion of delivery plans will inform the
development of the IMTP for 2015/18, and as such should be
completed as an integrated production.
Next Steps
• Increased engagement with and ownership by the Directorates
and Localities of the Strategic Change Programmes
• Continued development of operational plans for delivery of
strategy (APIG and Operational Management Teams). These should
include the robust plans for delivery of the planned savings,
enabling the investment in current and future years.
• The operational plans for delivery should be integrated with
the IMTP for 2015/18
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• To review governance arrangements for the Strategic Change
Programmes, including the role of the Health Board and Health Board
Sub Committee. And advise the Strategic Change Programmes and SPMO
accordingly.
• To consider the endorsement of the Patient Experience
Programme commitment from the Strategic Change Fund
• To hold further investment beyond the £2m cumulative
investment, subject to transfer of the Patient Experience
commitment above, until robust operational plans for delivering
savings are in place, as agreed by the Health Board.
• For the Health Board to consider the risks and mitigating
actions as described by the Strategic Change Programmes and advise
the SPMO and Programmes of any additional action required.
• To note that an updated position to be provided to the Health
Board in March 2015.
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Changing for the Better: Integrated Medium Term Plan (IMTP)
2014-2017 – Summary Paper
CHANGING FOR THE BETTER
OUR INTEGRATED MEDIUM TERM PLAN - SUMMARY
-
Changing for the Better: Integrated Medium Term Plan (IMTP)
2014-2017 – Summary Paper
Published by: ABMU Health Board, One Talbot Gateway, Seaway
Parade, Baglan Energy Park, Port Talbot SA12 7BR. This document is
available in Welsh and a range of alternative formats including
Large Print. Please let us know if you require an alternative
version of this document by calling 01639 683311 or emailing
[email protected]
Copies of the full and summary versions of the Integrated Medium
Term Plan are also available on our website
www.abm.wales.nhs.uk.
mailto:[email protected]://www.abm.wales.nhs.uk/
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Changing for the Better: Integrated Medium Term Plan (IMTP)
2014-2017 – Summary Paper
Page | 1
August 2014
Chair and Chief Executive’s Introduction
The NHS in Wales is facing real challenges of rising demand,
increasing expectations of what health services can be provided,
difficulties in recruiting staff and limited cash.
We are clear we cannot meet these challenges by doing “more of
the same”. Working closely with our patients, citizens, staff and
other organisations, we have developed solutions to meet these
challenges. They are ambitious, innovative and are motivated by
national and local standards. They build on our successes to
transform the quality, safety and the way our services are
delivered. This plan explains how we will consistently deliver high
quality care, in the right place, at the right time, by the right
people.
This is the first time that NHS organisations in Wales have been
able to plan for the medium term – next three years - rather than
for just the year ahead. Our plan is ambitious and we will change
how we deliver healthcare, support and advise our citizens living
in Swansea, Neath Port Talbot and Bridgend and indeed more
widely.
Over the next three years we will:
We are proud of our University status and know that through
closer working with the Universities we will deliver better care
for you, our patients.
• Increasingly deliver excellent care, where people live,
instead of in hospital; when it is safer and better to do so;
• Support citizens to have more control of their own health so
that they are less dependent on the NHS;
• Create a health service that allows people and their GPs to
get advice and support from specialists without delay, if they need
it;
• Develop a community network, made up of groups of local
primary care services, who are best placed to understand local
health needs and solutions and to help halt the widening health
inequalities. This will mean increased investment to help people
personally make healthier lifestyle choices, particularly regarding
smoking and managing their weight and activity.
• Increasingly work in an integrated way with local authority,
third and voluntary sector partners to create joined up, more
efficient and effective systems of care.
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Changing for the Better: Integrated Medium Term Plan (IMTP)
2014-2017 – Summary Paper
Page | 2
This plan describes how we expect to do this and how, over the
next three years, we will change for the better, whilst using the
resources available to us responsibly in all that we do.
This summary report provides a shortened version of our three
year plan for the future of healthcare services provided by your
Health Board.
The paper describes:
• Where we want to be (our purpose, vision and aims); • The
challenges we face; • What the future looks like; • How we will
deliver the plan; and • What support is needed to deliver our plan?
• The next steps; • How you can get involved.
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About Us Changing for the Better: Integrated Medium Term Plan
(IMTP) 2014-2017 – Summary Paper
Page | 3
1 About Us Abertawe Bro Morgannwg University Health Board was
established in October 2009, as a result of merging the former
Local Health Boards (LHBs) for Swansea, Neath Port Talbot and
Bridgend and the Abertawe Bro Morgannwg University NHS Trust. The
Health Board covers a population of approximately 500,000 people
and has a budget of £1.3 billion. At the end of March 2014, the
Health Board employed 15,758 members of staff, 70% of whom are
involved in direct patient care.
We are responsible for improving the health of our communities
as well as the planning, commissioning and provision of both
primary (General Practitioner, Optometry, Pharmacy and Dental
services), and secondary (Hospital) care services. We are also
responsible for a range of community based services delivered
within patients’ own homes, community hospitals, health centres,
and clinics. In addition we provide a range of highly specialised
services such as Burns and Plastic Surgery Services (for South
Wales and the South West of England), Forensic Mental Health
Services (for the whole of South Wales) and Learning Disability
Services (Swansea, Cardiff and the Rhondda Cynon Taf and Merthyr
Tydfil areas).
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Where we want to be Changing for the Better: Integrated Medium
Term Plan (IMTP) 2014-2017 – Summary Paper
Page | 4
2 Where we want to be 2.1 Our purpose (why we exist)
Our purpose is to ‘fulfil our civic responsibilities by
improving the health of our communities, reducing health
inequalities and delivering effective and efficient healthcare in
which patients and users feel cared for, safe and confident’.
2.2 Our vision (where we want to be)
We will be an excellent healthcare, teaching and research
organisation for the ABMU area and the wider region. This means we
will:
• Respect people's rights in all that we do and plan our
services and their care with them and their carers. Wherever it is
provided, care will be delivered to a consistently high quality, 24
hours a day, and seven days a week. This means it will be safe and
compassionate, meeting agreed national standards, providing
outcomes valued by patients and citizens and an experience that is
as good as it could be;
• Make it easy for everyone to get the information and advice
they need
to be in control of their own health and to live healthier
lives;
• Work with our partner agencies to provide integrated health
and social care in or close to people’s homes:
• Support high-quality research, education and innovation that
benefit
our patients and staff. We will encourage everyone to share
their care experiences with us so that we can learn how we can do
even better.
2.3 Our Aims
In achieving our vision, we have identified six key aims:
To support our citizens to be as healthy as possible; To provide
excellent patient care and experience; To provide sustainable and
accessible services; To create strong partnerships; To promote and
develop excellence amongst staff and To develop clear
accountability arrangements.
We have used our vision and aims to help us develop our three
year plan.
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The challenges we face Changing for the Better: Integrated
Medium Term Plan (IMTP) 2014-2017 – Summary Paper
Page | 5
3 The challenges we face We are facing a number of
challenges:
Increasing demand for healthcare
The recent report on the health needs of our population shows
that: • Our population is increasing; • The number of older people
with one or more long
term conditions is increasing • More people are making poor
lifestyle choices which
have a negative effect on their health. These challenges will
increase demand for healthcare services.
Delays in people being seen in hospital
We are having difficulties assessing and treating people as
quickly as we would like.
The quality of our services varies between services and across
the days of the week
Quality is a big issue across the NHS. The tragic failings of
the healthcare provided by Mid Staffordshire NHS Foundation Trust
have led to a number of recent national reports and guidelines
being produced.
Locally the Advancing Quality Alliance (AQuA) carried out an
independent quality and safety review of the Princess of Wales
Hospital. Professor June Andrews has also led an independent review
of patient care. Both reports identified failings and
recommendations for improvement. Our Board is committed to using
these recommendations to drive forward high quality care.
Some of our services are not sustainable in the longer term
The way our hospital services are organised, across many
hospital sites and the availability of suitably qualified staff is
not sustainable and adds costs without improving quality of
care.
Our services are not joined up
We need to develop stronger networks of joined-up community
services with our partners who also