Bundel of Health Board - Public on 23 June 2016 1 OPENING BUSINESS & EFFECTIVE GOVERNANCE 1.1 16/108 Chair's Introductory Remarks 1.2 16/109 Apologies for Absence 1.3 16/110 Declarations of Interest 1.4 16/111 Draft Minutes of the Health Board Meeting held on 19.5.16 for Accuracy, Matters Arising and Review of Actions 16_111.2 Summary Action Plan Public_ live v58 10.6.16.doc 16_111.1 Minutes Board 19.5.16 Public v0.03 draft.doc 2 ITEMS FOR CONSENT 2.1 16/112 Summary of In Committee Board business to be reported in public 16_112 Items in committee reported in public.docx 2.2 16/113 Documents Signed Under Seal – Update 16_113 Documents signed under Seal June 16 Board.doc.docx 2.3 16/114 Welsh Language Services Annual Monitoring Report 2015-2016 16_114 BCUHB Welsh Language Services Annual Monitoring Report 2015-2016.doc 2.4 16/115 Committee and Advisory Groups Chairs’ Reports 16_115.1 F&P Chairs Report 26.4.16.pdf 16_115.2 Chair's Assurance Report RaTS 16.5.16 V1.0.pdf 16_115.3 LPF Advisory Group Chairs' Report 11.4.16 v1.0.pdf 16_115.4 Chair's Assurance Report Audit 31.5.16 V1.0.pdf 16_115.5 Chair's Assurance Report QSE 10.5.16 V1.0.pdf 3 FOR DISCUSSION 3.1 16/116 Special Measures Improvement Framework – Task & Finish Group Chair’s Assurance Report 2.6.16 16_116 Chair's Assurance Report SMIF T&F 2.6.16.doc 3.2 16/117 Integrated Quality & Performance Report 16_117 IQPR revised.pdf 3.3 16/118 Finance Report – Month 1 16_118 Finance Report Month 1- Final 16th May 2016.docx 4 CLOSING BUSINESS 4.1 16/119 Date of Next Meeting - 21.7.16, Venue Cymru, Llandudno
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Bundel of Health Board - Public on 23 June 2016
1 OPENING BUSINESS & EFFECTIVE GOVERNANCE
1.1 16/108 Chair's Introductory Remarks
1.2 16/109 Apologies for Absence
1.3 16/110 Declarations of Interest
1.4 16/111 Draft Minutes of the Health Board Meeting held on 19.5.16 for Accuracy, Matters Arising and Review of Actions
16_111.2 Summary Action Plan Public_ live v58 10.6.16.doc
16_111.1 Minutes Board 19.5.16 Public v0.03 draft.doc
2 ITEMS FOR CONSENT
2.1 16/112 Summary of In Committee Board business to be reported in public
16_112 Items in committee reported in public.docx
2.2 16/113 Documents Signed Under Seal – Update
16_113 Documents signed under Seal June 16 Board.doc.docx
2.3 16/114 Welsh Language Services Annual Monitoring Report 2015-2016
16_114 BCUHB Welsh Language Services Annual Monitoring Report 2015-2016.doc
2.4 16/115 Committee and Advisory Groups Chairs’ Reports
16_118 Finance Report Month 1- Final 16th May 2016.docx
4 CLOSING BUSINESS
4.1 16/119 Date of Next Meeting - 21.7.16, Venue Cymru, Llandudno
Ka109599
Typewritten text
10.00am, Catrin Finch Centre, Glyndwr University, Wrexham
1.4 16/111 Draft Minutes of the Health Board Meeting held on 19.5.16 for Accuracy, Matters Arising and Review of Actions
1 16_111.2 Summary Action Plan Public_ live v58 10.6.16.doc
1 Summary Action Plan – Health Board – arising from meetings held in public
HEALTH BOARD SUMMARY ACTION LOG – ARISING FROM MEETINGS HELD IN PUBLIC
Lead Executive / Member
Minute Reference and Action Agreed Original Timescale Set
Update Action to be closed
17.3.16:
C Wright 16/54.5 – provide a briefing note on the Welsh language Team capacity, following publication of the operational plan
29.4.16
31.5.16 A briefing note was circulated on 6.6.16 Closed
21.4.16:
A Thomas 16/68 – arrange for All Wales Blood Service monitoring report to be submitted to QSE Committee, outlining whether any of the risks originally identified have come to fruition (after the service has been running for 6 months)
1.12.16 Raised at the AWBS stakeholder meeting – will report back to QSE in December 2016. Added to QSE cycle of business.
Closed
JM Jones 16/70.2.3 – Use the Engagement Strategy approved 21.4.16 as a model document to develop a Staff Engagement Strategy
29.7.16 Further discussion has taken place at the Committee Business Management Group and it has been agreed that the draft strategy will be taken to SPPH in July prior to Board in August. Capita have been appointed to assist with the development of the strategy.
JM Jones 16/71.2.7 – add total numbers to the core mandatory training compliance chart in the IQPR
6.6.16 The Workforce & OD team has collated the data and the Performance team will have put in place arrangements for this to be routinely included in the IQPR from July/August
M Olsen 16/71.2.7 – provide a briefing on readmissions
23.6.16 Will be submitted to the QSE Committee. Added to QSE cycle of business
Closed
19.5.16:
M Walker 16/85.2 – arrange for a timetable to be produced setting out when R&D opportunities for clinical research
23.6.16 Dr Walker has requested the information – in hand.
2 Summary Action Plan – Health Board – arising from meetings held in public
facility/strategy will be brought back to the Board via the Committee structure
V Morris 16/88.1 – circulate Prof B Duerden’s report to Board members
23.5.16 Circulated 20.5.16 Closed
G Lang 16/90.5 – complete further work on the performance monitoring/public facing aspects of the Operational Plan
23.6.16 Performance monitoring of items not covered by the Integrated Quality & Performance Report to be reported to the Strategy, Partnerships & Population Health Committee in July. Public facing document currently being drafted.
C Wright 16/91 – arrange for special measures pages on website to give prominence to End of Phase 1 Report
23.6.16 Completed – added to website page: http://www.wales.nhs.uk/sitesplus/861/page/81806
Closed
G Lewis-Parry
16/91 – update Special Measures End of phase 1 Report and arrange submission to Welsh Government
20.5.16 Updated document submitted 20.5.16 Closed
P Higson / G Doherty
16/92.2 – review the governance aspects of the SSWB/WFG Acts
23.6.16 Dr Higson will be leading a programme of work jointly with the Chief Executive of Conwy Local Authority to review partnership governance.
Closed
JM Jones 16/94 – re-circulate the recent report on sickness absence
23.6.16 Re-circulated 25.5.16 Closed
B Cuthel 16/95 – provide further information on the actions to be taken to develop a separate learning disabilities strategy
23.6.16 The development of the strategy has involved a wide range of stakeholders including staff from Learning Disabilities . Whilst the overarching strategy will be underpinned by a common set of priorities, these will be reflected differently in the new models of care for the different client groups within Mental Health and Learning Disabilities across the life cycle. It is anticipated that the strategic review will deliver clear priorities for each client group across health and Social Care and this will include the range of services for children and adults with learning disabilities. There is a well- developed Regional partnership for children and adults with Learning Disabilities which will play a key role in informing these priorities.
Closed
V58 10.6.16
2 16_111.1 Minutes Board 19.5.16 Public v0.03 draft.doc
Minutes Health Board 19.5.16 V0.03 draft Public session GLP PH comments 1
Betsi Cadwaladr University Health Board (BCUHB)
DRAFT Minutes of the Board Meeting held on 19.5.16
in Neuadd Reichel, Bangor
In Attendance: Mrs L Jones Translator, staff, observers and members of the public.
Head of Corporate Affairs, Office of the Board Secretary
Present:
Dr P Higson (PH) Chairman
Cllr C Carlisle Mr J Cunliffe Ms B Cuthel (BC) Ms J Dean
Independent Member Independent Member Interim Director of Primary, Community & Mental Health Strategy Independent Member
Mr G Doherty (GD) Cllr P Edwards Mr R Favager
Chief Executive Associate Board Member - Chair, Stakeholder Reference Group Executive Director of Finance
Cllr B Feeley Mrs M Hanson
Independent Member Vice-Chair
Mr JM Jones (JMJ) Mr G Lang (GL) Mrs G Lewis-Parry
Executive Director of Workforce & Organisational Development Executive Director of Strategy Board Secretary
Ms L Meadows Independent Member
Mrs V Morris (VM) Ms M Olsen
Interim Executive Director of Nursing, Therapies & Health Sciences Chief Operating Officer
Prof M Rees Mrs B Russell-Williams Mr C Stradling Ms N Stubbins
Associate Board Member - Chair, Healthcare Professionals Forum Independent Member Independent Member Associate Member ~ Local Authority (part meeting)
Mr A Thomas Assistant Director ~ Therapies and Health Science (part meeting)
Dr M Walker (MW) Mr C Wright (CW)
Interim Medical Director Director of Corporate Services
Agenda Item
Action
16/81 Chairman’s Introductory Remarks Dr Higson opened the meeting and welcomed those present, in particular Mrs Russell-Williams following her recent illness. Mrs Russell-Williams was pleased to report that she had received excellent care at Ysbyty Gwynedd. Dr Higson also reminded those present of the events taking place to celebrate Equalities Week, such as running up the rainbow flag at each main hospital site.
16/82 Apologies for absence
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Apologies were received from Mrs MW Jones, Prof J Rycroft-Malone and Mr A Jones.
16/83 Declarations of Interest There were no new declarations of interest.
16/84 Draft minutes of the Health Board meeting held on 21.4.16 16/84.1 Accuracy The minutes were approved as a correct record. 16/84.2 Matters arising and review of actions The action plan was reviewed and updated accordingly. Ms Olsen noted that the readmissions briefing referred to under item 71.2.7 would be submitted as a paper to the Quality, Safety & Experience Committee.
16/85 Presentation: Research & Development (R&D) 16/85.1 Dr Nefyn Williams and Dr Lynne Grundy attended to give this presentation, covering the reasons for conducting research, the current position, funding, key areas of research, ambitions and challenges. They concluded by stating that they were seeking commitment to R&D from the Board, a visible dedicated clinical research facility and also strengthened links to Bangor University. Board members questioned Dr Williams and Dr Grundy and commented on a range of topics. These included the impact of reducing referral and treatment delays, R&D links to prudent healthcare, the need to share examples of good practice particularly in primary care research, raising the profile of R&D in North Wales, income generation resulting from R&D, national work regarding introducing an academic element into clinical jobs, promoting multidisciplinary research, the specification for the proposed clinical research facility and the potential for management research and joint projects with Local Authorities. 16/85.2 Dr Higson stated that the new R&D Strategy referred to would need to come to the Board via the Strategy, Partnerships & Population Health Committee in due course. Mr Doherty acknowledged the importance of training staff in R&D and innovation, although he added that there were challenges relating to the request for space to house a clinical research facility. He explained that the costs and benefits of a dedicated facility would need to be considered alongside other requests for additional space for different purposes across the organisation. He concluded that the Board was committed to R&D and would welcome exploration of the opportunities for a clinical research facility. Dr Higson stated that a timetable setting out when the R&D Strategy would be brought back to the Board and how it would integrate with other strategies was required. Dr Williams and Dr Grundy were thanked for attending and they left the meeting.
MW
16/86 Update of the Mental Health Act 1983 as amended by the Mental Health Act 2007 Register (All Wales) Section 12(2) Approved Doctors and Approved Clinicians (Wales) Directions 2008
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16/86.1 Section 12(2) Approved Doctors This item was ratified. 16/86.2 Approved Clinicians This item was ratified.
16/87 Standing Orders amendments Mrs Lewis-Parry presented this agenda item. The amendments listed were ratified, with the exception of the third entry (Table A, 11u) which it was agreed should have listed the Director of Workforce & Organisational Development as having delegated and operational responsibility for the Voluntary Early Release Scheme, but with the Director of Finance responsible operationally for sign-off of the financial viability aspect. It was noted that further changes would be made in due course to reflect the evolving organisational structure.
16/88 Update on the Prevention & Control of Infections 16/88.1 Mrs Morris presented this agenda item. She explained that Prof B Duerden’s latest report would be submitted to the July Board meeting, following scrutiny by the Quality, Safety & Experience (QSE) Committee in June. Dr Higson commented that this seemed to be a long timeframe and he was keen to get the report into the public domain. Mr Doherty responded that he would expect the improvement actions identified in the report to be well underway by the time it was presented to the Board. It was agreed that, in the interim, the report would be circulated to Board members for information. 16/88.2 Cllr Feeley expressed disappointment regarding the continuing over-prescription of antibiotics referred to in the update. Dr Higson responded that the key issue was what the Board needed to do to get to where it wanted to be. Cllr Carlisle expressed concerns relating to mandatory training, which she observed had not shown sufficient improvement. Mrs Morris agreed that mandatory training was an issue of concern that required significant improvement. To this end, steps were being taken to support individual access to computers so that e-learning could be undertaken. 16/88.3 Mrs Hanson stated that the update presented should be viewed in its proper context. She pointed out that infection prevention and control was not simply about MRSA and similar infections, as it also involved wider population issues such as responding to the ebola virus. Some actions that needed to be taken were outwith the Health Board’s gift. She concluded that the Health Board only had a small team to deal with such issues, however the situation was set to improve as there were plans to fill the gaps in capacity over the next few months. She suggested that the QSE Committee should receive regular reports on the prevention and control of infection. Following discussion, the update was noted.
VM VM
16/89 Committee and Advisory Group Chairs’ Assurance Reports 16/89.1 Finance & Performance Sub-Committee 23.2.16
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This report was noted. Cllr Carlisle queried where discussions regarding minor injury units were taking place. Ms Olsen confirmed that this was part of planning for the future. In response to Cllr Feeley, Mr Favager stated that budget holders had been given a deadline of 20.1.16 to sign off accountability agreements. 16/89.2 Finance & Performance Committee (extraordinary) 8.3.16 This report was noted. 16/89.3 Finance & Performance Committee 22.3.16 This report was noted. 16/89.4 Audit Committee 15.3.16 This report was noted. In response to Mr Stradling, who drew attention to the risks and concerns section of his report, Mrs Hanson stated that the Special Measures Improvement Framework Task & Finish Group had recently discussed the issue of ensuring completion of all actions from historic governance Audit reports. Committee Leads had been asked to work with Executives to confirm that all loops had been closed. 16/89.5 Charitable Funds Committee 14.3.16 This report was noted. 16/89.6 Quality, Safety & Experience (QSE) Committee 8.3.16 This report was noted. 16/89.7 QSE Committee 12.4.16 This report was noted. 16/89.8 Remuneration & Terms of Service (extraordinary meetings) 3.3.16 and 7.4.16 This report was noted. 16/89.9 Healthcare Professionals Forum 22.1.16 This report was noted. 16/89.10 Local Partnership Forum 10.12.15 This report was noted. 16/89.11 Stakeholder Reference Group 7.3.16 This report was noted. In response to Cllr Feeley who queried whether the groups connected to the SRG were the right ones and whether there were sufficient numbers, Cllr Edwards stated that he and Mr Wright were currently reviewing the membership. An
Minutes Health Board 19.5.16 V0.03 draft Public session GLP PH comments 5
issue with Local Authority attendance remained, however progress was being made.
16/90 Annual Operational Plan - summary of key deliverables 2016/17 16/90.1 Mr Lang presented this agenda item. He explained the background to the submission of the final draft of the full Plan to Welsh Government and subsequent circulation of the document to Board members. It was felt that a summary document would be helpful to focus on the key areas of health improvement and inequality, resilience in primary care and community services, with a clear focus on quality and safety. Evidence of improvement was necessary and the summary of key deliverables needed to capture the main actions and milestones. Mr Doherty added that the summary document was required as the main Plan was such a large document. He stated that clarity was required on unscheduled care as that pathway represented the biggest challenge. 16/90.2 Dr Higson stated that there was a process for keeping track of progress in 2016/17. The Executive would use the long version of the Plan and would report quarterly through the Committee structure. Cllr Edwards suggested adding the 11 improvement areas to the spreadsheet at the back of the document. Mr Lang explained that the indicators were taken from Welsh Government core data sets, however he agreed to review the chart and consider distilling the information and show it in a slightly different way. In response to Mrs Meadows, Mr Doherty explained that elements of the Social Services & Wellbeing Act and Future Generations Act were covered in the main Plan. Mrs Hanson stated that the essence of the document should be turned into a separate document that the population could use for holding the Health Board to account. She added that the document needed to explain to members of the public what difference the Plan would make to their health and that of their families. In addition, it needed to set out ways of measuring improvements. Mrs Hanson emphasised that this transparency would be an important step in regaining public trust. She also stated that jargon should be avoided, as should any language that potentially stigmatises particular groups of patients. Dr Higson concurred that there was a need to translate both documents into a narrative for the public, containing statements such as ‘the Board will...’ 16/90.3 Mrs Russell-Williams pointed out that there was a key role for groups and communities in delivering new services and it was important to involve them. The third sector was also key to delivering services differently, however she was not sure that the Plan documents gave adequate detail on how the challenges would be met, although she welcomed the commitment to being clear on progress to the public. Dr Higson stated that the Health Board did not as yet have a longer term strategic plan or objectives. However, high level goals had been agreed and these were sufficient for the time being in order to develop the strategic vision. Mr Doherty stated that the Health Board would need to move towards 3, 5 and 10 year planning cycles, but the current document covered just the current year. Cllr Feeley commended the holistic approach set out in the document. Dr Higson stated that he believed the current document to be a good summary. 16/90.4 Mr Cunliffe expressed concerns that the document was aspirational in nature rather than a plan for delivery with identified outcomes and outputs for which the Executive could be held to account. Dr Higson agreed that clear metrics and commitments were needed. Mr Doherty reminded the Board that there were over 100 project initiation documents sitting beneath the Plan, each with quantifiable success
Minutes Health Board 19.5.16 V0.03 draft Public session GLP PH comments 6
measures. Dr Higson queried how information could be meaningfully distilled for use for assurance purposes, and Ms Olsen responded that the Integrated Quality & Performance Report reflected this and was scrutinised by Committees and the Board. Discussion ensued on the commitment of Divisions to the Plan and its deliverables, divisional annual reports, lack of visibility of additional investment in staff engagement and organisational development, the follow-up appointments backlog, timelines for the development of the clinical services strategy and the need to have connectivity between service strategies in recognition of the fact that individuals can have both physical and mental health problems. Mr Doherty confirmed that there was a timetable in place for developing the clinical strategy. There was also a plan in place for an organisational development strategy, though this would require an options appraisal on additional investment. 16/90.5 Prof Rees commented that the 7 domains referred to in the document felt right. He called for messages to staff to be more positive. Mr Doherty responded that there were many positive examples that could be quoted in relation to staff engagement. Mr JM Jones reminded Board colleagues of the recent development session where there had been recognition of areas doing well on staff engagement, but there remained a question as to whether more pace was needed behind this work. Dr Higson summarised that his impression was that the Board was eager for the Plan to be taken forward. He believed that having the Plan and summary document was a significant step forward, enabling the organisation to focus and progress with an agreed set of commitments. He thanked all those involved in producing the Plan documents. The summary of key deliverables 2016/17 was approved, subject to more work being done on the performance monitoring and a public facing document, as discussed.
GL
16/91 Special Measures Improvement Framework – End of Phase 1 Report Mr Doherty presented this agenda item. He described the background to the report and highlighted its content. He explained that the Task & Finish Group was collating the evidence to underpin the progress reports. Mrs Hanson added that the Group had met the previous day to determine priorities for phases 2 and 3 and also to discuss the evidence base and the possibility commissioning support for this aspect of the work. The beginning of the next Board development session would be used to discuss the approach being taken by the Task & Finish Group. Dr Higson stressed that all improvements achieved must be sustainable. Cllr Edwards commented that the report represented a milestone, as it demonstrated to the public that the Health Board had embraced special measures. It was agreed that the report would be given prominence on the special measures pages of the Health Board’s website. Following discussion, the report was approved for submission to Welsh Government, subject to an update to page 11 to reflect the fact that the Operational Plan key deliverables had now been approved.
CW GLP
16/92 External partnership governance - Social Services & Wellbeing (Wales) Act 2014 and Wellbeing of Future Generations (Wales) Act 2015 16/92.1 Mrs J Charles was in attendance for this item. Mrs Lewis-Parry introduced the paper and explained that Board briefings were being scheduled to ensure that Board members were fully conversant with their responsibilities under the Acts. She also described the Regional Partnership Board and the intention to formalise its associated governance arrangements. Mrs Charles explained the content of the paper relating to the Wellbeing of Future Generations in more detail, noting that there was commitment to the
Minutes Health Board 19.5.16 V0.03 draft Public session GLP PH comments 7
new legislation across Wales, but implementation would be challenging. She highlighted the legally binding common purpose, the sustainability principle at its heart, preparation for Public Service Boards and the model set out in the International Framework: Good Governance in the Public Sector. Cllr Feeley gave an update on an all Wales workshop she had attended regarding the Regional Partnership Board, where it was noted that pooling of budgets would require the breaking down of barriers. Mrs Hanson added that issues of subsidiarity and ‘sovereignty’ would need to be explored with other public bodies. Ms Olsen reported that membership had been discussed at a recent Partnership Board meeting and it was felt that public health was missing, therefore the suggestion was to include three Health Board members rather than two. Mr Lang commented that the complexity of North Wales had been evident at a recent national meeting. He added that there was a need to agree tangible deliverables. 16/92.2 Dr Higson stated that he agreed with the need for a Health Board nomination for a public health member to the Regional Partnership Board. He added that the governance around the Partnership Board and Regional Leadership Board required more clarity and a ‘de-cluttering’ exercise. Mrs Lewis-Parry explained that the chart provided in Appendix 1 was the first cut at setting out these reporting arrangements. Dr Higson stated that the Health Board would need to better understand where the new arrangements fit with its own governance. Following discussion, it was agreed that there was strong support and commitment to making the new arrangements work, however further work was required on the governance aspects and therefore authority was delegated to Dr Higson and Mr Doherty to work together on this in liaison with the Regional Leadership Board. Mr Thomas and Ms Stubbins left the meeting.
PH/GD
16/93 Finance Report Month 12 16/93.1 Mr Favager presented this agenda item. He explained the end of year position and the accounts process. The financial year had closed with a deficit of £19.5 million, just below the forecast. There had been a £26.6 million deficit in the previous financial year, which amounted to a cumulative deficit of £46 million. This meant that unless the Health Board could deliver a £46 million surplus at the end of the next financial year, it would fail in its statutory duty to break even over a three year period. Mr Favager reported that the Health Board had remained within its capital resource limit and had achieved 93.4% compliance with the Public Sector Payment Policy. The accounts had been submitted to the Wales Audit Office and the auditing was underway prior to consideration by the Audit Committee on 31.5.16. 16/93.2 Mr Favager stated that he did not anticipate any change to the outturn position, other than a few minor presentational issues in the remuneration report. He explained that, in respect of charitable funds accounts, the Wales Audit Office was unable to conduct their audit until September 2016, after which the accounts would need to be submitted to the Charities Commission by January 2017. Prof Rees queried the locum overspend. Ms Dean updated on the scrutiny that had taken place at the Finance & Performance Committee. She noted that £31 million of savings had been achieved, but £11 million of this was non-recurrent. She added that medical agency costs were increasing as were unscheduled care costs. The fragility of the care home situation was also cause for concern. Following discussion, it was agreed to approve the recommendations set out in the paper presented, including delegation of authority to approve the accounts and Annual Governance Statement to the Audit Committee.
Minutes Health Board 19.5.16 V0.03 draft Public session GLP PH comments 8
16/94 Integrated Quality & Performance Report (IQPR) Ms Olsen presented this agenda item, noting that the relevant elements had undergone prior scrutiny by the Finance & Performance and Quality, Safety & Experience Committees. She described the new service improvement methodology to be employed within the organisation. Board members were asked to give Ms Olsen notice should they require more in-depth information on particular aspects of the IQPR. Prof Rees stated that he would like additional information on sickness absence and work related stress. Mr Jones agreed to re-circulate the recent report previously shared with Board members. Mrs Hanson observed that media reports suggested that performance in the Health Board was deteriorating, however the IQPR suggested that it was the highest performing Health Board in Wales in many areas. Mrs Russell-Williams stressed the need to draw more attention to successes such as national awards. It was noted that understanding the IQPR would be covered during a forthcoming Board development session. Following discussion, the report was noted.
JMJ
16/95 Development of an Integrated Mental Health Strategy for North Wales Ms Cuthel presented this agenda item. She described the key elements involved in developing the strategy, including the cultural shift to include the third sector as equal partners, governance arrangements, the need to commission a strategic partner and the need to increase pace. Board members commended the approach being taken and it was agreed that further information should be provided on the actions to be taken to develop a separate learning disabilities strategy. Following discussion, the recommendations listed in the paper were approved.
BC
16/96 Corporate Risk Register 16/96.1 Mrs Lewis-Parry presented this agenda item. She explained that the Committees had been scrutinising in detail the risks allocated to them. She explained that information on when the target risk was likely to be achieved would be added in and other layout and format changes were underway under the guidance of the Audit Committee and Mrs Ann Lloyd. She added that an additional risk regarding Safeguarding had been escalated to Executives since the current update paper had been written. The new risk would however be added to the version of the register published on the website once finalised. 16/96.2 In response to Ms Dean, Ms Olsen explained that Health & Safety Executive feedback and steps take to reduce risks had meant that the Health & Safety risk discussed in February 2016 no longer required escalation to the corporate register. It would be managed at an operational level. Mrs Hanson, referring to the primary care strategy risk, queried whether the actions quoted were sufficient and she believed that the implementation elements should be allocated to the Quality, Safety & Experience Committee. Mr Stradling commented that the infection prevention & control risk could be more optimistic. In response to Cllr Edwards, Mrs Morris explained that the continuing healthcare (CHC) risk had a likelihood of ‘5’ due to the fragility of the nursing home sector as a whole. Cllr Edwards also raised the issue of Deprivation of Liberty Safeguards (DoLS) in connection with the CHC and care home risk and it was noted that the Mental Health Act Committee would review this.
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16/96.3 It was noted that the capital risk might be de-escalated following review by the Audit Committee. Consideration would need to be given to disaggregating the informatics and organisational development risks. Dr Higson raised the issue of connectivity with the Operational Plan and asked if it would be possible to cross-reference risks back to the plan. In response to Cllr Feeley, Ms Olsen recommended awaiting risk registers from the Area Teams before deciding whether partnership working and partnership governance should be escalated to the corporate risk register. Following discussion, it was agreed to approve the risk register on the understanding that its component parts were to be reviewed by the relevant nominated committee.
16/97 Emergency Ambulance Services Committee (EASC) 26.1.16 and summary of key matters 22.3.16 Noted for information.
16/98 Welsh Health Specialised Services Committee minutes 26.1.16 and summary of key matters 22.3.16 Noted for information.
16/99 NHS Wales Shared Services Partnership Committee Assurance Report and summary of key matters 17.3.16 Noted for information.
16/100 Date of next meeting 23.6.16, Wrexham.
2.1 16/112 Summary of In Committee Board business to be reported in public
1 16_112 Items in committee reported in public.docx
Board Paper 23.6.16 Item 16/112
To improve health and provide excellent care
Title: Summary of In Committee Board business to be reported in public.
Author: Mrs L Jones, Head of Corporate Affairs
Responsible Director:
Mrs G Lewis-Parry, Board Secretary
Public or In Committee
Public
Strategic Goals (Indicate how the subject matter of this paper supports the achievement of BCUHB’s strategic goals –tick all that apply)
1. Improve health and wellbeing for all and reduce health
inequalities
√
2. Work in partnership to design and deliver more care
closer to home
3. Improve the safety and outcomes of care to match the
NHS’ best
4. Respect individuals and maintain dignity in care
5. Listen to and learn from the experiences of individuals
6. Use resources wisely, transforming services through
innovation and research
√
7. Support, train and develop our staff to excel. √
Approval / Scrutiny Route
The issues listed below were considered by the Board at its private in committee meeting of 19.5.16.
Purpose: Standing Order 6.5.3 requires the Board to formally report any decisions taken in private session to the next meeting of the Board in public session.
Significant issues and risks
Issues with commercially sensitive content were considered as follows: - Single tender waivers (STW): Chairs action in respect of one STW noted and confirmation of the Chief Executive’s authority to extend a contract in respect of a second STW. - Replacement of legacy telephony systems: the full business case was approved. - Welsh Health Specialised Services Committee confidential minutes 26.1.16 and summary of key matters 22.3.16.
Equality Impact Assessment
No equality impact assessment is considered necessary for this paper.
Recommendation/ Action required by the Board
The Board is asked to note this paper.
Disclosure: Betsi Cadwaladr University Health Board is the operational name of Betsi Cadwaladr University Local Health Board
2.2 16/113 Documents Signed Under Seal – Update
1 16_113 Documents signed under Seal June 16 Board.doc.docx
1
Board Paper 23.6.16 Item 16/113
To improve health and provide excellent care
Title: Documents Signed Under Seal: Update 18.9.15 – 26.5.16
Author: Mrs Liz Jones, Head of Corporate Affairs
Responsible Director:
Mrs Grace Lewis-Parry, Board Secretary
Public or In Committee
Public
Strategic Goals (Indicate how the subject matter of this paper supports the achievement of BCUHB’s strategic goals –tick all that apply)
1. Improve health and wellbeing for all and reduce health
inequalities
2. Work in partnership to design and deliver more care
closer to home
3. Improve the safety and outcomes of care to match the
NHS’ best
4. Respect individuals and maintain dignity in care
5. Listen to and learn from the experiences of individuals
6. Use resources wisely, transforming services through
innovation and research
7. Support, train and develop our staff to excel.
Approval / Scrutiny Route
This paper has been reviewed by the Executive Team.
Purpose: To comply with Standing Order 8.1.1, which requires a report of all documents signed under seal to be presented to the Board for noting at least bi-annually.
Significant issues and risks
None.
Equality Impact Assessment
Not considered necessary for a paper of this nature.
Recommendation/ Action required by the Board
The Board is asked to note the update presented.
Disclosure: Betsi Cadwaladr University Health Board is the operational name of Betsi Cadwaladr University Local Health Board
2
The Health Board is requested to note the following documents signed under seal during the period 18.9.15-26.5.16
16.10.15 Deed of settlement
11.11.15 Bryn y Neuadd farm business tenancy
11.11.15 Sale of part of HM Stanley Hospital
11.11.15 Engrossment lease for Caia Park Primary Care Resource Centre
11.11.15 Endoscope decontamination unit, Wrexham – building contract
11.11.15 Refurbishment of bedrooms, Heddfan Unit, Wrexham
17.2.16 Bus stop relocation, Ysbyty Gwynedd
17.2.16 Midwife led unit, Ysbyty Gwynedd
17.2.16 Hergest Unit seclusion suite
17.2.16 Discharge lounge, Ysbyty Gwynedd
17.2.16 Renal Unit, Ysbyty Gwynedd
17.2.16 Paediatric Assessment, Ysbyty Gwynedd
17.2.16 New lift at Ysbyty Alltwen
17.2.16 Primary Care Centre and Medical Ward, Tywyn Hospital
7.3.16 Deed variation: Primary Health Care Centre at Colwyn Bay
7.4.16 Lease relating to GP surgery at Tywyn Community Hospital
21.4.16 Transfer of former Prince Charles Road Clinic to Caia Park Community Council
21.4.16 Transfer of Llangollen Community Hospital to Grwp Cynefin Cyf.
11.5.16 Sale of Buckley Health Centre to Grwp Cynefin
2.3 16/114 Welsh Language Services Annual Monitoring Report 2015-2016
1 16_114 BCUHB Welsh Language Services Annual Monitoring Report 2015-2016.doc
Board Paper
23.6.16
Item 16/114
To improve health and provide excellent care
Title: Welsh Language Services Annual Monitoring Report 2015-2016
Author: Mrs Eleri Hughes-Jones, Welsh Language Services Manager
Responsible
Director:
Mr Chris Wright, Director of Corporate Services
Public or In
Committee
Public
Strategic Goals (Indicate how the subject matter of this paper supports the achievement
of BCUHB’s strategic goals –tick all that apply)
1. Improve health and wellbeing for all and reduce health
inequalities
2. Work in partnership to design and deliver more care
closer to home
3. Improve the safety and outcomes of care to match the
NHS’ best
4. Respect individuals and maintain dignity in care
5. Listen to and learn from the experiences of individuals
6. Use resources wisely, transforming services through
innovation and research
7. Support, train and develop our staff to excel.
Approval /
Scrutiny Route
This report has been subject to prior scrutiny by the Welsh Language
Strategic Forum and the Strategy, Partnerships and Population Health
Committee. Final approval of the Annual Monitoring Report is reserved
for the Board.
Purpose: The Welsh Language Services Annual Monitoring Report for 2015-2016
provides the Board with an overview of delivery against key
performance indicators.
This report is presented for approval by the Board prior to submission to
Welsh Language Services Annual Monitoring Report 2015-2016 Page 1
the Welsh Language Commissioner.
Significant issues
and risks
This report demonstrates the Health Board’s compliance with its Welsh
Language Scheme under the Welsh Language Act 1993 and details
progress made and initiatives implemented during the last reporting
year.
The report also acknowledges and addresses the required actions and
resource implications of the delivery of the Welsh Language Standards
that will be made applicable to Health Boards under the Welsh
Language Measure (Wales) 2011.
There are inherent risks that services will not be delivered bilingually
which will lead to non compliance with the Welsh Language Standards.
These risks are being managed and mitigated as part of detailed
implementation arrangements to ensure there is no detrimental impact
on the quality and safety of services.
Equality Impact
Assessment
No equality impact assessment is considered necessary for this paper.
Recommendation/
Action required by
the Board
The Board is asked to approve this report.
Welsh Language Services Annual Monitoring Report 2015-2016 Page 2
Welsh Language Services
Annual Monitoring Report
2015 - 2016
Welsh Language Services Annual Monitoring Report 2015-2016 Page 3
Welsh Language Services Annual Monitoring Report 2015-2016 Page 4
Content Page Executive Summary 2 Foreword 3 Welsh Language Standards 4 More than just words 5 Primary Care Services 6 Achievements and Awards 7 Performance Indicators Data 9
Policy Impact Assessment 9
Services Provided by Others 11
Workforce Planning 12
Training to Improve Welsh Language Skills 17
Recruitment 20
Language Awareness Training 22
Website 23
Welsh Language Services Provided 24
Complaints 26
Next Steps and Forward Vision 28
Welsh Language Services Annual Monitoring Report 2015-2016 Page 5
Executive Summary
This report addresses the statutory duty of Betsi Cadwaladr University Health Board to provide an annual report to the Welsh Language Commissioner on compliance with its Welsh Language Scheme. The Health Board continues to make progress in implementing its Welsh Language Scheme and in providing services bilingually, and in establishing processes to facilitate the implementation of the Welsh Language Standards under the Welsh Language (Wales) Measure 2011. The report reflects the format and content included in the guidance produced by the Welsh Language Commissioner and details compliance within the eleven domains outlined in the Health Board’s Welsh Language Scheme; New policies and initiatives, Services provided by others, Face to face contact with the public, Information Technology, Recruitment, Language Skills, Training to improve Welsh language skills, Language awareness training, Complaints, Publicity and Workforce planning. It gives an overview of general progress including areas of good practice and areas for development. The report also takes account of the feedback received from the Welsh Language Commissioner following submission of the 2014-2015 Annual Monitoring Report. This report reflects work undertaken to develop a Bilingual Skills Strategy, implementation of ‘More than just words’ and the “Active Offer”, as well as further developments with primary care contractors. Plans and processes are in place to ensure that progress can be monitored in preparation for the Welsh Language Standards. Further areas of good practice and service improvements have been included throughout this report.
19 May 2016
Welsh Language Services Annual Monitoring Report 2015-2016 Page 6
Foreword This report reflects the Health Board’s performance against key legislative requirements and obligations under the Welsh Language Act 1993. The report also focuses on Welsh Government’s Strategic Framework for Welsh Language Services in Health, Social Services and Social Care, ‘More than just words’. The 2011 Census showed there were 204,406 Welsh speakers in the Betsi Cadwaladr University Health Board’s region (all ages), amounting to a total of 30.8 per cent of the whole population of North Wales. The Health Board’s Welsh Language Team is responsible for monitoring delivery of the Welsh Language Scheme across North Wales, and the provision of a high quality Welsh language translation service across all areas.
Number of staff within the Welsh Language Team
1 x Welsh Language Services Manager (1 WTE) 2 x Welsh Language Officers (1.8 WTE) 4 x Translators (4 WTE)
Number of staff within the organisation
18,592
Population in catchment area
676,000
Demographics of Welsh speaking population within each county served by the Health Board
County % of Welsh speakers
Number of Welsh speakers
Gwynedd 65.4% 77,000
Anglesey 57.2% 38,568
Conwy 27.4% 30,600
Denbighshire 24.6% 22,236
Flintshire 13.2% 19,343
Wrexham 12.9% 16,659
A significant proportion of the population of North Wales speak Welsh as a first language. Evidence based research has identified that a substantial number of patients prefer to speak Welsh when accessing health services, and delivering care to patients in their preferred language of choice can improve quality and safety.
The vision of the Health Board is to provide a service that satisfies the needs of Welsh speakers and their families or carers, by ensuring that they are able to receive services in their own language.
Welsh Language Services Annual Monitoring Report 2015-2016 Page 7
Welsh Language Standards
It is anticipated that the Health Board will become subject to the Welsh Language Standards under the Welsh Language (Wales) Measure 2011 in 2016. There will be four specific areas of compliance:
i. Service Delivery Standards – focusing on promoting or facilitating the use of Welsh in activities associated with service delivery
ii. Policy Making Standards – ensuring that public bodies give full consideration to the way developing and/or implementing specific policies will impact on the availability and accessibility of Welsh-medium services
iii. Operational Standards – focusing on promoting and facilitating the use of Welsh within internal administrative arrangements.
iv. Record Keeping Standards – ensuring that public bodies keep detailed records relating to any actions or developments with regards to Welsh language service provision
The Health Board has been proactive in preparing and addressing future requirements with the Standards. Work has already been undertaken to establish the current position with bilingual service provision and to identify potential gaps to ensure that activities can be targetted at specific areas. Implementation and Delivery The Health Board will drive implementation through three delivery dimensions that will allow planning, engagement and monitoring on an organisation wide level: Workstreams have been identified aligning to the NHS Outcomes Framework, focusing on behavioural change, strategic intervention and monitoring performance. In delivering, the Health Board will build on its current provision by focusing on
Behavioural Change in the form of Training, Corporate Identity and Communicating Key Messages
Strategic Intervention in the form of Workforce Planning, Service Delivery and incorporating requirements into ICT Systems
Securing Performance in the form of Frontline Provision, Governance and Identifying Good Practice
Welsh Language Services Annual Monitoring Report 2015-2016 Page 8
service delivery, workforce planning, mainstreaming requirements into ICT Systems, as well as securing robust channels of communication to provide awareness and support on an organisation wide level. A high level Project Management Group has been established with senior leads across services, who will address key challenges and associated risks and drive and co-ordinate the process of implementation within the Health Board. Ownership of the standards across all service areas will be essential. Key Challenges There will be challenges gloing forward, and these include potential additional costs, clinical recruitment and embedding the requirements in service planning and delivery. An initial standards mapping exercise has identified a substantial increase in terms of document and simultaneous translation requirements and the need to develop and deliver bilingual internal operating procedures. These challenges and proposed solutions are currently being further explored.
‘More than just words’
The Welsh Government’s 2012 Strategic Framework for Welsh Language Services in Health, Social Services and Social Care ‘More than just words’ is a three year framework for strengthening Welsh language services to improve the quality of care, maintain professional standards, meet the language need of users and comply with legal and statutory requirements. The “Active Offer” principle is fundamental to the successful delivery of the framework as a means for organisations to accept responsibilty of offering patients services in the language of their choice, rather than the service user having to specifically request a Welsh language service. The Strategic Objectives set within the framework require the implementation of systematic approaches to service planning and delivery based on the “Active Offer”. They require a strengthening of the capability of the workforce to provide Welsh language services, an increase in language awareness among staff; the creation of leaders who will foster a supportive ethos within the organisation; the development of targeted learning programmes; and the guidance of national strategies, policies and leadership.
The Health Board’s position at the end of Year three demonstrates progress against all objectives, notably the collation of data with regard to the language skills element of the Electronic Staff Record (ESR).
Other progress includes the development of an Older People’s Mental Health project to map current provision and capacity to deliver the “Active Offer” within dementia services. The Health Board has also seen progress in its
Welsh Language Services Annual Monitoring Report 2015-2016 Page 9
obligation to increase staff confidence to speak Welsh at work. This has been delivered through the provision of varying levels of Welsh language courses and resources offered, as well as targeted promotional activities such as ‘Diwrnod S’mae’. We have aquired and promoted ‘Learning Welsh’ lanyards for staff, with the aim of encouraging staff to converse with patients in their mother tongue. One of the key actions required during Year three was to ensure effective provision of service for Welsh speaking patients by mainstreaming the ‘Active Offer’ into dementia services. This has been proactively addressed within dementia and stroke services, identifying Welsh speaking patients and staff, and planning services so that Welsh speaking clinical staff and allied health professionals are paired with Welsh speaking patients. Additional progress against key targets is further detailed in this report.
Primary Care Services
Work has been undertaken during the reporting year to further develop the relationship between primary care providers and the Health Board in terms of Welsh language provision. It should be noted that primary care providers are independent, self employed contractors and therefore not bound by the Health Board’s Welsh language requirements. Proactive work has been undertaken to develop a number of initatives to meet the needs of service users. A report was presented to the Board in March 2016 detailing progress against the recommendations made in the Welsh Language Commissioner’s Inquiry into the Welsh Language in Primary Care ‘My Language, My Health’, with areas of good practice noted and highlighted. Link to Primary Care Report - Item 1 Following a concern raised in 2014 regarding the provision of bilingual prescriptions, a project has been developed collaboratively between Bangor University and the Health Board to provide cautionary instructions on prescribed medicines, for the first time, in Welsh. This innovative provision, endorsed by the Chief Pharmaceutical Officer for Wales, will ensure that bilingual labels on prescription medicines will be made available to patients. A team comprising language specialists and pharmacists has made the first step by translating 30 cautionary instructions given to patients on prescription medicines. These will now become available to all pharmacies and doctors, increasing the amount of health support provided in Welsh within the NHS in Wales. The labels are available in the online edition of the British National Formulary, the standard pharmaceutical reference text used by prescribers, nurses and pharmacists within the NHS, and will become available in the next printed edition. A working partnership has been established with Bron Derw Medical Centre in Bangor, with the Practice Manager actively working with the Health Board’s Welsh Language Team to provide bilingual correspondence to its patients. The Centre makes full use of the Health Board’s Translation Team to ensure letters, information
Welsh Language Services Annual Monitoring Report 2015-2016 Page 10
and pamphlets are provided bilingually. The Centre has also undertaken a data cleanse project to update patients’ medical records, asking patients to update their language details. Forms were provided to patients in the surgery to encourage them to note their spoken language and preferred language of care. Posters were also displayed at reception to inform them that a Welsh language service was available, whilst ensuring visibility was given to the Welsh language in the form of the Welsh Language Commissioner’s ‘Working Welsh’ resources. Work has also been undertaken with the Centre to develop a bilingual website to improve accessibility for patients in their first language.
Achievements and Awards
The Health Board received eight awards at last year’s Welsh Language in Healthcare Awards. Derwen, the Integrated Team for Disabled Children won the award for ‘Work done with priority groups’ for the creation of, ‘May I join you?’, a bilingual booklet to support parents in developing their children’s needs. In the ‘Working in Partnership Category’ the Gyda’n Gilydd Team, bringing together Gwynedd Council’s Early Years Unit, the Health Board, Barnados and Citizens Advice was awarded for providing a wide range of preventative services bilingually to families in Gwynedd. Denbighshire’s Single Point of Access provision between Denbighshire County Council and the Health Board, including British Red Cross were also successful in the same cateogry for developing an integrated model of community services for preventative and rehabilitation work for adults. The Health Board also received two awards in the ‘Technology and the Welsh Language’ category for a fully Bilingual Appointment Reminder Service and The North Wales Cancer network Patient Forum for an online bilingual cancer information resource. Three members of staff were awarded Welsh Leaners of the Year titles for learning Welsh to an exeptional standard. Services to Bilingual Healthcare also continue to be celebrated as part of the Health Board’s Staff Achievement Awards. This year’s winners included North Wales Clinical School for providing training to increase the capability of the workforce to provide bilingual care. Other winners also included Derwen and the Ysbyty Gwynedd Orthodontic Team for the provision of bilingual British Orthodontic Society patient information leaflets.
Welsh Language Services Annual Monitoring Report 2015-2016 Page 11
Winners in the Welsh Language in Healthcare Awards
2015
Gareth Hutchinson, Community Pharmacy Technician, joint winner in the category for
‘Learner of the Year – Under 2 years’
Laura Owens, Dietician at Ysbyty Gwynedd – joint winner in the category for Learner of the
Year - Under 2 years
Amy de Cunha Prys, Staff Nurse in Tegid Ward, Ysbyty Gwynedd - winner in the category for Learner of the Year - Over 2 years
Informatics Team, Appointment Reminders Service in the ‘Technology and the Welsh Language’ Category
Derwen, ‘May I Join you’ bilingual communication pack for children with communication problems in the category for ‘Work done with people with learning difficulties including
speech and language therapy’
Welsh Language Services Annual Monitoring Report 2015-2016 Page 12
Performance Indicators Data
The Welsh Language Commissioner has requested quantative and qualatative data on key performance indicators relating to the Health Board’s Welsh Language Scheme requirements as detailed below.
Policy Impact Assesment
Number and percentage of policies (including those that were reviewed or revised) where consideration was given to the effects the policy would have on the use of the Welsh language
All new policies and initiatives produced by the Health Board are subject to an Equality Impact Assessment, which includes language impact assessment. 111 policies were produced or revised during 2015/16, of which 100 per cent have been scrutinized for language impact assessment. Of these, four policies (3.6 per cent) made specific reference to the Welsh language, where the policy would have an effect on the use of the Welsh Language as part of the organisations’ service delivery. Policies which did not include reference to the Welsh language ranged from clinical policies (e.g. Infection Surveillance policy, Decontamination of Endoscopes Protocol), Finance policies (e.g. Income and Debt Recovery Procedure and Petty Cash Procedure) to Healthcare record policies (e.g. Locating Casenotes out of core hours, Binding of Acute Casenotes Procedure) and Medical Devices Policies (e.g. Decontamination of Medical Devices Procedure, Single Use Medical Devices Procedure), where the policy, as part of the robust impact assessments, had been identified that it would not have an effect on a patient’s ability to receive services through the medium of Welsh.
2015 / 2016 Data:
In total there are 269 policies and procedures, of which 100 per cent have
been assessed, with 26 of these (9.6 per cent) including references to the use
of the Welsh language.
2014 / 2015 Data: 40 new policies were produced, of which 100 per cent were considered for Welsh language effect. No Welsh language references were required in those policies.
Welsh Language Services Annual Monitoring Report 2015-2016 Page 13
Example of an assessment deemed to have an impact on the use of the Welsh language and details of how the policy was amended as a result
The Health Board’s policy impact assessment procedures allow for the consideration of how certain policies will affect service provision. One example is the Health Board’s ‘Consent to Examination or Treatment Policy’ which includes specific reference to the Welsh language in the body of the policy:
“Provision for patients whose first language is Welsh 4.6 The Health Board is committed to ensuring that patients whose first language is Welsh receive the information they need and are able to communicate appropriately with healthcare staff. In order to safeguard the consent process and when seeking written consent, a healthcare professional who is fluent in Welsh should be sought from within the healthcare team in the first instance. If this is not possible and in an emergency then Language Line should be contacted.
The policy also refers to the fact that the Health Board has purchased Eido INFOrm4U Patient Information documents which are available bilingually. This allows the Health Board to provide a comprehensive bilingual service in terms of providing both face to face and written information bilingually. This policy not only ensures better bilingual care for the patients, it also addresses complex and crucial issues in relation to patient safety and informed consent to treatment. The Patients Visitors Protocol for the Tŷ Llywelyn Medium Secure Unit also makes specific reference to the Welsh Language. The policy addresses complex issues in relation to both patients and families and their care, thus ensuring a bilingual service in exceptional and difficult circumstances:
“If the Supervisor feels it is appropriate the visit may be terminated at any time. An explanation should be given to the visitor and if they are not happy with the explanation given, should be made aware of the Complaints Procedure. N.B. consideration should be given to making such explanations in Welsh or English and the visitor(s) preference sought.”
Furthermore, to ensure operational delivery and recording of preference, the Visitors Approval Form in Appendix 1 of the Protocol includes a question about Visitor’s Preferred Language: Welsh / English.
Patients Visitors Protocol - Tŷ Llywelyn Medium Secure Unit.pdf
Welsh Language Services Annual Monitoring Report 2015-2016 Page 14
Services Provided By Others Number and percentage of third party agreements monitored to ensure
they comply with the relevant requirements of the Welsh Language Scheme
2015 / 2016 Data: Number: 40 contract reviews Percentage: 51 per cent of all contracts issued by the Health Board
2014 / 2015 Data: Number: 30 contract reviews Percentage: 43 per cent of all contracts issued by the Health Board
Example of monitoring work undertaken to assess whether or not a third party agreement complied with the relevant requirements of the Welsh Language Scheme and details of any action taken as a result of the monitoring work
Welsh language compliance is included as part of the legal / statutory requirements within the final contract review and service contract checklist. However, processes have recently been established to strengthen and clarify Welsh language requirements within contractual agreements. Whilst the majority of care is provided directly by the Health Board, care is also commissioned from a wide range of NHS and independent healthcare providers. It is imperative that Welsh language requirements are taken into account during the commissioning process. As a commissioner of care, there is a responsibility to ensure that external providers are formally contracted to deliver care in line with the Health Board’s expectations, with specific reference to Welsh language needs. In order to ensure the robustness of contractual performance management, a Contracts Review and Governance Group has been established to oversee a robust assurance process, supporting Area, Secondary Care, Children’s and Mental Health teams (the commissioners), Finance, Planning and Performance departments to take a multidisciplinary approach to support overall contract management arrangements. The Welsh Language Team will work as part of this multidisciplinary approach to performance management working in conjunction with Finance, Quality and Performance teams. Welsh language outcome measures have been identified with specification and monitoring controls to ensure an integrated approach to the delivery of bilingual care. A robust checklist has also been developed to ensure adherence to all aspects of performance issues and Welsh Language Scheme requirements. Contractors will be
Welsh Language Services Annual Monitoring Report 2015-2016 Page 15
required to ensure the delivery of bilingual correspondence, telephone communication, signage, producing bilingual information, publicity and activities as well as staffing requirements before contracts are issued, i.e. in ‘Pre-placement agreements’. During the course of the contract, monitoring controls will be established and performed via quarterly contract review meetings, spot visit checks as well as patient feedback.
Workforce Planning
An update on progress made to adopt/implement the organisation’s Welsh language/bilingual skills strategy
The Bilingual Skills Strategy is designed to enable effective workforce planning and the recruitment of staff to ensure the delivery of bilingual services through the medium of Welsh and English, according to individual choice and the needs of the population in the area. The vision is to provide a service that satisfies the needs of Welsh speakers and their families or carers, by ensuring that they were able to receive services in their own language through the care process. To deliver this, the Bilingual Skills Strategy has four key workstream areas to ensure that appropriate Welsh language skills are available within the workforce to deliver a bilingual service:
Identifying Patient’s Language Choice An urgent assessment was required by the community mental health team for a 53 year old woman, living on a farm in a very rural area. The Duty Officer would usually make such an assessment, but because the family spoke Welsh, the Duty Officer (who could not speak Welsh) requested for two Welsh speaking Occupational Therapists to attend to make the initial assessment. The patient was very unwell and classed as high risk and was to be admitted to the mental health unit in Ysbyty Glan Clwyd. The paramedics were informed that the patient was a Welsh speaker and was not comfortable communicating in English. The Welsh speaking paramedic sat with her in the back of the ambulance to reassure and care for her. The unit was also informed of her language needs and a Welsh speaking nurse was present on arrival to greet the patient and to help with the admission assessment. The Approved Mental Health Practitioner and a doctor attended the unit to make this assessment, and the Welsh speaking Occupational Therapist (who conducted the initial assessment) was also asked to attend to act as a translator. The Practitioner and doctor were sensitive throughout and apologized for not being able to speak Welsh but stated that they were happy for her to answer any questions in Welsh. Following a two week stay in hospital she was discharged to the care of the community mental health team, and her language needs prioritized. A Welsh speaking Care Manager was assigned to support her and her family. Community Mental Health Team
Welsh Language Services Annual Monitoring Report 2015-2016 Page 16
Audit of current workforce Welsh language skills
Assessment of the Welsh/bilingual service needs
Identifying skills gaps
Workforce planning and recruitment During the reporting year, progress has been made in terms of auditing the Welsh language skills of the workforce (figures are presented in performace indicators section). Monitoring processes have also been established in the form of a reporting template that will allow the Health Board to scrutinze vacancy bulletins on a weekly basis to identify any shortfalls in terms of bilingual requiremernts within the recruitment process. The Bilingual Skills Implementation Group, chaired by the Assistant Director of Workforce and Organisational Development, has also been focusing on reviewing the Welsh Language Operational Standards. This has allowed the Helath Board to mainstream future requirements into the Bilingual Skills Strategy ensuring overall incorporation and inclusion. To allow for adequate training provision to upskill the workforce, the Health Board has included Welsh language training as part of its Study Leave Policy to ensure it is a key element of personal development. This will ensure that training is offered to both clinical and administrative staff to support the implemention of the Welsh Language Service Delivery Standards. The strategy has been ratified by the Health Board’s Strategy, Partnership and Population Health Committee, chaired by the Health Board’s Vice Chair. Link to Bilingual Skills Strategy - Item 2 Progress has been made in auditing Welsh language skills, service needs assessment, creative ways of working, staff development and strategic recruitment. Information provided below reflects the work undertaken during the reporting year.
Update on Welsh Language skills audit (data cleansing) of employee records: Individual e-mails containing a list of non-compliant staff (staff with no Welsh Language skills levels recorded in their ESR record) were sent to line managers throughout October and November 2015 requesting them to update ESR with the employee’s individual Welsh Language skills levels. Managers were given three options for updating employee ESR records:
Employee or manager to update ESR using ESR Self Service
Manager to submit WL return for mass update
Employee to complete and submit individual WL skills questionnaires
Welsh Language Services Annual Monitoring Report 2015-2016 Page 17
Progress to date with regards to the cleansing of records is as follows:
2014 / 2015 Data: 62.1% of the entire workforce had recorded their Welsh language skills on ESR. Further work is required to improve the quality of the Welsh language data held. Given the scale of the data cleansing undertaken to date and efforts made to cleanse outstanding records, service areas which have yet to respond will be escalated to senior management to ensure full compliance.
1 Nov
2012
1 Apr
2013
1 Oct
2013
1 Nov
2014
1 Jan
2015
1 Aug
2015
16 Oct
2015
3 Nov
2015
13 Nov
2015
08
Apr
2016
Assignment Count
16,551
16,494
16,456
16,930
17,081
17,164
17,140
17,143
17,175
18,592
No. Achieved
867
1,000
6,081
6,590
6,780
8,064
10,380
10,641
11,183
12,874
Compliance %
5.24%
6.06%
36.95%
38.92%
39.69%
46.98%
60.56%
62.07%
65.11%
69.2%
Welsh Language Services Annual Monitoring Report 2015-2016 Page 18
Number and percentage of employees whose Welsh language skills have been assessed (data was unavailable during 2014 / 2015):
Number Percentage
Across the organisation 12,874 69.2%
Per priority group
- Children and young people 935 78.92%
- Older People 17 39.53%
- People with Learning disabilities and Mental Health
1177 68.9%
- Dementia services Not known – difficult to identify from WOD reports
- Stroke services 11 (but may not be accurate as difficult to identify from WOD reports
Speech and language therapy services 126 97.7%
Number and percentage of employees who have Welsh language skills, per skill level (data was unavailable during 2014 / 2015):
Across the organisation
Count of Employee Number
Individual Proficiency Level Total %
0 - No Skills / Dim Sgiliau 5222 28.1
1 - Entry/ Mynediad 1951 10.5
2 - Foundation / Sylfaen 1076 5.8
3 - Intermediate / Canolradd 1142 6.1
4 - Higher / Uwch 1545 8.3
5 - Proficiency / Hyfedredd 1936 10.4
Blank 5718 30.8
Grand Total 18592 100
Children and young people
Count of Employee Number
Individual Proficiency Level Total %
0 - No Skills / Dim Sgiliau 396 30.2
1 - Entry/ Mynediad 143 10.9
2 - Foundation / Sylfaen 61 4.7
3 - Intermediate / Canolradd 74 5.6
4 - Higher / Uwch 111 8.5
5 - Proficiency / Hyfedredd Blank
150 376
11.5 28.6
Grand Total 1311 100
Welsh Language Services Annual Monitoring Report 2015-2016 Page 19
Older people
Count of Employee Number
Individual Proficiency Level Total %
0 - No Skills / Dim Sgiliau 11 23.2
1 - Entry/ Mynediad 2 4.7
2 - Foundation / Sylfaen 1 2.3
4 - Higher / Uwch 1 2.3
5 - Proficiency / Hyfedredd Blank
2 27
4.7 62.8
Grand Total 43 100
People with learning disabilities and mental health services
Count of Employee Number
Individual Proficiency Level Total %
0 - No Skills / Dim Sgiliau 353 20.7
1 - Entry/ Mynediad 201 11.8
2 - Foundation / Sylfaen 128 7.5
3 - Intermediate / Canolradd 160 9.4
4 - Higher / Uwch 161 9,5
5 - Proficiency / Hyfedredd Blank
173 530
10.1 31
Grand Total 1706 100
Speech and language therapy services.
Count of Employee Number
Individual Proficiency Level Total %
0 - No Skills / Dim Sgiliau 53 41.1
1 - Entry/ Mynediad 14 10.9
2 - Foundation / Sylfaen 6 4.7
3 - Intermediate / Canolradd 10 7.7
4 - Higher / Uwch 25 19.4
5 - Proficiency / Hyfedredd Blanks
18 3
13.9 2.3
Grand Total 129 100
The system is currently unable to provide a breakdown for dementia and stroke services. However, the Health Board is pro-actively targeting stroke and dementia services with a new initiative to identify patients’ preferred language of care at ward level.
Welsh Language Services Annual Monitoring Report 2015-2016 Page 20
Training to Improve Welsh Language Skills
Number and percentage of the organisation’s workforce that received training to improve their Welsh skills to a specific qualification level
BCUHB provided funding to allow 62 of its staff to attend Wlpan courses during 2015-16, with priority given to front line staff working with vulnerable groups on a day to day basis. Welsh for Adults: North Wales (which is based within Bangor University) provides a range of Wlpan courses – for beginners, individuals with some Welsh-medium skills, and more experienced learners – at locations throughout North Wales. The Health Board has secured a working partnership with Bangor University for both daytime and evening lessons for staff to allow the greatest possible number of individuals to attend. As described earler, as part of the Study Leave Policy, Welsh language training is now being considered as all other study leave requirements, demonstrating the Health Board’s commitment to improving the Welsh language skills of its staff. Further information is detailed below with regard to specific qualification levels achieved:
Identifying Patient’s First Language on Wards Welsh language provision is a crucial part of the care of dementia patients, who often revert back to their mother tongue as the condition progresses. In order to ensure the best possible services for dementia patients, an initative has been developed on Ward Glaslyn in Ysbyty Gwynedd to include the ‘Speaking Welsh’ emblem magnets on patient white boards on the ward so that staff are able to identify Welsh speaking patients. This allows the ward to plan its workforce so that Welsh speaking staff are paired with Welsh speaking patients. This ‘opt in’ system has also ensured that large ‘Speaking Welsh’ magnets are displayed above a patient’s bed. This has also ensured wider planning, allowing physiotherapists, pharmacists and the wider clinical workforce to plan their care when attending the ward. Following the success of this pilot, it has been rolled out with stroke patients on Ward Prysor, and will continue to be further rolled out.
Welsh Language Services Annual Monitoring Report 2015-2016 Page 21
Wlpan Courses provided by Welsh for Adults: North Wales
September – December 2015
Type of course
Number of BCUHB staff that received funding to attend
Number of different courses attended by BCUHB funded staff
Entry Level (i.e. Beginner)
35 16
Foundation Level
18 10
Intermediate Level
7 5
Advanced Level
2 2
Total
62 33
2015 / 2016 Data: Number of the organisation’s workforce that received training to improve their Welsh skills to a specific qualification: 62 This total equates to 0.37 per cent of the Health Board’s current workforce.
2014 / 2015 Data: Number of the organisation’s workforce that received training to improve their Welsh skills to a specific qualification: 70 This total equated to 0.3 per cent of the Health Board’s workforce at that time
The Health Board has also provided funding to enable certain priority areas to engage the services of an external Welsh language tutor during 2015-16, allowing a further 50 members of the Health Board’s workforce to improve their Welsh skills. A tutor from Welsh for Adults: North Wales was engaged to assist the Wrexham Central Community Mental Health Team with their Conversational Welsh Group. This group – which convenes once a week – provides opportunities for staff members (and for learners especially) to speak Welsh in an informal and relaxed atmosphere whilst continuing to offer guidance and support in an encouraging environment. Such regular opportunities to practice linguistic skills will ensure that more members of the Wrexham Central Community Mental Health Team will gain confidence to enable them to use Welsh in more formal situations. The same external tutor was also engaged to provide a short series of basic Welsh lessons for 30 members of staff from the Pharmacy Department at Wrexham Maelor Hospital,
Welsh Language Services Annual Monitoring Report 2015-2016 Page 22
with arrangements in place to further extend training offered due to the positive response received. To ensure all staff are supported to learn or improve their ability to speak Welsh, internally produced resources, focused on key areas such as frequent communication with Welsh speakers, whether face to face or by telephone are key aspects of the Health Board’s training programme.
Along with providing funding to allow staff to improve their Welsh skills by attending formal lessons, the Health Board has also developed a language course that staff can follow and complete in their own time and at their own pace (i.e. Welsh courses that are not delivered through tutor-led face-to-face sessions). The ‘Welsh in the Workplace – Level 1’ course CD has been designed for individuals who have no previous experience of speaking Welsh and is offered to all staff in the Health Board. The course primarily focuses on developing a vocabulary of words and phrases which specifically relate to the healthcare sector. This year, a follow on course ‘Welsh in the Workplace – Level 2’ CD has been produced which allows staff to build upon skills already gained. Further training support is offered to the workforce in the form of useful resources that allow staff to develop their basic linguistic skills informally, without having to attend formal Welsh lessons or committing to complete a full course. ‘Gair i Glaf’ is an English-Welsh phrasebook that has been designed for health care professionals and contains phrases and vocabulary relevant to a number of areas within health
Mr Phillip Moore, ENT
surgeon at Ysbyty Gwynedd
has learned Welsh to an
exceptionally high standard,
often conducting clinics
through the medium of Welsh.
At this year’s ‘Rhoi’r Iaith ar
Waith’ Conference in Bangor
University, Mr Moore gave a
presentation, speaking of the
support received from the
Health Board in further
progressing with his learning,
as well as highlighting the
importance of speaking Welsh
with patients.
Welsh Language Services Annual Monitoring Report 2015-2016 Page 23
care (along with some guidance about how to pronounce letters and words when speaking Welsh). A clinically based phonetic Welsh phrases card is also offered to staff to assist in using basic Welsh phrases with patients on a day to day basis. To secure support not only for clinical staff, but also within the Health Board’s corporate and administrative areas, a ‘Bilingual Greetings’ card has been produced to inform staff of the protocol on answering the telephone bilingually, offering relevant phrases, all written both grammatically and phonetically, for the user’s convenience. All resources have been offered through various promotional events and within the Health Board’s internal information distribution channels.
2015 / 2016 Data: Number of bilingual greeting cards and Welsh phrases cards distributed: Approximately 1,200 Number of Level 1 and 2 CDs distributed: Approximately 500
2014 / 2015 Data:
Number of resources distributed: Approximately 900 Number of Level 1 CDs distributed (Level 2 CD had not been produced at that time): Approximately 185
Recruitment
Number and percentage of new and vacant posts advertised with the requirement that:
2015 / 2016 Data:
- Welsh language skills are essential - 62 (2%) - Welsh language skills are desirable - 3042 (98%) - Welsh language skills not required - 0
Welsh Language Services Annual Monitoring Report 2015-2016 Page 24
Link to Breakdown of Recruitment Data - Item 3
2014 / 2015 Data:
- Welsh language skills were essential - 28 (1.2%)
Data for posts where Welsh language skills were desirable or not required was not requested for the report
Example of an assessment which shows how a decision was taken to advertise the post :
- Welsh Language skills are essential; - Welsh language skills are desirable; - Welsh language skills are not required.
The Workforce and Organisational Development Team have added Welsh language skills requirements assessment to the Health Board’s position request form. This assists managers to determine whether posts should be advertised as Welsh Essential or Welsh Desirable. The tool ensures that recruiting managers follow set formulae, looking at language needs of the population, current skill mix and skills gap within the team. This allows services to ensure that individuals with the required level of Welsh language ability are recruited to ensure a comprehensive bilingual service is available. Follow link to an example of an assessment undertaken that determined Welsh language skills were essential for a post: Link to WL Skills Assessment - Engagement Officer - Item 4 Follow link to an example of an assessment undertaken that determined Welsh language skills were desirable for a post: Link to WL Skills Assessment - Dietician - Item 5 All posts advertised require either Welsh language as an essential skill or Welsh language as a desirable skill.
Of those posts advertised with an essential requirement, the number and percentage of posts filled by individuals who met the requirement - Of the 62 posts advertised as Welsh essential, 35 Welsh speaking
candidates were appointed (56 per cent). - 5 adverts had multiple appointees therefore the 35 candidates were
appointed to 29 advertised posts
Welsh Language Services Annual Monitoring Report 2015-2016 Page 25
- The remaining 33 posts advertised were either closed with no appointees, the appointee withdrew the application, the post was withdrawn or the post was re-advertised as Welsh desirable
Language Awareness Training
Number and percentage of the organisation’s new staff (i.e. new since 1 April 2015) that received Welsh language awareness training
The Health Board’s newly formed Orientation Programme incorporates Welsh language awareness, including legislative requirements and the “Active Offer” principle. 2015 / 2016 Data: Number: 859 newly appointed staff have received Welsh language awareness training This total equates to 100 per cent of the Health Board’s new starters.
2014 / 2015 Data: Number: 1099 newly appointed staff received Welsh language awareness training This total equated to 100 per cent of the Health Board’s new starters.
Welsh language awareness training is also offered across the organisation to individual services and areas, including volunteers. 25 newly qualified doctors attended Welsh language awareness sessions as a part of their induction training at the Medical Institute in Wrexham and in Ysbyty Gwynedd, with two sessions provided to 200 nursing students across the Health Board. A total of 18 newly recruited Spanish nurses also attended similar training sessions, specifically arranged as part of their induction to the Health Board. The Health Board secured a Welsh language interactive awareness session during the annual Health Care Support Workers’ Conference at Venue Cymru, with approximately 100 attendees.
Number and percentage of the organisation’s entire workforce that has received Welsh language awareness training since the training was introduced
Welsh Language Services Annual Monitoring Report 2015-2016 Page 26
Since the establishment of Betsi Cadwaladr University Health Board, apart from the organisation’s newly appointed staff as noted above, 5,073 of the organisation’s entire workforce have received Welsh language awareness training.
Number of the organisation’s entire workforce that has received Welsh language awareness training since the training was introduced: 6075 This total equates to 32 per cent of the Health Board’s current workforce.
Website
Percentage of the organisation’s website that is available in Welsh
An update on progress made to improve/ increase the Welsh language provision of the website
Information relating to the process used to ensure that existing content, updates and new content, complies with the relevant requirements of the Welsh language scheme (if the process has changed since the 2014-15 report)
100% of the Health Board’s is available in Welsh. There is no need for the user to look for the information in Welsh, it is offered proactively and includes over 1000 pages. The website:
- offers users language choice proactively from the start of their visit; - provides a clear language choice on each page; - Welsh and English pages are of equal quality; and - offers a search function that works in Welsh and English;
Users can search in Welsh or English and the results are returned in the present interface language used at the time. The search results do not inform the user if there are additional results available in the other language. The website interface is exactly the same in both languages. The layout is of the same quality, is as clear for example in relation to colour, size, font and text format. The Health Board has produced guidelines on publishing bilingual web pages (Cascade Users Handy Hints - Bilingual Pages). During training sessions, standard requirements are highlighted in relation to format, naming files and documents bilingually, using images and consistency. The Health Board’s Communication Team is responsible for loading, editing and reviewing content on the Health Board’s website but due to the organisation’s
Welsh Language Services Annual Monitoring Report 2015-2016 Page 27
substantial size, the task of editing the website has been delegated to a core of some 20 devolved website editors from various departments. Each editor receives training on how to manage the website’s Content Management System (provided by NHS Wales Informatics Service). Ensuring understanding of the guidelines on publishing bilingual web pages is an essential component of this training. The editors receive directions not to publish revised or new content on the website until it is available in Welsh and English, in order to ensure the consistency of pages in both languages. When text is available to the editors in one language (English usually) they must arrange for it to be translated into the other language. A process has been established whereby a devolved web editor sends a request to the Health Board’s Translation Service to prepare the text in the other language (further comments on the translation process are provided on the next page). The translated text is returned to the devolved editor for placing it on the new page and then the corresponding Welsh and English pages are simultaneously published on the website. All of these robust processes ensure the Health Board fully complies with its Welsh Language Scheme and ensures a fully bilingual website is provided.
Welsh Language Services Provided
Information about methods used to promote the organisation’s Welsh language services and evidence of any subsequent increase in the public’s use of the services
The Health Board is committed to ensuring that awareness is raised of all its Welsh medium provision and publicity is used to promote the organisation’s Welsh language services.
The Health Board’s S4C documentary, ‘Ward Plant’, drew attention to the range of Welsh language services provided to vulnerable groups, predominaantly children and young people. Members of the ENT Team demonstrated commitment to improving communication, initiating a cultural awareness of the importance of speaking Welsh when caring for children.
Welsh Language Services Annual Monitoring Report 2015-2016 Page 28
Information is regularly provided on the Health Board’s weekly noticeboard round-up which is circulated to all staff. In the last reporting year, examples of promoting the organisation’s Welsh language services included informing staff of the requirements under the Health Board’s Welsh Language Scheme to provide all internally produced information for the public bilingually. In this respect, details of the services provided by the Health Board’s Translation Team were provided and circulated organisation-wide. The organisation has delivered campaigns to draw staff attention to ‘More than just words’, the “Active Offer” and the importance of providing services bilingually in general.
The national ‘Diwrnod Su’mae’ in October was met with great enthusiasm as members of the Welsh Language Team held a display event outside the dining areas of all three main hospital sites. This also afforded the opportunity for staff discussion, distribution of ‘Cymraeg’ resources such as lanyards and badges, and provision of advice regarding the Health Board’s Welsh
Language Scheme and its obligations. Information stalls were also held across the Health Board to celebrate St David’s Day and to raise awareness of the Standards and the “Active Offer”. These campaigns are also valuable in that they raise awareness amongst the public of services that are provided bilingually, such as the Pharmacy’s Bilingual Medicines Helpline.
The Health Board, in its endeavours to internally promote, encourage and support the Welsh language amongst staff, has gone above and beyond its current Welsh Language Scheme requirements in ensuring bilingual key messages and correspondence from the Chief Executive and the Chairman. The Chief Executive has developed a weekly round up to inform staff of his daily activities and deliver a personal message to staff. This assists in creating a bilingual environment, fostering an ethos of leadership and demonstrating top-down commitment in Welsh language provision.
Information about methods used to assess the quality of the organisation’s Welsh language services by assessing the experience of service users (such as surveys, mystery shopper etc)
The North Wales Community Health Council (CHC) independently monitors the provision and delivery of health services in North Wales and conducted a year-long Welsh language monitoring exercise following on from their findings in their previous surveys of the Health Board’s Welsh-medium services. The survey encompassed unannounced visits to all of North Wales’ District General and community hospitals (a total of 27 locations) and a mystery shopper exercise (which was conducted via telephone), whilst the contents of the Health Board’s website, social media pages and press releases were also regularly monitored.
Welsh Language Services Annual Monitoring Report 2015-2016 Page 29
Furthermore, documentation received by the CHC from the Health Board (including correspondence and papers relating to specific meetings) were also reviewed, in order to verify their compliance with the requirements noted in the Welsh Language Scheme. Whilst particular attention was given to signage, the hospital visits also allowed the CHC to monitor other aspects of the Health Board’s bilingual provision, including the availability of Welsh-medium posters and leaflets, and the extent and quality of the bilingual service provided verbally by frontline staff at main receptions. Improvements were identified in terms of bilingual signage, as well as further progress reported in the provision of bilingual greetings by staff at all sites. The monitoring exercise also highlighted some concerns in certain areas in relation to temporary signage and this is being addressed at local level and at an organisation wide level through regular reminders and site visits. Regular walkabout inspections are now held at hospitals throughout North Wales allowing the Welsh Language Team to remind staff about the availability of a range of useful resources to swiftly resolve any issues. The Health Board’s ‘Temporary Signs Database’ on the Welsh Language Section of the intranet site has recently been expanded, facilitating compliance with the Health Board’s Welsh Language Scheme.
Further insight into the quality of the Health Board’s Welsh-medium services was also provided through the publication of ‘A new measure; a new mind-set: The Welsh Language Commissioner’s Assurance Report for 2014–15’ in October 2015. The contents of the Assurance Report were primarily based on the results of a number of mystery shopper surveys. Useful information was received about the quality of the Welsh-medium service provided by reception staff at six BCUHB sites and at switchboards. The exercise gathered positive results in terms of bilingual telephone services and reception areas in Ysbyty Gwynedd, Ysbyty Penrhos Stanley, Ysbyty Alltwen, Denbigh Infirmary and Ysbyty Llandudno. Specific reference to the Health Board’s main public website as an example of best practice noting that the Welsh-medium content is as easy to use as its English language service and this is celebrated as part of the Commissioner’s final report. Link to Welsh Language Commissioner Assurance Report - Item 6
Complaints
Number of complaints received about the implementation of the Welsh Language Scheme
The Health Board received 14 complaints relating to the implementation of its Welsh Language Scheme during 2015-16. (The Health Board received 18 complaints relating to the implementation of its Welsh Language Scheme during 2014-15). The main themes and lessons learned are highlighted below.
Welsh Language Services Annual Monitoring Report 2015-2016 Page 30
Welsh-medium telephone services These complaints covered a wide range of issues – from the failure to provide Welsh-language versions of certain forms, to the provision of S4C for inpatients, to the shortcomings in relation to Welsh-medium telephone services. However, further investigation revealed that the Health Board’s provision of Welsh-medium telephone services referred to isolated incidents, which were all unavoidable, caused by temporary staffing issues (i.e. each of the reported shortcomings was caused by a short-term leave of absence of Welsh-speaking staff at a certain location). This does not therefore reflect the general quality of the Health Board’s Welsh-medium telephone service provision. However, in order to further develop and sustain our ability to provide comprehensive Welsh medium provision, the Health Board recently published a Bilingual Skills Strategy, detailing how teams and departments can maximize their ability to provide Welsh-medium services through strategic recruitment, creative ways of working and workforce planning to make the most of their staff’s linguistic skills. Thus, it is envisaged that the implementation of the new Bilingual Skills Strategy will contribute towards ensuring that such shortcomings are addressed and planned for in advance, eliminating the possibility of any reoccurrence. Primary Care Three of the fourteen complaints received by the Health Board during 2015-16 were about issues which related to services provided by independent primary care contractors. Whilst clause 1.5 of the BCUHB Welsh Language Scheme states that the ‘Health Board will continue to build on the relationship and contacts established by previous Local Health Boards with primary care, by working closely with the contractors and their staff, and will continually encourage and support them in the delivery of a bilingual service to the people of North Wales’, the same passage also emphasizes that ‘Primary Care Contractors (i.e. General Practitioners, Dentists, Pharmacists and Opticians) are independent, self employed contractors and are not employees of the Health Board’. In this respect, as independent contractors, they are not obliged to comply with the Health Board’s Welsh Language Scheme. However, these concerns were fully addressed with the Welsh Language Team offering support and encouragement in the form of resources, awareness sessions as well as the services of its Translation Team. The Health Board has established relationships with key contractors within its limited resource and capacity and will continue to expand its support. The Welsh Language Commissioner’s Investigation and Report into the Health Board’s provision of Cognitive Assessments through the medium of Welsh
The Health Board was subject to an investigation by the Welsh Language Commissioner during 2015-16 relating to an alleged failure to provide a child with a Welsh-medium Cognitive Assessment. The Commissioner’s investigation considered
Welsh Language Services Annual Monitoring Report 2015-2016 Page 31
eight specific clauses within the Health Board’s Welsh Language Scheme, and concluded that the Health Board had acted in accordance with six of them. Whilst the investigation concluded that the Health Board had breached the other two clauses in question by failing to provide a Welsh-medium Cognitive Assessment, the report explained that these contraventions occurred because ‘it was not possible for the Health Board alone to arrange for the standardization of the assessment’ with a formal understanding that in the absence of a nationally standardized Welsh language translation of the Wechsler Intelligence Scales for Children – it was ‘inevitable’ that the Health Board would fail to comply fully with its Welsh Language Scheme in relation to providing Cognitive Assessments. This point of view is confirmed by the report’s only recommendation to draw the attention of relevant partners, including the Welsh Government, to the absence of Welsh language tools or assessments which hinder their ability to treat the Welsh and English languages on a basis of equality in the conduct of public business. Discussions have already taken place with other organisations, including Bangor University, Welsh Government and the Welsh Language Commissioner and the Health Board will continue to provide specialist knowledge from within the service area to advise and facilitate further collaboration with all involved.
Next Steps and Forward Vision Betsi Cadwaladr University Health Board is confident that it will meet its obligations to the public through the implementation of the Welsh Language Scheme over the remaining term of the Scheme. The Health Board has continued in its endeavours to foster a sense of ownership and responsibility of the Welsh Language Scheme amongst its workforce. The Welsh Language Team will continue with their efforts to raise language awareness within services directed towards the four vulnerable groups, and to improve bilingual service provision. Work will also progress with nominated senior leads across all service areas, including West, Central and East areas, Secondary Care, Mental Health, Estates and Procurement to implement improvement plans within the structures. As noted in the main body of the report, the Health Board is fully aware of its challenges and operational pressures during the next reporting year. However, its vision to provide a service that satisfies the needs of Welsh speakers and their families or carers will not be compromised. The Health Board has undertaken a population needs assessment in order to plan its services in accordance and will focus on four key areas during the next reporting year:
Welsh Language Services Annual Monitoring Report 2015-2016 Page 32
The Welsh Language Standards will drive the implementation of service delivery through key dimensions, notably Behavioural Change, Strategic Intervention and Performance and Delivery. This will allow planning, engagement and monitoring on an organisation wide level. We look forward to further developing the working relationship with the Welsh Language Commissioner during the unfolding of the implementation of the Welsh Language Standards that will replace the Welsh Language Schemes. The Bilingual Skills Strategy will be further progressed to ensure implementation across the Health Board, enabling service planning to ensure a sufficient amount of Welsh speakers to deliver services to its Welsh speaking population. ‘More than just words’ and the “Active Offer” will be incorporated into Welsh language service and communication plans to raise awareness at all levels through social and interactive engagement with staff and the public. A pan North Wales ‘More than just words’ Forum has been established with local authorities and other key organisations to ensure an integrated approach to Welsh language planning. Primary Care services will also form a key element of the Health Board’s agenda by continuing to build upon relationships already established with Primary Care contractors, focusing on the Welsh Language Commissioner’s recommendations in her report ‘My Language, My Health’. Welsh language requirements will be mainstreamed into local cluster plans and leads will be identified within the Area Teams to work with the clusters to identify needs, implement imminent achievable actions and roll out existing good practice The Health Board will continue to work with key partners and stakeholders in taking forward Welsh language requirements and encouraging the use of the Welsh language across healthcare provision within the Betsi Cadwaladr University Health Board area. 23.6.16
2.4 16/115 Committee and Advisory Groups Chairs’ Reports
1 16_115.1 F&P Chairs Report 26.4.16.pdf
Date of Meeting 23.6.16
Item 16/115.1To improve health and provide excellent care
Committee Chair’s Report
Name ofCommittee:
Finance & Performance
Meeting date: 26.4.16
Name of Chair: Ms Jenie Dean, Independent Member
ResponsibleDirector:
Mr Russell Favager, Executive Director of Finance
Summary of keyrisks and otheritems discussed:(Minutes areavailable viaSecretariat)
1. Provide summary of discussion of each relevant risk on theCorporate Risk Register:
Financial The finance report for month 12 was discussed. The year
ended with a deficit of £19.5m which is slightly below the£19.7m deficit forecasted but £5m more than the originalbudget set.
The Board did not achieve its savings target of £42.5mhowever £34m of savings were delivered which in cash termsin relation to the other Health Boards is a good achievement.Of this, £11m of savings has been gained through nonrecurring measures which adds to the underlying deficitposition.
For the year ahead, so far savings plans have been producedfor different schemes amounting to £23m of the required£30m.
Access and Delivery Discussion of domains assigned to the Committee within the
IQPR focussing on RTT, Cancer, Stroke, ED performanceand GP out of hours. In relation to RTT, at the end of Marchthere were 643 over 52 week waiters (against a WelshGovernment expectation of zero) and 3,666 over 36 weekwaiters (against the expectation of 3,142). The team arenow working to deliver 3142 over 36 week waiters by theend of quarter 1.
Estates & Environment/ Capital Systems
The month 12 capital programme report was discussed.
The discretionary capital programme was discussed andapproved. Recommendations for bids against Welshgovernment additional discretionary capital were supported.
Informatics The replacement of legacy telephone systems was
endorsed for board approval, noting the robust procurementexercise that had been undertaken.
Continuing Health Care A report with recommendations for a new structure for
Continuing Health Care fees over the next 12 monthsincluding issues such as funded nursing care (FNC), CHCcare homes and domiciliary care was discussed in detail. Allrecommendations were endorsed noting that decisions maygive rise to questions and challenges. The Committee weremindful of the fragility and challenges within the care homeand domiciliary care sector in reaching a decision to supportthe recommendations.
Capital resource limit achieved with all the resourcesallocated expended by year end.
Significant progress in regularising external contracts hasbeen made with improved scrutiny around quality andsafety. In addition the requirements of the Welsh LanguageAct are written into the contracts and a Welsh languagecoordinator is part of the Contracting Group.
GP Out of Hours performance was praised in the JETmeeting in relation to performance against the 20 and 60minutes target at the same time as a large increase in thenumber of calls.
Cat A Ambulance performance good only missing the targetfor one week through the Winter
Performance and accountability reviews are taking place ona monthly basis. The quarter 3 work has been completedand a one day event is taking place on Friday 13th May torecognise the work completed during the last year.
Key risks andconcerns:
Medical Agency usage is of concern; costs are increasingwith little sign these will change in the short term.
Unscheduled care costs have not been contained within thewinter pressures funding indicating the degree of the stressin the system around emergency activity.
Final forecast year end cost pressure resulting from externalcontracts including WHSSC is £9.3m.
There is a particular need to review orthopaedic waitingtimes and how this can be managed going forward workingwith Welsh Government.
Staff uptake of flu vaccine was low in Secondary Care andMental Health. The uptake rate was also low in nursing,ancillary staff and healthcare support workers therefore acontingency plan is required in these areas. The 2016/17 fluplan will be submitted to the Executive Team in June and tothe Committee in July 2016.
Issues to bereferred to anotherSub-Committee
None
Matters requiringescalation to theBoard:
Board to be aware of issues around Continuing Health Carefunding.
Planned businessfor the nextmeeting:
A range of regular reports including Finance, Capital, Workforceand IQPR plus
Intermediate Care Fund Funding 2016/17 Performance Plan and Proposed Integrated Quality
& Performance Reporting Arrangements Update on PADR and Mandatory Training Relocation Expenses Policy Committee Annual Report Shared Services Partnership Committee Assurance Report.
Date of nextmeeting:
24.05.16.
Disclosure:Betsi Cadwaladr University Health Board is the operational name of Betsi Cadwaladr University Local Health Board
Item 16/115.2To improve health and provide excellent care
Committee Chair’s Report
Name ofCommittee:
Remuneration & Terms of Service Committee
Meeting date: 16.5.16
Name of Chair: Dr Peter Higson
ResponsibleDirector:
Mr Martin Jones, Executive Director of Workforce & OrganisationalDevelopment
Summary of keyrisks and otheritems discussed:
The workforce related risks on the Corporate Risk Register areformally monitored by the Strategy Planning & Partnerships SubCommittee. No additional risks were identified for escalation.
Public Session:
The Committee received papers on: The NHS contract and leavers which detailed provisions for the
rotation of staff, options for individuals leaving the organisation,current data on leavers and displaced staff across BCUHB andthe range of supporting policies and procedures.
The Committee endorsed: Its annual report for 2015-16, for submission to the Health
Board A paper outlining proposals in relation to relocation expense
allowances of overseas recruitment of both temporary, fixed-term and substantive medical staff
A protocol for determining salaries of interim appointments atexecutive and other senior level posts to cover a vacant role forwhich is an establishment within the BCUHB structures
Proposals to increase hourly rates paid to substantive medicalstaff undertaking additional duties – internal locums
In Committee Session:
The Committee received an update on agreed salaries forrecent substantive Executive appointments details of JESPoutcomes for other senior posts.
The Committee considered a range of applications made underthe Voluntary Early Release Scheme.
The Committee were provided with a copy of the deed ofsettlement on the mutually agreed separation with the formerChief Executive.
Key assurancesprovided at thismeeting:
None to report
Key risks andconcerns:
Reputational and potentially regulatory risks were highlighted withinthe papers considered.
Issues to bereferred to anotherCommittee
The Committee agreed that the Audit Committee be asked toapprove the final version of the Remuneration and Staff Report aspart of the accountability and financial statements report.
As part of the NHS Contract and Leavers paper, further informationin displaced staff was requested for the Finance & PerformanceCommittee.
Matters requiringescalation to theBoard:
None
Planned businessfor the nextmeeting:
Range of standard items plus: Update on consultant sessions, job planning, private practice; Policy for provision of pay flexibility for executives taking on
significant additional responsibilities; Options for use of VERS monies.
Date of nextmeeting:
18.7.16
Note – an extraordinary in committee meeting was also held on the19.5.16 to consider an application for pay flexibility.
Disclosure: Betsi Cadwaladr University Health Board is the operational name of Betsi Cadwaladr University Local Health BoardV1.0
3 16_115.3 LPF Advisory Group Chairs' Report 11.4.16 v1.0.pdf
Board meeting 23.6.16
Item 16/115.3To improve health and provide excellent care
Advisory Group Chair’s Report
Name of AdvisoryGroup:
Local Partnership Forum
Meeting date: 11.4.16
Name of Chair: Mr Martin Jones / Mrs J Hughes / Mrs J Tomlinson(Rotational)
ResponsibleDirector:
Mr Martin Jones, Executive Director Workforce and OrganisationalDevelopment
Summary of keyitems discussed:
Presentations were received on the Mental Health (MH) Strategyand Primary Care Strategy. Trade Union representatives wereinvited to feed into the MH commissioning process beingdeveloped and consider TU representation within the new primarycare model and engagement with clusters.
An update on progress with healthcare provision for HMP Berwynwas received.
The implications of the introduction of Welsh Language Standardswere outlined across the organisation, including employmentpractice areas supported by Trade Union representatives.
Following a request by Trade Union representatives, progress withBCUHB’s Health and Safety Management structure was outlined.Concern was raised over provision within Area Teams andclarity sought on how Violence and Aggression was supported.
Continued concern on the lack of progress with Job Evaluation wasnoted, including availability of management trained job matchersfor scheduled panel meetings.
Following concerns raised on the findings of the Health andWellbeing pulse survey, further information on BCU’s approach towork related stress would be addressed at a future meeting.
The draft LPF annual report 2015/16 was approved for submissionto the Board.
A presentation on the Proud of campaign was well received.
A Working Time Directive statutory rate of 12.07% across BCUfrom 1.4.16 was supported, subject to further work beingaddressed on inconsistencies and substantive employees workingon the bank.
Presentations on the Leadership Behaviours Framework and DraftWorkforce Engagement Strategy provided opportunities to feedinto the developments.
Key advice /feedback for theBoard:
The Chief Executive commended the work that had beenundertaken by staff during the busiest quarter of the year toachieve reductions in waiting times in certain areas. Heextended a big thank you to staff.
Planned businessfor the nextmeeting:
Recruitment and Retention Strategy;Whole Systems Strategy.
Date of nextmeeting:
21.6.16.
Disclosure:Betsi Cadwaladr University Health Board is the operational name of Betsi Cadwaladr University Local Health Board
Item 16/115.4To improve health and provide excellent care
Committee Chair’s Report
Name ofCommittee:
Audit Committee
Meeting date: 31.05.16
Name of Chair: Mr Ceri Stradling
ResponsibleDirector:
Mrs Grace Lewis-Parry
Summary of keyrisks and otheritems discussed:
1. Summary of discussion of each relevant risk on theCorporate Risk Register:
None.
2. Summary of other business discussed:
Agreed the updated Annual Report of the Audit Committee Approved the Audit Committee improvement plan arising
from the annual self-assessment. Approved recent amendments to the Standing Orders Endorsed the updated Governance Statement for Board
approval. Received the Internal Audit Annual Report and Audit Opinion Received the Annual Report of Post Payment Verification
work. Received the Annual Report of the Local Counter Fraud
service. Discussed the quarterly Financial Conformance Report. Discussed the Accountability Reports that support the
Financial Statements. Received the ISA 260 Report on the Financial Statements
from the External Auditors.
Key assurancesprovided at thismeeting:
The Audit Committee complies with most aspects of goodpractice and has an action plan to address any improvementareas identified.
The Audit Committee has started the process of identifying,classifying and evaluating key sources of Board Assurance andthis will be further refined in 2016-17.
The Annual Governance Statement is a comprehensive
2
analysis of the position of the Board in 2015-16 reflecting theprogress made and the challenges facing the Board as it movesforward.
The Board can be assured that its primary care payments andsupporting arrangements are operating well.
The Board can be assured that the measures it employs, viathe local counter fraud service, to deter, prevent and detectfraud are effective.
Good assurance has been provided by both Internal andExternal Audit that the Board’s financial procedures andcontrols are operating as intended and that areas of risk arenow subject to regular scrutiny.
The Board’s Financial Statements for 2015-16 were preparedpromptly (by 29 April) and the WAO found they were to a highstandard and supported by comprehensive working papers. TheWAO were able to conclude that the accounting policies andestimates used were appropriate and disclosures unbiased, fairand clear. As a result it is the AGW’s intention to issue anunqualified audit report on the financial statements.
Key risks andconcerns:
The Head of Internal Audit provided a Limited Audit Opinion for2015-16. The opinion was based on the limited assurance obtainedfrom audit work in the primary domain of corporate governance,risk management, regulatory compliance and capital and estatesmanagement.
Some recent reviews had contributed to this limited opinionnamely:
the declaration of gifts and hospitality below Board level; partnership governance over section 33 agreements; the Tywyn Hospital redevelopment project.
Issues to bereferred to anotherCommittee
The Finance & Performance Committee should be aware of thefindings of the three audit reports referred to above when available.
Matters requiringescalation to theBoard:
None other than those referred to above.
Planned businessfor the nextmeeting:
Range of Standing Items plus:
BCUHB Response to Wales Audit Office Consultation on Well-Being of Future Generations
Annual Quality Statement Draft Organisational Annual Report 2015-16 Gifts and Hospitality / Declarations of Interest Annual Review Annual Clinical Audit Plan Final Internal Audit Reports (Business Conduct / Gifts &
3
Hospitality and Tywyn Capital) WAO Local Report Medical Equipment & Management
Response.
Date of nextmeeting:
14.7.16.
Disclosure:Betsi Cadwaladr University Health Board is the operational name of Betsi Cadwaladr University Local Health Board
Item 16/115.5To improve health and provide excellent care
Committee Chair’s Report
Name ofCommittee:
Quality, Safety and Experience
Meeting date: 10.5.16
Name of Chair: Mrs Marian Wyn Jones, Independent Member
ResponsibleDirector:
Mrs Vicky Morris, Executive Director of Nursing, Midwifery,Therapies & Health Science.
Summary of keyrisks and otheritems discussed:
Summary of discussion of each relevant risk on the Corporate RiskRegister:
CRR2 Infection PreventionAs part of consideration of the integrated quality performancereport, the Committee suggested that norovirus and numbers ofbed moves be included as local indicators.
CRR3 Continuing Health Care/Nursing HomesDiscussion around delayed transfers of care, resulting in decisionto seek paper from Area Directors for the Stakeholder ReferenceGroup regarding relationships with local authorities.
CRR4 Maternity ServicesFactors contributing to a deteriorating position with caesareansection rates would be picked up by the Interim Executive NurseDirector, and an exception report be provided.
CRR5 Patient ExperienceListening and learning report – noting rich data but a range ofvariation in patient feedback for Q3 2015/16. An increase innumber of complaints but high percentage of patients still ratedcare as good. Implementation of PALS, Patient advice and liaisonservice should help resolve some low level issues.
CRR13 Mental HealthAssurance paper deferred pending appointment of substantive MHDirector into role.
Summary of other business discussed:
Director of Quality Assurance’s Report – discussion aroundclinical audit, with concern expressed re dissemination ofclinical audit actions and recommendations. HIW reports intoindependent/private contractors/review of learning disabilities.Presentation on quality improvement objectives and suggestionthat the Healthcare Professionals Forum could provide achampion role.
Year end self-assessed position for health and care standardswas noted.
A short in-committee meeting was held at the end of themeeting to sight members on two issues which would besubject to public papers at the next meeting.
Key assurancesprovided at thismeeting:
Progress with addressing and responding to Health & SafetyExecutive interventions
Receipt of internal audit report regarding the QualityImprovement Strategy which provided a level of moderateassurance.
Key risks andconcerns:
Ongoing work required to improve links between Clinical AuditGroup, Clinical Effectiveness Group and Area Groups.Schedule of high priority audits to be presented to the QualityAssurance Executive.
Issues to bereferred to anotherCommittee
The Chief Operating Officer was asked to raise at Executive Teamthe issue of Board level influence / direction of Area Quality &Safety Groups.
Matters requiringescalation to theBoard:
The endorsement of Policy MD18 “Being Open”, noting that theduty of candour should apply to all health professionals, not justdoctors and nurses.
Planned businessfor the nextmeeting:
Range of regular reports plus Putting things right annual report Ombudsman’s annual report Accessible healthcare standards Women’s service assurance report Mental Health assurance report Safeguarding activity Annual quality statement National complex care Mortality Infection prevention / Prof B Duerden’s report.
Date of nextmeeting:
14.6.16.
Disclosure: Betsi Cadwaladr University Health Board is the operational name of Betsi Cadwaladr University Local Health BoardV1.0
3.1 16/116 Special Measures Improvement Framework – Task & Finish Group Chair’s Assurance Report 2.6.16
Date of Health Board meeting: 23.6.16 Agenda item number
To improve health and provide excellent care
DRAFT Committee Chair’s Report
Name of Committee:
Special Measures Improvement Framework Task & Finish (SMIF T&F) Group
Meeting date: 2.6.16
Name of Chair: Mrs Margaret Hanson, Health Board Vice-Chair
Responsible Director:
Mrs Grace Lewis-Parry
Summary of key risks and other items discussed:
Information requirements for the covering letter to accompany the submission of the End of Phase 1 Report to Welsh Government
Reporting arrangements to Board – SMIF T&F to submit monthly updates via Chair’s Assurance Reports
Embedding special measures in core business – Committee and Board coversheets to include an additional field requiring authors to identify to which element of special measures their paper applies
Progress against the Improvement Framework progress and action log relating to Phase 2.
Key assurances provided at this meeting:
Risks and timescales associated with the Special Measures Improvement Framework are being managed appropriately; overall, good progress has been made.
There is linkage between the expectations and deliverables in the Improvement Framework progress and action log and the Operational Plan
Each theme within the Improvement Framework is to be allocated to a specific Committee of the Board.
Key risks and concerns:
Sustaining a stable Board is of primary importance; the Board has made key new appointments but there are instability risks during this transitional phase
Scope, timescales and preparedness of the system/public are the key challenges relating to the whole system change
Staff engagement and culture change requires further development otherwise progress may be impeded
Additional resources will be required to support continued progress against the Improvement Framework
Mental health remains an area of risk, and there are also risks associated with HMP Berwyn.
Issues to be referred to another Committee
Themes will be allocated to Committees as follows, for additional scrutiny and monitoring purposes: Leadership – to be retained by the SMIF T&F Governance – to be retained by the SMIF T&F Strategic & Service Planning – Strategy, Partnerships & Population Health Committee Engagement – Quality, Safety & Experience Committee Mental Health Services – Quality, Safety & Experience Committee Maternity Services – Quality, Safety & Experience Committee Primary Care – Strategy, Partnerships & Population Health Committee.
Matters requiring escalation to the Board:
None.
Planned business for the next meeting:
Progress monitoring for Phase 2.
Date of next meeting:
7.7.16
Disclosure: Betsi Cadwaladr University Health Board is the operational name of Betsi Cadwaladr University Local Health Board
Item 16/117 To improve health and provide excellent care
Title: Integrated Quality & Performance ReportAuthor: Jill Newman, Director of Performance
Richard Gillett, Head of Business Intelligence & Performance AssuranceResponsibleDirector:
Morag Olsen, Chief Operating Officer
Public or InCommittee
Public
Strategic Goals
1. Improve health and wellbeing for all and reduce healthinequalities
2. Work in partnership to design and deliver more carecloser to home
3. Improve the safety and outcomes of care to match theNHS’ best
4. Respect individuals and maintain dignity in care
5. Listen to and learn from the experiences of individuals
6. Use resources wisely, transforming services throughinnovation and research
7. Support, train and develop our staff to excel
Approval /Scrutiny Route
Four sections of the report have had prior scrutiny with the Finance &Performance Committee and three sections have had prior scrutiny bythe Quality, Safety and Experience Committee.
Purpose: This report provides the Board with a summary of key quality,performance, financial and workforce indicators.
Significant issuesand risks
The integrated quality and performance report for March 2016 includes: National Indicators aligned to the seven national performance
domains Locally agreed indicators aligned to the performance domains
Monthly updates against National Indicators
The national indicators for the domains demonstrate the followingchanges in direction of performance since last month’s report:
National Targets
Domain ImprovedPerformance
SustainedPerformance
Decline inPerformance
2
Staying Healthy 8 6 3
Safe Care 5 6 1
Effective Care 3 4 2
Dignified Care 1 0 1
Individual Care 1 1 3
Timely Care 6 1 9
Staffing and Resources 3 1 2
Total 27 19 21
Local Targets
Domain ImprovedPerformance
SustainedPerformance
Decline inPerformance
Staying Healthy 1 0 1
Safe Care 4 1 8
Effective Care 2 0 2
Dignified Care 2 0 1
Individual Care 2 1 2
Timely Care 8 0 2
Staffing and Resources 2 0 0
Total 21 2 16
Staying Healthy
Good progress has been made on reducing the numbers of babies whoare born with low birth weight, a key indicator for a healthy population.This improved to 6.1% in April 2016. It is expected that performance willimprove further this year. Further detail can be found on page 17.
Safe Care
3
Ward to Board measures, contained within the Ward Quality Auditsdeteriorated slightly by 1% to 87% this month. There has been adeterioration of theme scores in general wards, in particular inCommunity Hospitals, and an improvement in performance in MentalHealth and Learning Disabilities. There was a small improvement incompliance in general wards, but a reduced compliance in Mental Health
There we no new never events this month.
Performance against the complaints response target for 30 days, shownon page 27, has deteriorated this month to 19.3% and still remains shortof the target of 75%. Performance is managed locally and staffs areaiming to offer direct contact with complainants to improve responsetimes.
Effective Care
The continuing investigation into higher mortality at the Wrexham Maelorsite is reported, together with the actions being taken to investigatecauses of concern. A detailed investigation is expected to report in mid-2016. The report is on page 38.
Individual Care
Performance against the I Want Great Care pilot at Wrexham Maelorscore was 4.66 out of 5.00.
The number of non-mental health patients who were delayed transfers ofcare performance worsened again this month, however the overallnumber of bed days lost due to delays improved. The actions which arefocussed around nursing and residential care home beds were reviewed.The percentage of patients who leave Emergency Departments withoutbeing seen has deteriorated further at the Wrexham Maelor site.Further detail can be found on page 48.
For Mental Health services, we saw a decline in performance inassessment and treatment waiting times in April, Adult Mental Healthservices mentioned sickness absence levels for the decline inperformance. Ensuring that all service users have an agreed care planis a key indicator for the services, the continued performance gains showthat in April the service is only just short of the 90% target, see page 46of this report for further detail.
Dignified Care
Performance against the target to ensure we cancel fewer patient’sprocedures after they have been admitted continues to improve.However, cancellations prior to admission continues to show poorperformance (page 50).
4
Timely Care
Referral to Treatment showed a deterioration in performance from Marchto April (page 55). Therapy waiting times have achieved the target ofzero patients waiting at the end of April. Diagnostic services havesignificantly increased the volume of patients accessing tests this year,unfortunately at the end of April, the 8 week target was breached.Actions are being taken to increase the number of tests and scansperformed per month to support improvement in performance which isexpected to be evident in May and June 2016. Emergency Departmentperformance remains poor, with a modest improvement in April overMarch. Wrexham Maelor remains the poorest performer of our hospitals,with actions to improve the performance by focusing on low acuitypatients at Wrexham Maelor’s Emergency department (page 57). Thestroke measures have been refined this month to reflect the 2016/2017performance measures as set out in formal guidance from the WelshGovernment.
Our Staff & Resources
The financial position of the Health Board is reported, an adversevariance of 2.7% is shown at the end of Month 1. Further detail can befound in the finance report. The rolling 12 month sickness absence hasworsened slightly from last month; however our performance is the bestout of the 6 large health boards (page 67).
Referrals & Activity
New referrals at the Health Board, both from GPs and consultants, areincluded in the report in line with Ann Lloyd’s recommendations. Overallreferrals have increased by 11.4% compared to April last year, howeverthis variance is just for a single month of April. The previous April hadfewer referrals due to the Easter holiday period falling within it.
Quality & Effectiveness Measures
The indicators covering readmissions, complications and misadventuresare not included in this month’s report due to data processing issues atthe clinical benchmarking company used to produce the report. It isanticipated that correct figures will be available in time for the next fullreport.
Equality ImpactAssessment
The Health Board’s Performance Team are establishing a rollingprogramme to evaluate the impact of targets across the Equality &Diversity agenda.
Recommendation/Action requiredby the Board
The Board is asked to note the report.
5
Disclosure:Betsi Cadwaladr University Health Board is the operational name of Betsi CadwaladrUniversity Local Health Board
Integrated Quality & Performance Report 2016/17
Performance to the end of April 2016
To improve health and provide excellent care
Health Board
Title
Contents
Foreword
1.0 Executive Summaries
2.0 Overview and Areas of Escalation
2.1 Staying Healthy
2.2 Safe Care
2.3 Effective Care
2.4 Individual Care
2.5 Dignified Care
2.6 Timely Care
2.7 Our Staff & Resources
3.0 Referrals & Activity
Appendix A
Further information and links
Section Content
Contents
Performance Report April 2016
Page 2
Table of Contents
Table of Contents
Performance Report April 2016
Page 3
Title 1 New Serious Incidents 23 MHM Treatments (Part 1) 45 Sickness 67
We present performance to the Board using the frameworks against which
NHS Wales is measured. This report includes the indicators from the
seven domains of; Staying Healthy, Safe Care, Effective Care, Dignified
Care, Individual Care, Timely Care and Our Staff and Resources.
The first three domains of Staying Healthy, Safe Care, Effective Care are
scrutinised at the Quality, Safety & Experience committee.
From October 2015 the Individual Care domain has shared scrutiny, with
some indicators being scrutinised by the Quality, Safety & Experience
committee and the remaining indicators being scrutinised by the Finance
& Performance committee.
The final three domains of Dignified Care, Timely Care and Staffing &
Resources are scrutinised by the Finance and Performance Committee.
Introductory Reports & Exception reports
Each new local indicator has an introductory report that gives the context of the indicator. We include exception reports where
performance is either worse than the required standard or the Board require sight of the actions we are taking to maintain or
improve performance. After we have achieved an indicator for three consecutive months, it will be stood down from exception
reporting.
Foreword
Performance Report April 2016
Page 4
Status Guide and Legend Status On the following pages, we report the overall escalation status of the Health Board. We use the Welsh Government’s status levels. The status level of each indicator group is graded from zero to four, with four being of most concern.
Legend
This report uses trend arrows. They show if the position has become better or worse than the previous month. Where the arrow is coloured, green signifies that performance is better than where we planned to be this month, whereas red signals that we are worse than where we planned to be this month. ↑ The value is better than the previous month → The value is the same as the previous month ↓ The value is worse than the previous month
Level 0 – local delivery of all targets and / or within trajectory
Level 1 – failure to deliver achieve or deliver one target or deliverable
Level 2 – continued failure to achieve or maintain one or more key deliverables
Level 3 – continued failure to maintain an agreed improvement trajectory
Level 4 – continued failure to improve performance or failure to engage with the national process
Special
Measures
This escalation status applies at Health Board level. Five key areas are a focus of the intervention
by Welsh Government; Reconnecting with the public, Staff Engagement, Mental Health, Obstetric
Care, Out of Hours Care and Board Governance.
Cross-hatch
Cross-hatch background. Where the background is cross-hatched this figure is the provisional, unvalidated position.
No Target No target level or the trajectory has not been set. This is used for new indicators which we are introducing into the report. The relevant executive director has been asked to set the target level. -
Status Guide
Performance Report April 2016
Page 5
Summary of
performance
within theme
(Red/Green)
Domain
Theme
Legend
1 Executive Summary
Executive Summary (Sunburst)
Mo
rta
lity
Staying Healthy
SafeCare
EffectiveCare
Individual Care
DignifiedCare
Timely Care
Staff & Resources
Performance
Summary
Our Achievements Staying Healthy I am well informed & supported to manage my own physical and mental health
North Wales Cancer Treatment Centre and
Tenovus Cancer Care
Tenovus Cancer Care, in partnership with the
Health Board, has launched Chemotherapy
Education Sessions. These sessions are for new
patients who will be undergoing chemotherapy
treatment at the North Wales Cancer Treatment
Centre.
Patients are invited to the session at the
centre before to their first chemotherapy
treatment, along with a family member, friend or
carer. Hospital staff use their professional
judgement to determine who the session is
suitable for and tailor this decision on; the
distance the patient would need to travel to the
session, the complexity of that individual’s
particular treatment and the patient’s individual
circumstances
For some patients, a one to one information
session is more appropriate, but for the majority
of patients the group education session is best.
The session gives an insight into the treatment,
a chance to see the chemotherapy department,
meet some of the staff involved and ask any
questions. It includes a talk about chemotherapy
from a nurse and a talk from Tenovus Cancer
Care about the free cancer support services that
are on offer to patients. This includes a welfare
benefits advice service, counselling service and
nurse telephone support, accessible via a free
support line. The attendees are then given time
to chat to NHS and Tenovus Cancer Care staff,
before being shown around the department.
One benefit of the session to NHS staff is
that considerable time can be saved by
delivering information in a group setting. The
first session took place on 15th April 2016.
Sessions have taken place at a rate of 1 per
week (every Friday afternoon) over a period of 4
weeks to date. Over the 4 sessions, a total of 24
people (patients and supporters) have attended
the sessions.
86% of
respondents
said they
found the
session
extremely
useful
Achievements Staying Healthy
0
5
10
15
20
NoKnowledge
LimitedKnowledge
FairKnowledge
GoodKnowledge
Attendees' knowledge of chemotherapy treatment after
session
Performance Report April 2016
Page 7
Our Achievements - Safe Care I am protected from harm & protect myself from known harm
New infection prevention measures developed by Betsi nurse gets UK-wide launch
A new tool which will help surgical teams prevent infection has been launched following
pioneering work by a senior Betsi Cadwaladr University Health Board nurse. Glan Clwyd Hospital-
based Tracey Radcliffe has worked with the OneTogether Partnership over the last two years to
develop a self-assessment tool which encourages best practice among operating theatre staff. The
OneTogether infection prevention programme is a network of professional associations and
industry partners working together to improve patient outcomes.
Tracey worked with other leading professional organisations to develop the clinical tool, which
encourages surgical staff to assess their everyday work and the way they care for patients. The
two-year project was supported by theatres at Wrexham Maelor Hospital, which was one of 15
clinical pilot sites where the new self-assessment tool was put to the test.
The self-assessment tool helps theatre staff compare their work with NICE guidelines,
highlighting areas where they can improve their clinical practice. Tracey said: “There hasn’t been a
tool like this for surgical teams to use before, so hopefully it’ll prove to be a really valuable
resource for education, assessment and quality improvement. “It’ll be used by staff involved in
treating patients who need surgery to help assess their own standards and identify where
improvements can be made. We looked at all areas of practice that contribute to preventing
surgical site infection, for example education for patients in keeping themselves warm prior to
surgery and theatre staffs’ practices to keep them warm during surgery.
We worked on creating the tool and launched a pilot phase in April 2015 in hospitals across the
UK, including Wrexham Maelor. It ran for approximately three months, giving all sites capacity to
carry out the assessment needed.
The new toolkit was launched at the OneTogether Conference at Birmingham’s Think Tank
science museum, which brought together leading theatre practitioners and specialists in infection
prevention. Tracey is now working with fellow OneTogether partners to look at further ways of
promoting the spread and adoption of best practice in surgical site infection prevention, having
polled participants at the conference on areas they felt were a priority for improvement.
There hasn’t
been a tool like
this for surgical
teams to use
before, so
hopefully it’ll
prove to be a
really valuable
resource for
education,
assessment and
quality
improvement.
Achievements Safe Care
Tracey Roberts
Performance Report April 2016
Page 8
Improvement of Psychiatric Liaison
A psychiatric liaison team works in general
hospitals, for example in the emergency
department or in-patient wards. They provide
psychiatric assessment and treatment to those
patients who may be experiencing distress
whilst in hospital and provide a valuable
interface between mental and physical health.
The Psychiatric Liaison Accreditation Network
(PLAN) works with services to assure and
improve the quality of psychiatric liaison in
hospital settings.
PLAN engages staff and patients in a
comprehensive process of review, through
which good practice and high-quality care are
recognised and services are supported to
identify and address areas for improvement.
Accreditation assures staff, patients and carers,
commissioners and regulators of the quality of
the service being provided.
PLAN includes core areas common for all
teams, such as assessment and care planning,
but also recognises that some areas may be
outside a team’s remit. This means that a small
but well functioning team can still be accredited
in the domains that it is measured against.
PLAN provides year round support to help
accreditation members maximise opportunities
for learning and development. This support
includes the option of taking part in email
discussion groups, learning events and annual
conferences, as well as quality improvement
advice targeted at individual services
Why is PLAN accreditation So Valuable?
It provides formal recognition…
Accreditation assures patients, carers, frontline
staff, commissioners, managers and regulators
that the liaison service is of a good quality and
that staff are committed to improving care.
Meeting accreditation target helps meet other
priorities too, including national and government
drives. PLAN accreditation and quality
improvement activity is highly valued
Our Achievements - Effective Care I receive the right care & support as locally as possible & I contribute to making that care successful
PLAN engages
staff and patients in
a comprehensive
process of review,
through which good
practice and high-
quality care are
recognised and
services are
supported to
identify and
address areas for
improvement.
Staff Member
PLAN
Achievements Effective Care
Performance Report April 2016
Page 9
Our Achievements - Individual Care I am treated as an individual, with my own needs and responsibilities
Maternity Outpatient Assessment Unit
(MOAU) Womens Services
The MOAU’s were introduced with the aim of
improving service user experience and
increasing efficiency within the maternity units.
Previous to this model of service delivery
there were Antenatal Day Units in each of the
maternity units, operating a weekday service
mostly during office hours. The majority of
women requiring closer monitoring can be
managed as outpatients if an enhanced facility
exists, such as an assessment unit accessible
on a 24hr 7 day per week basis. The Obstetric
Units (Labour Wards) were often at capacity
as women were being admitted for
assessment and observation in the latent
phase of labour. Women requiring
assessment and observation during night time
hours would need to be admitted to the
antenatal ward as no facility existed to assess
them out of hours.
The first MOAU opened in Glan Clwyd
Maternity Unit in September 2014, followed by
the opening of an MOAU in Wrexham and
Bangor maternity units in April 2015. The
MOAU consists of an assessment unit
operating scheduled appointments during the
day, with a 24hr triage service alongside,
available to all pregnant women ensuring ease
of access and support, whilst also maintaining
capacity on the Obstetric Unit.
This new model of care enables all health
care professionals to consistently deliver a
high standard of outpatient antenatal
surveillance to women whose pregnancy
requires further monitoring. Health care
professionals refer to relevant national and
local guidelines as necessary when monitoring
and assessing maternal and fetal wellbeing
therefore providing consistent evidence based
care.
Majority of the
women who
attend an
MOAU return
home with an
identified plan
of care based
on their
individual risk
assessment Paula (Patient), 47, from
Kinmel Bay
Achievements Individual Care
Performance Report April 2016
Page 10
Our Achievements - Dignified Care I am treated with dignity & respect and treat others the same
Community Formulary:
Continence & Urology Products 2016
A Health Board Community Formulary for
Continence & Urology Products was launched
on the 12th April 2016.
The Formulary and related Product Order Form
have been developed for the Prudent Medicines
Management Continence Work Stream. The aim
is to standardise continence and urology
products that are available on prescription
across North Wales.
It will simplify the prescribing of these products,
promote best practice and ensure efficient use
of NHS resources. The purpose of the evidence-
based Continence Formulary is to provide a list
of urinary products that can be used for the
majority of patients and as an educational
resource.
To celebrate the launch a drop in session was
arranged at the Optic Centre, St Asaph.
The session was well attended by community
nurses as an opportunity to become familiar with
the Formulary products and discuss the
implementation process with members of the
Continence Team, Improvement Team,
Medicines Management and Company
Representatives. Real sense of
satisfaction
seeing how
happy the
nursing staff
were at the
launch that the
Formulary is
published. The
first of many
more goals to
come Adam El Lamie
Project Manager
Achievements Dignified Care
Performance Report April 2016
Page 11
Performance Report April 2016
Page 12
Reducing Outpatient Waiting Times
Outpatient services are on a transformational
journey, under the guidance of Simpler
Healthcare. We identified that there was a lack of
a proactive coordinated approach to managing
the outpatient waiting times, a need to remove
waste in the process, reduce the follow-up
backlog, DNA rates and hospital initiated
cancellations. This project aims to develop a
flexible service to meet needs, demands and
capacity as required. Planning cells are now
established on each site to support:
i) Cohesiveness and joined up working
ii) Horizon planning ‘no surprises’
iii) Reduction in non-notified clinic cancellations
due to improved communication
iv) Reduction in Non Value Add time spent
v) Understanding and root cause of the data
we get
vi) No blame culture.
Examples of success so far are:
• A Direct Booking pilot is about to be
introduced, linking with the Welsh
Government, because project work has shown
that this will significantly improve the current
process flow and improve the patient
experience.
• Validation processes for the follow up backlog
have been developed and roll out across
specialties is being planned
• In Gastroenterology new templates are to be
implemented from May that improve the
capacity of the clinics, one example of
success is below:
Medical Records Improvement
Medical records have completed an ambitious
programme of work to improve both the flow of
their work and the work environment. They are
about to implement a new electronic tracking
system in East that will significantly help in the
management of records. Through collaborating
with nursing staff in the urology clinics in
Wrexham they have released 100 hours a month
of nursing time previously spent in prepping case
notes before clinics.
Our Achievements - Timely Care I have access to services based on clinical need & am actively involved in decisions about my care
The approach
is proven to
work – the
challenge now
is to roll out the
lessons
learned in
order to make
a real
difference
Alison Ravenscroft
Project Lead
Achievements Timely Care
NHS Wales Honoured at Global Sepsis Awards
The Global Sepsis Alliance is an international non-profit organisation responsible for numerous
worldwide sepsis awareness initiatives – such as World Sepsis Day. NHS Wales’ contribution to
sepsis awareness and prevention was recognised in the “Governments and Healthcare
Authorities” category. 1000 Lives Improvement has long been supporting the prevention of sepsis
in NHS Wales through its Rapid Response to Acute Illness Learning Set (RRAILS) programme.
Through this work, Wales became the first country to adopt NEWS (National Early Warning
Score): with the life-saving intervention now an integral part of ward care in hospitals across the
nation.
Chris Hancock, 1000 Lives Improvement’s programme lead for the (RRAILS) said: “I am really
proud that NHS Wales has won the Global Sepsis Award recognising the outstanding work across
all health boards and trusts in improving treatment and reducing death from sepsis. Participants in
the 1000 Lives Wales Rapid Response to Acute Illness Learning Set (RRAILS) have made a huge
difference, working tirelessly and going above and beyond the expectations of their day to day
roles to improve safety for all people accessing healthcare in Wales.”
Our Achievements - Our Staff and Resources I can find information about how the NHS is open & transparent on its use of resources & I can make careful use of them
1. Improve health and wellbeing for all and reduce health
inequalities
2. Work in partnership to design and deliver more care
closer to home
3. Improve the safety and outcomes of care to match the
NHS’ best
4. Respect individuals and maintain dignity in care
5. Listen to and learn from the experiences of individuals
6. Use resources wisely, transforming services through
innovation and research
7. Support, train and develop our staff to excel.
Approval / Scrutiny Route
Scrutiny provided by the Finance and Performance Committee prior to submission to the Board.
Purpose: The purpose of this report is to brief theFinance and Performance Committee and the Board on the financial performance and position of the Health Board for the month, alongside the forecast for the year.
Significant issues and risks
The Health Board approved an Interim Financial Plan on 17 March which approved a deficit budget as a planning assumption of £30m; following a need to deliver savings of £30.3m. There is an assumption within the budget that the Health Board will receive an additional allocation of £4.8m to support in the delivery of issues arising from the Health Board’s Special Measures status. Being placed under Special Measures has put a greater focus on addressing longstanding service issues. This has resulted in risks against the Health Board’s ability to deliver the transformational financial savings schemes previously identified. To date, the Health Board has overspent by £2.9m; of which £2.5m relates to the planned deficit and £0.4m relates to unidentified savings, slippage in savings delivery, and other operational pressures. This position will need to be recovered over the remainder of the financial
2
year in order to achieve the forecast position of £30m.
Equality Impact Assessment
Not applicable
Recommendation/ Action required by the Committee
It is asked that the report is noted.
3
Finance Report
Month 1 (April) 2016/17
Russell Favager Executive Director of Finance
Betsi Cadwaladr University Health Board
1. Executive Summary
1.1 Purpose
The purpose of this report is to outline the financial position for the year to date; performance against savings targets for the year and the outlook for the remainder of the year.
1.2 Context
The Health Board has two statutory duties to achieve: 1 To ensure that its expenditure does not exceed the aggregate of the funding
allocated to it over a period of 3 financial years (the first of which commenced on 1 April 2014 and will end on 31 March 2017), and
2 To prepare a plan to secure compliance with the above duty, providing healthcare and improving the health of the population, and for that plan to be submitted to, and approved by the Minister (required for the first time in 2014/15).
The Health Board has, in agreement with Welsh Government, not submitted a three-year plan in either 2014/15 or 2015/16 and will not do so for 2016/17. As a result of this, the Health Board has been operating under Annual Operating Plan arrangements.
The Health Board’s deficit for 2014/15 was £26.6m, and the (unaudited) deficit for 2015/16 was £19.5m. Consequently, the aggregated deficit for the first two financial years of the first three year period is£46.1m.
The agreement of a deficit budget in 2016/17 of £30m therefore means that the Health Board is forecasting an aggregate deficit of £76.1m for the three year period ending 31 March 2017.
The Minister for Health and Social Services placed the Health Board in Special Measures in June 2015, expected for a period of two years. The implementation of the Special Measures Improvement Framework has resulted in additional costs for the Health Board, necessitated to address longstanding areas of concern. Nonetheless, this requires further resources, and £4.8m of additional resources have been assumed for the financial year from Welsh Government.
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1.3 Summary of key financial targets
Key Target Annual target
Year to date
target
Year to date
actual Risk
Achievement against Revenue Resource Limit (Performance against £30m budget deficit)
(30,000) (2,500) (2,930)
Performance against savings (Internal target)
30,334 1,855 961
Achievement against Capital Resource Limit 50,219 2,337 2,288
Compliance with the requirement to pay Non-NHS invoices within 30 days of receipt of a valid invoice
95.0% 95.0% 95.5%
Cash balance at month-end 0 7,300 5,283
1.4 Revenue position
At Month 1, the Health Board has overspent by £2.9m. Of this, £2.5m relates to the Health Board’s planned budget deficit and £0.4m represents an adverse variance against this plan.
1.5 Cash releasing efficiency savings
Of the savings target of £30.3m, £26.0m have been identified to date. £1.0m of savings were achieved in Month 1, against an expected delivery of £1.9m.
1.6 Forecast revenue position and risk assessment
The Health Board is managing a number of financial risks, but the forecast position is a £30m deficit, in line with the interim Financial Plan.
1.7 Balance sheet
The Health Board is required to pay non-NHS invoices within 30 days of receipt of a valid invoice. The benchmark requirement is to pay 95% of valid invoices within this period. During Month 1, the Health Board paid 95.5% of its invoices within 30 days.
The closing cash balance as at 30 April was £5.3m. This represents 1.45 days turnover, which is within of the Health Board’s internal target to carry less than the equivalent of 2 days of turnover. Cash remains a key risk for the year end as the Health Board will be required to repay cash support received in 2014/15 of £20.6m.
1.8 Key actions to be taken
The agreement of the Operational Plan will be critical in ensuring that the operational and performance expectations of the Board are clarified within the available financial resources.
The Health Board needs to ensure that savings targets are identified in full; and that delivery of savings is a priority alongside cost management.
2. Revenue position
2.1 Cumulative revenue position by division
Red: represents adverse variances in excess of 0.5% Amber: represents adverse variances equal to, or less than, 0.5% Green: represents favourable variances
2.1.1 Commentary
Area Teams as a whole have achieved a breakeven position, mainly as a result of services provided across North Wales, in particular healthcare contracts which underspent by £0.1m.
Secondary Care teams have overspent by £0.5m as a result of unidentified and undelivered savings in Month 1 (£0.4m) alongside operational pressures arising from agency staffing.
Mental Health and Learning Disabilities have overspent by £0.5m, largely as a result of unidentified and undelivered savings in Month 1 (£0.3m) alongside continued pressures on agency staffing.
Corporate Services have underspent by £0.2m as a result of slippage in appointing to vacancies.
Other variances of £0.4m relate to the phasing of reserves, including those to support the development of the organisational management structure and to address cost pressures. These reserves will be transferred to operational budgets as appointments are made.
2.1.2 Actions
It is imperative that action is taken across the East health community to address the system-wide issues on identifying and delivering savings; and on addressing operational pressures.
In addition to this, Secondary Care need to focus on identifying and delivering savings in Ysbyty Gwynedd.
Management grip within Mental Health and Learning Disabilities needs to be enhanced, and this will be an area of immediate focus for the new Director.
2.2 Cumulative revenue position by expenditure category Annual
Budget Current period
variance
Year to date actual
Year to date
variance
Section
£’000 £’000 £’000 £’000
Primary Care 158,453 (42) 13,162 (42) Section 2.2.1
Pay 649,687 268 55,300 268 Section 2.2.2
Non-pay 440,356 635 33,792 635 Section 2.2.3
Healthcare contracting
172,077 (84) 14,118 (84) Section 2.2.4
Continuing Healthcare and Funded Nursing Care
84,826 163 7,232 163 Section 2.2.5
Total expenditure 1,505,400 940 123,605 940
Income (107,760) (510) (10,637) (510) Section 2.2.6
Net expenditure 1,397,640 430 112,968 430
Budgeted deficit (30,000) 2,500 0.0 2,500
Position against plan
1,367,640 2,930 112,968 2,930
2.2.1 Primary Care
Primary Care services is balanced overall.
Within General Dental Services, work is ongoing to develop investment plans for additional activity to improve dental access across North Wales. This work will be focussed on areas with the lowest access levels.
Within General Medical Services, there is a significant risk against this forecast as the Doctor and Dentist Pay Review Body has agreed a 2.2% uplift for the GMS contract for 2016-17, which equates to £2.2m for North Wales and which cannot be contained within the current budget. However, the Health Board is currently appealing against the rateable value of a number of GP premises within North Wales, back dated to 2010. This may result in a benefit of up to £2.9m to the Health Board in the current year.
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2.2.2 Pay
Pay costs, in particular variable pay costs arising from the use of Agency staffing in particular is a serious concern, as demonstrated above.
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The total Agency costs for April was £3.5m compared to average monthly expenditure of £3.2m in quarter 3 and £3.8m in quarter 4 in the last financial year.
Agency Nursing has increased from an average of £0.5m per month in 2015/16 to £0.6m in April. Medical Agency costs are £2.5m in April compared to an average of £2.4m per month in 2015/16. Further Agency analysis is shown in Appendices 2 and 3.
The total Agency costs for 2015/16 where £37.4m, further efforts are required to reduce expenditure in 2016/17; with continued problems with medical recruitment this remains a significant challenge.
2.2.3 Non-pay
The majority of the £0.6m overspend relates to undelivered savings which were phased in Month 1.
Other non-pay variances have arisen with drugs, utilities and rates. 2.2.4 Healthcare contracting
The Health Board’s externally delivered Healthcare Contracts is under spent by £0.1m.
BCU Managed Welsh and English contracts are balanced at the end of April and the net position on WHSSC-commissioned contracts is an under spend of £0.2m.While WHSSC is forecasting a year-end underspend of £0.8m, the historic performance of WHSSC means that this is an area of volatility and risk to the financial position.
No outsourced RTT activity has been charged in Month 1. 2.2.5 Continuing healthcare
Continuing Healthcare and Funded Nursing Care is overspent by £0.2m in Month 1.
This is an area of known risk, and the service demand, complexity of care packages and issues with the stability of the provider market mean that it will be subject to close scrutiny over the year.
2.2.6 Income
Favourable income variances have arisen from: o Services commissioned from the Health Board by WHSSC; o Income from R&D and grants; and o Income from non-contract activity with other Health Boards, Private Patient
Income and Local Authorities.
3. Cash Releasing Efficiency Savings
3.1 Savings requirement
The Health Board has a challenging savings target of £30.3m for 2016/17. A 3% target has been applied across all non-ringfenced budgets.
A programme board framework has been introduced. The framework is made up of a number of strategic work streams, which feed into a total of ten programme boards, each led by an Executive Director. All savings schemes will be allocated against a relevant work stream.
3.2 Identified Savings
Savings plans of £26m have been developed at Month 1 against the target (85.81%).These have all been financially risk assessed as follows.
o Low: £9.45m o Medium: £13.93m o High: £2.61m o Unidentified: £4.34m
Of the above planned savings, £21m are considered to be recurrent while the remaining £5m have been identified as non-recurrent. Work is ongoing in order to identify recurrent and non-recurrent schemes which will in turn reduce the unidentified savings figure.
3.3 Performance
Cash releasing Savings of £1.0m have been delivered as at Month 1 against a planned profile of £1.9m (53%).This variance in Month 1 can largely be attributed to MHLD, which did not record any savings (£0.4m variance) and Secondary Care (£0.4m variance).
It is expected that delivery will increase over the coming months once reporting processes have been fully embedded.
4. Forecast position and risks
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4.1 Financial year forecast revenue position
The Health Board’s financial position has been subject to a financial risk assessment in order to understand the risks to achieving the financial plan.
The effect of this is shown below, which demonstrates a best case favourable variance against plan of £0.9m; and a worst case adverse variance against plan of £6.0m. The most likely position at the current time is a balanced position against plan.
Consequently, the planned deficit of £30m is the forecast position at this stage. Best
case £’000
Most likely £’000
Worst case £’000
Risk level
Explanation
Risk factor
Continued use of agency staffing
1.0 5.0 10.0 Medical Agency staffing, in particular, continues to grow.
GMS uplift 1.0 2.0 2.2 Uplift in GMS contract cannot be contained within the ringfenced budget.
Hepatitis C drugs 0.0 3.0 3.0 Pressure on expensive Hep C drugs develops in line with WG expectations
Savings non-delivery 0.0 2.0 5.0 Savings do not deliver as expected.
Demand growth in WHSSC
0.0 0.0 2.0 New treatments and growth in numbers exceed allocated resources.
Anticipated Special Measures funding not allocated by WG
0.0 0.0 4.8 WG are unable to fund Special Measures costs arising for the Health Board.
Total gross quantified financial risks
2.0 12.0 27.0
Mitigation measure
Primary Care Business Rate rebate
(2.9) (2.0) (1.0) Business Rate rebate review provides a non-recurrent benefit.
Additional funding provided by WG relating to Hep C
(3.0) (3.0) WG agree to fund additional Hep C drugs costs.
Commissioning controls put in place through WHSSC
(2.0) The Health Board works with other Boards and with WHSSC to manage demand growth and activity.
Additional savings measures required
(2.0) (3.0) Additional non-recurrent savings required to manage the financial position.
Mitigating actions to address agency usage
(5.0) (5.0) Medical Agency issues are managed closely through the Managed Service provider.
Urgent recovery actions needed to recover position
(7.0) Additional non-recurrent actions could be required to address residual financial risks.
Residual risk (2.9) (12.0) (21.0)
Residual risk (0.9) 0.0 6.0
There is also a contingent risk not included within the above, arising from Continuing Healthcare fees which are subject to ongoing dialogue with Local Authority partners, Welsh Government and providers.
5. Balance Sheet
5.1 Cash
The Health Board is required to not draw down cash from the Welsh Government ahead of need and has an internal target of holding a maximum balance of £7.3m. The month end balance was £5.283m which is within the target.
The effective management of cash remains a key priority has the Welsh Government will not provide cash funding to meet deficits and a year-end cash shortfall is anticipated. Further work will be done on this over coming months.
5.2 Capital expenditure
The Capital Resource Limit for Month 1 is £50.219m. The Welsh Government issued the initial allocation for the 2016/17 financial year in March 2016.
Actual expenditure for Month 1 was in line with the budget of £2.3m.
6. Conclusions and Recommendations
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6.1 Conclusion
The Health Board has agreed an interim Financial Plan which includes an assumed deficit of £30m as a planning assumption. This forecast assumes that additional funding will be provided to the Health Board of £4.8m to address issues arising from the Special Measures Improvement Framework.
The Health Board has overspent by £2.9m at the end of April in the new financial year, or £0.4m (0.4%) against the plan for the year after accounting for the original £30.0m budgeted deficit.
The agreement of the Operational Plan will be critical in ensuring that the operational and performance expectations of the Board are clarified within the available financial resources.
The Health Board needs to ensure that savings targets are identified in full; and that delivery of savings is a priority alongside cost management.
Achieving the financial plan, while not compromising the quality and safety of its services, is an important element in developing trust with Welsh Government, the Wales Audit Office, Health Inspectorate Wales and the public.
As such, the adverse variance incurred in Month 1 will need to be recovered over the remainder of the year through reviewing the delivery expectations of savings schemes and cost control.
6.2 Recommendations
It is asked that the report is noted, recognising the risks to the financial position which are outlined in Section 4.