Draft - IMTP NHS Planning Framework Version 1.4 Powys Teaching Health Board Sheets C1 Outcomes Framework - Delivery of Measures C1.1 Commissioned RTT Profile C2 Bed Capacity C3 Outpatient RTT C4 IPDC RTT C5 Direct Access Diagnostics C6 Service Change C22 Recruitment Difficulties C23 Education Commissioning
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Draft - IMTP NHS Planning Framework Version 1.4
Powys Teaching Health Board
Sheets
C1 Outcomes Framework - Delivery of Measures
C1.1 Commissioned RTT Profile
C2 Bed Capacity
C3 Outpatient RTT
C4 IPDC RTT
C5 Direct Access Diagnostics
C6 Service Change
C22 Recruitment Difficulties
C23 Education Commissioning
DRAFT IMTP Profile and Performance for 2015/16 Financial Year
Number of emergency admissions for basket of 8 chronic
conditions - Powys ResidentsReduction
Number of emergency readmissions for basket of 8 chronic
conditions - Powys Residents
Public HealthAnnual
assessment
% uptake of
the influenza
vaccine in the
following
groups:
75%
95%
95% 95% 95%
95% 95% 95% 95%
% smokers treated by NHS smoking cessation services who
are CO- validated as successful40% 40% 40% 40%
95% 95%
95% 95% 95% 95%
95% 95%
2015/16 Profiles
Welsh
Government
2015/16 Target
Latest
Position
Estimated
March 15
position
Internal
Powys
2015/16
Target
STAYING HEALTHY - I am well informed & supported to manage my own
physical & mental health
Flu is measured as a cumulative figure the profile is to meet the targets set for 2015/16
Latest
Position
Estimated
March 15
position
Internal
Powys
2015/16
Target
Calendar Quarterly Subset -
Quarter 2
Calendar Quarterly Subset -
Quarter 3
Calendar Quarterly Subset -
Quarter 4
Calendar Quarterly Subset -
Quarter 1
Profile
% of reception class children (aged 4/5) classified as
overweight or obese
Only 2 data points are available for this indicator (2011/12 and 2012/13), which doesn't provide enough information to understand trends in childhood
obesity and therefore set a numerical target. However, Powys tHB is committed to reducing childhood obesity rates through a programme of work being lead
through a partnership approach via the Healthy Weight Steering Group.
Comments for Measures
Child hood vaccinations commentsThe latest COVER report has shown a downturn in performance, which may represent a true downward trend or quarterly variation. Information from Public Health Wales has been used to set immunisation
trajectories for 2015/16 as well as year end positions.
% estimated LHB smoking population treated by NHS smoking
cessation services1.1% 1.1% 1.1% 1.1%
Comments for smoking measure This is based on a Tier 1 target of 900 treated smokers.
Monthly 11.22% 10.00% Crude mortalitly will be monitored on a qualitative basis and given the nature of the case mix is not appropriate to set a specific target or profile
Monthly 103 100 RAMI 2013 will be monitored but given the nature of this measure and its relation to Powys tHB it is not appropriate to set a specific target or profile.
EFFECTIVE CARE - I receive the right care & support as locally as possible & I contribute
to making that care successful
Measure
Welsh
Government
2014/15 Target
Latest
Position
Estimated
March 15
position
Internal
Powys
2015/16
Target
Medical
Directorate
Crude Mortality - Powys Provider
Reduction
RAMI 2013 - Welsh Commissioners
Planning &
Performance
% valid principle diagnosis code 3 months after episode end
date - monthly
% valid principle diagnosis code 3 months after episode end
date - rolling 12 months
Number of NISCHR clinical research profile studies and
Commercially Sponsored studies19 non commercial and 2 commercial studies are profiled for the 2015/16 financial year
Number of Audits the organisation is participating in against the
national clinical Audit ProgrammeAs the National Audit programme for 2015/16 has yet to be announced it is anticipated that it will be very similar to 2014/15
% people aged 45+ who have a GP record of blood pressure
measurement in the last 5 yrs. Currently investigating a data source to allow profiling and reporting of the new measure
Medical
Directorate
Comments for Measures
Crude Mortality Comments
No major service developments are being planned, therefore we can expect our crude mortality rate to remain constant over the next 12 months. It should be noted that 85% of deaths in Powys hospitals are of
patients who are specifically receiving End of Life Care. 11% of deaths are of patients with known multiple morbidities who are considered to have had an unsurprising but not anticipated death whilst only 4% of
patients (<10 per annum) are considered to have had a truly unexpected death. Full review of these cases rarely results in the identification of any cases where the outcome could have been realistically altered. As
above crude mortality will be monitored on a qualitative basis and given the nature of the case mix is not appropriate to set a specific target or profile.
Audits participated commentsWith regards to audit the National Audit programme for 2015/16 has still to be announced but content will be similar to 2014/15
Participation for the year 2014/15 as follows: Note that Powys tHB participated in all the National Audits for which it was eligible to participate
-National Audit programme consists of 36 audits (counting the components of the National Diabetes Audit as one audit)
-Powys participated in 8 audits or programmes from the national list
-National Diabetes Audit – first section reported: Powys GP scored between average and above average
-National Paediatric Diabetes Audit – report to be published shortly
-All Wales Audiology audit – just started in December
-Fundamentals of Care Audit – data being extracted by nursing directorate at the moment
-Childhood Epilepsy Audit – report to be published shortly
-Sentinel Stroke audit – rehabilitation care only part
-Two “audits” are actually continual monitoring tools
-SHOT – serious hazards of transfusion
-Cardiac Rehabilitation register
% people aged 45+ who have a GP record of blood pressure measurement in
the last 5 yrs.
Currently blood pressure information is collected from Qof (BP001). The new requested measure does not relate to the current measurement which is Age 40+ for 2013/14 financial year (*latest available). The
measure for the current financial year is set at Age 50+ 2014/15 but the annual figure will not be available until the end of March 2015. Currently we are investigating a new data source to allow the measure to be
Stroke data reporting and profiling is still under development by the Health board its Providers and Welsh Government are actively pursuing a resolve. We have data that confirms that operational
standards are being met but currently we are unable to populate the stroke bundles.
TIMELY CARE - I have timely access to services based on clinical need & am actively
involved in decisions about my care
Measure
Welsh
Government
2014/15 Target
Latest
Position
Estimated
March 15
position
% of patients waiting less than 8 weeks for diagnostics
% GP practices offering appointments between 17:00 and
18:30 at least 2 days a weekImprovement
% of GP practices open during daily core hours or within 1 hour
of the daily care hours
% of patients waiting less than 26 weeks for treatment – all
specialties - Powys Provider
Number of 36 week breaches – all specialities - Powys Provider
Commissioned RTT waits profile
Therapies &
Health
Science
% compliance
with acute
stroke
bundles:
95%
% of new patients spend no longer than 4 hours in MIU
Number of patients spending 12 hours or more in MIU
% of Cat A Ambulance responses within 8 minutes
Number of over 1 hour handovers
% of patients referred as non-urgent suspected cancer seen
within 31 days (Welsh)
% of patients referred as non-urgent suspected cancer seen
within 31 days (England)
% of patients referred as urgent suspected cancer seen within
62 days (Welsh)
% of patients referred as urgent suspected cancer seen within
62 days (England)
Patients treated by an NHS dentist in the last 24 months as %
of population
Primary &
Community
Care
Please look to separate Commissioned Services RTT profile sheet
Comments for Measures
GP practice performance comments
The Health Board's responsible medical practices are experiencing difficulty in recruiting new GPs when vacancies occur. Some practices have vacancies currently which have been vacant for some time. This is
placing strain on the existing partners who are attempting to provide the service whilst being understaffed at the practice. Some practices have also experienced difficulties in recruiting replacement practice nurses.
Age profile of both GPs and practice nurses continues to be a great concern for Powys.
Diagnostic profile commentsTo meet the profile for Obstetric ultrasound we will have additional sonographer support in place by May 2015. To maintain our performance in 2015/16 with diagnostic endoscopy there will be a consultant nurse
endoscopist appointed.
Patients treated by an NHS dentist commentaryAny improvement to this figure would require additional capacity to be commissioned either via new dental practices or the increase to existing contracts. This would equate to an additional 17 dentists required to
INDIVIDUAL CARE - I am treated as an individual, with my own needs & responsibilities
Measure
Welsh
Government
2014/15 Target
Latest
Position
Estimated
March 15
position
Internal
Powys
2015/16
Target
Nursing
Directorate
% of assessments by the LPMHSS undertaken within 28 days
from the date of referral
% of therapeutic interventions started within 56 days following
assessment by LPMHSS
% of LHB residents (all ages) to have a valid CTP completed at
the end of each month
% of hospitals with arrangements to ensure advocacy available
to qualifying patients
Data not routinely available at Health Board (however QoF dementia registers in place).
DIGNIFIED CARE - I am treated with dignity & respect & treat others the same
Measure Target
% procedures postponed on >1 occasion, had procedure <=14
days/earliest convenience
Comments for Measures
% of over 65 registered as having dementia with their GP practice
The Health board currently has access to Dementia data via CMWEB interface and QOF. *The current view within CMWEB provides dementia figures without the age cutoff that is requested in the measure. NWIS
have been requested to supply the relevant data.
% of over 65 registered as having dementia with their GP
DToC delivery per 10,000 LHB population - mental health
Reduction rolling
12 monthsDToC delivery per 10,000 LHB population - non mental health
(75 years and over)
SAFE CARE - I am protected from harm & protect myself from known harm
Measure
Welsh
Government
2014/15 Target
Latest
Position
Estimated
March 15
position
Internal
Powys
2015/16
Target
Therapies &
Health
Science
Number of healthcare acquired pressure sores in a hospital
setting
Number of total cases of C Difficile per month
Number of new Serious Incidents
Reduction
Number of new Never Events
Comments for Measures
Mental Health DTOC commentary There has been an improvement this year – and the profile shows we plan to sustain it and further improve performance so it is closer to the Welsh average.
C Difficile infections have been profiled to 10 cases in total for the 2015/16 year
Number of total cases of MRSA per month
Quarterly
assessment
% compliance with patient safety solutions - alerts
Improvement
% compliance with patient safety alerts - rapid response notices
Infection Control (C Difficile and MRSA rates)
Powys Infection control lead has spoken to WHAIP (PHW) and taken Infection Prevention advice from WG as she feels its inappropriate as a HBS that we have profiles for each month going
forward. She feels that this recommendation is a blanket requirement for the other HB who are not meeting the WG target and does not apply to PtHB. Both experts were in agreement and feel that
a monthly profile is unnecessary. The WG Target for C diff is 31 per 100,000 popn. Unlike the rest of Wales, PtHB have not been set a reduction target, due to the relatively low numbers we
diagnose. PtHB rate of C diff from 1 April - 31 Dec 2014 is 7 per 100,000 according to PHW data analysis. However, I have reported a further 7 cases from across the border in January and there
could be some more from Welsh labs. Despite our cases standing at 14 in total we still fall below the national target rate.
OUR STAFF & RESOURCES - I can find information about how the NHS is open &
transparent on its use of resources & I can make careful use of them
Measure
Welsh
Government
2014/15 Target
Latest
Position
Estimated
March 15
position
Internal
Powys
2015/16
Target
Performance appraisals commentary
Although the PADR Compliance target has declined since April 2014 from its peak in March 2014 and we are currently some 17% underperforming against the tier 1 target of 85% and 22% below
our local target of 90%. Going forward into 2015-16 we should aim for 95% compliance as appraisals are one of the key enablers to staff engagement and high performance as part of the OD
strategy.
% staff absence due to sickness
% of total medical staff undertaking performance appraisals
% of total non medical staff undertaking performance
appraisals
Comments for Measures
Staff Sickness commentary
During the past 12 months WOD have been working closely with all managers to ensure that staff are being managed consistently in accordance with the sickness absence policy, focus has been
on any individuals who have more than 5+ episodes of sickness in a rolling 12 month period to ensure that they are in the sickness process. We have also concentrated on individuals who are on
long term sickness to ensure they are all being managed and in the sickness process and receiving the appropriate support to enable their return to work. This position is reviewed monthly by
WOD and followed up with relevant managers.
To compliment this work an Absence Call Back Scheme pilot project is working with hot spot areas to reduce their sickness absence, individuals are contacted on the first day of sickness to ensure
that they have the right support, an early referral to occupational health or are signposted to other appropriate agencies. This pilot has highlighted issues with timely input of sickness into ESR and
WOD have addressed these issues with the relevant managers to ensure the policies are applied. This initiative has been successful for invest to save funding. During 2015 we will be looking to
extend the pilot areas to include other hot spot areas within the organisation.
The management of sickness absence also links to the Health and Well Being agenda. The North Locality have run Mindfulness taster sessions for staff to look at ways in which to deal with
pressures or stresses in their work or personal lives. Further taster sessions are due to be rolled out during 2015 with a view to running an 8 week course for any interested participants.
The occupational health department have actively promoted the ‘flu campaign’ amongst the workforce with a encouraging take up. Further work continues to promote the campaign especially to
Assume Powys Provider secures capacity to maintain 26 weeks
Assume the performance against the 26 week target remains constant (this therefore gives us our estimate of how many Powys patients will be waiting in total which, when combined with our assumptions about the 26
week target and the long waiters, leads to our estimate of those in the 26-35 week band).
DRAFT Commissioned RTT profile for 2015/16 financial year
Assume long waiters (>36 weeks) will reduce to 0 by year end and further assume this will happen 'smoothly' over the 12 months.
Assume an alternative offer scheme will operate during 15/16 where Providers lack capacity to deliver target
Assume Commissioned services baselines are set at 2014/15 outturn to meet demand
Assume Providers are able to deliver sufficient capacity for complex cases
This profile does not yet recognise change in patient/service pathways nor change in Provider pathways
The estimate of year end position is based on average of the latest 12 months available for first 2 bands but long waiter position assumed as equal to latest month available- this to be updated as more up to date
information becomes available until such time as we actually have year end (i.e. end March 2015) position.Growth based on 3% for the year. This taken as 1/12 of the 3% each month for each of the 12 months.
average activity 2014/15 for all localities + W&C April-Dec extrapolated to full
year + 3% uplift in demand discussed via waiting list meetings ( all activity
taken from outpatient activity on IFOR, excluding AMI, old age psychiatry,
urodynamics as captured in diagnostcs, prostate nurse clinics, day hospital,
urology specialist nurse clinics, haematology clinics). Mental health clinics are
excluded since not Powys provider; others excluded since not reportable
under RTT.
2. Backlog to Deliver target
waiting time0 0 0 0 0 0 0 0 0 0 0 0 0
assume 26 weeks met in 2014/15
3. Current core capacity 14/15 2516 2516 2516 2516 2516 2516 2516 2516 2516 2516 2516 2516 30192capacity derived from 2014/15 activity (does not include 3% uplift) minus the
non recurrent capacity last year (approx 50 patients per month)
profiled for 12 months + 3% increase. Factored in 20 patients extra per month demand following
introduction of consultant nurse endoscopist for endoscopy (repatriated demand)
2. Backlog to Deliver target
waiting time16 0 0 0 0 0 0 0 0 0 0 0 16
assume some ultrasound patients waiting above 8 weeks in April - awaiting confirmation of extra sessions
3. Current core capacity 14/15 2079 2079 2079 2079 2079 2079 2079 2079 2079 2079 2079 2079 24948 activity 2014/15 - avg number of patients seen in extra sessions per month this year (16)
4. Additional recurrent capacity
for 15/160 0 0 72 72 72 72 72 72 72 72 72 648
introduce endoscopy sessions by consultant nurse endoscopist July 2015
5. Additional non recurrent
capacity 60 33 33 33 33 33 33 33 33 33 33 33 423
extra sessions for endoscopy/ultrasound needed to meet demand (based on what was needed last year
approx 16 per month) + 17 patients per month to account for increase in demand. Higher number in April
Non delivery of unscheduled care targetsInterim General Manager Mid and
South Localities
Development of Virtual
Ward/Community Resource Team
Model in Mid and North Powys
Primary Care Yes Feasibility studies underway
Design of the most appropriate model;
agreement within Locality and other
stakeholders
Project planning completed and
underwayImplementation of new model underway Ongoing implementation and review Evaluate service so far
Escalation of costs in secondary careDirector of Primary and
Community Care / USCB
Reduction in non Mental Health
DTOCsUnscheduled Care No
Scope work required to achieve 20%
reduction
deliver project plan thru USCB and
ICPOP
Monitor improvements made through
internal changes and use and effective
use of the ICF
Ensure maintenance of progress in
Winter periodOngoing implementation and review Evaluate service so far
Escalation of costs in secondary careDirector of Primary and
Community Care / USCB
Improved patient flow through
Community HospitalsUnscheduled Care No
Work underway to scope Brecon as an
example . Patient tracker in place and
escalation processes in place
Scoping of work with ABUHB and
English Trusts on optimum flow
Test out new system metrics and
performance in Brecon Commence roll out to other sites Ongoing implementation and review Evaluate service so far
Escalation of costs in secondary careDirector of Primary and
Community Care / USCBEnhanced Care Co-ordination Unscheduled Care No Initial scoping with Shropdoc underway
Develop consistent method of working
and pathways
Introduce CCC as mainstay of DGH and
Community Hospital provision
Review satisfaction with service and
effectiveness of placement thru points
prevalence
Ongoing implementation and review Evaluate service so far
Non delivery of diagnostic waiting timesInterim General Manager Mid and
South Localities
Development of sonography
services for local ultrasound
scanning
Primary Care No Business plan approved Recruitment processes underway
Training underway for any newly
recruited staff; if training posts required
detailed training scheme agreed
Ongoing training and implementation of
service
Ongoing implementation, review and
development of serviceService fully operational
Non delivery of RTTImproved access to local
diagnostics Primary Care yes Pre-pilot planning underway; pilot study
Pilot completed and evaluation
completed
Business plan completed with
recommendations to proceedProject underway as per new plan
Implementation underway; option to
procure or commission as agreed Service implementation
Failure to deliver improved patient
experienceTBC
Implementation of local
Chemotherapy serviceCancer Services No
Project planning underway; project Board
convened
Modelling work undertaken for approval
by executive team
Implementation plan devised and
underwayOngoing work as per project plan Service in place by end of year 2 Business as usual
Non delivery of RTTInterim General Manager Mid and
South Localities
Development of orthopaedics
services to include Fracture
Clinics and further development of
CMATs
Planned Care Yes
Clinical audit and evaluation of CMATs
services underway; recommendations for
development identified
Business case completed for fracture
clinics
Pathway redesign work; negotiations with
providers to secure additional sessions
required for fracture clinics; engagement
Fracture clinic service implemented by
the end of the year
New model in place and operational;
review of changesBusiness as usual
Non delivery of USC targetsLocality General Manager
supported by LGM
Refinement / Evaluation and
further development of Health and
Wellbeing Centre Models across
Powys
Primary Care yesNew model established at Bronllys
operational
Model design underway based on
feedback from changes in model at
Bronllys Hospital
Planning ImplementationHealth and Wellbeing Centre Models
implemented across SouthBusiness as usual
Non delivery of RTTLGM'S Supported by patient
service managers
Reduce incidence of DNAs at
practice level by developing the
use of texting appointment
reminders (cluster priority South)
Planned Care No Request to join NWIS pilot Ongoing Ongoing Ongoing Review position following NWIS pilot
Escalation of costs in secondary careUSC Board through Director of
Primary and Community Care
Establish same day rapid access
to secondary care
assessment/advice to support
people remaining in the
community
Unscheduled Care No Identify lead via Care Planning GroupOngoing discussion with relevant
providersProtocols agreed Access implemented
Escalation of emergency admissionsLGM / Director of Primary and
Community Care
Introduction of Lifestyle LES and a
psychological support to the
management of long term
conditions
Primary Care Yes Implementation in South Ongoing engagement with Mid Practices Ongoing engagement with Mid Practices Sign up and agreement of Mid practices Implementation underway in Mid Powys
Non delivery of USC targetsUSC Board through Director of
Primary and Community Care
introducing new ways of working
to reduce Length of Stay: new
clinical protocols specified for
rehabilitation and frail/elderly
beds; introduction of new
discharge protocols for nurses
Unscheduled Care NoDevelopment of protocols; agreement
and engagement
Protocols agreed, implementation plan
produced
Implementation underway to start to
reduce LOSOngoing implementation
Risk of failure of GP practice
Director of Primary and
Community Care/ Primary Care
Team
Review practice viability and
sustainability across Powys to
highlight high risk areas and
implement support mechanisms.
Primary Care No
Non delivery of therapy waiting timeInterim General Manager Mid and
South Localities
Implement a sustainable model
for audiology services.Planned Care Yes
Non delivery of USC targets North Locality General ManagerImplement Discharge to Assess
(D2A)Unscheduled Care Yes
Implementation of the D2A agreed three
pathways
Implementation of the D2A agreed three
pathways
Maintain Implementation of the D2A
agreed three pathways
Maintain Implementation of the D2A
agreed three pathways
Maintain Implementation of the D2A
agreed three pathways
Maintain Implementation of the D2A
agreed three pathways
Non delivery of USC targets Locality Lead Nurse
Integrated Reablement Beds to
support VW and 'Discharge to
Assess'
Unscheduled Care
and Primary Care No Finalise business case Go to contract. Implementation Implementation Maintain Implementation Maintain Implementation
Increase in respiratory emergency
admissionsLocality Lead Nurse
Redesign of Respiratory
Specialist Nursing Team &
Therapy support.
Unscheduled Care NoFinalise business case with support from
speciality lead.Consult with staff and stakeholders Implementation Implementation Implementation Implementation
YEAR 1
Primary and
Community
Care
Detailed
plan in
place
DirectorateImpact of non delivery Officer Lead
Change/Scheme Ref in IMTP
YEAR 2 YEAR 3
Q1 Q2 Q3 Q4
YEAR 1Detailed
plan in
place
DirectorateImpact of non delivery Officer Lead
Change/Scheme Ref in IMTP
North Locality General ManagerRationalisation of Local Enhanced
ICT Programme Manager Implement MtED national system ICT Yes Commission project readiness / pilot readiness / pilot implementation and completion
Non delivery would mean a core platform
for better interface between health and
social care would not be in place
ICT Programme Manager PtHb LYNC deployment ICT No Readiness Implementation
Non delivery would mean planned
clinical risk mitigation would not be in
place
ICT Programme ManagerImplement Case Note tracking in
MyrddinICT No ? ? ? ?
Non delivery would mean the core
strategy by which all ICT flows through
would not be delivered, compromising
the entire ICT strategy in Powys tHB
ICT Programme Manager Roll out Welsh clinical portal ICT No Readiness readiness / pilot
Non delivery would mean innovative
technology to support enhanced clinical
practice would not be in place
ICT Programme Manager Digital Powys tech trials ICT No Phase 3 design phase 3 trials
Finance
YEAR 2 YEAR 3
Q1 Q2 Q3 Q4
YEAR 1Detailed
plan in
place
DirectorateImpact of non delivery Officer Lead
Change/Scheme Ref in IMTP
Non-delivery as a result of not increasing
Organisational Development capacity to
support this initiative will result in
reduced pace of delivery, potential
change failure and reduced productivity
of the workforce and reduction in staff
engagement as demonstrated through
the staff survey.
Assistant Director of Workforce
and Organisational Development
Implementation of OD Strategy
and Chat to Change (staff
engagement programme) at all
levels of the organisation.
Yes
Social Media of Twitter, Facebook and
Linked In launch. Promote the changes
that have occurred, using "You said",
"This Happened" Develop Project Plan in
partnership with Chat2Change
Champions. Plan for the delivery of the
development programmes and team
based journey in light of new structures.
Commence Chat to Change forums to
progress key objectives.
Identify Board Level lead for Staff
Engagement and feature Staff
Engagement and Staff Stories as a
regular feature at board meetings.
Commence delivery of development
programmes.
Review of impact 12 months on from
Chat to Change
Continue to implement Project Plan and
achieve Chat to Change objectives ü ü
Assistant Director of Workforce
and Organisational Development
Values and Behaviour Framework
developed and used to inform
recruitment, appraisals, staff
development and ways of
working.
Yes
Values and Behaviour Framework
launched.
Redesign of appraisal materials to
support Values and Behaviour
Framework and to ensure meaningful
appraisals. Establish a project group to
implement Values Based Recruitment
across organisation and agree
approaches.
Further Values in Action products
launched. Identification of appointing
officers and develop training action plan
Further Values in Action products
launched. Training for all appointing
officers and panel members.
Further Values in Action products
launched. Training for all appointing
officers and panel members
Review of impact 12 months on. All
recruitment to be undertaken based on
Values Based Recruitment.
Review. All recruitment to be undertaken
based on Values Based Recruitment.
Assistant Director of Workforce
and Organisational Development
Launch of Leadership and
Management Core Competence
Framework. Identification and
meeting of any skills gaps (both
technical and soft skills)
YesQualifications uploaded into ESR and
skills gaps identified
Options for development to meet skills
gaps identified
Monitoring of take up of development
gaps
Monitoring of take up of development
gaps Review Framework and skills gaps Review Framework and skills gaps
Non-delivery as a result of not increasing
Organisational Development capacity to
support this initiative will result in
reduced pace of delivery, potential
change failure and reduced productivity
of the workforce and reduction in staff
engagement as demonstrated through
the staff survey.
Assistant Director of Workforce
and Organisational Development
A refreshed and more bespoke
Team Based Working programme
aligned with values and
behaviours, IQT, Managing
Change, Leadership and
Management development.
Yes
Linking together appraisal, team based
working, IQT, values and behaviour
framework with the annual planning
process and vision for the organisation 3
community areas begin their Team
Journey
3 community areas begin their Team
Journey
3 community areas begin their Team
Journey
3 community areas begin their Team
Journey Review and further roll out
Further roll out until Team Journey
implemented across the whole
organisation
Lack of a safe and sustainable workforce Deputy Director of Workforce and
Organisational Development
Implement recruitment and
retention strategy. Develop
succession planning and Talent
Management.
No
Review current status of recruitment
shortages. Review workforce profile and
identify priority areas for succession
planning. Identify opportunities for
modern apprenticeships.
Develop and implement action plan to
meet recruitment shortages. Develop
and implement action plan to support
succession planning.
Review Academy Wales
recommendations on Talent
Management.
Develop Talent Management strategy.
Implement Talent Management strategy.
Review and improve succession
planning
Review and improve Talent Management
strategy
Unable to introduce new ways of working
and upskilling of registered workforce as
a result of not developing Support
Workforce.
Assistant Director of Workforce
and Organisational Development
Develop our HCSW Strategy
based on our known priorities for
the next 3 years to: Evaluate
Band 4 posts, maximise the
potential of all support workers
within their current bands,
continue to develop support
workers according to service
priorities and needs (Credit Based
Learning), implement the NHS
Wales Skills and Career
Framework for Clinical Healthcare
Support Workers
professionalising the roles,
development for managers in
delegation and deployment of
HCSWs.
Yes
Task force to be identified to develop
HCSW strategy, undertake TNA, and
plan the implementation of the NHS
Wales Skills and Career Framework for
Clinical Healthcare Support Workers.25
Admin support workers commence the
Level 3 QCF diploma in Business
administration
Assess and review Job Descriptions in
light of NHS Wales Skills and Career
Framework for Clinical Healthcare
Support Workers. Delivery of Credit
Based Learning for HCSWs according to
TNA and service priorities. development
for managers in delegation and
deployment of HCSWs.
Delivery of Credit Based Learning for
HCSWs according to TNA and service
priorities. Review of Band 4 posts
Delivery of Credit Based Learning for
HCSWs according to TNA and service
priorities
Review of HCSW Strategy and Delivery
of Credit Based Learning for HCSWs
according to TNA and service priorities
Review of HCSW Strategy and Delivery
of Credit Based Learning for HCSWs
according to TNA and service priorities
Unable to repatriate services and deliver
care closer to home Deputy Director of Nursing
Develop Advanced Practitioners
in the following fields 1. CMATS
(Clinical Musculo-Skeletal
Assessment Treatment Service)
Physiotherapy
2. Stroke and Neuro-rehabilitation
3. Paediatric and 14+
Physiotherapy Service
4. Cardiac and Heart Failure
Service
5. Continence and Urology
6. Diabetes Service
7. Lymphoedema Nurse Services
8. Minor Injury Services
9. Parkinson’s Service
10. Respiratory Service
11. Tissue Viability
12. Primary Care
Yes
Expressions of interest by appropriately
qualified (Educated to master’s module
level) staff from within these services
who are already working at band 7
The first cohort of between 6 and 12
selected applicants are supported
through an Action Learning Set to
develop their personal Advanced
Practice Portfolio
Ongoing review, monitoring and rollout Ongoing review, monitoring and rollout Ongoing review, monitoring and rollout Ongoing review, monitoring and rollout
Lack of a safe and sustainable
workforce. Patient safety and increase in
admissions to acute hospitals
Deputy Director of Workforce and
Organisational Development
Primary Care Recruitment -
Support GP practices to recruit to
hard to fill vacancies in GPs and
Practice Nurses. Explore possible
alternatives of Physician
Associates and development of
Advanced Practice Roles for
Nursing. Co-ordinate the Primary
Care Workforce Development
Group.
Yes
Implement GP recruitment campaign.
Further investigate the feasibility and
benefits of employing Physician
Associates - Site visit to Birmingham GP
practice to view Physician Associates
working in Practice. Working with Cardiff
University to give opportunities to
trainees to experience rural medical
practice - 300 trainees to visit Powys.
Ongoing support to explore and develop
Primary Care recruitment strategies and
campaigns.
Ongoing support to explore and develop
Primary Care recruitment strategies and
campaigns.
Ongoing support to explore and develop
Primary Care recruitment strategies and
campaigns.
Review support and development of
Primary Care recruitment strategies and
campaigns.
Review support and development of
Primary Care recruitment strategies and
campaigns.
Deputy Director of Workforce and
Organisational Development
Attendance Management ensure
consistent application of Sickness
Policy and associated policies to
ensure employees are supported
to maximise their attendance at
work
Yes
Implement revised All Wales Policy and
devise training programme
provide a case conference approach to
sickness.
Extend Absence Call-back pilot areas to
establish more tangible data to
undertake an evaluation of the scheme.
Implement training programme on
sickness policy in partnership with Trade
Union and Occupational Health.
Undertake an evaluation of the Absence
Call-back scheme to assess viability to
extend to whole organisation.
Monitor and evaluate Monitor and evaluate Review Review
Deputy Director of Workforce and
Organisational Development
Refocus work of WBaW group
aligning to the Health and
Wellbeing and OD strategy.
Yes
Alignment of the OD Strategy with the
Health and Wellbeing work stream.
Focus groups established. Seek bids
against £15000 funding for wellbeing at
work activities. Self assessment of Gold
standard
Focus groups to meet bi-monthly and
feed in to Well Being at Work Group.
Health and Wellbeing Roadshows pan
Powys. Formal revalidation of Gold
Standard
Ongoing. Maintain Gold standard and
working towards Platinum.
Ongoing. Maintain Gold standard and
working towards PlatinumOngoing. Achieve Platinum standard Ongoing. Maintain Platinum standard
Workforce & OD
YEAR 2 YEAR 3
Q1 Q2 Q3 Q4
YEAR 1Detailed
plan in
place
DirectorateImpact of non delivery Officer Lead
Change/Scheme Ref in IMTP
Staff not working in efficient ways which
may compromise their capacity to deliver
services to patients
Deputy Director of Workforce and
Organisational Development
To fully realise the benefits from
full deployment of electronic
systems, in particular Electronic
Staff Record (ESR) and ESR 2
including Self Service and
Manager Self Service and ensure
integration with other systems and
OD work
No Implementation plan Start rollout Continue rolloutComplete Manager Self Service by
March 2016Completion
Ineffective deployment of staff Deputy Director of Workforce and
Organisational Development
Development of a business case
and implementation plan for e-
Rostering
No Appoint project team Undertake procurement exercise Establishment of implementation plan Commence rollout Continue rollout Complete
Director of Workforce and
Organisational Development
Implementation of the
Organisation Partnership
Development Programme to
support the One Plan.
Yes
Scope 3 projects exploring an integrated
approach across Health Board and
County Council. 1) Shared corporate
services commencing with Workforce
and OD. 2) Leadership and Management
development and Talent Management.
3) Staff engagement.
Review recommendations from projects
and develop implementation plan.Ongoing Ongoing Ongoing Ongoing
Communications officer
Communication strategy
implementation
YesCommunications plan agreed by board.
Implimentation has begun.
Web redevelopment project is underway.
Branding guidelines are in draft format
for presentation to Executive team.
Communications strategy will be written
after the completion of the Web and
branding sections of the plan
ongoing ongoing ongoing ongoing
Very limited capacity available to develop
relationships, put in place systems and
provide robust assurance on the quality
and safety of care provided by
commissioned services to Powys
residents. Will not be sufficient to allow
improvement in services and meet
current and future targets.
Quality and Service Improvement Risk
Assistant Director Quality and
Safety
Development of organisational
capacity to support delivery of
quality and safety monitoring to
allow improvement in services
and meet current and future
targets.
yes No
Complete role evaluation and go out to
recruitment for senior clinical quality and
patient safety data analyst post
Appoint senior clinical quality and patient
safety data analyst
Review existing processes for gathering
and analysing data
Put in place improvements to strengthen
processes working alongside the
Information department
No strategic vision and direction on
patient experience for staff, patients,
visitors and other stakeholders. No
recognised approaches to patient
experience activity and risk of
inconsistent approaches being applied.
Reputational risk
Assistant Director Quality and
Safety
Finalise the Patient Experience
Strategy and Supporting
Implementation Plan
yes No Produce a framework to structure the
strategy.
Develop an implementation plan
engaging with service users and
representative groups
Board approval of the Patient
Experience Strategy and Implementation
Plan
Report progress to the Board Annual Report on Patient Experience
Annual Report on Patient Experience
Review Strategy and implementation
plan
Patient experience surveys and activity
cannot be relied upon, will affect validity
and accuracy of results and will not be
able to benchmark improvements.
Reputational Risk
Assistant Director Quality and
Safety
Produce a framework to use for
patient experience survey work
and data collection
yes No Engage individuals with research and
evaluation skills
produce a framework to use for patient
experience and survey work
Appendix the framework to the Patient
Experience Strategy prior to Board
approval
Introduce the framework to Localities/
Service Directorates
Review the framework and its impact on
the patient experience agenda
No mechanism to challenge
performance of providers and take
action.
Quality and Patient Safety Risk; financial
risk
Assistant Director Quality and
Safety
Pilot the commissioning
performance framework and
escalation plan
yes Yes
Finalise the development of the draft
commissioning performance framework
and escalation plan
Pilot the framework and escalation plan
with Localities/ Service Directorates
Review outcome of pilot and put
improvements in place
Implementation of finalised framework
and escalation plan
Review effectiveness of framework and
escalation plan
Build on the learning from Year 1
Share the learning
Review effectiveness of framework and
escalation plan Build
on the learning from Year 2 Share
the learning
Potential HSE enforcement actions as
current model of health & safety may not
be ‘fit for purpose’; potential increase in
incidents, complaints and personal injury
claims could lead to financial loss
Patient and staff safety risk; financial risk
Assistant Director Quality and
Safety
Appoint an external consultant to
advise on a health and safety
model that befits the needs of the
Health Board
yes No Review applications and arrange for
panel to select external consultant
Appoint external consultant and identify
start date Liaise
with HSE to keep them informed of
progress with appointment as discussed
in January 2015
Monitor work undertaken and provide
regular updates to the Board and
Executive Team
Provide the final report to the Board Implement actions as agreed at Board Monitor and review arrangements put in
place
Risks to the Health Board and Powys
residents of no infection control doctor
means no clinical support to deal with
issues relating to healthcare associated
infections, outbreak management,
building risks, decontamination, policies
and procedures, etc. The Health Board
operating in a vulnerable state.
Quality and Patient Safety risk, financial
risk; reputational risk.
Assistant Director Quality and
Safety
Finalise the arrangements with
Public Health Wales to secure
and implement microbiology
support to provide medical advice
on infection prevention & control
issues
yes Yes
Finalise the Service Level Agreement
with Public Health Wales for 3 sessions
for medical support. Agree a start
date for the SLA.
Put a paper to the executive team to
seek approval of funding for 1 session
for antimicrobial stewardship support.
The named infection control doctor to
participate in infection prevention and
control (IP&C) committees
Ongoing engagement of the named
infection control doctor in developing and
delivering on the IP&C agenda
Review the SLA and its delivery prior to
securing service for Year 2
Review the SLA and its delivery prior to
securing service for Year 3
Review the SLA and its delivery prior to
securing service further
Not able to work towards a centralised
approach to management of records or
able to work towards long term goal of
electronic records. Risk of ICO fines.
Quality and Patient Safety Risk; financial
risk
Assistant Director Quality and
Safety
Appoint a Project Manager to take
forward the records appraisal and
develop a business case
proposing solutions for managing
patient’s medical records.
yes Yes Seek funding to support project manager
role recruit project manager complete records appraisal
develop solutions for management of
medical records in conjunction with
Powys County Council
paper to Board outlining solutions for
approval
take forward preferred solution
Monitor and review arrangements put in
place
Workforce & OD
Therapies &
Health Sciences
YEAR 2 YEAR 3
Q1 Q2 Q3 Q4
YEAR 1Detailed
plan in
place
DirectorateImpact of non delivery Officer Lead
Change/Scheme Ref in IMTP
ReProvision of Pharmacy
distribution service - resolving
WDA issue
Medicine Use and
PrescribingNo mapping option appraisal planning for preferred option planning for preferred option commence implementation ongoing
Pharmaceutical support for
discharge
Medicine Use and
PrescribingNo Engagement with stakeholders Engagement with Stakeholders Options and Model agreed Planning/training for implementation Implementation
Ward support for Medicines
Management Issues, including
MTeD and Trusted to Care
response
Medicine Use and
PrescribingNo Engagement with Stakeholders Options and Model agreed Planning/training for implementation Implementation
Integrated Pharmaceutical Care -
Rural Model
Medicine Use and
Prescribing &
Primary Care
No Engagement with Stakeholders Options and Model agreed Planning/training for implementation Implementation
Pharmaceutical Needs
AssessmentPrimary Care No
Discussion with WG, HBs to determine
model
Discussion with WG, HBs to determine
modelPlanning/training for implementation pilot work Implementation
Pharmacy support for Mental
Health Service
Medicine Use and
PrescribingNo Engagement with Stakeholders Business case Planning/training for implementation pilot work Implementation
Empower patients through Self
administration within hospital
wards
Medicine Use and
PrescribingNo
Bid for funding for Patients Own
Medicines Lockers
Follow up invest to save bid for
pharmacy supportPlanning/training for implementation installation of lockers Implementation
Clinical Pharmacy 'at a distance'
for wards
Medicine Use and
PrescribingNo
Finalise plans, bid for relevant resources,
including scanning equipment, options
appraisal
Implementation plans,
installation/recruitment/contractingPlanning/training for implementation implementation snagging/ongoing
Develop medicines support
mechanisms for patients in cared
for environments
Medicines Use and
Prescribing/Elderly
Care
No
Develop plans with AHPs, Comm
Pharmacy, Social Services, for
appropriate models, including shared
budgets
Implementation plans,
installation/recruitment/contractingPlanning/training for implementation implementation snagging/ongoing
Corporate
Governance
Failure to govern the organisation,
escalation of concerns to WG by
inspectors/auditors, reputational
Corporate Governance ManagerImplement a Governance
Improvement Programme
Stewardship &
Governance No
Non delivery of strategic service changeAdult Mental Health Services NHS
Management Arrangements Yes
Phase 2 plan initiated. LTAs revised;
revised Mental Health Committee
arrangements subject to Feb Board
decision
TUPE consultationPotential transfer of NHS staff within
existing NHS structures
Finalise integrated management
structure with PCC
NHS arrangements needed for agreed
service model and integration
Escalation of costs in secondary care
Improve arrangements for people
with continuing and complex
mental health care needs
Yes
Develop "framework approach";
establish local /core service solutions
approach ; Director panel for exceptions;
separate out s117/low secure/joint
expenditure & benchmark with other
HBs; FNC reviewer; management of
integrated s117 register.
Proposed "framework approach" agreed
Local and core service solutions for
patients; improved governance and
financial control.
Continued in-equity in service provisionRe-commissioning of third sector
servicesNo
Re-commission PAVO (brokerage);
agree joint commissioning for 4th
tranche; consultation on revised APB
strategy & continue to strengthen
governance
Revised APB specification Recommissiong of alcohol and
substance misuse services
All-Wales commissioning for
independent advocacy
Services in line with strategy; new model;
and strengthened governance
Non delivery of Mental health targetsImplement on-line CBT plan;
implement Part 1 plan Yes
Implement on-line CBT plan; implement
Part 1 plan
Implement on-line CBT plan; implement
Part 1 plan
Implement on-line CBT plan; implement
Part 1 plan
Implement on-line CBT plan; implement
Part 1 plan Compliance with Part 1 targets
Non delivery of Mental health targets
Integrated training in place
including voice of people using
services
YesIntegrated training in place including
voice of people using services
Extend "Team Around Family " approach
from CYPP to adults
Part 2 compliance; person centred care
and treatment planning
Escalation of costs in secondary careMaximise flexibility of bed use in
Powys for Powys residentsYes
Prepare for Powys management of beds
and policies Aim to reduce from 8% to 4%
Poor physical health for people with
mental health issues
Improve physical health needs of
mental health patientsNo Implement salaried GP pilot Implement salaried GP pilot Evaluation
Non delivery of improved waiting timesExtend the use of psychological
therapies Yes
Finalise proposal for psychology waiting
list initiative; consider roll-out of co-
production approach
Revise NHS management arrangements Improved psychology waiting times
Increased dependancy on health
services
Improve the health of people with
dementiaYes
Implement agreed plan; develop
proposals for home based assessment
team
Higher rates of suicide and self harm Reduce suicide and self-harm Yes Revise Talk To Me
General Practitioners recruitment to certain practices; Emergency Nurse Practitioner - Band 6
Health Care Scientists
Medical & Dental including
Primary Care
CAMHS, Care of the
Elderly and GP's
Consultant
and GPs
Medical & Dental – The roles in Medical & Dental, Primary and Secondary care that are currently experiencing recruitment difficulties are Consultant CAMHS, Consultant Care of the
Elderly and GP’s. There is definitely a national shortage of doctors and therefore recruitment of doctors is a national issue.
REASONS - Some reasons for this are:
1. National lack of doctors finishing their higher training in the speciality
2. Training schemes are a long way away, doctors tend to be geographically settled when they end their training, so see Powys as inaccessible
3. Training occurs in cities. No confidence in working in rural areas so do not apply.
4. Worries about being isolated and no local training opportunities, so doctors never find out that it is good to work here. No one has heard of Powys.
5. Lower consultant pay in Wales
6. Worries about the need to speak welsh
7. If we got to the stage when someone was applying (CAMHS post - which we did not) the poor estate facilities for offices and patients would put people off
8. In south Wales there is an assumption that Powys is an unattractive place to work. This is sometimes based on evidence (eg accommodation issues above) but it is wider than
that and the same issues are not picked up in north Wales. However all the training in Wales is based around Cardiff and Swansea, so the Welsh trainees do not consider working in
Powys
9. Not enough experience and exposure to rural medical practice. (GPs). 10.
No support provided to partners/families of medical staff wishing to relocate to Powys - partner needs to find own employment if relocates to Powys, children move schools etc
11. Need for incentives packages to encourage medical staff to relocate to Powys e.g increased study leave funding, help paying student debt, sponsorship/scholarships
12. Increased marketing of Powys as a place to work and live
IMPACT - Impact is likely to be:
1. More patients have to travel out of county for their care
2. Slower rate of development of services as consultants bring a leadership capability
3. The more ill and riskiest children get much poorer care as consultants are better at assessing complex situations and managing risk. This can also lead to more inpatient
admissions (CAMHS)
4. Impact on the multidisciplinary team. Children’s mental health can feel lonely and scary if there is not someone who will take ultimate responsibility for a patient. There is a risk
that recruitment issues will then become apparent within the CAMHS team (CAMHS)
5. Children who need medication may not get it. We do now have a nurse prescriber, but there will be some children needing medication who she is not skilled to see (CAMHS)
6. Reduced breadth of training of medical students on their community and psychiatric placements. This will worsen the issues about recruitment into the speciality and reduce the
opportunity to see that rural medicine is exciting and fulfilling. (CAMHS)
7. Lost opportunities to influence the national health agenda, leading to Powys being increasingly overlooked.
In the below box, please specify any posts or specialties that you consider to be having difficulty in recruiting to that does not fit into the definition given above, or any post/specialty that you foresee will be difficult to recruit to in the future:
Shortage of registered nurses to recruit into certain geographical areas within Powys, agency nurses have been used to fill the shortfall in some areas.
Allied Health ProfessionalsPhysiotherapy -
Community 5 - 7 National shortage of Physiotherapists, applicant numbers has significantly dropped
Additional Professional,
Scientific & Technical
In the below section, a recruitment difficulty is defined as a post or specialty which you have advertised for recruitment more than once, with no appointment having been made due to:
• no applications being received;
• no suitable candidates being identified from those who did apply; or
• an offer of recruitment being turned down by the successful candidate.