REPORT SPONSORED BY - NHS Wales Board Papers Jan... · REPORT SPONSORED BY: Win Griffiths, Chairman ... St David’s Hall, ... Director of Nursing Met with Paul Roberts, ...

_____________________________________________________________________________________ Chairman’s Activities 1

REPORT SPONSORED BY: Win Griffiths, Chairman

HEALTH BOARD 26th January 2012

AGENDA ITEM: 01(vii)

CHAIRMAN’S REPORT AND ACTIVITIES

Recent Activities: 17 October Met with Paul Roberts, Chief Executive 19 October Admin. Met with DIR regarding patient complaint 20 October Admin Met with Director of Patient Referral Management Systems Attended Non Emergency Patient Transport Project Autumn

Seminar, Margam. 21 October Admin. Called in Swansea CALS Course, Swansea University Met with GMC on their Health Board visit to Swansea University 22 October Attended Inauguration of Sir Paul Williams as Chancellor of Saint

Cymru at Brecon Cathedral 24 October Admin.

ABMU Structured Assessment Interview with Carol Moseley, Wales Audit Office. Visit to Singleton Hospital Attended Inauguration of Chancellor of Swansea University

25 October Visit to A&E Dept., Morriston Hospital

Attended 1,000 Lives Walkround at Ty Olwen/Endoscopy & Ward J at Morriston Hospital

Admin. 27 October Admin. 28 October Met with Edwina Hart, AM 31 October Admin. Attended All Wales Chairs Meeting with Lesley Griffiths, AM 1 November Met with Paul Roberts

ABPI Cymru Wales Annual Lecture & Dinner/Lord Robert Winston at National Museum of Wales


2 November Met with Barry Goldberg, NOM

3 November Chaired ABMU Health Board Annual General Meeting Met Cllr. Mel Nott, NOM Attended AGM of Neath Port Talbot Council Voluntary Service Attended RCGP-Harvard Davis Lecture, Llanelli 4 November Attended Learning Disabilities Working Group Meeting, Cardiff Met with Rt. Hon. Carwyn Jones AM, Bridgend Met with Dr Edward Roberts, NOM

6 November Visit to Wards 19/20 & A&E Department, Princess of Wales Hospital 7 November Met with Michael Williams, NOM 8 November Attended 1,000 Lives Event, SWALEC Stadium, Cardiff

Attended Chairman’s Briefing: Sierra Leone, MPEC, Princess of Wales Hospital

9 November Attended Wales for Africa Health Links, Taff Vale Practice, Ynysybwl Admin.

Attended Public Meeting-Mental Health Engagement Process at the Liberty Stadium, Swansea Attended Welsh NHS Confederation Annual Conference Pre-Conference Reception, Senedd, Cardiff Bay Attended Welsh NHS Confederation Conference Dinner, Millennium Centre.

10 November Welsh NHS Confederation Conference, Cardiff City Stadium 11 November Met with Janice Gregory, AM Met with Julie James, AM

Attended Public Meeting–Mental Health Engagement Process at Heronston Hotel, Bridgend

13 November Health Link Visit to Freetown, Sierra Leone 14 November Visited the Ola During Children’s Hospital Met with Sandra Lako and Welbodi staff Met with staff of the German Charity, Cap Anamur

Visit to Laboratory and meeting with Dr Baion, Doctor in Charge of Hospital Met staff from Mercy Ships

15 November Visited the National School of Midwifery Met with Vice-President, His Excellency Sam-Samuna


Met with Dr Joan Shepherd, Principal of the National School of Midwifery Met with Dr Baion Met Ruby Williams, temporary Matron at the Maternity Hospital Attended 2008/2011 comparison meeting discussion with Welbodi staff

16 November Met with Dr Baion and visited Wards 17 November Returned from Sierra Leone

Attended Sierra Leone debrief at Princess of Wales Hospital Attended Epilepsy Action Cymru, Bridgend

18 November Attended RCN Clinical Leadership programme Celebration Event, Singleton Hospital

Attended HMS Diamond Reception & Capability Demonstration, Kings Dock, Swansea

21 November Chaired ABMU Equality Strategic Group Meeting, Baglan Met Paul Roberts Attended Chairs Meeting-Autumn with Lesley Griffiths, AM

Hill House Hospital Engagement Meeting, Gorseinon Centre

23 November Attended Minister’s Visit & launch of “Pathway to Care for Older Prisoners, HMP Swansea

28 November Admin.

Board Development Session/Programme, Morriston Hospital Attended Partnership Board Meeting with Swansea University

29 November IPFR Training on All Wales Policy, Port Talbot Resource Centre 2 December Met with Director of Diverse Cymru, Senedd, Cardiff Bay Attended LD pathway T&F Group Meeting, NLIAH Attended 1,000 Lives Plus Executive Walkround, Morriston Hospital 5 December Attended Official Completion “Ready for Business” ILS Phase 2

Development with Prof. R B Davies &Carwyn Jones, AM Conducted appraisal meeting with Cllr. Mel Nott, Baglan Attended Meeting with NOMs, Baglan Met with Phil Williams, CHC and Heather Barrow, CHC, Baglan

Met with Barry Goldberg, NOM

6 December Met with Sue Thompson, Transport Board Attended Non-Emergency Patient Transport Board Meeting Admin. 7 December Admin. Morgan Cole Seminar via NLIAH, Swansea Attended Disability Equality Group Meeting, School of Medicine


8 December Met with Public Health Wales (PHW) candidate, Baglan Admin. 9 December Attended VIP opening of new Maggie’s South West Wales, Singleton

Hospital 12 December Consultant Anaesthetist Interviews, Singleton Hospital 13 December Attended Rural Health Implementation Group December Meeting,

Gregynog, Mid-Wales 14 December Public Health Wales Candidate telephone call Attended Travel and transport Steering Group, Neath Port

Talbot Hospital. Attended CLIC 29th Annual Carol Concert, St David’s Hall, Cardiff 15 December Citizen Engagement Learning Seminar for NHS Wales-Board level,

Liberty Stadium Attended Bridgend Care Partnership meeting, Bryngarw House,

Bridgend Attended Neath Port Talbot Hospital Carol Service 16 December Met with Dr Davis Abankwa/Prof. Steve Allen re. Pennies from

Heaven Met with Public Health Wales candidate 19 December Admin Visited Singleton Hospital for carol singing on Wards 20 December Visit to Hill House, Cefn Coed, Garn Goch, Gorseinon, Gelli Nedd,

Tonna, Cimla and Maesteg Hospitals 21 December Met Victoria Franklin, Director of Nursing Met with Paul Roberts, Chief Executive Visit to Morriston Hospital 22 December Attended Director of Public Health Interviews, Princess of Wales

Hospital 23 December Admin. Visit to Neath Port Talbot Hospital, Caswell Clinic and Glanrhyd and

Princess of Wales Hospitals.

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SUMMARY REPORT ABM University Health Board

Health Board 26th January 2012Agenda item 01(viii)

Subject Chief Executive’s report

Prepared by Steve Combe, Board Secretary Approved by Paul Roberts, Chief Executive Presented by Paul Roberts, Chief Executive Purpose

Decision Approval x Information x

This report is aimed at updating the Board of key issues that do not appear elsewhere on the Board agenda.

Other Corporate Objectives

Safety Quality Efficiency Workforce Health Governance X X

Executive Summary The report provides an update on Planning for 2012/13; Together against Cancer; Shared purpose – Shared Delivery; IVF services; Appointment of Director of Public Health; Mid year reviews; Shared Services; Board report format and Board reporting Key Recommendations

The Board is asked to note the contents of the report and approve proposed revised board reporting arrangements

Assurance Framework The report provides an update on the full range of Board activities

Next Steps The proposals on Board report format and Board reporting will be progressed.

Corporate Impact Assessment Quality and Safety HCS 7,8 Financial Implications

Implications of IVF decision being assessed

Legal Implications None directly Equality & Diversity

None Directly

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Chief Executive’s Report Health Board

26th January 2012

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MAIN REPORT ABM University Health Board

Health Board 26th January 2012Agenda item

Subject Chief Executive’s report

Prepared by Steve Combe, Board Secretary Approved by Paul Roberts, Chief Executive Presented by Paul Roberts, Chief Executive PURPOSE To advise Board Members of key issues not covered within reports elsewhere on the Board agenda. KEY ISSUES 1. Planning for 2012/13 Work is now underway to develop the Operational Plan for 2012/13. It is proposed that this is based onensuring we focus our attention on a small number of key priorities to ensure we make a positive difference to the lives and experiences of local people and to work in partnership to deliver these. This means for 2012/13 we plan to give particular attention to the following priorities;

• Improving Cardiovascular Health • Reducing Hospital Acquired infections • Improving Access • Improving Services For Older People

Given the need to focus on these priority areas, whilst continuing to improve the services provided day in day out we will put in place a number of supporting programmes to ensure we meet our priorities. Briefly these are:

• Together For Health Programme • Delivering Capacity, Workforce and Financial Plans • Leadership Development • Developing Infrastructure • Strengthening Partnerships

It is planned that there be further discussions on this at the next board development session, with a full report to the next meeting of the Board.

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26th January 2012

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2. Together against Cancer The Welsh Government is currently consulting on a draft Cancer Delivery plan – Together against Cancer. The draft plan sets out the Welsh Government’s vision for tackling cancer and its consequences; ambitions for what NHS services will look like by 2016; the themes for action up to 2016 through local cancer services delivery plans and how success will be measured. The consultation commenced on 19th December 2011 and will continue for 12 weeks, with all responses to be submitted by 5th March 2012. Board Members will have the opportunity to comment on the ABM draft response. 3. Shared Purpose – Shared Delivery The Welsh Government have issued the above consultation document which sets out proposed new statutory guidance intended to integrate local service planning, streamline partnership working and strengthen the strategic role and accountablitiy of local service boards. A copy of the consultation document has been circulated to Board Members. A response to the consultation document will be developed and Board members will have the opportunity to comment on the draft response which has to be submitted by 30th March 2012. 4. IVF Services The Board will recall receiving a report advising that WHSSC, Cardiff & Vale and ABM Health Boards had agreed that a single IVF service should be established for South Wales. It was agreed that an external review team would visit both Health Boards and recommend which should be the lead Health Board for the South Wales IVF Service. An external panel was engaged by WHSSC which comprised of a Consultant in Reproductive Medicine and Senior Embryologist and a Specialist Nurse from the North of England. The review took place on the 17th October 2011 and its report recommended that ABM Health Board should be the lead Health Board responsible for the delivery of the service. This should be based on a “bicycle” model with IVF laboratories and clinics at both University Hospital of Wales and Neath Port Talbot Hospital. The report was considered and approved by WHSSC at its Committee meeting on 29th November 2011 (a copy of the report is available from the Director of Planning). A Project Team which includes representatives of WHSSC (Director of Planning and Specialised Commissioner), Cardiff & Vale (Director of Planning, Medical Director, Directorate Manager and IVF Consultant) and ABM (Clinical Director, Directorate General Manager and Head of Nursing) Health Boards have been established and is chaired by Paul Stauber, Director of Planning. The Project Team are now working through a range of issues to establish the South Wales IVF service as soon as possible, which include the structure to run the South Wales service, the staffing

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26th January 2012

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establishments for both IVF Units and managing the workload over a transitional 15 month period whilst the Units become fully established. 5. Director of Public Health Board Members will be aware that Dr Sara Hayes has been appointed as Director of Public Health and will take up post in February 2012. I would wish to record my personal thanks to Dr Jane Wilkinson who has been acting Director of Public Health for her hard work and support in taking forward this role over recent months. 6. Mid Year Reviews Execuitve Directors have been meeting with Directorates and Localities to undertake a mid year review of performance. Key to these reviews has been the need to ensure we meet key Welsh Government performance targets and manage within our resources. These are subject to separate reports. 7. Shared Services As Board Members will know the Welsh Government has announced that Shared services will be hosted by Velindre trust with effect from 1st April 2012. Work is now underway to ensure the appropriate governance arrangements are in place. 8. Board Report format The format for this Board report has been changed to reflect a proposed revised format. It is planned to use this format for all future reports to the Board, Board Committees and other key meetings. Comments on the proposed format are welcomed and should be made to Steve Combe, Board Secretary. 9. Board Reporting A review of recent Board agendas has highlighted that the Board receives several reports for noting on specific issues as part of the process of ensuring the Board is kept appraised of the broad range of activities undertaken by the Health Board. Given the need for the Board to focus on key priorities it is proposed that such reports be circulated separately to Board Members and that Board members can contact the appropriate Executive Director directly to discuss any issues arising from the report. Details of all reports circulated in this way will be included at the end of each of the Chief Executive’s report so that Board members have an opportunity to raise any key issues or bring something to the attention of the Board if they feel this is appropriate. It is proposed this is piloted over the next 3 months. Reports recently circulated are:

• Prison Health Services • Hospital Catering and Nutrition : A checlist for Health Board Members

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26th January 2012

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9. New Years Honours Finally I would like to formally congratulate the Chairman, Win Griffiths on being awarded an OBE in the recent New years Honours. I am sure Board Members will agree that this is well deserved. RECOMMENDATION The Board is asked to:

• Note the foregoing • Approve the proposed arrangements for Board reporting set out in the report.

REPORT PREPARED BY: Andrew Evans, Assistant Director, Governance REPORT SPONSORED BY: Bruce Ferguson, Medical Director

HEALTH BOARD 26TH JANUARY 2012

AGENDA ITEM: 1 (ix)

QUALITY AND SAFETY IMPROVEMENT (1,000 LIVES) REPORT

1. Purpose This report s to provide the Board with a narrative review of progress to date and to highlight key issues in relation to the 1,000 Lives Programme as we look ahead to it’s continued development in 2012/13. It is a supplement to the quantitative performance information contained within the Performance Report.

2. Introduction The Annual Quality Framework 2011/12 includes 4 primary drivers for change as shown in Figure 1 below. The 1,000 Lives Programme is a specific, national response to the third driver: “Deliver and sustain excellent services that meet the needs of patients and maximize clinical outcomes”.

Figure 1

The 1,000 Lives Programme provides a framework for structured improvement activities to reduce avoidable harm to our patients; and to eliminate waste and unacceptable variation in our services.

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3. Situation In April 2011 our local 1,000 Lives Programme established priorities for quality and safety improvement as set out in the driver diagram below:

The Quality and Safety Committee receive regular detailed reports on progress with regard to the key areas within the 1,000 Lives Programme, and the current position, linked to the Annual Quality Framework, is shown in the ABMU Performance Report. 3.1 Delivering the Benefits The Health Board uses Risk Adjusted Mortality Index (RAMI) and Global Trigger Tool (GTT) as indicators of avoidable mortality and harm. 3.1.1 Mortality Background The Risk Adjusted Mortality Index is a statistical calculation which assesses the observed deaths in an organisation against the expected deaths, assessed on the patient record data submitted for the period. The algorithm risk adjusts mortality based on the age, sex, admission method and most importantly clinical coding information. An index value of 100 represents the expected level of mortality for the patients treated during the period. The index is periodically rebased to take account of general improvements in care over time. This occurred during 2011, resulting in an increased index for the organisation.

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Assessment Our RAMI continues to show a reducing trend, reflecting improvements in both clinical practice and data quality. This is pleasing and we remain optimistic of achieving our target of an Index of <100 by April 2012 3.1.2 Harm Background The Global Trigger Tool is a mechanism for assessing the level of harm occurring within the organisation, based on an assessment of a random selection of 80 patients’ notes per month (20 per main site). The assessment, undertaken by a panel of staff looks for indicators of potential or actual harm recorded within the notes. Assessment Our current performance shows that we are identifying less than 15 episodes of harm per 100 admissions. Statistical calculations show that 20 case notes are sufficient to detect change with statistical confidence assuming 20 – 40 harms / 100 admissions. This assumption is central to the limitations in using the GTT to monitor current safety initiatives. ABMU is currently recording less than 20 harms /100 admissions and there is therefore a question going forward as to the continued value of the GTT as a mechanism for assessing harm .Whilst consideration will be given to the potential of combining the GTT and Mortality Review processes we are in the short term committed to continue with this measurement as part of a research programme in Wales which is investigating the sensitivity of this measure. 3.2 Key Interventions/Domains These were assessed as being the key areas for 2011/12 that would have the biggest impact on reducing avoidable mortality and harm. 3.2.1 Infection Control Background Patients expect to receive healthcare without experiencing any unnecessary complications such as acquiring an avoidable healthcare associated infection (HCAI). The cost to patients in terms of morbidity and mortality is difficult to quantify. Data from death certificates suggests an average of 63 deaths per annum are due to MRSA in Wales and 78 deaths per annum due to C Difficile. It is likely however that this is an underestimate. An estimate based on American data suggests that as many as 321 deaths per annum may be directly attributable to HCAI in Wales with a further 963 deaths where HCAI might be a substantial contributor. The Health Board has a zero tolerance to healthcare associated infections Assessment Current performance shows a 20% reduction in the number of C Difficile infections identified in year, and a 40% reduction in Methicillin Resistant Staph Aureus (MRSA) infections. This demonstrates the effectiveness of the current improvement action plans. While pleasing, the increase in the number of Methicillin Sensitive Staph Aureus (MSSA) infections experienced in year shows that there is more work to be done in 2012/13 to continue the improvement further.

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3.2.2 Recognition of the Deteriorating Patient Background Patients who become acutely ill whilst on wards benefit from early recognition and intervention with rapid treatment and escalation if needed. The aim is to avoid further deterioration and possibly death. Assessment The Health Board can demonstrate very good use of Early Warning Scores to highlight deteriorating patients, and the introduction of a Sepsis Screening Tool, Patient Status at a Glance (PSAG) Boards, and dedicated handover briefings have all combined to improve both the recognition of the deteriorating patient, and the response to them. It is anticipated that these improvements will lead to reductions in avoidable harm and mortality, and this will be a focus of review in 2012/13. 3.2.3 Pathways

3.2.3.1 Fractured Neck of Femur Background Amongst elderly patients, hip fractures are associated with an in-hospital mortality rate of 7–14%, and profound temporary and sometimes permanent impairment of independence and quality of life. Hip fracture guideline from NICE emphasise the importance of early treatment of hip fracture patients. Hip fracture surgery is often subject to delay in comparison with other operations. Surgery is considered the best form of pain relief. Postponement of surgery prolongs pain and carries an increased risk of complications. The early treatment of fractures should result in a reduced length of stay for this group of patients and this can be used as an outcome measure. Assessment Changes to the process now mean that over 90% of elderly (over 65) patients who fracture their hip are routinely being treated within 24 hours across the Health Board. This is a significant improvement across the Health Board. The impact of this on mortality and length of stay will be monitored on an ongoing basis now that there appears to be consistency in the process. 3.2.3.2 Falls Background Slips, trips and falls represent the largest number of reported incidents within the Health Board and as such represent a key safety risk area. The following table provides details on the number of patient falls recorded within hospital sites. Assessment The introduction of assessment and intervention bundles across inpatient areas appears to be having a positive impact with the number of recorded falls reducing. The work to apply the bundles in hospital settings will continue and the potential to roll out into community care settings will be further explored. 3.2.3.3 Cardiac Background

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Heart failure is increasing in prevalence as a chronic condition and it presents significant challenges to individuals, their families and the healthcare system. The incidence and prevalence of heart failure rises steeply with age, the average age of first diagnosis is 76 years. Heart failure has a poor prognosis, around 40% of patients diagnosed die within a year – thereafter mortality is less than 10% annually. Prevalent cases of heart failure on General Practitioner registers appear to have a significant mortality risk with a 5 year survival of 58% compared to 93% in the age and sex matched general population. A GP will look after, on average, 30 patients with heart failure and suspect a new diagnosis in 10 patients annually. It is anticipated that GPs who work in more deprived areas will have more cases. GP consultations cost an estimated £45 million per year with an additional £35 million for GP referrals to out patients. Assessment The introduction of assessment and intervention bundles has progressed well, and although the Health Board’s performance in relation to the all Wales mean rate of death within 30 days of a myocardial infarction is good, continued monitoring of the effectiveness of reducing the rate locally over time will need to take place. 3.2.3.4 Stroke Background Stroke is defined by the World Health Organization as ‘a clinical syndrome consisting of rapidly developing clinical signs of focal (or global in case of coma) disturbance of cerebral function lasting more than 24 hours or leading to death with no apparent cause other than a vascular origin.’ Stroke is a preventable and treatable disease. It can present with the sudden onset of a neurological disturbance, including limb weakness or numbness, speech disturbance, visual loss or disturbance of balance. Assessment The adoption of a “Care Bundle” approach to this pathway is showing evidence of consistent changes in practice. The bundles, which have been proven to have the highest impact on outcome following stroke have been grouped together so that they are performed in the same timeframe or by a particular group of clinicians. The effect of this on outcomes will be tracked during 2012/13. 3.2.3.5 Healthcare Acquired Thrombosis Background Data show that the death rate from hospital acquired thrombosis is sixteen times that from hospital acquired infection and that pulmonary embolism is responsible for 10% of in-hospital deaths. Assessment The development, and acceptance of Risk Assessment Tools is a good start to improving this area, and whilst progress has been made rolling this out across the Health Board further audit work is underway aim at providing assurance regarding the choice of prophylactic regimes. 3.2.3.6 Unscheduled Care Background Access to the healthcare system through the unscheduled care pathway is an important in terms of patient outcomes. Measures used to assess this

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pathway include both Accident and Emergency Department turnaround times and Ambulance Handover times. Assessment These remain priority issues going forward.

3.2.4 Communication Background The issue of communication between and within teams and between teams and patients and the public continues to be a significant challenge Assessment Recent evidence from external bodies such as the Welsh Risk Pool, has suggested that the quality of medical and nursing notes is very good when compared to others. However, there is still a need to improve these further, particularly in relation to noting times and signing entries. In addition, the introduction of the WHO Surgical Checklist and the SBAR communication system in some key areas has also been shown, anecdotally, to have improved overall communications. Continuing efforts are being made within both manual and electronic systems to improve communication around discharge and transfer of patients, and this will need to continue going forward. 3.2.5 Mortality Reviews Background The Health Board adopted a screening and review process, using standardised proformas, based on the one use by Royal Berkshire NHS Foundation Trust. The screening form is completed by the junior doctor who confirms the patient’s death. These forms are reviewed by the Medical Director’s team and those that meet the criteria for having potentially avoidable elements are subject to more in-depth review. On average 25-30% of deaths are recommended for further review which can represent up to 80 deaths a month. Assessment The limiting factor in embedding the two-stage process across all four acute sites has been the capacity of the Consultants who have agreed to undertake the reviews to complete them in a timely was so that feedback can be provided to the clinical teams to enable lessons to be learned. As a result spread into the remaining hospitals has been halted until Patient Safety Champions have been identified in all Directorates and Localities. These individuals will be responsible for ensuring that the reviews are undertaken. It is estimated that the Health Board will have the capacity to fully review 60 deaths a month once this network of individuals is established. 3.2.6 Data Quality Background Clinical coding is required to calculate a number of the key quality and safety indicators used to assess performance. High levels of completeness within reasonable timeframes are therefore vital if accurate and up to date information is to be provided. The national target is 95% completeness within 3 months. Assessment

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The introduction of new national systems during the year has meant that the capacity for clinical coding has been stretched at times, although this position is now improved. 3.3 Key Issues for Consideration in 2012/13 In addition to the continuation of the activity currently underway, there are two key considerations as we move towards 2012/13: 3.3.1 Changes to the National Programme The National 1,000 Lives Programme has signalled a change in focus for the year 2012/13. It is envisaging a shift away from the mini collaborative approach to improvement towards a more supportive and facilitative approach to locally derived programmes, reflecting the recommendations contained in the White Paper produced following a visit to Jonkoping in Sweden earlier in the year. The full impact of this, and the creation of a local “Faculty for Improvement”, will be assessed before producing our local plan for 2012/13 which will also align the priorities in our local 1,000 lives programme with the Health Board’s Strategic Priorities. 3.3.2 The need to ensure the effective spread of good practice Although both our local and the national Programme, have achieved significant improvements during the year, there is recognition that a key challenge for 2012/13 and beyond is to ensure that, where change can be demonstrated as an improvement, this improvement is reflected across all appropriate areas. This will also need to be considered and addressed within the plan for 2012/13. 4. Recommendation The Board is asked to:

• Receive this report and to note progress

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REPORT PREPARED BY: Steve Combe, Board Secretary Joanne Davies, Assistant Director of Planning REPORT SPONSORED BY: Paul Roberts, Chief Executive


AGENDA ITEM: 2 (i)

TAKING FORWARD “TOGETHER FOR HEALTH”

1. PURPOSE To update the Board on action being taken locally and across South Wales in taking forward “Together for Health” 2. INTRODUCTION On 1st November 2011 the Minister for Health and Social Services launched a five year vision for NHS Wales: Together for Health. Together for Health is a response to a number of factors:

− a rising elderly population

− inequalities in health

− increasing numbers of patients with chronic conditions

− medical staffing pressures and

− some specialist services being spread too thinly

The main commitments in Together for Health are:

− service modernisation, including more care provided closer to home and specialist ‘centres of excellence’

− addressing health inequalities

− better IT systems and an information strategy ensuring improved care for patients

− improving quality of care

− workforce development

− instigating a ‘compact with the public’; and

− a changed financial regime.

A summary of the key actions set out in Together for Health is attached at Appendix 1. On the 1st November the Minister wrote to Health Boards confirming the requirement set out in Together for Health for them to submit detailed plans within twelve months describing how they will ensure sustainable services for all communities.

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Whilst most of these plans can and should be developed at a local level by individual Health Boards there are a range of issues which can only sensibly be addressed at an “all Wales” level or at a “regional” level. The six Health Boards that commission and provide NHS services in the South of Wales have agreed to set up a joint Programme to develop a plan for those services which are best considered at a regional level. The complexity and scale of this work together with the relatively short timescales involved mean that a considerable resource will need to be made available by the Health Board (along with the others in South Wales) for the National Programme and for our own ABM programme “Changing for the Better – Taking Forward Together for Health”. This is particularly important given the extent of the clinical and public engagement required. This paper sets out the proposed governance and management arrangements for both the South Wales joint programme and the local ABM programme. 3. IMPLEMENTING TOGETHER FOR HEALTH NATIONALLY Good progress has been made nationally, including putting in place arrangements to drive the programme forward and ensure delivery. Andrew Carruthers has been seconded from Cardiff and Vale UHB to act as the National Director for Together for Health, and together with Dr Chris Jones Medical Director for NHS Wales, has visited each LHB to discuss current arrangements and initial responses to the strategy. Other developments include: National Clinical Forum The National Clinical Forum has been established and two meetings have been held to date. It is to be co-chaired by Professor Mike Harmer (Chair of WHSSC) and an external person, yet to be appointed, to further support the programme; meetings will be rotated across Wales. It is important to note that the Forum is not a decision making body; its role is purely advisory. The National Clinical Forum will also need to link to the local Healthcare Professional Fora, whose members need to be engaged in the development of local plans and have the opportunity to comment on them before they are submitted to the national forum. The National Clinical Forum will also expect to have two “formal” engagements with LHBs, once during the informal engagement and pre-consultation phase, and secondly to provide formal feedback on the local plan. National Case for Change The Welsh Government is working with the Welsh Institute for Health and Social Care to develop the national case for change. This will involve identifying 4-5 key messages to support the need for change, and each of these will have a supporting evidence based document, to include the issue being addressed, why it is a national issue and the evidence to support this and the benefits to the population of service change. Various approaches to presenting this Case for Change to the public are being considered and the Welsh NHS Confederation is playing a core role in this. Timescales The timescales set out to support this work are:

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• Pre-Consultation Engagement: Dec 11- April 12 • Presentation of Consultation Proposals: April 12- June 12 • Formal Consultation: June 12 – Sept 12 • Proposals Review: Aug 12 – Sept 12 • Plan Implementation: October 12 onwards

4. SOUTH WALES PROGRAMME For Health Boards to work together effectively on such a range of complex issues it is vital to agree the principles which are the foundation of the partnership from the start. These will be:

• The common aims and objectives of this partnership are those set out in the Welsh Government five year vision for the NHS: Together for Health

• The guiding principles for clinical services will be: o Safety and quality o Sustainability o Accessibility

• The aims and objectives of the partnership will be delivered through a formal Programme, the establishment of clear governance arrangements and a jointly funded programme office.

• The principle of “subsidiarity” applies. In other words the Programme will only focus on those matters which need to be dealt with at a regional level. All other issues (e.g. Primary Care and Community Services) will be planned and managed by individual Health Boards.

• The Programme will be governed and managed using sound programme/project management methodology

• Individual projects which focus on clinical services will, where possible, be clinically led and incorporate as wide a clinical engagement as feasible

• The special requirements for providing rural healthcare which are particularly important in Hywel Dda and Powys will be taken into account

• It is recognised that each Health Board is in a different position in terms of agreed plans and developing new service models. The Programme will need to be sufficiently flexible to take this into account

• Whilst Together for Health is driven by an ambition for quality of care; the economic and financial situation will also be a significant context for this programme. Services can only be sustainable if they are affordable.

• Engagement with the public, patients, partners, politicians and staff is of vital importance and will be enabled by the programme

• Whilst Health Boards are sharing resources and reaching common conclusions they are not pooling their formal statutory authority in this programme. The delegated authority of the Programme Board will be that of its individual members. Each Board will therefore need to consider each significant issue and sign off each stage of the programme individually

• It therefore follows that any one individual Health Board can insist that any decision needs to be taken by its own Board

• Notwithstanding the above; Health Boards will undertake to make best efforts to settle any issues of disagreement which may emerge by using the Programme Board and the Programme Chair.

Programme Governance Structure The diagram below describes the key elements of the Programme Governance Structure including illustrative project boards.

Programme Board The Programme Board will be chaired by an independent chair, Dr Peter Barrett and the membership will be made up of the Chair and Chief Executive of each of the six participating Health Boards as well as the Programme Director. The Post-Graduate Dean and the Chief Executive of Public Health Wales will be co-opted members. Draft Terms of Reference are set out in Appendix 2. The purpose of the Programme Board is:

• To act as the collective sponsor of the Programme • To agree the overall common purpose and objectives of the Programme • To hold the Programme Director to account • To ensure that there is proper public engagement and consultation which

complies with Welsh Government guidance • To sign off decisions on major issues or (where necessary) make

recommendations to individual Health Boards • To agree a dispute resolution process • To sign off regular progress reports to individual Health Boards and Welsh

Government • To ensure that the Programme is governed using proper “managing

successful programmes” methodology or equivalent • Regularly to review programme risk and agree appropriate management • The Board will meet in private but its papers will be subject to the Freedom of

Information Act

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Programme Executive The Programme Executive will be a large group chaired by the Programme Director, Mr Jeff James and will draw membership from executive directors of the six Health Boards, the Project Board Chairs, the Chair of the Engagement Reference Group and NHS Trusts. The purpose of the Programme Executive is:

• To manage the performance of the Programme and the Projects • To agree and oversee the Programme and Project processes • To agree, oversee and ensure the inclusion of feedback from the engagement

and communication process for the Programme • To provide co-ordination of cross-cutting issues • To make recommendations on significant issues to the Programme Board • To use “managing successful programmes” methodology or equivalent • The Executive will meet in private but its papers will be subject to the

Freedom of Information Act

Engagement Reference Group One of the most important elements of the Programme will be the engagement of partners, stakeholders, patients and the public. It is envisaged that a reference group will be created where engagement leaders and representatives are brought together across South Wales to co-ordinate the engagement processes and ensure that feedback and recommendations are taken fully into account by the Programme Executive. These engagement activities will remain the statutory responsibility of each individual Health Board who will be able to discharge these on a collaborative basis or at a local level linked into the local programme undertaken. Project Boards Each major work stream will be over seen by a Project Board. The chairs of the Project Boards will, where possible, be clinicians with enough time resourced to undertake this role. Project Chairs will be appointed by the Programme Director and Chair and signed off by the Programme Board. The Project Chairs will be members of the Programme Executive. The purpose of the Project Boards will be:

• Agree with the Programme Executive the scope and terms of reference of the project

• To oversee and performance manage the project • To oversee the processes of public and clinical engagement for the project • To work with partners and professional bodies to develop plans for clinical

services. • To make recommendations on clinical services to the Programme Board • To use appropriate project management methodology within the managing

successful programmes methodology.

Programme Management Arrangements Delivery of the programme aims and objectives within twelve months will require proper resourcing and a properly established Programme Management Office led by the Programme Director whose role is:

• To be the senior responsible officer for the Programme • To set up and lead the Programme Management Office • To lead and ensure that there is proper public engagement and consultation

which complies with the guidance provided by Welsh Government.

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• To co-ordinate, lead and manage the work of the project managers who provide support to the individual projects

• To lead and manage the Programme to ensure that it meets its aims and objectives

• To be a member of, and accountable to, the Programme Board from where the post holder will take direction. The Independent Programme Chair will agree and monitor the objectives of the Programme Director

• To chair the Programme Executive and ensure that the aims and objectives of the programme are fulfilled through this forum

• To recruit, lead and manage the chairs of the clinical projects • To manage the Programme Budget • To prepare and present programme risk management reports for the

Programme Board to consider

It is anticipated that the Programme will be fully operational by 31st January 2012. 5. ABM PROGRAMME – “CHANGING FOR THE BETTER – TAKING FORWARD

TOGETHER FOR HEALTH” On the publication of “Together for Health” in November 2011 ABMU Health Board initiated discussions internally on how best to establish its own programme for developing a plan for high quality, affordable and sustainable services in line with the Minister’s requirement for these proposals to be developed by Autumn 2012. A draft Programme Initiation Document was prepared outlining how the arrangements for “Changing for the Better – Taking Forward Together for Health” could be implemented. The arrangements outlined in the document are in line with the South Wales programme, but in preparation for this work and to gain initial views on how to progress the ABM programme a workshop was held on 6th December 2011 with 90 key leaders within the Health Board, and this has been used to update and further refine the programme approach to be used. As a result the ABM programme will be based on using workshops with wide representation from partner organisations, the third sector, patient and carer groups, staffside representatives and clinical leaders. Invitations have been distributed for the series of workshops, starting on 25th January 2012, which will take this work forward. In order to ensure a new approach to looking at how services should be developed for the future, creative problem solving techniques are being used through these workshops to help develop a different approach to planning the future pattern of services for the ABM area, and crucially focusing not only on ill health services but also what we can do to improve people’s health and keep them healthy. Non Officer Board members have been invited to attend the workshop in January, and part of the Board Development session in February will be used to update members on progress with the programme to date. As with the South Wales programme, “Changing for the Better – Taking Forward Together for Health” is being established with clear governance arrangements and a dedicated programme team in order to ensure its work is successful and significant engagement of all stakeholders can effectively take place throughout this work. It is anticipated that the programme will be fully operational by end January 2012. 6. RECOMMENDATION The Board is asked to note the foregoing and the upcoming work on the South Wales and ABM programmes.

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APPENDIX 1 TOGETHER FOR HEALTH – PRIORITIES FOR ACTION Priority Action(s) Improving health as well as treating sickness

• Every Local Health Board (LHB) will set clear targets for action and deliver against them, explaining each year how health is improving and health inequalities are narrowing.

• The WG will press forward its early years programme which will offer particular support for those facing the greatest challenges in life.

One system for health

• Within 12 months WG will issue delivery plans for major services such as cancer, cardiac care, stroke care and mental health, specifying the next steps in service improvement;

• Personal care plans will be introduced for people with cancer, mental health issues and chronic health problems.

Hospitals for the 21st century as part of a well designed, fully integrated network of care

• Every LHB will, within a year, set out its plan for creating sustainable services for all communities;

• Stroke service swill be progressively improved including, for example, 24 hour access to thrombolysis so that by 2015 every LHB will be fully compliant with the national standards and targets for stroke.

Aiming at excellence everywhere

• By March 2012 a Quality Delivery Plan will set out how the new quality assurance and improvement arrangements will operate;

• Within a year, the NHS will be able to demonstrate that every major service, such as cancer, is constantly monitored for quality and tested against the latest evidence.

Absolute transparency on performance

• Within 6 months, the WG will have published an Information Strategy, indicating how it will dramatically improve information for the public;

• Within 6 months, the WG will have in place new clinically-focused targets, focused on key priorities such as cancer, cardiac care and stroke services, against which LHBs will be required to publish their performance.

A new partnership with the public

• Within 9 months the WG will issue a draft compact with the public for consultation;

• Within 12 months, each LHB will have in place its own process for annual patient audits, and,

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following discussion at board level, these and agreed actions in response will be published.

Making every penny count

• A new financial regime will be put in place within the next year that will improve planning and utilisation of financial resources in line with clinical priorities;

• Over the next year every LHB will develop a budgeting system which includes greater clinical involvement in financial decision making.

And always with our staff • A strategic workforce and organisation

development framework that secure the right staff and fully supports and engages them in delivering excellent care will be issued by spring 2012;

• To help deliver this, current partnership arrangements linking the WG the NHS and trade unions will be strengthened to support the creation of an NHS people will be proud to work for.

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APPENDIX 2

SOUTH WALES TOGETHER FOR HEALTH PROGRAMME

PROGRAMME BOARD TERMS OF REFERENCE

Purpose of the Programme Board The purpose of the Programme Board is to act as the collective sponsor of the Programme, to make key decisions about the programme, to agree what decisions will be recommended to individual Health Boards, to ensure there is excellent public and clinical engagement and to hold the Programme Director to account for the aims delivery of the aims of the programme. Programme Board Functions The Programme Board will:

• Act as the collective sponsor of the Programme • Agree the overall common purpose and objectives of the Programme • Hold the Programme Director to account • Ensure that there is proper public engagement and consultation with

reference to Welsh Government guidance • Sign off decisions on major issues or (where necessary) make

recommendations to individual Health Boards • Agree a dispute resolution process • Sign off regular progress reports to individual Health Boards and Welsh

Government • Ensure that the Programme is governed using proper “managing successful

programmes” methodology or equivalent • Review programme risk and agree appropriate management • Meet in private but its papers will be subject to the Freedom of Information Act

Membership The Programme Board will be chaired by an independent chair appointed by the Health Boards The membership will be made up of the Chair (or other non-officer member nominated by the Chair) and Chief Executive of each of the six participating Health Boards and attended by the Programme Director. Whilst members will make every effort to attend, deputies will be allowed. Deputies will be assumed to have the full delegated authority of the member they represent. A quorum for the Board will be one full member from each of the four core Boards (ABMU, AB, C&V, CT). Conduct of Business The conduct of Programme Board business will be as follows:

• The Programme Board will meet monthly (or more frequently at the discretion of the Chair)

• A year of meeting dates will be agreed in advance • Papers will be prepared and distributed at least five working days prior to the

meeting. Late papers will only be allowed at the discretion of the Chair.

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• All members can ask for an item or paper to be included on the Agenda. The Chair will agree the final agenda

• Attendance at meetings in addition to full members and the Programme Director will be at the discretion of the Chair

• Where urgent business is conducted by the Chair between meetings it will be fully reported to the next Programme Board

Review These of Terms of reference can be changed at any Programme Board Meeting but will, in any case, be reviewed in April 2012.

________________________________________________________________________________ CHANGING VALE OF NEATH GP PRACTICES FOR THE BETTER

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REPORT PREPARED BY: Joanne Davies, Assistant Director of Planning (Service Planning) REPORT SPONSORED BY: Paul Stauber, Director of Planning

HEALTH BOARD 26th JANUARY 2012

AGENDA ITEM: 2 (ii)

OUTCOME OF PUBLIC CONSULTATION PROCESS ON CHANGING VALE OF NEATH

GP PRACTICES FOR THE BETTER

1. INTRODUCTION The Board will be aware that a public consultation process has been underway on Changing Vale of Neath GP Practices for the Better, following a previous engagement process. This document outlines the public consultation which has taken place, the comments received and the proposed way forward.

2. BACKGROUND Discussions have been underway for some time regarding the problems with the current configuration of GP services in the Vale of Neath, in particular the practical difficulties and limitations on services which the GP Practice experiences by providing its services on two sites, and the significant problems with the current buildings, which are not fit for purpose, not accessible and overcrowded. The proposal developed by the ABM University Health Board and Vale of Neath General Practitioners is to replace existing GP surgeries in Glynneath and Resolven in the Vale of Neath with a purpose-built, modern primary care centre, to improve the way care is delivered in the area. The drivers for change include the following: • The main surgery building in Glynneath has been a GP surgery since 1946. Despite

extending and remodelling, it is now too small and poorly designed to cope with the increased demands placed on it by the needs of modern day healthcare.

• The Health Centre at Resolven, where the Resolven surgery is based, was built in the late 1960s. Despite every effort by practice staff to provide the highest quality service, the building itself does not support this. The building is simply unable to cope with or deliver healthcare services at the standards we all expect and deserve.

• Even though improvements have been made for disabled access, both buildings are only able to fulfil the requirements set out in the Disability and Equality Act 2010 to a basic level. A recent Community Health Council Report (Aug 2011) referred to accessibility at Glynneath as a matter of concern and a key issue.

• Increasing the number of healthcare services from any building means an increase in the number of people attending the surgery and arriving by car. Currently both surgeries have limited parking and drop-off facilities for patients, which are particularly problematic at Glynneath because of its location directly on a road.


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• Due to patients attending more than one site their confidential records have to be transferred between sites. This not only has confidentiality and safety issues, but also means a patient’s records might not be available at the same place as the patient’s appointment.

• Sometimes GPs have to work on their own in Resolven, which raises safety implications, particularly for female GPs. In addition, there are fewer opportunities for GPs to discuss a potential diagnosis or treatment with colleagues, or get a second opinion when they are on their own. Clinics can also be affected if a GP is on another site, leading to patient waits.

Following the engagement process in September 2011, the public consultation process ran from 7th November to 16th December 2011 and a discussion document was produced outlining details of the proposals for developing a new Primary Care Centre for the Vale of Neath to replace the current Resolven and Glynneath facilities. 3. CONSULTATION PROCESS The discussion document and the consultation plan were made available on the ABMU Health Board website, information was also placed on the public information boards, the ABMU HB Facebook page and made available in the GP Practice buildings and relevant public buildings e.g. Glynneath and Resolven public libraries, shops in Glynneath and Resolven. The document was issued to local Assembly Members and MPs as well as Neath Port Talbot Councillors, with an offer of briefings on request. Discussions were also held with staff, professional forums and primary care colleagues on the proposals. The proposals were also distributed to the Borough Council, Local Medical Committee, Local Pharmaceutical Committee, the Local Service Board, Council for Voluntary Services, Older People’s Forum, Disability Forum in the Neath Port Talbot area plus the 5 Community Councils covering the affected area. In addition presentations were made to community staff in the Vale of Neath area, the ABM Partnership Forum, the ABM Stakeholder Reference Group and the ABM Patient Experience Forum (East). Three public meetings were held in Resolven, Glynneath and Cwmgrach, chaired by the Community Health Council, where the proposals were presented by the GPs from the Vale of Neath GP Practice and the Health Board, and the public were able to raise concerns and ask questions on issues. 153 people attended the public meetings. Notes of the public meetings are attached as Appendix A. Fifteen written responses were received and thirty two email responses through the dedicated email address. In addition a petition was received with 806 signatures, most responses from Resolven residents. In addition a questionnaire was circulated by Councillor Davies on the proposed changes and ten were received by the Health Board. 4. ISSUES RAISED THROUGH THE CONSULTATION PROCESS Of the 47 written responses received, 36 were in support of the proposals, although some of the concerns outlined below were raised. Of the 10 questionnaires, 9 raised concerns over transport and one supported the proposals. In addition there were also the 806 residents who signed the petition to retain a facility in Resolven.


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There were a number of issues raised during the consultation process, which are summarised here:

• Concern that a GP service would not be provided in Resolven as had been promised when the Practice had taken over the previous single-handed practice in 2001 and the impact on the Resolven wider community and pharmacy services there.

• Wide concerns over public transport and the need for better transport links between Resolven and other outlying areas of the Vale to the new facility should it go ahead.

• Specifically stated support from Ystradfelte residents and Community Council, Trem y Mor Residential Home residents, Cwmgrach Old Age Group, Glynneath Town Council for the proposed new development.

• A lot of support for new facilities and wide recognition that the current buildings were completely unsuitable for providing GP services from.

• Concern that it is taking too long to develop the new facilities, which are needed as soon as possible.

• Concern over antenatal and podiatry patients having difficulty accessing clinics at the new facility.

• Questions over why a third party developer is being proposed. • Concern that repeat prescriptions will only be available at the new Primary Care

Centre, requiring significant travelling for residents. • What will happen to the existing Resolven building, will it be allowed to become

derelict. • Will financial help be available to low income patients for increased travelling costs. • Concern over the impact on the pharmacy in Resolven and its continuing viability if

the GP Practice is moved. • Need to have separate car parking at the new site for Trem y Mor and the Primary

Care Centre and a loop road to facilitate access to the Centre.

5. COMMENTS ON ISSUES RAISED THROUGH THE CONSULTATION PROCESS We have considered the issues outlined above which were raised during the consultation process. Clarification on most of these issues was provided during the engagement exercise but the Health Board would wish to re-emphasise the following in response to points made:

• The Health Board recognises the concerns from the Resolven population regarding the commitments made by the previous Health Board and the GP Practice in 2001 to continuing services in Resolven. However the reasons this is not sustainable are clearly laid out in the consultation document and reflect that the Practice’s ability to sustain two facilities is no longer practical or able to provide the best services to all the Practice’s patients.

• We recognise the transport difficulties widely reflected through the consultation. As a result discussions have already been commenced with Neath Port Talbot County Borough Council and First Cymru around potential solutions. The Health Board’s intention, should the proposal be agreed, is to continue these discussions. To support this a transport assessment will be carried out, taking into account patient accessibility and highlighting issues which need to be addressed. The outcome will enable us to develop an action plan including looking at Community Transport and discussions with the developer over parking and access issues. An equality impact


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assessment has been carried out by the Health Board’s Locality Team and quality assured corporately and is attached as Appendix B.

• The Health Board, in line with Welsh Government guidance, has to work with a third party developer for Primary Care premises. However there are wide ranging processes in place which will ensure that the NHS gains value for money from such an arrangement.

• We recognise the concerns over repeat prescriptions. There will be a pharmacy within the new Primary Care Centre and this would be able to dispense acute prescriptions if patients wish. Discussions will take place with the Pharmacy in Resolven regarding whether they would wish to provide a collection and delivery service for repeat prescriptions in the area. The GP Practice already provides a postal service for repeat prescriptions via SAE so that there is no need to visit the surgery as they are sent to the pharmacy of the patients’’ choice. There is no intention to change this arrangement.

• Should the proposals be accepted, the building in Resolven will be sold as soon as the services have moved into the new Primary Care Centre.

In summary the Health Board notes the comments raised through the consultation process and whilst it recognises it needs to put effort into improving transport availability between the more remote areas of the Vale of Neath and the proposed new Primary Care Centre but believes that these and the other issues raised can be addressed while the facility is being planned in detail. Overall we believe that the new Primary Care Centre will provide an improved range and level of services to the GP Practice population and the staff who provide these services. The outcome of the consultation will be considered by the CHC at its meeting on 24th January 2012. Following this the CHC will advise the Board whether it supports the proposal. It is anticipated that this will be reported orally to the Board at its meeting.

6. RECOMMENDATIONS The Board is asked to: – Note the consultation process undertaken on the proposals for Changing Vale of Neath GP

Practices for the Better – Note the issues raised in this consultation process – Agree the responses proposed to the issues raised in the consultation process – Note that the Community Health Council will consider the proposals for Vale of Neath GP

Practices and the outcome of the consultation process in January and subsequently advise the Health Board whether it will support the development of the new Primary Care Centre or not.

– Confirm next steps in light of the CHC decision.


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APPENDIX A

VALE OF NEATH PUBLIC CONSULTATION MONDAY 28TH NOVEMBER 2011 VENUE: TRW CLUB RESOLVEN

Approximately 55 patients attended. Chair: Sheila Ranno – Community Health Council Platform: Dr Paul Westwood Dr Steve Harrowing Hilary Dover – Locality Director NPT

COMMENTS RESPONSES Councillor Des Davies – Resolven Town Council:

• Resolven was the patient group most adversely affected by the proposals

• It was the belief of Resolven patients that maintaining GP services in Resolven was part of the agreement of VON practice taking over from previous single handed GP

• Did not understand why there had been an apparent recent change of policy by the HB to support a single site solution and close Resolven Clinic

• Felt that Resolven Clinic provided adequate accommodation for GP services

• Resolven patients would like to have their own GP services, although he did understand the implications of patients numbers

HD responded: Practice had written to HB to confirm that, for the reasons outlined in the presentation, they were unable to continue to provide services on two sites. The HB therefore needed to agree the most appropriate way forward bearing this in mind.

Suzy Davies AM: • Could the HB offer guarantees that the

services mentioned in the presentation would be delivered from the new surgery

• Transport was a concern – was there any scope to reconsider the site

• Had community transport been considered

• What would happen to the pharmacy in Resolven should the clinic close

HD was able to confirm that the ABM would provide uplifted services into the community as they were key to supporting the model of increased services into the community ABM would investigate all possible solutions to transport included community transport Dr H said that he hoped that Resolven


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patients would continue to support the local Pharmacy in Resolven

From the Floor: • Patients thought that previous letters

received had given them mandate for the clinic to remain.

• Will opinion of Resolven patients be taken into consideration or was it a fait acompli?

Sheila Ranno reiterated that no decision had been made regarding the proposals. It was as a direct result of the previous engagement meetings that full consultation was put in place.The CHC would make their decision in January once they had all the feedback from the consultation exercise

From the Floor: • Patient with disability had concerns

about access to public transport and having to wait in the rain in a wheelchair for a bus

From the Floor: • It was felt that once the clinic closed

the Pharmacist would be forced to close as well.

• Had the HB considered the impact on the village of Resolven in terms of amenties

From the Floor: • Always felt new surgery would be built

but had always felt that clinic would remain in Resolven as well

From the Floor: • Why was a pharmacy being included

in the development? • If the pharmacy closes patients would

have to travel to Aberpergwm to get a repeat prescripton

Developer explained that it was normal practice to include a pharmacy within a new development. Dr W confirmed that patients did not need to travel to the surgery to order repeat prescriptions this could, and was already being done, by the pharmacists who would arrange to get the prescription from the surgery on behalf of the patient.

From the Floor: • Was unclear of the link between the

HB and Developer

Paul Stauber – Director of Planning, addressed the meeting to explain that large new developments were undertaken on behalf of the ABM by a developer. The NHS paid a rent for the building and in return the landlord maintained the premises to the standard required for health services. The age of the two buildings, Glynneath built in 1946 and Resolven 1960, meant that they were long past being fit for purpose and needed to be replaced.

Rob Davies – Resolven Pharmacist Dr H said that the practice valued the professional relationship between the


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• Did have concerns about the move to a single site but did understand why it was being made. He would continue to work with the practice to maintain his very good working relationship with them but he could not predict the long term viability of his being able to remain in Resolven

surgery and Mr Davies and would like to give his personal assurance that they would wish to support him to continue to operate in Resolven

Member of Ystradfelt Community Council: • Ystradfelte patients had further to

travel to reach the new surgery than Resolven patients. However, he had undertaken a canvass opinion from Ystradfelte residents and he could confirm that they were 100% in agreement for the new surgery


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VALE OF NEATH PUBLIC CONSULTATION TUESDAY 29TH NOVEMBER – CWMGRACH MINERS WELFARE HALL

Approximately 28 patients attended. Chair: Sheila Ranno – Community Health Council Platform: Hilary Dover – Locality Director - NPT Roy Miller – Practice Manager – VON practice

COMMENTS RESPONSES From the Floor:

• Did not understand why the consultation was being undertaken again as it appeared the decision had already been made to close Resolven Clinic

Sheila Ranno reiterated that no decision had been made regarding the proposals. It was as a direct result of the previous engagement meetings that full consultation was put in place.The CHC would make their decision in January once they had all the feedback from the consultation exercise

From the Floor: • Was not in opposition to the new

surgery or where the new site was, but did not understand why a GP could not remain operating in Resolven

Roy Miller explained that for reasons outlined in the presentation, the practice felt that they needed to consolidate all their services into one building. Also, the practice covered an area of 82.5 square miles and the site chosen was considered to be the most central for all 9,600 patients registered with the practice.

Ex Doctors Receptionist: • Felt that a new surgery was long

overdue as the practice was still working in the same building as she had and she had retired 20 years ago.

• Also felt new surgery was essential in order to encourage new GPs to work in the upper valleys and that if we didn’t provide new premises the patients would be left with no doctors at all

From the Floor: • Could the new building be available to

provide out of hours services

This would not be possible as, although some of the GPs from VON did undertake out of hours sessions, GP out of hours services were provided on a central basis.

From the Floor: • Felt that the consultation events had

not been publicised enough in other

HD apologised if patients felt that this was the case but every effort had been made to publicise the event with posters in local


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areas outside of Glynneath and Resolven. It was only by chance they had found out about the meeting.

• The meeting was also being held at a time when many people had to go and collect children from school so the opinion of the younger population was not being heard

amenities, press releases and information in the surgery

Representative of Cwmgrach Old Age Group: • Apologised for most of the members

not attending but they were on a Christmas shopping trip. However, they had asked her to pass on their 100% support for the new surgery


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VALE OF NEATH PUBLIC CONSULTATION TUESDAY 29TH NOVEMBER – GLYNNEATH TOWN HALL

Approximately 70 patients attended Chair: Sheila Ranno – Community Health Council Platform: Hilary Dover – Locality Director - NPT Dr Steve Harrowing – GP, VON Practice

COMMENTS RESPONSES Town Councillor from Glynneath reiteration the support of the Town Council for the new development. He was concerned that the fact that there were fewer attendees at the meeting may have a detrimental effect but thought that people had not attended this meeting as they had made the feelings known at the previous meeting in September. Wondered why letters to all households had not been sent as this was stated at the last meeting. Glynneath TC understood the concerns of other communities but they would like to see the deveoment happen in the soonest time possible,

SR reiterated that the numbers of patients attending did not impact on the decision of the CHC who would take account of both attendance and comments from both meetings.

Huw Patrick – Ystrafelte Community Council fully supported the proposals even though Ystradfelte would have the furthest to travel of any of the communities.

Patient from Ystradfelte appealed for a quick decision in order to progress the development. She had previously moved from England and had been shocked at the poor state of the premises in Vale of Neath

Patient who had moved back to Cwmgrach after many years of living mostly in England, had also been shocked that the premises still remained the same as they had been when she had left 25 years ago

Caroline Edwards, Glynneath Town Council, wished to express her anger that they were still waiting for what was a much needed development and uplifted health care in vale of Neath. She did not understand why is was taking so long to reach a decision to make

Paul Stauber, Director of Planning, addressed the meeting and explained that the Health Board were keen to see new premises being provided but that they needed to follow the correct process with regard to Public Consultation, when


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progress. significant opposing opinion had been expressed during one of the meetings held during the Public Engagement exercise.

APPENDIX B

Changing Vale of Neath GP Services for the Better Equality Impact Assessment

Service Area: Primary Care and Planning

Directorate/Locality: Neath Port Talbot Locality, ABMU Health Board

Locality Director: Hilary Dover

1. Introduction

This Equality Impact Assessment examines the impact on patients, staff and stakeholders of the Health Board’s proposal to replace existing GP surgeries in Glynneath and Resolven in the Vale of Neath with a purpose-built, modern primary care centre to improve the way care is delivered in the area.

2. Background

ABMU Local Health Board, as part of its five year plan, has prioritised the modernisation of hospital and primary care services and extending the range of services provided in the community.

Currently, the Vale of Neath GP practice operates out of two premises – the main surgery in Glynneath since 1946 and a branch surgery in Resolven built in the 1960’s. The registered practice population of the Vale of Neath is 9617 (6820 in Glynneath and 2792 in Resolven) mainly resident in neighbouring towns and villages including Glynneath, Resolven, Cwmgwrach, Pontneddfechan, Ystradfelte, Rhigos, Melin Court, Clyne and Abergarwed and it is these people mainly who will be affected by any changes made to the services they receive.

There has been a marked increase in the practice population since the ‘60s and despite some attempts at modernisation in the past, these premises and the range of services offered within are no longer deemed by the GPs to be adequate for the patients served by them. The GPs and the Health Board are of the view that consolidating the two surgeries on modern purpose-built premises would offer better services to patients. In order to do this, the surgeries in Glynneath and Resolven will have to be closed. A site has been identified for development , if the proposal is accepted. This is located in the former Aberpergwym Washery site and is large enough for future development and expansion if required.

This initiative will have an impact on direct frontline service delivery to patients in terms of where and how it is delivered. The proposed new purpose built centre will be built by a third party and rented by the Health Board and the Vale of Neath practice. If the proposal is agreed then a detailed design and planning process will be


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undertaken.

3. Methodology

The Health Board has based this Equality Impact assessment on data available to it on the makeup of the resident population of the wards covered by the registered practice population, the makeup of the registered practice population, Community Health Council inspection reports and responses from interested parties.

As part of this process, the Health Board with the co-operation of the CHC carried out an initial engagement exercise consisting of two public meetings held on the 19th and 20th of September 2011 in Resolven and Glynneath respectively. Thereafter a more extensive 6 week consultation exercise was carried out from 7th of November 2011 to 16th of December 2011. This involved a press release, the distribution of a public consultation document to a wide variety of stakeholders, 3 public meetings, offers of presentations to community and other groups, meetings with staff and other interested parties. The Health Board has also engaged actively with political and community leaders in the affected areas and with NPT County Borough Council.

The Health Board has obtained a wide range of views from people who will be affected by the changes including patients, residents, GPs and practice and community staff.

4. Assessment of potential impact on people by reason of their ‘protected characteristics’.

This equality impact assessment considers the impact of the proposed change on people across the protected characteristics as defined by the Equality Act 2010 namely:

• Gender • Age • Disability • Race • Religion/belief • Gender re-assignment • Sexual orientation • Pregnancy and maternity

It also considers the impact on Welsh speakers and on the human rights of individuals.

It is generally envisaged that relocating the GP services to a modern purpose built premises will have a positive impact on the entire registered population of the Vale of Neath practice. Expected positive outcomes for patients include:

• healthcare needs of all patients in the area being effectively met • highest standard of care delivered in a comfortable, modern and a safe

environment • More accessible health services delivered closer to the patient’s home • premises which meet the access requirements of all particularly the elderly,

disabled people and those with young children. • Dignity, privacy and confidentiality being effectively maintained


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• parking and drop-off points provided

Available information, data and research shows the following impact for the protected characteristics:

a. Gender and Age – Overall Impact positive

The gender and age breakdown from available Vale of Neath practice information is as follows:

Age Female Male 0-5 297 285 6-18 662 704 19-25 407 439 26-65 2396 2500 65+ 1003 908 4765 4836

There are slightly more male patients than female registered to the practice. In general, the impact on men and women would be neutral as there is no clear differential impact by reason of a person’s gender on relocating the practice.

Practice information shows that about 6% of the registered population is under 5. Currently Child Health clinics are being held in the cramped spaces and a purpose built more spacious premises could ensure that the clinic area was more child-friendly. For parents of young children there is likely to be an overall positive impact in terms of access e.g. for parents with prams and who need changing facilities these will be taken account of in a purpose built premises.

Nearly 20% of the practice population is over 65. Although many older people remain relatively fit, active and independent into their 70s and beyond, yet increasing age and growing frailty are linked1. Some older people may therefore have less mobility than other people and particularly for residents of Resolven, relocation of the practice may have some impact on their ability to get to the practice. On the other hand, having a modern purpose building would have an overall positive impact on these groups in that they would have a more accessible building in which to receive the service. There is very little parking space in the current locations which would be addressed in the new premises and this would result in a positive impact on elderly patients who drive or are driven to the practice and on parents of young children.

b. Disability – Overall impact positive

The practice provides general medical services to registered patients who have a wide range of health conditions. These include patients who have physical or mental impairment which have a substantial and long-term adverse effect on their ability to

1 Older person Strategy for Wales 2088-2013


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carry out normal day-to-day activities.

For people who have limited mobility the current premises are not accessible. They are cramped and the consulting rooms and treatment rooms lack adequate space. The premises have no lifts to the upper floors (although Glynneath surgery has a stair lift, the staircase is very steep and narrow and the door at the top needs to open on to the stair lift which is far from ideal). A recent report of the Community Health Council (2011) has identified accessibility as a matter of concern and a key issue.

Again, parking for disabled people at the current premises is inadequate and would be improved in a new purpose built site. In designing the new premises, the developer will be expected to involve disabled people, as has been done in recent Health Board capital developments, to ensure that the premises is completely accessible to people with a wide range of disabilities.

Neath Port Talbot Disability Network Action Group in response to the consultation accepted the reasoning behind the proposed changes. The Disability network has however raised a number of concerns including how people on low incomes from the lower parts of the valley and people who are disabled and have no access to personal transport would get to the new development. They were concerned about the potential for patients to incur extra costs as a result and asked the health Board to consider alternative transport or financial aid to patients. They suggested that if treatment and Therapy services are provided from the proposed centre instead of the Hospital, Disabled people who are unable to use Public Transport and have no access to private transport should be allocated Ambulance Transport as when travelling to Hospital appointments. These points will be considered fully by the Health Board once all comments during the consultation process have been received. Discussions will also be held with the Community Health Council as part of the process.

The Health Board recognises that some people, particularly in Resolven will have to travel further to get to the surgery. ABMU Transport group is carrying out a transport assessment and will work very closely with the CBC and the Bus and community transport services to mitigate any impact. The Health Board is also aware from comments made by members of the public at the consultation meetings that although they live further away than the distance from Resolven to Aberpergwm they would be in favour of travelling this increased distance if they could access more modern/fit for purpose premises (e.g., presentation made by a patient from Ystradfellte).

The network was also concerned about people with Mobility Disabilities having to make additional journeys to collect medication and suggested that consideration should be given either to providing a Pharmacy on site or having an alternative Prescription Service e.g. Practitioners could E mail Prescriptions to Pharmacy of choice and Medication delivered to patient`s Home address. The intention is that the new development will have a pharmacy on site which will be able to dispense acute prescriptions and which will therefore save multiple journeys. Patients have freedom of choice over where to have their repeat prescription dispensed. The pharmacy in Resolven might want to offer a collection and delivery service. The Practice operates a postal service already, so repeat prescription requests can be sent to the surgery in the post with a SAE. The prescription can then be returned to the patient of sent directly to the pharmacy of choice. There is no need to visit the surgery for repeat


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prescriptions now and there is no reason to suspect that would change in the future.

The network was also concerned that any development should have due regard to the Equality Act, consider accessibility in terms of the environment, the structure and the service provision; and comply with relevant Building regulations. In applying for Outline Planning permission, the developer has filed a Design and Access Statement. This sets out their commitment to the principles of ‘Inclusive design’ compliant with relevant building regulations, standards and codes of practice and to ensuring that the building and surroundings are accessible.

c. Different Racial Groups – overall impact neutral

There is incomplete information on the ethnicity of the patients registered in the practice. However, the vast majority of patients whose ethnicity has been recorded are White British. This is in accord with available data on the profile of the wards which make up the areas served by the practice. Available information from the practice shows the following;

Ethnicity Numbers White British 7946 Irish 4 Other white 21 Other Asian 5 Mixed African 3 Indian 2 Other 13 Not recorded 520 Unknown 1077

Ward profile information (from the 2001 census information) shows that for the 3 main wards served by the GP practices, the ethnic profile is as follows:

Ward White Non-White Glynneath 99.4% 0.6% Resolven 99.1% 0.9% Blaengwrach 99.8% 0.2%

There is currently no evidence to suggest that the proposed change will have a differential impact on any racial groups by virtue of that protected characteristic. The practice already makes arrangements to meet the access, language and cultural needs of people from different backgrounds and will continue to do so if it moves in to new premises. Staff will continue to receive Equality Training

d. Different Religions and beliefs – overall impact neutral

The practice does not hold information on the religion/belief or non- belief of its


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registered patients. However, there is currently no evidence to suggest that the proposed change will have a differential impact on anyone because they belong to a particular religion, hold any beliefs or none. The practice is able to meet the religious or cultural needs of people from different backgrounds when necessary and will continue to do so if it moves in to new premises. Staff will continue to receive Equality Training.

e. Sexual orientation – overall impact neutral

The practice does not hold information on the sexual orientation of its patients. However, staff are aware of the need not to discriminate against people and to treat people fairly and will continue to do so if the practice moves in to new premises. There is currently no evidence to suggest that the proposed change will have a differential impact on any person because of their sexual orientation.

f. Gender reassignment – overall impact neutral

Staff are aware of the need not to discriminate against people who have undergone gender re-assignment and to treat people fairly and will continue to do so if the practice moves in to new premises. There is currently no evidence to suggest that the proposed change will have a differential impact on people who have undergone or are going through the process of gender reassignment.

g. Welsh language speakers – overall impact neutral

Evidence from the 2011 census shows the percentage and numbers of people over 3 who can speak write or read Welsh as follows:

Ward Percentage Numbers Glynneath 28.9% 993 Resolven 19.6% 569 Blaengwrach 21.0% 408

The practice does not hold information on which of its patients can speak Welsh, but is aware of those who wish to be communicated with in Welsh. The practice employs some Welsh speakers and they are able to meet that need to some extent. There is currently no evidence to suggest that the proposed change will have a differential impact on Welsh speakers.

h. Pregnant women and women who have recently given birth – overall impact positive

The development of the purpose built centre will provide the opportunity for the centralisation of several community services including Ante-natal and post natal services as well as family planning clinics. The current premises do not lend themselves to having a wide range of services at the moment.


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Also the environment will be conducive and child friendly. Women will be able to breastfeed their babies in comfortable surroundings and in privacy if needed.

i. Marriage and civil partnership – overall impact neutral

There is currently no evidence to suggest that the proposed change will have a differential impact on people because of their martial or civil partnership status.

j. Carers – overall impact positive

Neath Port Talbot has a greater number of carers than many other parts of Wales. However it is not known how many of the registered practice population are carers or are cared for by other people. Just as moving to a purpose built site will have a positive impact on disabled people and parents with young children, it is expected that Carers will have a similar outcome. Carers may have similar difficulties in terms of transport to the new site and the Health Board has taken note of this and will ensure that any issues are considered in the planning stage if this proposal is agreed. Overall, however, a relocation of the practice to more accessible premises which can house a wide range of services is likely to have a positive impact on carers.

5. Assessment of potential impact on staff – overall impact positive

Staff meetings have been held with practice and community staff who currently work in the local area to enable them give their views on the proposal. Responses show that all the GPs affected by the change and the staff, are fully in support of the proposal.

Staff in particular see the benefits of the change to include:

• Improved working environment in terms of space, layout and decoration including more dedicated space within the building (own rooms)

• Better storage and consequently less clutter • Less stressful for patients, so less stressful for staff • Ability to park close to the Centre • Reduced opportunity for damage to car • Better team working by co-locating related roles • Properly designed ergonomic work areas • Greater confidentiality when dealing with patients • Suitable area for breaks and lunchtime rather than using offices • Less complaints regarding inadequacy of the building, air conditioning,

ventilation and heating • Improved infection control, cleaning and maintenance of clinical areas • Equipment availability and access improved • Easier to cover colleagues for sickness and holiday absence

There have been no concerns raised regarding a change in location or travel difficulties. Staff have mentioned that there would need to be:


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• a pedestrian crossing (to aid patient access if walking) • adequate lighting (Important to have) natural light (no small windows)

6. Potential impact on the Human Rights of individuals, particularly with regard to the principles of Dignity, Respect, Fairness, Equality and Independence

The development will have a positive impact on the Human Rights of patients. Currently, the buildings out of which the practices operate do not lend themselves easily to the maintenance of dignity and confidentiality. The CHC have raised concerns about the danger of confidential discussions being overheard by reason of the cramped environment in both buildings.

Also, operating between two sites often results in confidential patient records having to be moved between two sites as patients could attend surgery at either. Also having a more accessible building and surroundings with several services under one roof will enhance the independence of some patients who may then be able to attend the practice unaided.

Patient safety will also be enhanced in terms of better infection control, safer environment, and compliance with Health and Safety regulations.

7. Mitigation of potential negative impacts

On the whole, this proposed change will largely have a positive impact on patients and residents. There is however a possibility that a small number of people may have to travel further to access the proposed Primary Care Centre.

The Health Board has noted this concern and will do all it can to mitigate against any negative impact. It has already started dialogue with NPT CBC and First Cymru Bus services. NPT locality will, with the support of ABMU Transport group build on this dialogue as the development progresses. As part of ABMU’s planning process, a Transport Assessment will be completed by the Locality (with help from Service Planning) and this will then be quality assured by the Transport Group. The assessment will take into consideration patient accessibility (i.e. Bus services etc) and will highlight all issues that need to be addressed, including things like transport of notes/bloods and whether WAST will need to be involved . The outcomes of the Transport assessment will then help us to identify whether we need to engage other providers such as Community Transport and whether there needs to be discussions with the developer re car parking etc.

The Developers will also ensure that access issues are fully considered and addressed in the planning and design stage. As has been done with other recent Health Board developments, all sections of the community particularly disabled people will be involved throughout the process.

In terms of service accessibility, as the planning progresses, the practice will ensure that policies and practices and procedures are revisited to ensure that staff and patients alike are not disadvantaged or discriminated against.


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8. Conclusion

Though some negative impacts have been identified, the positive impacts far outweigh these. The Health Board acknowledges the Equality Impact Assessments are not an end in themselves, but must be a continuous process through service change. Therefore, if this proposal is agreed, the Health board will continue to involve patients, staff, community members and other stakeholders in the development of the Vale of Neath Practice.

Hilary Dover (Locality Director)

20th December 2011

Assessment Team

Kevin Duff (Planning and Partnerships Manager) Marie Amanoritsewor (Planning Partnerships Support Manager) Roy Miller (Vale of Neath Practice Manager) 19th December 2011

REPORT PREPARED BY: Joanne Davies, Assistant Director of Planning (Service Planning) REPORT SPONSORED BY: Paul Stauber, Director of Planning


AGENDA ITEM: 2 (iii)

OUTCOME OF ENGAGEMENT PROCESS ON HILL HOUSE HOSPITAL

1. PURPOSE To seek ratification of Chairman’s Action in respect of Hill House Hospital 2. BACKGROUND The paper submitted to the Board meeting in November 2011 outlined the engagement process undertaken in relation to services at Hill House Hospital, the issues raised and the actions proposed by the Health Board in order to take these forward. This included agreement that Chairman’s Action be taken in light of the Community Health Council (CHC) decision. It was noted at the Board meeting that the CHC would be meeting on 15th November to consider the outcome of the engagement process and therefore decide whether it would support the Health Board’s proposals for Hill House Hospital. The CHC subsequently confirmed that they support our proposals and therefore we can proceed with the transfer of services from Hill House Hospital provided that the wards at Singleton and Gorseinon are fully commissioned to the appropriate standards before rehabilitation patients are moved and the work on providing a Children’s Development Centre at Singleton Hospital is progressed as quickly as possible. Chairman’s Action was subsequently taken to enable us to progress to implement these changes as soon as possible. This included formal confirmation that the property was surplus to the Health Board’s requirements and the appropriate disposal process is being implemented. The CHC received a presentation on, and were given the opportunity to contribute to, the plans for the Children’s Development Centre at their meeting on 17th January 2012. 3. RECOMMENDATIONS The Board is asked to:

Note the agreement of the Community Health Council to the Health Board’s proposals for Hill House Hospital

Ratify Chairman’s Action in approving the transfer of services from Hill House Hospital to Singleton and Gorseinon Hospitals and agreeing that the site has formally been confirmed as surplus to Health Board requirements and that therefore the appropriate disposal process is being implemented.

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OUTCOME OF ENGAGEMENT PROCESS ON “CHANGING MENTAL HEALTH SERVICES FOR THE BETTER”

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REPORT PREPARED BY: Joanne Davies, Assistant Director of Planning (Service Planning) Tegwyn Williams, Clinical Director, Mental Health Directorate REPORT SPONSORED BY: Paul Stauber, Director of Planning and Alex Howells, Director of Primary, Community & Mental Health Services


AGENDA ITEM: 02(iv)

OUTCOME OF ENGAGEMENT PROCESS ON “CHANGING MENTAL HEALTH SERVICES

FOR THE BETTER”

1. INTRODUCTION The Board will be aware that an engagement process has been underway regarding the development of a 5 year plan for Mental Health Services in the ABMU area, entitled “Changing Mental Health Services for the Better”. This document outlines the engagement process which has taken place, the main issues raised and the actions it is recommended the Health Board take as a result of this process in order to finalise this plan for Mental Health services going forward. Overall, the Health Board’s proposals were well received and further detail would be provided on certain elements when formal public consultation takes place on the specific proposals.

2. BACKGROUND Plans had been developed by predecessor organisations for the development of Mental Health services in Bridgend and Neath Port Talbot and separately in Swansea. However when the Health Board considered the comments made through the engagement process on our 5 year plan “Changing for the Better” a consistent theme was that there was not enough clarity about how mental health services were going to develop and change in the future. A commitment was therefore made that a 5 year plan for mental health services in the ABMU area would be produced and be subject to a separate engagement process prior to being finalised. Therefore the draft discussion document “Changing Mental Health Services for the Better” was approved at the Health Board meeting in September 2011 as the basis for a wide-ranging engagement process prior to finalisation of the 5 year plan for Mental Health Services in the ABMU area. The engagement process ran from 8th September to 9th December 2011 and the discussion document was utilised as the basis of debate, outlining the direction of travel proposed for mental health services but also including a number of questions which the public and stakeholders were asked to give their views on. In contrast to some discussion documents produced by the Health Board, “Changing Mental Health Services for the Better” was always intended to be the start of a process to develop a 5 year plan for mental health services rather than the finished article. 3. ENGAGEMENT PROCESS The discussion document and the engagement plan were made available on the ABMU Health Board website, information was also placed on the HB’s public information boards, the ABMU HB Facebook page and made available in public buildings e.g. the Civic Centre, and GP surgeries. Informal briefings were provided to local councillors and Assembly Members and

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MPs on request. Discussion sessions were held with a wide range of groups, staff, professional and advisory forums and primary care colleagues on the proposals. In line with the engagement process agreed at the Health Board meeting in September, 39 stakeholder meetings were held which ranged from one-to-one sessions to open public meetings. A wide range of people attended the sessions which provided the opportunity for questions and comments to be raised. Out of the three public meetings, approximately 30 people attended, although a lot of people who would have attended these had already received a briefing through one of the other sessions organised as part of the process. Three written responses were received and seven email comments/ enquiries were received through the dedicated email address. 4. ISSUES RAISED THROUGH THE ENGAGEMENT PROCESS Overall there was enthusiasm from participants in having an open debate with the Health Board on the future direction of travel for mental health services in the ABMU area. The following building blocks of the Health Board’s proposals were set out in “Changing Mental Health Services for the Better”

• Promoting and expanding access to a range of services that help people to help themselves, and promote mental health and well being.

• Developing a Primary Mental Health Services in line with Welsh Government requirements, working closely with GPs and helping to assess and signpost people into appropriate services.

• A new single point of access will be developed to speed up and simplify access to mental health services, particularly in an emergency situation.

• Community Mental Health Teams will continue and will be the major focus for specialist community mental health services that help to keep people out of hospital, or help people following discharge.

• An increasing range and volume of alternatives to admission will be available across the Health Board, enabling people to stay out of institutional care – even in a crisis situation.

It is clear that in overall terms the proposals were well received, although there were a number of issues which were consistently raised during the engagement exercise, which highlights further work is required, as follows: The issues raised during the engagement exercise were as follows:

• A requirement for more information about demand for mental health services and the level of services which will be provided both in terms of bed numbers and community support to support the delivery of the proposals.

• The emphasis on “Tier 0” was welcomed and encouraged, but identified a need to develop the plans for promotion of mental health wellbeing in more detail as part of the overall development of the 5 year strategy.

• Partner organisations want to be more formally included in the development of the 5 year strategy for mental health services in the ABMU area

• There needs to be greater regard to the needs of carers in relation to all proposals for services.

• There is an opportunity to further develop collaboration with acute hospital services, in particular the relationships with Emergency Departments and Palliative Care services.

• The involvement and contribution of the third sector needs to be recognised more fully and developed in the future.

• Further detail is required regarding the proposed change to acute assessment services and the physical and geographical implications of this. This work needs to explain the

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comparative costs and benefits of a centralised approach versus a local approach, and needs to include an analysis of the location options. Transport plans would need to underpin any proposals and bed numbers would need to be quantified. The development of community services, relationships with other parts of the unscheduled care service need to be further explained.

• In general there was considerable support for the proposal to develop a mental health triage model, but a recognition that more detailed work was ongoing to understand the implications for other services – in particular Local Authority based services.

• There was support for the need to help care for more people in their own homes and plans to develop community services need to be accelerated to ensure that these were in place before changes to hospital based services

• The main concerns raised over the proposals to move mental health beds from Maesteg Hospital related to the impact of this change on the viability of the hospital itself. Equally it is important that appropriate care solutions were developed for individuals currently accommodated at Maesteg Hosptial involving their families and carers.

• With the majority of patients with mental health problems also having coexisting substance misuse problems there was concern that the plan did not reflect this or explain how these patients with dual diagnosis would have their needs met. In particular the impact on vulnerable groups (e.g. Homeless, refugees, gypsy travellers etc) needed to be considered.

• The primary care component of the service was agreed to be important and this would be taken forward as part of the implementation of the Mental Health measure which would be critical in ensuring talking therapies and lower level interventions were available and accessible.

• The opportunity to improve liaison psychiatry services in general hospitals was noted due to the critical part they can play in assessing and ensuring appropriate care is provided to patients admitted through general medical or surgical services.

• Concerns were raised over provision at Tonna Hospital and the lack of facilities and accessibility for families.

• The need for more and more flexible respite provision for older people with mental health problems was felt to be a priority which had been under emphasised in the document.

5. ACTIONS PROPOSED ON ISSUES RAISED THROUGH THE ENGAGEMENT

PROCESS We have considered the issues outlined above which were raised consistently through the involvement process. Fundamentally the Health Board wants to be clear that the discussion document “Changing Mental Health Services for the Better” was always intended to start an open and honest debate over the future of mental health services in the ABMU area. Further work was always going to be necessary before a final 5 year strategy could be published. Therefore it is proposed that the following actions are taken to address the issues raised and to move towards the completion of the 5 year strategy for mental health services in ABMU. These have been discussed and agreed with the Community Health Council:

• The key statutory organisations will form a partnership with other parties through a Programme Board to further develop the 5 year plan for Mental Health services.

• This Programme Board will oversee the development of plans for strategic service changes to services, including quantifying needs, activity, capacity requirements to ensure that they integrate across agencies.

• A formal public consultation will be undertaken, in partnership with the Community Health Council, in 2012, on the options for the future provision of acute adult mental health beds. In order for this to happen, considerable work will need to be carried out to

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develop, quantify and consider these options prior to the Consultation document being produced, as well as clarifying how these services will be linked to Emergency Department, Liaison Psychiatry and GP Out of Hours services. It is therefore anticipated that proposals for this public consultation will be presented to the Health Board in May 2012. Work is underway to complete an analysis of current and proposed bed numbers where changes are proposed for the Community Health Council meeting later in January. Because of the further work involved in finalising the 5 year plan for Mental Health services in the ABMU area these will be indicative at this stage and may be subject to change.

• Transport issues were such a concern in the debates over the future of mental health services that the Health Board will develop an action plan prior to the implementation of any changes in service location with transport and voluntary sector providers to ensure that any changes to the provision of services are addressed.

• Through the new Programme Board referred to above, the mental health triage model will be further developed to ensure there is a clear role and benefits realisation plan, and an understanding of how this integrates with current services.

• The plans for developing 28 low secure beds on the Glanrhyd Hospital site to replace and expand the current 14 at Cefn Coed Hospital will be implemented without further engagement because there were no concerns raised about this proposal.

• The Day Service at Tonna Hospital will change its operating hours as outlined in the document because there were no concerns raised about this proposal and it will enable us to meet patients’ and their carers needs more appropriately.

• Because of the key role for community services in being able to deliver the vision for mental health services, a detailed action plan will be developed through the new Programme Board to ensure proposals are affordable, integrated with other services, and deliverable.

• The mental health beds at Maesteg Hospital will be transferred to Glanrhyd Hospital. A separate process will be undertaken through a multiagency planning group being set up by the Locality Director for Bridgend to identify how the beds released at Maesteg can best be used to care for the general health needs of the population. The intention of the Health Board is to continue to use all the beds at Maesteg Hospital, but for older people, rather than for patients with mental health problems.

• The new Programme Board will consider how best the needs of patients with dual diagnosis of mental health and substance misuse problems will be cared for, as part of its development of the 5 year plan for Mental Health services in the ABMU area.

• Partnership work in the implementation of the primary care service in response to the Mental Health measure will continue, with an emphasis on enhancing communication and the changes.

• Detailed proposals will be developed for the transfer of beds for Older People with Mental Health problems in the Neath Port Talbot area from Tonna Hospital to Neath Port Talbot Hospital, including planning facilities for these and addressing transport issues highlighted through the engagement process. As a result a discussion document on these proposed changes will be produced for the Health Board to consider at its meeting in May 2012.

• The Health Board recognises the key importance of the provision of respite care for older people with mental health problems and will ensure that this is addressed as part of the new Programme Board’s work on developing the 5 year strategy for mental health services in the ABMU area.

• Further detail on the provision of Tier 0 services will be developed through the Programme Board to clearly outline the proposals for these services.

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In summary the Health Board recognises the importance of addressing the comments raised through the engagement process and believes that the actions proposed above will ensure that these are addressed. The establishment of the new Programme Board for Mental Health in ABMU will ensure that these are taken forward on a multiagency, partnership basis, optimising the opportunities for integration of services and better outcomes for clients. Attached as Appendix A for clarity is a draft timeline for the actions identified above to be implemented. All other comments made as part of the engagement process will be made available to the new Programme Board to ensure all of these are addressed as the final 5 year plan for Mental Health services in the ABMU area is developed.

6. RECOMMENDATIONS

The Board is asked to:

Note the engagement process undertaken on the discussion document “Changing Mental Health Services for the Better”

Note the issues raised in this engagement process Agree the establishment of a new Programme Board in partnership with the

organisations listed above to ensure a 5 year plan for Mental Health services is developed, addressing the issues raised in the engagement.

Agree the range of actions proposed in section 5 above and note the timescales involved in these (as outlined in Appendix A)

Appendix A

ACTION PLAN – OUTCOMES FROM “CHANGING MENTAL HEALTH SERVICES FOR THE BETTER”

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Action

Lead

Timetable

Day Services for Older People at Tonna Hospital to amend operating hours to reflect patients’ demands

HB January – February 2012

Establish Programme Board with partner organisations to oversee development of 5 year plan for Mental Health Services

HB February 2012 Transfer Older People’s Mental Health beds from Maesteg Hospital to Glanrhyd Hospital

HB February – March 2012

Programme Board to consider range of issues raised in involvement process and oversee development of detailed plans for changes to services, including quantifying needs, activity, capacity requirementsand how these will integrate with other partners’ ser

vices. Also the

Programme Board will: ‐ Ensure a detailed action plan is developed for the expansion of

MH community services to ensure proposals are affordable, integrated with other services and deliverable

‐ Consider how best the needs of patient with dual diagnosis of mental health and substance misuse problems will be cared for

‐ Oversee implementation of the primary care service in response to the Mental Health measure

‐ Ensure respite care for older people is addressed in the strategy ‐ Develop further detail on the provision of Tier 0 services ‐

HB / Programme Board February – July 2012 Proceed with developing detailed proposals for the transfer of beds for Older People with Mental Health problems in the Neath Port Talbot area from Tonna Hospital to NPT Hospital, including planning facilities for these and addressing transport issues so that further engagement / consultation can occur, in agreement with the CHC

HB May 2012

Formal public consultation on options for future provision of acute adult assessment mental health beds

HB in conjunction with Community Health Council

May 2012 – August 2012

Develop Transport Action Plan reflecting all proposed changes to services and work with Transport providers and Local Authorities to address concerns

HB with Local Authorities & Transport providers

February – April 2012

Implementation of the proposed Mental Health Triage model involving all partners

HB February – July 2012

Develop Outline Business Case for 28 low secure beds on the Glanrhyd Hospital site to replace and expand the current 14 at Cefn Coed Hospital for submission to Welsh Government

HB February – March 2012

REPORT PREPARED & SPONSORED BY: Paul Stauber, Director of Planning


Agenda Item: 2(v)

CLYDACH WAR MEMORIAL HOSPITAL

Purpose To set out proposals regarding the future of Clydach War Memorial Hospital. Introduction Clydach War Memorial Hospital was built in 1925 and is typical of hospitals of this age. The funding and use of the hospital has changed considerably over the years, with it being funded by public donations prior to its transfer into the NHS in 1948. There have been no inpatient beds at the hospital since 2003 and the site has significant access issues, largely due to its location on a steep hill, and the shortage of parking in the vicinity. Background At the present time the hospital is the base for the Community Mental Health Teams, Paediatric Occupational Therapy and the office base for Swansea / Neath Port Talbot Crossroads. Limited sessions are also provided for Physiotherapy, Podiatry and Speech Therapy. It has also been used as an interim base for the MCAS service (for the whole population of Swansea) and on an ad hoc basis for a few additional services. Almost all of the services provided on the site are for a wider population of Swansea than just Clydach because the services specifically for the local population were transferred to the new Clydach Health Centre which opened in 2008. The Board will be aware that as part of the modernisation of Mental Health Services in Swansea, a new purpose built CMHT base is being established at Ty Einon which was completed prior to Christmas. The CMHTs moved into their new accommodation on the 9th January 2012 which will effectively leave nearly three quarters of Clydach War Memorial Hospital empty. It was therefore felt a small group led by the Director of Planning should review the services remaining at the hospital. This group has been established involving the Community Health Council, Swansea / Neath Port Talbot Crossroads, Director of Finance, Locality Director, Assistant Director of Therapy Services, Assistant Director of Planning and Staff Side representatives. The group has met on 2 occasions and has concluded:- 1. Paediatric Occupational Therapy should be accommodated in the Children’s

Development Centre which is anticipated will be available towards the end of 2012/13.

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2. Limited Physiotherapy, Podiatry and Speech Therapy have been carried out at the hospital for some time and can be accommodated elsewhere within the locality.

3. Crossroads provide a service for the whole of Swansea and Neath Port Talbot and so could be located elsewhere within these areas.

4. Musculoskeletal Clinical Assessment Service will be relocated to the new Beacon Primary Care Centre at SA1 in Swansea.

Based on the above, the group’s conclusion is that the Health Board already has in place plans which will result in Paediatric OT, MCAS and the CMHTs vacating Clydach War Memorial Hospital. Therefore Clydach War Memorial Hospital will then no longer be required to provide services. Therefore it is recommended thata period of public engagement should now take place on the future of the Hospital. Discussions will also be held with representatives of the local community and the possible options for its future use. It has to be appreciated this is a very sensitive issue for the local community, partly because of the fact it was funded from voluntary donations from them, and partly because of the location of the War Memorial which is integral to the frontage of the building. Recommendation The Board is asked to confirm that services should no longer be provided at Clydach War Memorial Hospital and a period of public engagement should be undertaken. Also, initial discussions be held on the potential for its future use.

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REPORT PREPARED BY: Eifion Williams, Director of Finance Samantha Lewis, Assistant Director of Finance HEALTH BOARD

26th January 2012

AGENDA ITEM: 03(i)

FINANCIAL REPORT - MONTH 9

1 INTRODUCTION 1.1 This report updates the Health Board with information relating to the overall financial position of

ABMU Health Board as at 31st December 2011. This Finance report provides the following updates:-

(i) the Financial Position of the Health Board to 31st December 2011;

(ii) an update of the Capital Programme current position;

(iii) the Performance against the P.S.P.P. 30 day target; and

(iv) the Debtor’s Position as at 31st December 2011.

2 REVENUE FINANCIAL POSITION

2.1 The ABMU Health Board commenced the year with an Interim Resource Plan that identified cost pressures and underlying carry forward costs of £63m, with a savings / cost containment framework currently required of £43m. The delivery of the savings programme requires Locality Directors and Clinical Directors to implement robust measures to contain costs to the budgets set and achieve cost savings through cost reduction initiatives. The balance of the requirement was proposed to be met through a further allocation. The Health Board has now received £17m additional funding, which leaves the Health Board with a further £3m savings to identify in order to balance the Financial Plan.

2.2 The Health Board’s financial performance throughout the year has faced significant financial challenges from meeting delivery costs associated with Service Access targets, and other operational pressures.

2.3 The Health Board has reported an overspend of £9.629m to the end of December which will be reduced by year end, but the Health Board is forecasting a £3m deficit position at the end of the financial year. The delivery of this is extremely challenging.

2.4 Maintaining service delivery and service quality is important and identifying further savings opportunities must not jeopardise these requirements. The task is receiving focused management attention to attempt to curb overspends, with significant efforts being made to restrict any non-essential and premium rate costs being incurred.

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3 CAPITAL FINANCIAL PLAN 2011/12

3.1 The forecast Capital Financial Plan for 2011/12 was approved at the Capital Investment Committee on 29th June 2011 and forecasted an over commitment of £2.444m.

3.2 Performance to Month 9 At Month 9, the plan is showing an over commitment of £0.080m against planned spend to date.

Table 1 - Capital Financial Plan 2011-12 – Expenditure to Plan at Month 9

3.3 Additional Allocations

Allocations have been received in the last month for the following schemes:- • HVS 1B, Scheme 4, Combined Services Centre (Diabetic Reprovision & Enabling Works)

£1.737m • Pharmacy Robots £0.213m

3.4 Forecast Outturn 2011/12

After taking account of the allocation adjustments above and also updated spend estimates across all schemes, the forecast financial outturn for 2011/12 is showing an over commitment of £4.975m. Further allocations to support expenditure within the plan of £4.975m are anticipated on the following schemes, which would reduce this over commitment to a breakeven position. This funding is available within the Health Board’s control total to support these developments and will be approved once the relevant Business Cases have gone through the WG scrutiny process: • HVS 1B, Scheme 4, Combined Services Centre. £0.929m. BJC submitted to WG December

2011 • A&E, Expansion, Morriston £2.538m. BJC submitted to WG December 2011 • Singleton Wards £1.508m. BJC due to be submitted to WG by end January 2012

There are a number of risks and opportunities within this position, including remaining contingency within the spend estimates of £0.577m. Should any additional slippage occur this year, there are plans in place which could utilise the slippage, by bringing forward schemes from next year.

2

4 PUBLIC SECTOR PAYMENT POLICY 4.1 The Health Board has achieved a cumulative compliance level to the end of December of 96.66%

of supplier invoices paid within the 30 day target, with an in-month compliance of 97.60%. This represents a key achievement and confirms compliance with the Welsh Government PSPP compliance target of 95%.

5 DEBTOR’S POSITION 5.1 The position on debtors across the Health Board as at 31st December 2011 is set out in the table

below. The movement on debtor balances, compared to the equivalent figures for the previous month is also shown.

Type

Position At

Total

Outstanding

Current Month To 30 Days Past Due

31-90 Days

91 Days and

Over NHS 31st December

30th November 7,457,357 7,413,830

6,835,835 6,562,361

188,636 718,792

432,866 132,677

Non-NHS

31st December 30th November

2,731,871 2,235,971

1,928,720 1,337,614

197,907 264,628

605,244 633,729

5.2 The Health Board’s outstanding debts have increased by £0.539m between 30th November and

31st December. NHS debts have increased by £0.043m and non NHS debts have increased by £0.495m. The increases are due to invoices raised in advance for the final quarter of the financial year. There has been a small increase of £0.230m in the value of NHS debts outstanding for more than 30 days whilst there has been a reduction of £0.095m in the value of non NHS debts outstanding for more than 30 days. Efforts continue to be made to further reduce these debts over 30 days old with a significant number of the Non NHS debts being paid in monthly instalments.

6 RECOMMENDATION 6.1 The Health Board is asked to note: -

(i) the Financial Position of the Health Board to 31st December 2011 and the action being taken to meet the financial target;

(ii) a report on the current position of the Capital Programme; (iii) the Performance against the P.S.P.P. 30 day target; and (iv) the Debtors Position as at 31st December 2011.

3

REPORT PREPARED BY: Darren Griffiths, Assistant Director of Planning, Acting Assistant Director of Acute Care REPORT SPONSORED BY: Hamish Laing, Director of Acute Care Victoria Franklin, Director of Nursing Bruce Ferguson, Medical Director Paul Stauber, Director of Planning Alexandra Howells, Director of Primary, Community and Mental Health Services


AGENDA NO: 3 (ii)

INTEGRATED PERFORMANCE REPORT Purpose The aim of this report is to inform the Health Board of the organisation’s position against key performance indicators. As the report spans the year end it will contain a blend of the following measures: - • 2010/11 Welsh Government Annual Operating Framework (AOF)

measures. • Rolled over 2010/11 AOF measures into the 2011/12 Annual Quality

Framework (AQF). • Level of care delivered to the population of ABM University Local

Health Board through Quality and Safety measures. Introduction This report updates the Health Board on the range of key performance measures that the Health Board is broadly assessed against, along with some additional measures which have been identified as important to the organisation which are outside of mandatory reporting requirements. In line with the last report the charts have been retained which gives a sense of the general direction of travel of performance against the measures and their relationship with target levels. This detail against each of the measures is attached as Annex A to this overview report. As with previous reports, a summary of the Red, Amber, Green rating of each performance area is set out in table 1. It is worth noting that with effect from December, some of the detail of the recording of the Accident and Emergency measure has been revised by Welsh Government, bringing Welsh reporting in line with English reporting. Further narrative is provided in section 4.2 of Annex A.

1

Table 1 – summary of Annex A performance measures Number of Indicators

Domain Green Amber Red 1. Safety 3 5 0

2. Effectiveness 0 2 0

3. Patient Focus 0 1 1

4. Timeliness 3 3 3

5. Efficiency 0 4 3 Key Issues Overall performance against the key domain indicators remains at the same level as reported at the last meeting. The main exception to this relates to cancer performance where there has been a slight deterioration in performance although the exact position remains to be validated as explained in section 4.4. Impact Assessment The Health Board is requested to be aware of the following: - • The report supports both the Health Board’s strategic plan in the sense

that it identifies opportunities for performance improvement and potential efficiency and satisfies the corporate objective that performance is routinely reported in a transparent way to the Health Board meeting.

• There are no key risks within this proposal but failure to achieve performance levels in key patient quality areas could increase clinical risk.

• There are no specific resource impacts in preparing this report but delivery of the measures within the report could release resource and increase quality of care.

• Delivery of the quality measures in particular are weaved within the Healthcare Standards

• Equality Impact Assessment – not required in preparing this report.

Recommendation The Health Board is asked to note the content of the performance report.

2

1. Safety Indicators

1.1 MRSA Bacteraemia

Target: N/A

Stable

1.2 C Difficile

Target: N/A

Improving

1.3 Hospital Falls

Target: N/A

Movement: Improving

1.4 Walk Arounds

Target: 15

Improving

Source: Workforce Development

Movement:

Movement:

Performance:

Performance:

Performance:

Movement:

Source: Infection Prevention & Control Dept

Performance:

Source: Welsh Healthcare Associated Infection Programme

Source: Ward Metrics Information

This measure shows the total number of MRSA bacteraemia cases in-month for the Health Board. The trend shows a steady decline in cases although there has been a marginal increase in November and December. The Health Board reported no infections in June & July. The Health Board is planning to implement 2% chlorahexidine skin preparation which should help to reduce rates further.

A further reduction in C. difficile infections has been observed in the 3rd quarter of this year, the Health Board is now narrowly within target to achieve the minimum 20% further reduction this year. Work is being undertaken in relation to enhancing cleaning and improving the environment of care.

The in-month breakdown of executive walkarounds is below: Singleton Hospital: 3 Morriston Hospital: 3 Princess of Wales Hospital: 8

The trend line shows that Hospital fall numbers vary markedly by month, April had the highest number of falls recorded with 279, this reduced again this month to 162, although data validation may be ongoing. Focus on hospital falls avoidance at ward level has been introduced following the rollout of ward metrics.

0

1

2

3

4

5

6

7

8

ABM

Linear (ABM)

0

50

100

150

200

250

Cumulative monthly count to achieve Target

Actual cumulative C. difficile monthly count

0

5

10

15

20

25

30

35

40

Walkarounds

Target

0

50

100

150

200

250

300

350

Number of patient slips/trips/falls

Linear (Number of patient slips/trips/falls)

9th January 2012 1 ABMU HB Performance Summary

1.5 Risk Adjusted Mortality Index

Target: N/A

Improving

1.6 Pressure Ulcer Incidents

Target: N/A

Improving

1.7 Global Trigger Tool

Target: N/A

Movement: N/A

1.8 POVA

N/A

Stable

Movement:

Source: Nursing Data Metrix

Source: CHKS

Performance:

Performance:

Movement:

Performance:

Target: Performance:

Movement:

Source: Clinical Audit

Source: Nursing Data Metrix

The overall ABMU RAMI score for the 12 months Nov 2010 to Oct 2011 is 109, exceeding the Health Board set improvement target of less than 100. All Wales RAMI for this period is 100 and the CHKS Top 40 Hospital Peer Group is 92. The Health Board RAMI for more recent months is likely to improve once clinical coding for these months is more complete (all deceased records within this period have been clinically coded) .

Incidence of Pressure Ulcers has continued to fall since June (which peaked at 23), indicating excellent progress, with 8 cases recorded in December.

The POVA measure now considers reported incidents that occur in community sites as well as acute.

The Global Trigger Tool baseline has been established over the period April to October 2010 as part of the 1,000 Lives Plus Programme based on an assessment of 20 sets of notes per site per month. Analysis is currently taking place but the complexity of the review process leads to data being reported some time in arrears. Trends will be built and action taken based on the data. The random audit of 20 notes per site in August uncovered no events and hence the score of Nil indicates strong performance.

0

5

10

15

20

25

0

2

4

6

8

10

12

14

16

18

20

80

90

100

110

120

130

140

150

160

ABMU ALL WALES Linear (ABMU ) Linear (ALL WALES)

0

5

10

15

20

25

Number of incidents of pressure ulcer development on the ward


2. Effectiveness

2.1 Vaccines & Immunisation

Target Jul-Sep10 Oct-Dec10 Jan-Mar11 Apr-Jun 11 Jul-Sep 11

95%

SWA - 90.4%

BGD - 90.4%

NPT - 86.7%

SWA - 91.4% BGD

- 91.1% NPT -

88.6%

SWA - 92.2%

BGD - 90.7% NPT

- 88.3%

SWA - 90.9% BGD -

90.8% NPT -

88.9%

SWA - 92.6%

BGD - 90.4% NPT

- 92.0%

95%

SWA - 91.9%

BGD - 94.8%

NPT - 93.4%

SWA - 93.3% BGD

- 95.3% NPT -

94.2%

SWA - 94.9%

BGD - 94.8% NPT

- 94.9%

SWA - 94% BGD -

92% NPT - 93.6%

SWA - 93.5%

BGD - 94.3% NPT

- 94.1%

95%

SWA - 86.2%

BGD - 87.9%

NPT - 84.3%

SWA - 86.7% BGD

- 84.5% NPT -

88.6%

SWA - 88.6%

BGD - 81.9% NPT

- 87.4%

SWA - 85.2% BGD -

77.9% NPT -

84.1%

SWA - 87.6%

BGD - 83.8% NPT

- 84.1%

95%

SWA - 95.9%

BGD - 95.6%

NPT - 96.8%

SWA - 95.6% BGD

- 97.1% NPT -

94.6%

SWA - 96.7%

BGD - 96.9% NPT

- 99.0%

SWA - 97.2% BGD -

97.4% NPT -

97.2%

SWA - 96.8%

BGD - 98.9% NPT

- 96.5%

95%

SWA -91.6%

BGD - 89.4%

NPT - 89.9%

SWA -90.7% BGD -

87.5% NPT -

91.9%

SWA -90.8% BGD

- 86.0% NPT -

90.1%

SWA - 89.2% BGD -

81.7% NPT -

89.8%

SWA - 91.0%

BGD - 84.3% NPT

- 88.5%

Target: See table

Stable

2.2 Human Papilloma Virus

Target: See Table

Improving

Source: Vaccine Uptake in Children's in Wales (COVER Report 99), Public Health Wales

% coverage level of MMR at age

2


5 (1 dose)


5 (2 doses)

% coverage level of 5 in 1

vaccine at age 1

Performance:

Movement:

Performance:

Source: Vaccine Uptake in Children's in Wales (COVER Report 99), Public Health Wales

Movement:

% coverage level of 4 in 1

vaccine at age 5

Vaccines and Immunisation data is presented in a tabular format as there are 15 measures per month to consider. A run rate for the last 4 reported quarters has been provided to show how performance in each locality under each target has behaved. Generally, Health Board performance is strong, with 2 dose MMR at age 5 and level 4 vaccine at age 5 the areas where improvement is required. For the last reported quarter (July to September 2011) improvement is noted across a large majority of the indicators.

The Health Board continues to commission a Human Papilloma Virus (HPV) Local Enhanced Service, which provides a catch up programme for children under 18 who have not been immunised in school. The Health Board is showing performance at or around the 88% level with some measures exceeding this. Progress to the last reported period has been steady and work is ongoing to improve the performance level.

60%

65%

70%

75%

80%

85%

90%

95%

100%

Dose1- BGD

Dose 1 - NPT

Dose 1 - SWA

Dose 2 - BGD

Dose 2 - NPT

Dose 2 - SWA

Target


3. Patient Focus

3.1 Survey

Target: 95%

Movement: Stable

3.2 Complaints

Target: 100%

Stable

Source: Datix

October-11 38

Jul-11 2Aug-11 12

September-11 14

Performance:

Movement:

As at: 03/01/2012Outstanding Responses

Performance:

Source: Patient Experience Unit

Numbers of complaints have increased over recent months (from around 80 per month) to 151 in October. For complaints received in the period from 1st April 2010 to 31st January 2011, the performance against the 2-day acknowledgement target was 100%. Performance against the new 30-day response target in October is 63%.

The overall patient satisfaction rate for November 2011 is 88% which is below the 95% target level. Individual feedback is provided to each area in order to improve. Robust local monitoring of actions implemented is routinely undertaken, with a significant number of satisfaction surveys already completed.

60%

65%

70%

75%

80%

85%

90%

95%

100%

Patient Satisfaction Level

0

200

400

600

800

1000

1200

1400

Number of Patient Satisfaction Survey's Undertaken

0%

10%

20%

30%

40%

50%

60%

70%

80%

Compliance with 30 working day response target

0

20

40

60

80

100

120

140

160

No

v-09

Dec

-09

Jan

-10

Feb

-10

Mar

-10

Ap

r-10

May

-10

Jun

-10

Jul-

10

Au

g-10

Sep

-10

Oct

-10

No

v-10

De

c-1

0

Jan

-11

Feb

-11

Mar

-11

Ap

r-1

1

May

-11

Jun

-11

Jul-

11

Au

g-1

1

Sep

-11

Oct

-11

Number of Complaints covering Acute and Mental Health


4. Timeliness

4.1 Referral to Treatment Times

Target: 95%

Stable

4.2 A&E Waiting Times

Target: 95% (4 Hr) 99% (8 Hr)

Deteriorating

4.3 Ambulance Handover

Target: 100%

Movement: Deteriorating

Source: Welsh Ambulance Services Trust

Source: ABMU PAS Data

Source: ABMU PAS Data

Performance:

Performance:

Movement:

Performance:

Movement:

The funding mechanisms for Plastic Surgery and Cardiac Surgery (through WHSSC) are preventing swift resolution of performance in these specialties, but for all other non performing specialties it is critical that performance levels are delivered as they are preventing the Health Board from achieving its bottom line target delivery. Directorates and localities have been given clear delivery objectives which will now be performance managed through the remainder of 2011/12. Plans are now in place to improve Cardiac Surgery and Plastic Surgery long waiting performance. Orthopaedic Surgery long waits are improving and whilst 5 weeks behind profile have showed material positive improvement over recent months.

In December changes to the measure of the 4 & 8 Hr Emergency Department performance were introduced. These changes , which have been based on English guidance, will result in fewer reported breach patients. The primary changes are that where a clinical decision that the safest place for a patient is the Emergency Department or where patients are awaiting transfer out of the department to their home or another hospital, these patients should no longer be considered as breaches. December performance is 91.48% (4 hour) and 96.98% (8 hour). Performance for the same period last year was 81.45% and 93.12% respectively. Please note in line with guidance from WG, A&E 4 & 8 hour performance at Major Units will now be taken from the Emergency Department Dataset and not Sitreps. Performance is now calculated as follows: Major Units - Emergency Dataset (full calendar month) Minor Units - Sitreps (based on sitreps reporting weeks).

Performance against the ambulance 15 minute handover target in A&E is 67.60% in December. The 30 minute handover for December is 87.80% . The 30 minute target is not a formal target but is included for information.

90%

91%

92%

93%

94%

95%

96%

26 wks percentage

26 weeks target

79%

81%

83%

85%

87%

89%

91%

93%

95%

97%

ABM 4 Hour Performance

ABM

Target

90%

91%

92%

93%

94%

95%

96%

97%

98%

99%

100%

ABM 8 Hour Performance

ABM

Target

40%

50%

60%

70%

80%

90%

100%

ABM 15 Min Hand

ABM 30 Min Hand

15 Min TARGET


4.4 Cancer Waiting Times

Target: 95% (62) 98% (31) 62 day 31 day

Stable/Deteriorating

4.5 Dental Activity

Target: 95%

Improving

4.6 DTOC

Target:

Mixed

Source: CANISC System

Performance:

Movement:

See table

Movement:

Source: Delayed Transfer of Care Website

Source: NHS Business Services Authority

Performance:

Movement:

Performance:

Due to the timing of the publication of this report, the December figures must be considered as draft. It is important to note that there has been considered action in December to treat as many breach patients as possible to enable future months performance to be higher. A further update will be provided once validation is complete. The current December position against the 62 day target shows there are 12 breaches (out of 79 patients), whilst 4 patients (out of 102) have exceeded the 31 day target.

The Health Board exceeded the target of 95% for 2010/11, but cumulative performance to date in 2011/12 is marginally behind last year's levels. It is anticipated that the target level will be achieved in 2011/12.

These charts show the numbers of non-mental health and mental health patient delays across the Health Board. Whilst improvement is indicated in the numbers of patients delayed in non-mental health, the trend for mental health delays remains upward despite operational changes being made to reduce the numbers of patients delayed. Further work is underway to recover this position from its current high level.

70%

75%

80%

85%

90%

95%

100%

% Urgent suspected cancer wait no more than 62 days from referral to treatment

62 Day Target

88%

90%

92%

94%

96%

98%

100%

% Non urgent diagnosed cancer wait no more than 31 days from diagnosis to treatment

31 Day Target

0

5

10

15

20

25

30

35

40

45

Mental Health - No Patients Delayed (ABMU)

20

40

60

80

100

120 Non-Mental Health - No Patients Delayed (ABMU)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2010/11

2011/12

Target


4.7 Sexual Health

100%

Stable

4.8 CRHT

95%

Movement: Stable


Source: Monthly Sexual Health Target Monitoring Form

Movement:


Source: Mental Health

The Health Board is sustainably delivering 100% against the 100% target for 48 hour access to Sexual Health services and has consistently delivered performance at the 99% level or above since April 2010.

This target is sustainably achieved with performance at 100% since July.

82%

84%

86%

88%

90%

92%

94%

96%

98%

100%

ABM

Target

92%

93%

94%

95%

96%

97%

98%

99%

100%

Service users admitted to a psychiatric hospital between 0900 and 2100 will have received a gate-keeping assessment by the CRHT service prior to admission Target


5.Efficiency

5.1 Prescribing* Quarter 4 Position (Mar 2011)

Target Locality Perf

SWA 2585

BGD 2864

NPT 2483

SWA 72.27

BGD 63.02

NPT 75.63

SWA 1976

BGD 1928

NPT 2492

SWA 56.82

BGD 41.56

NPT 55.65

SWA 78.65

BGD 77.55

NPT 78.62

SWA 160.86

BGD 169.6

NPT 179.79

SWA 77.84

BGD 75.10

NPT 79.65

SWA 4.28

BGD 4.49

NPT 3.61

SWA 53.43

BGD 39.93

NPT 47.52

SWA 5.86

BGD 9.41

NPT 5.09

Target: See Table

Stable

5.2 Average Length of Stay

Average Length of Stay

* Nov 11 (12 Month Rolling) Position

3.3 3.5 6 6.3

2.2 2.5 3.2 3.6

3.4 4.0 10 13.5

0.9 1.2

3.2 3.4 2.3 1.9

2.4 3.0 0.9 2.9

9.9 10.6

11/12 Target: See Table

Mixed

5.3 Elective As Day cases - BADS 50

11/12 Target: New - 80%

Movement: Improving

Source: Health Solution Wales Web Indicators

Statins

Hypnotics & Anxiolytics - DDD per 1000

patients

Chiral Drugs - Items per 1000 Pus

>=76.97

<=3.77

>=33

<=5.15

Performance:

Drug

>=49.91

>=76.84

Antibiotics - Anti bacterial items per 1000 PUs

Antibiotics - Top 9 Antibacterials

NSAID - Ibuprofen & Naproxen

ACE Inhibitors

Antibiotics - Quinolone items per 1000 PUs

Antibiotics - Trimethoprim 200mg 3 Day

NSAIDs DDD Per 1000 PUs <=2201

Performance:

Source: ABM PAS System Data

>=75.14

<=1901

<=136.36

Movement:

ENT

Combined Medicine

Elective Target Elective Perf

Plastic Surgery

Performance:

Source: Provider Spell Dataset - Health Solutions Wales (derived from ABM PAS data)

Movement:

Urology

Trauma & Orthopaedics

General Surgery

Emer. Target Emer. Perf

Gynaecology

An updated set of national prescribing indicators were agreed for 2010/11 and have been widened to include antibiotics as well as a range of quality and cost indicators. These indicators are closely monitored and targeted via in-house practice support by medicines management teams and practices themselves and are linked with the local prescribing indicators and incentive schemes. Commentary is not provided on each individual drug, but traffic light scoring is provided to show an illustrative picture of overall delivery.

This measure attributes the average length of the provider spell length of stay to the admitting hospital. Health Board rolling performance remains outside of target achievement against most specialties with only Plastic Surgery meeting the emergency target.

The Health Board is achieving the required level of BADS performance overall in month and is 1% off the required level on a rolling 12 month basis.

60%

65%

70%

75%

80%

85%

90%

MORRISTON HOSPITAL

NEATH PORT TALBOT HOSPITAL

PRINCESS OF WALES HOSPITAL

SINGLETON HOSPITAL

TARGET


5.4 Did Not Attend*In-month performance

10/11 Target: New - 5.0%, Fol - 5.7%

Movement: Deteriorating

5.5 New to Follow Up Ratios

Dec-11 Rolling 12

Month PositionTarget

Oct-11 in Month

Position

Nov-11 in Month

Position

Dec-11 in Month

Position

General Surgery 1.1 1.2 1.1 1.2 1.1

Urology 1.5 1.6 1.3 1.5 1.5

Trauma &

Orthopaedics1.8 1.9 1.8 1.7 2.0

ENT 1.4 1 1.4 1.2 1.4

Ophthalmology 3.1 2 3.2 3.0 3.1

Oral Surgery 1.3 1.3 1.1 1.7 1.7

Neurosurgery 1.5

Plastic Surgery 3.7 2.8 5.1 3.8 4.5

General Medicine 3.0 2 3.3 2.9 3.2

Dermatology 1.8 1.1 1.6 1.3 1.6

Other Neurology 1.5 1.2 1.3 1.3 1.4

Rheumatology 2.0 2.1 1.9 1.9 1.9

Paediatrics 2.3 2.1 2.5 2.4 2.2

Gynaecology 0.9 1.1 1.0 0.9 0.9

Target: See Table

Stable

5.6 Late Starts/ Early Finishes

Stable

Performance:



Source: Thesis System (West), Galaxy System (East)

Movement:

Performance:


Movement:

The first column of the table shows the rolling 12 month performance for each ratio (based on 2010/11 targets), which reflects how Welsh Government monitor performance. To give a clearer indication of recent performance, the last 3 months of "in-month" only performance is provided as the rolling 12 month measure is not sensitive to recent improvement. Achievement of New:Follow Up targets in the December "in-month" position is evident in General Surgery, Urology, Rheumatology and Gynaecology but is not consistent across all specialities.

Prior to the seasonal increase in Did Not Attend (DNA) rates during December, performance continues to improve. Performance however remains outside of target levels and work is ongoing within the Health Board's Outpatient Departments to further develop patient focussed booking which engage patients in the appointment agreeing process with the intention of improving DNA rates. This report excludes Mental Health activity.

Performance deteriorated over the latter part of 2010 due to the pressures on beds as a result of the Winter & Flu crisis, which also affected theatre staff causing higher than usual sickness. The Transforming Theatre project continues to address issues with a step change noted from April 2011 to date, although performance has stabilised over the summer months. Work is ongoing to improve performance and a draft Delivery and Support Unit report (commissioned at the request of the Health Board) has recently been received and is currently being considered for delivery of the actions therein.

0%

5%

10%

15%

20%

25%

30%

35%

40%

Late Starts

Late St Target

Early Finishes

Early Fin Target

7%

8%

9%

10%

11%

12%

13%

New

Fol


5.7 Staff Sickness & Absence

5.08%

Movement: Stable


Source: Workforce Development

Directorates and Localities have been reminded of the requirement to proactively manage sickness and work is ongoing with HR department colleagues to deliver improvement to the rate.

4.6%

4.8%

5.0%

5.2%

5.4%

5.6%

5.8%

6.0%

6.2%

6.4%

In-Month

Rolling 12 Month

Target


REPORT PREPARED BY Lesley Bevan - Assistant Director of Nursing Chris Griffiths - Consultant Nurse Learning Disabilities REPORT SPONSORED BY Victoria Franklin, Director of Nursing


Agenda Item 3 (iii)

DEVELOPMENT AND IMPLEMENTATION OF A PATHWAY AND CARE BUNDLES FOR ADULTS WITH A LEARNING DISABILITY REQUIRING SECONDARY CARE

1. PURPOSE

This report is to brief the Health Board on the development of a Pathway and Care Bundles for adults with a learning disability requiring secondary care within ABM.

2. BACKGROUND/INTRODUCTION

The Learning Disabilities Steering Group chaired by the Director of Nursing and Medical Director requested that a Pathway and Care Bundles were developed to support the care of adults with a learning disability who access hospital services. This was seen as an urgent priority following the death of a patient (P. Ridd) with a complex learning disability within our care and subsequent Ombudsman report.

3. ASSESSMENT

A task and finish group was convened comprising colleagues from Learning Disabilities and secondary care chaired by the Assistant Director of Nursing and the Consultant Nurse for Learning Disabilities. Mrs Jayne Nicholls, the sister of the late Mr Paul Ridd attended the last meeting and has been invited to become a member of the group to provide a carer perspective.

The first draft of the Pathway and Care Bundles for Adults with a Learning Disability within ABM University Health Board has been developed. This includes a pathway for scheduled, un-scheduled and out-patient care and is supported by a number of tools to identify and assess the needs of people with a learning disability in acute settings. The next steps are to develop the Care Bundles that will provide a number of measurable outcomes. Integral to the Care Bundles an IM & T solution is being developed to identify people within the Health Board who have a Learning Disability via the Myrddin system. This will provide a database of people who access secondary care to support evaluation of the pathway. The following timescales for completion of the work are proposed:

Activity Timescales Development of Care Bundles January 2012 Consultation February 2012 Phased introduction March 2012 Evaluation, launch and full implementation April 2012

1

4. RECOMMENDATIONS Health Board members are asked to note the content of this paper and agree proposed timescales.

REPORT PREPARED BY: Laurie Higgs, Head of Health & Safety Emma Owen & Elizabeth Davies, Innovation & OD REPORT SPONSORED BY: Debbie Morgan, Director of Workforce & Organisational Development


AGENDA ITEM: 3 (IV)

PROTECTING STAFF FROM VIOLENCE AND AGGRESSION

UPDATE REPORT

1. Purpose

This paper updates the Board on progress made in the management of Violence and Aggression (V&A) and will advise the board of the Welsh Government proposals to mainstream the V&A programme into Health Boards business.

2. Introduction

Regular reports have been provided to the Board over recent years setting out the progress in tackling violence & aggression issues against NHS staff. The drive to protect NHS staff from V&A continues to be a priority for Welsh Government but the National Steering Group is seeking to move the agenda from a championing and project mode to one where it is firmly embed into mainstream executive and Board level business.

3. Update

Set out below is a summary of the key achievements to date, together with proposals to mainstream the work programme, and highlighted issues requiring further consideration.

3.1 Effective use of intelligence and information

The Health Board continues to review and analyse risk assessments and incident data to determine effective strategies to prevent and control violence and aggression. This current analysis indicates a need for improved interventions and support for staff who are affected by non intentional (non gratuitous) violence and aggression.

3.2 Case Management

Identifying Case Managers in the Health Board has proved to be a distinctive and effective response to supporting affected staff. The Health Board is making good progress in terms of developing the Case Manager role particularly in the area of spreading good practice and prevention. For example, staff are encouraged to make early contact with the Case Managers to access support and advice for the management of individual patients or difficult situations. In addition, they have played a pivotal role in building effective networks with the Police and Crown Prosecution Service (CPS).

The Health Board remains committed to taking action against the perpetrators of V&A. Within the Health Board we have interventions in place to ensure appropriate sanctions are being applied internally (e.g. Patient/Visitor Undertakings, exclusions) or through the criminal justice system (prosecutions / ASBOs). The Health Board has recently

successfully prosecuted an individual who caused criminal damage to hospital equipment in Morriston Hospital A&E department in December 2011 for example.

3.3 Training

Training staff to be aware of V&A; to de-escalate potential threats; and to break away from assailants, are all aspects of the current training Passport. It is accepted that the current passport system is often too prescriptive and does not address the emerging issues of non-intentional violence. The Health Board is investing and developing training schemes to provide a greater focus on specific V&A risks faced by particular groups of staff. The Health Board is adopting a proactive and holistic approach in assisting departments to conduct risk assessments and developing bespoke solutions which provide flexibility and sustainability to any risks identified. In addition to these developments there is continuing on-going support and training available to all new and existing employees.

3.4 Harnessing Technology to support staff

The Health Board has introduced and adopted a new system for Lone Workers within the community. In excess of 1,000 staff have been trained and issued with equipment that permits users to make a ‘red alert’ in the event that they feel their personal safety is compromised. A red alert allows the device to open an audible link to the central control centre which monitors and assesses if Police assistance should be deployed. In ABMU there have been two incidents where the LWAS red alert facility has been activated (both incidents involved the employees being subjected to verbal abuse – Police intervention was not required).

3.5 Communication

As part of the Health and Wellbeing strategy the Health Board has developed an intranet site and it is intended that we use a section of this site to inform, educate and promote the protection of staff against V&A.

3.6 Working with Others

The Memorandum of Understanding that records the working arrangements between the NHS, the Police and the Crown Prosecution Service is currently being reviewed to ensure that there are adequate arrangements in place for information sharing and case progression.

At a local level the Health Board has close relationships with the police, Safer City and Town initiatives and other Bodies to share information and develop common interventions and strategies.

3.7 Strong Leadership and Governance

The Health Board has established a V&A Sub-Group which will now report to the Health and Safety Committee. The sub group is chaired by Debbie Morgan, Director of Workforce and OD (V&A Executive Board Champion). The main purpose of the group is to champion the V&A agenda, to make recommendations and contribute to the Health Board’s V&A action plan and to report progress to the Health and Safety Committee. The Sub-group has developed an action plan which will be referred to the January 2012 Health and Safety Committee for ratification. In addition to the action plan a driver

diagram (Appendix 1) has been developed to demonstrate the breadth of the V&A agenda and indicates how the Health Board intends to align it with other initiatives such as 1000 Lives+ and integrate it into mainstream business at Health Board, Directorate and Locality level.

3.8 Primary care

The All Wales Primary Care V&A Sub Group has agreed bi-lingual awareness materials for all primary care contractors. This includes a newsletter, details of the Case Manager service, a model policy and posters. These materials were launched towards the end of last year and have been circulated to practices locally. A pilot of the Lone Worker Alert System in Primary Care will start shortly with six practices in Cardiff. The pilot will run for six months and will be subject to evaluation prior to any further decisions about roll out.

A risk assessment tool for pharmacies is also being developed.

4. Future Actions

A number of priorities have been identified for the forward work programme. These include:

1. To implement and enhance systems for the prevention of non intentional / non

gratuitous violence and aggression (e.g. guidance for the management for confused patients).

2. To further develop the holistic approach to risk assessment to ensure that local control methods for Violence and Aggression initiatives are appropriate and relevant including training needs analysis.

3. Evaluation of the Lone Worker Alert System. 5. Key issues / impact assessment

All initiatives and actions contained within this update report are aligned with the Welsh Government Ministerial Action plan, the Health Board’s Annual Quality Framework, Health & Safety legislation, and the Health Board Violence & Aggression Policy.

The V&A action plan is linked to the Health & Safety Intervention strategy Risk Register. The content of the update report does not alter the current risk classification.

The V&A action plan is linked to Healthcare standards 22 & 23.

6. Recommendation

It is recommended that in future the V&A Sub group provide regular reports to the Health & Safety Committee which (it is proposed) will in turn report to the Quality and Safety Sub-Committee of the Board. The Board is asked to note this update on action being taken to protect staff from V&A.

APPENDIX 1

Aim

Protect

&

respect

To prevent, reduce and

mitigate violence, and

aggression towards ABMU

Health Board employees

and to provide a safe and

secure working

environment

Effective V&A Training

Performance standards &

metrics

'Secured by design'

environment

Provision of the All Wales V&A Training and Information Scheme (Passport)

Bespoke training based on risk assessment and TNA

Share, communicate and learn from local / national best practice

Specific guidance and advice for managing and dealing with verbal aggression / non gratuitous V&A

Training & guidance for carrying out (action orientated) Risk Assessment and how to prevent V&A incidents

V&A publicity - maintaining public, patient & employee engagement in and awareness of the 'Zero Tolerance' message and benefits

associated with preventing V&A incidents in the Health Board

V&A information Intranet site for employees

Code of conduct for Patient relatives and visitors

Publicise prosecutions and use of other sanctions

Executive / Non Officer Member Safety Walkarounds - reinforce commitment to V&A agenda

The 'Zero tolerance'

message - clear & direct

communication

Promoting the health and

wellbeing of employees

Collaborative / effective

tri-partite working

(NHS / Police / CPS)

Improved quality of Patient

care - patient satisfaction

Analyse and respond to the outcomes of the 1000 lives + Safety Culture survey

Clear 'V&A' objectives - translated at a local level into Locality / Directorate V&A action plans

Clear policy framework for the management of V&A (link to other relevant Health & Safety and W&OD Policies)

Effective incident and near misses reporting procedures

Effective investigation of incidents (and follow up risk assessment) - Case Management / Local management

Collection / use of relevant metrics and qualitative data to understand V&A issues / identify V&A hotspot areas

Evaluation of metrics / qualititative data to inform and improve the V&A agenda and V&A action plans (collect - analyse - review cycle)

- at both a Corporate and Directorate / Locality level

Strong governance, reporting & audit structures to monitor performance of the V&A agenda

Ensuring a secure working environment - Identify and remove 'flashpoint' areas

Consideration for all new builds / refurbishment

CCTV / Security Guard Service

Regard for the physical and mental wellbeing of colleagues - promotion of Resilience / stress management / mindfullness

Effective people management (build & sustain trust commitment & engagement) & effective team working

Case management - supporting victims and teams

Promoting reflective practice - debrief post incident and as part of team meetings

Lone Worker Device Scheme (include maintain links with ACR network)

Sickness & absence management & support

PDR - competent employees with the skills to prevent and protect against V&A

Work patterns and good Job design

Strong communication links & collaborative working towards shared objectives with Primary Care & other HBs

Police engagement - 'memorandum of understanding'

Active participation in the 'Safety Community Initiative' / Safer City & Town Partnerships / MAPPA

iiiiiiiiiiiiiii

'Transforming Care' - Transform care at the bedside (TCAB)

Learning from Patient complaints / PoVA referrals & link with the Patient Experience Service

Care plans / medicine management

'Knowing our patients' and meeting their needs - use of the 'Hospital Information Traffic Light' scheme

Sharing intelligence and information about Patients between different Services within ABMU and with WAST

REPORT PREPARED & SPONSORED BY: Jane Wilkinson, Interim Director of Public Health


AGENDA ITEM: 3 (v)

MEASURING INEQUALITIES: TRENDS IN MORTALITY AND LIFE EXPECTANCY

PURPOSE To inform the Health Board of the findings of the “Measuring Inequalities – trends in Mortality and Life Expectancy” recently reported by the Public Health Wales Observatory. INTRODUCTION

Reducing health inequalities is a key theme in Welsh Government and local policies. The Board has previously considered programmes such as Communities First and Swansea Healthy Cities which seek to reduce health inequalities. This suite of publications covering Wales and local areas has been generated with two main aims:

• To measure the inequality gap between the most deprived and the least deprived and identify any changes over time;

• To provide stakeholders with information to help understand and monitor inequalities nationally and locally in support of delivery of local and national strategy.

New information on healthy life expectancy and disability free life expectancy has been provided at a local level for the first time.

The publications are available at:

http://www.wales.nhs.uk/sitesplus/922/news/21225 MAIN BODY OF REPORT Whilst life expectancy continues to rise, health gain has not been the same everywhere. The key messages generated from the profiles are:

• Nationally the inequality in life expectancy has slightly widened as life expectancy has increased more slowly in the most deprived areas compared to the least deprived in Wales.

• There are substantial geographical variations in all types of life expectancy.

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http://www.wales.nhs.uk/sitesplus/922/news/21225

• People in more deprived areas spend a lower proportion of their life in good health.

• Men living in the least deprived areas of Abertawe Bro Morgannwg University Health Board area can expect to live in good health for 21.3 years longer than those in the most deprived parts of the area, and 16.4 years longer for women.

Further details of the inequality gap in years for the three local authority areas of Bridgend, Neath Port Talbot and Swansea are given below. The Inequality Gap in years (2005-09) for the 3 Local Authority areas

Life Expectancy

Healthy Life Expectancy

Disability-Free Life Expectancy

Inequality Gap (years) 2005-09

Male Female Male Female Male Female

Bridgend 7.8 8.0 19.4 20.8 17.2 14.1 Neath Port Talbot

10.4 6.7 20.1 14.3 15.3 10.0

Swansea 12.2 7.4 22.9 14.8 17.7 13.7 CONCLUSION

The recent suite of publications reports various indicators of health at an All Wales, Abertawe Bro Morgannwg University Health Board and Local Authority level and measures the gaps between the least and most deprived areas. These differences in health outcomes are not inevitable and are an issue of social justice. RECOMMENDATION The Board are asked to note the findings of the report and seek to minimise health inequalities through the provision of its own services, and in partnership with key stakeholders.

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PAPER PREPARED BY: Lucy Anderson, Committee Services Manager PAPER SPONSORED BY: Charles Janczewski, NOM / Chair, Audit Committee


AGENDA ITEM: 4 (a)

KEY ISSUES - AUDIT COMMITTEE

1 PURPOSE

To update the Board on issues considered at the Audit Committee at its meeting held on 24th November 2011.

2 INTRODUCTION In order to provide speedier reporting to the Board on key issues considered by the Audit Committee it has been agreed that a summary report on key deliberations of the Committee at its most recent meetings be provided to the Board. The full minutes of the Committee meetings will be considered by the Audit Committee and are available on request from the Board Secretary. 3 KEY ISSUES FROM THE MEETING HELD ON 24th NOVEMBER 2011

(i) THEATRE IMPROVEMENT GROUP BRIEFING The Committee received and noted a report providing an update on the action plan in respect of the Operating Theatres and Day Surgery Audit that was being overseen by the Theatre Improvement Group. A report back would be prepared for 6-9months time.

(ii) INTERNAL AUDIT REPORT – SECURITY FRAMEWORK

The Committee received an Executive Summary of the Security Framework audit and noted the actions taken to date.

(iii) INTERNAL AUDIT REPORT – PATIENTS MONIES & PROPERTY The Committee received an Executive Summary of the Patients Monies and Property audit and noted the actions taken to date.

(iv) BAD DEBT WRITE OFF The Committee received and approved a report setting out a case for write

off of an overpayment of salary. (v) WALES AUDIT OFFICE

The Committee received a report on progress made in terms of the various aspects of External Audit work. It was noted that the Annual Audit Report would be submitted to the next meeting of the Committee and the findings of the Structured Assessment would be presented to Health Board in January 2012.

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(vi) INTERNAL AUDIT SERVICES

The Committee received and noted a report on progress made in terms of the Internal Audit Work Programme for 2011/12. The proposed changes to the audit plan were approved.

(vii) CAPITAL & PFI AUDIT SERVICES The Committee received and noted a progress statement for the Capital and PFI Audit Services 2011/12 audit plan.

(viii) LOCAL COUNTER FRAUD PROGRESS REPORT

The Committee received and noted an update in respect of work undertaken against the 2011/12 Work Plan during the period of September to October 2011.

(ix) FINAL AUDIT REPORTS Executive Summaries in respect of the following internal audits (both of which were rated as having adequate assurance) were received and noted:

− Cardiac ITU Payroll Management − Freedom of Information Act

(x) LOSSES & SPECIAL PAYMENTS FOR APPROVAL The Committee received a report providing an update on the losses and special payments for the period 1st September 2011 to 31st October 2011 which totaled £967,022 . The losses were noted by the Audit Committee which the Health Board would be asked to approve.

(xi) AUDIT REGISTERS & ACTION PLANS

The Committee received and noted a summary extract of the 2011/12 Internal Audit Register as at 14th November 2011 and noted that the Registers for Capital and PFI Audit Services and Wales Audit Office were in the early stages of delivering work against their plans and therefore not included within the report. The Committee received and noted the current position of the Action Plans for each area audited by Internal Audit, Capital and PFI Audit Services and Wales Audit Office.

(xii) KEY FINANCIAL RISKS

The Committee received and noted a report providing an update on the management of the Key Financial Risks facing the Health Board in 2011/12.

(xiii) MISCELLANEOUS

The Committee dealt with routine items including the Hospitality Register and Single Tender Actions and Quotations.

4. RECOMMENDATION The Board is asked to note the content of the report and approve the losses

and special payments detailed above.

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Quality and Safety Committee 1 Health Board

REPORT PREPARED BY: Steve Combe, Board Secretary REPORT SPONSORED BY: Cllr Mel Nott, Chairman, Quality and Safety Committee

HEALTH BOARD

26th January 2012

AGENDA ITEM: 4 (b)

KEY ISSUES - QUALITY AND SAFETY COMMITTEE 1 PURPOSE

To advise the Board of the key issues considered by the Quality and Safety Committee at its meeting held on 1st December 2011 and the Committee’s Annual Work Programme is attached for approval

2 INTRODUCTION In order to provide speedier reporting to the Board on key issues considered by the Quality and Safety Committee it has been agreed that a summary report of the key deliberations of the Committee at its most recent meeting be provided to the Board. The full minutes of the Committee meetings will be considered by the Quality & Safety Committee when it next meets and are available on request from the Board Secretary.

3 KEY ISSUES

1. Governance Arrangements – MSK and Surgical Services Directorates Services

The Committee received a presentation from both Directorates setting out the framework in place to address issues of governance as well as key quality & safety outcomes.

2. Patient Story

The patient story featured the experiences of a patient who had undergone two hip replacement procedures. The first had been using traditional orthopaedic surgical techniques whilst the second replacement had been via under the ‘Enhanced Recovery After Surgery’ (ERAS) project which had enabled more speedy recovery post operatively, significantly reduced pain, earlier discharge from hospital and rapid return to work. The patient had been very pleased with the outcome of their ERAS procedure.

3. 1000 Lives Programme – Quality & Safety Improvement Report

The Committee received an update regarding progress on structured improvement activities and outcomes aimed at reducing avoidable harm as well as eliminating waste and unacceptable variation in service delivery.


4. Infection Prevention & Control Annual – Quarterly Report

The Committee received a report for the period July – September 2011 providing an overview of activities and key infection outcomes for patients.

5. GP Out of Hours Clinical Governance Report

The Committee received a report outlining governance arrangements in place for GP OOH arrangements.

6. Continuing Healthcare

The Committee received an update on continuing healthcare processes.

7. Risk Management Review Group Summary Report

The Committee received a report summarising issues considered by the Review Group in November 2011.

8. Investigations & Redress

The Committee received an overview of investigation, performance and lessons learned.

9. Clinical Audit & Effectiveness Report

The Committee received a report on progress against the Annual Audit Programme

10. Human Tissue Authority

The Committee received a report in relation to Singleton Hospital.

11. Review of Advocacy Arrangements for Older People Resident in Care Homes in Wales.

The Committee received a report regarding the Health Board’s response to a request made by the Older Person’s Commissioner in relation to advocacy arrangements.

12. Individual Patient Funding Requests – Top Up Procedure

The Committee received a report regarding the process in place. Suggestions were made for consideration with a view to current processes being further amended.

13. Healthcare Standards Improvement Plan 2010/11

The Committee received a progress report regarding actions taken to progress the improvement plan.

14. Establishment of Reconstituted Health & Safety Committee

The Committee received a report around the arrangements for consideration of H & S issues.


15. Safeguarding Committee Exception Report

The Committee received an exception report outlining key adult and child safety matters arising during the period. The report included details of completed serious case reviews, incidents outcomes and action plans.

16. Incident Reports

The Committee received reports on serious incidents.

17. Cancelled Operations

The Committee received a report around instances of operations being cancelled due to bed availability, clinical reasons and patient choice. It was agreed that arrangements be made for a presentation on this topic in future detail by the Director of Acute Care.

18. HIW Report

The Committee received a report summarising findings recommendations and actions arising from a homicide case.

19. Infection Prevention & Control Exception Report.

The Committee received a report summarising the position.

20. Data Protection Act

The Committee received a report from the Medical Director on matters relating to the provisions of the Act.

21. Other Matters The Committee received professional reports on key issues given by the Medical Director, Director of Nursing and Director of Therapies & Health Sciences. RECOMMENDATION The Board is asked to note the summary of key issues.

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REPORT PREPARED BY: Wendy Penrhyn-Jones, Head of Corporate Administration REPORT SPONSORED BY: Charles Janczewski, NOM / Chair, Charitable Funds Committee


AGENDA ITEM: 4 (C)

KEY ISSUES FROM MEETINGS OF THE CHARITABLE FUNDS COMMITTEE

1 PURPOSE

To update the Board on issues considered at the Charitable Funds Committee at its meetings held on 8th November 2011 and 12th December 2011.

2 INTRODUCTION In order to provide speedier reporting to the Board on key issues considered by

the Charitable Funds Committee it has been agreed that a summary report on key deliberations of the Committee at its most recent meetings be provided to the Board. The full minutes of the Committee meeting will be considered and are available on request from the Board Secretary.

3 KEY ISSUES FROM THE MEETING HELD ON 8th NOVEMBER 2011 (i) CHARITABLE FUNDS COMMITTEE WORKPLAN The Committee received and noted the Charitable Funds Committee Annual

Work Plan for 2011/12. (ii) PROPOSED CHANGES TO THE CHARITY’S OBJECTS The Committee received a report setting out proposed changes to the ABMU

Charity Objects to incorporate the activities undertaken by the Africa Health Links fund. It was agreed that the proposed wording of the Charity’s objects be further amended to incorporate the additional charitable purpose.

(iii) USE OF CHARITABLE FUNDS TO SUPPORT CHRISTMAS FESTIVITIES The Committee received a report seeking approval to utilise charitable funds to support Christmas festivities. It was agreed that Christmas festivities would be funded from individual ward and departmental charitable funds, with the General Purpose fund being used as a secondary mechanism.

(iv) CHARITABLE FUND BANKING ARRANGEMENTS The Committee received an update on the proposals for future Charitable Fund banking facilities for cash held locally by the ABMU Health Board Charity. The proposal to maintain the existing Lloyds TSB current and high interest accounts and open a 12 month partial withdrawal fixed term account with an investment of £500k was approved.

(v) PROPOSED TRAINING PROGRAMME FOR CHARITABLE FUND MANAGERS The Committee received an update on proposals for a training programme for Charitable Fund Managers. There had been some slight changes to the agreed timetable and training sessions for Fund Managers would be completed in

2

January 2012. The content of the proposed training programme and the revised timetable were agreed.

(vi) CHARITABLE FUNDS FINANCE REPORT TO 30th SEPTEMBER 2011 The Committee received and noted a report setting out income and

expenditure, the performance of the investment portfolio, interest earned on cash held, the overall fund balances and legacies / bequests for the period ending 30th September 2011.

(vii) DELEGATED FUNDS INCOME AND EXPENDITURE REPORT TO 30th

SEPTEMBER 2011 The Committee received and noted a report setting out the income and expenditure by delegated fund for the period 1st April 2011 to 30th September 2011.

(viii) NEW CHARITABLE FUND REQUEST

The Committee noted the approval of one new request for a Charitable Fund. This fund had been created for CDU East to purchase equipment.

(ix) BEQUEST TO THE RADIOTHERAPY FUND AT SINGLETON HOSPITAL The Committee received and noted a report outlining a bequest to the

Radiotherapy Fund at Singleton Hospital.

4 KEY ISSUES FROM THE MEETING HELD ON 12th DECEMBER 2011 (i) UPDATED WORK PLAN

The Committee received an noted an update on the Charitable Funds Committee Work Plan.

(ii) CHARITABLE FUND ACCOUNTS FOR YEAR ENDED 31ST MARCH 2011 The Committee received the Accounts and approved them for submission to the Board of Trustees subject to any further comments being received from Charitable Fund Committee Members.

(iii) CHARITABLE FUNDS ANNUAL REPORT FOR YEAR ENDED 31ST MARCH 2011 The Committee received and approved the Charitable Funds Annual Report for submission to the Board of Trustees

(iv) AUDITORS REPORT ON THE CHARITABLE FUNDS ACCOUNTS FOR YEAR ENDED 31ST MARCH 2011 The Committee received the Wales Audit Office Auditor’s Report and noted the Auditor General intended to issue an unqualified audit report on the financial statements. There were no issues to report prior to the approval of the accounts.

(v) INVESTMENT ADVISOR’S REPORT The Committee received and noted a report confirming the change of name of its Investment Advisors from Rensburg Sheppards to Investec, a report from Investec for the period ending 30th September 2011. It was agreed that the Investment Strategy would be further considered at the next meeting of the Committee in March 2012. A report was also received from Investec on Ethical Investments in Pacific Rim Countries.

3

(vi) UPDATED MEMORANDUM OF UNDERSTANDING – ARTS IN HEALTH CO-ORDINATOR The Committee received and endorsed the proposed updated Memorandum of Understanding regarding the above joint post.

(vii) RATIONALISATION OF CHARITABLE FUNDS The Committee received an update on progress regarding the rationalisation of existing Charitable Funds.

(viii) PROPOSED AMENDMENTS TO THE ABMU CHARITABLE FUNDS CHARITY OBJECTS The Committee received and approved proposals (for submission to the Board of Trustees) to change the Charitable Objects to incorporate the activities undertaken by the Africa Health Links Fund.

(ix) NEW FUND REQUEST The Committee received and noted the approval of one new Charitable Fund request. This fund had been created to support training, research and patient amenities for patients with Grown Up Congenital Heart Disease (GCHD) in respect of the Regional Services Directorate.

(x) VIRGIN ON-LINE GIVING The Committee received a request for approval to utilize the facility offered by

Virgin Money Giving. The Committee deferred a decision on the item until the next meeting on the basis that further information was required.

(xi) DIRECTORATE/LOCALITY PRESENATIONS – USE OF CHARITABLE

FUNDS The Committee received presentations from the Bridgend Locality and Clinical

Support Services Directorate which set out details of their Charitable Funds including how the monies were being utilized. The Committee encouraged the Fund Managers to utilise the monies and agreed to receive a further update in 12 months time.

5 RECOMMENDATION

The Board is asked to note the foregoing.

REPORT PREPARED BY Kim Clee, Assistant Workforce Manager

REPORT SPONSORED BY Debbie Morgan, Director of Workforce and OD


AGENDA ITEM: 4 (d)

KEY ISSUES - PARTNERSHIP FORUM

1. PURPOSE To advise the Health Board of the key issues considered by the Partnership Forum at its meeting on 24th November 2011.

2. KEY ISSUES Mental Health Services Dr Tegwyn Williams, Clinical Director, Mental Health Services, presented a discussion document on the future of Mental Health Services in ABMU Health Board. He emphasised that any comments received on the document from members of the Partnership Forum would be noted and taken into consideration.

Financial Position The Partnership Forum received an update on the Health Board’s financial position. The Director of Finance emphasised the importance of working together to deliver the financial plan and the role of Directorates and Localities in achieving this. Together For Health The Chief Executive outlined the main provisions of “Together for Health” which sets out the vision for the NHS in Wales over the next 5 years. He emphasised the challenges in relation to the sustainability and accessibility of care, and the need to consider different ways of delivering care to those that require it. The Chief Executive indicated he was working with other Health Boards in Wales to consider different models of care to meet the needs of the population, and with colleagues within ABMU Health Board to develop a response to the proposals set out within the document.

Vale of Neath Consultation – Primary Health Care Hilary Dover, Locality Director, presented a consultation paper on the provision of Primary Health Care facilities in the Vale of Neath. Once the consultation is complete, all comments would be made available to the Community Health Council for their consideration.

1

Industrial action The Director of Workforce & Organisational Development provided an update on the contingency plans to deal with the planned industrial action. Agreement had been reached with Staff Side to provide a level of service normally delivered on bank holidays and certain exemptions. Discussions were continuing in relation to agreement of these exemptions and the provision of safe services on the day of planned strike action. Ad Hoc Movement of Staff / Rostering Policy The Nurse Rostering policy and the protocol on Ad Hoc Movement of Nursing Staff were presented to the Partnership Forum. The policy and protocol had been developed in partnership with the Staff Side and it was agreed that they be implemented. Retirement Policy The Retirement policy was submitted to the Partnership Forum. The policy had been developed in partnership with the Staff Side and subject to full consultation. It was agreed the policy be submitted to the Executive Board for approval.

Scheme of Delegation Guidelines

A paper was presented on the Scheme of Delegation Guidelines and the implementation plan, setting out the importance of safe delegation throughout the organisation. The Scheme and implementation plan was noted. Knowledge and Skills Framework (KSF)/Personal Development Review (PDR) A paper was presented setting out the progress being made in embedding and streamlining the KSF/PDR process within the organisation. Changes had been made in line with the findings of an NHS Wales review. The progress was noted.

3. RECOMMENDATION The Health Board is asked to note the report.

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REPORT PREPARED BY: Steve Combe, Board Secretary REPORT SPONSORED BY: Rhian Evans, Chair, Stakeholder Reference Group


AGENDA ITEM: 4 (e)

KEY ISSUES - STAKEHOLDER REFERENCE GROUP

1 PURPOSE To update the Board on issues considered at the Stakeholder Reference Group at its meeting on 21st November 2011.


the Stakeholder Reference Group it has been agreed that a summary report on key deliberations of the Group at its most recent meetings be provided to the Board. The full minutes of the Group meeting will be considered at its next meeting and are available on request from the Board Secretary.

3 KEY ISSUES FROM THE MEETING HELD ON 21st NOVEMBER 2011 (i) MENTAL HEALTH STRATEGY Alex Howells, Director of Primary, Community and Mental Health Services attended the meeting to participate in a discussion on the proposals set out in Changing Mental Health Services for the Better, : Key issues discussed included:

o Partnership working and strategic planning with the Third Sector and Unitary Authorities to enable effective working of tier 0/1 services.

o The importance of transport and accessibility o The need to consider services for Children and Young people eg -

substance misuse, CAMHs and Eating disorders. o Mechanisms to engage those people who will use the services the

most ( i.e service users with mental health diagnosis) o Mechanisms to engage those people in prisons and their families?

The SRG voiced general support for the proposals.

(ii) DEVELOPMENT OF COMMUNITY NETWORKS

Jane Harrison, Assistant Medical Director (Primary Care) gave a presentation to the Group on the development of Community Networks in ABM. In discussing the presentation the Group raised the following issues:

• The benefits of lifestyle changes, highlighted through the Obesity pilot in Bridgend

2

• The linkages between Community Networks and local agencies, including the Third Sector.

• The need to support elderly people in the community • The development of outcome measures to evaluate the success of the

Networks. • The public health challenges and the option of prioritisation services to

young people. • The challenge of moving resources from Secondary care to support

Community Networks. It was agreed Jane Harrison should be invited back to the next meeting to further discuss how Community Networks would link with actual Communities. (iii) TOGETHER FOR HEALTH

The Group noted the publication of Together for Health and the proposals for taking this forward within ABM. It was agreed that details of this would be circulated and that this matter would be a key element on the agenda for the next meeting.

4 RECOMMENDATION The Board is asked to note the foregoing.

RPG/PPH:\ABM HB JAN 2012\4 (f) Key Issues - MH - LD Committee 8th November 2011Edok.doc 1

REPORT PREPARED BY: Robert Goodwin, Directorate General Manager REPORT SPONSORED BY: Dr E Roberts Chairman, Mental Health Act Monitoring Committee for Mental Health and Learning Disabilities Services


AGENDA ITEM: 4 (f)

MENTAL HEALTH ACT MONITORING COMMITTEE FOR THE MENTAL HEALTH AND LEARNING DISABILITIES SERVICES WITHIN THE HEALTH BOARD

1. PURPOSE

To advise the Board of the key issues considered by the Mental Health Act Monitoring Committee for Mental Health and Learning Disabilities at its meeting held on 8th November 2011. The Committee has been convened in order to ensure that the procedures set out for detaining patients under the Mental Health Act 1983 and its Code of Practice were being competently applied.

2. KEY ISSUES

i) CEFN COED HOSPITAL SERVICE IMPROVEMENT STEERING GROUP The group, led by the Vice-Chairman, continued to meet regularly. A programme of further support was being developed with the Delivery Support Unit and NLIAH relating to the development of the Care Programme Approach to care planning processes within inpatient settings across the Directorate. This follows work already undertaken within the community and would initially focus on Adult Acute Assessment Wards within each of the localities. The Adult Mental Health Services Cefn Coed Hospital Development Programme for Senior staff within the hospital had evaluated very positively. Progress was being made in meeting the Welsh Government’s ‘Free to Lead – Free to Care’ requirements with all Ward Managers scheduled to attend the Health Board’s Empowering Ward Sisters Development Programme.

The Vice-Chair and the Service Manager for the Mental Health Directorate’s Older Peoples Service were reviewing funding options, possibly through endowment sources, for the purchase and ongoing maintenance of specialist chairs.

ii) LOCAL MENTAL HEALTH AND CRIMINAL JUSTICE PLANNING ARRANGEMENTS

Discussions were developing with the South Wales Police and local partners about the development of a Mentally Disordered Offender Group covering the South Wales Police Force area.

iii) TO RECEIVE A REPORT ON THE USE OF THE MENTAL HEALTH ACT 1983: 1ST

JULY – 30TH SEPTEMBER 2011 (INCLUDING CTO TRENDS) 71 patients were detained under the Section 2 Assessment provisions of the Mental Health Act in the reporting period. Section 5.2 (Doctors Holding Powers, 72 hours) was used on 35 occasions, a 20% increase compared with the same period last year. In terms of Section 136, this was used on 39 occasions where a hospital was the place of safety. There was a reduction in the number of movements between places of safety, which was being monitored by the Mental Health Act Department. The group considered the availability of Hospital Managers and were reassured that none of the scheduled Hearings had to be cancelled because of the unavailability of


members. The Hospital Managers Power of Discharge Committee would keep under review the need for further recruitment. Work was progressing on the development of the Mental Health Act workbook which would include a new section on the work of the Independent Mental Health Act Advocacy (IMHAA) Service. The group considered the information supplied on patient discharged from hospital under Supervised Community Treatment across Wales. Within ABMU Health Board, approximately 60 patients were subject to these CTOs at any one time. Across Wales during 2010/11, 233 patients were discharged from hospital under Supervised Community Treatment.

iv) WELSH GOVERNMENT REPORT – ADMISSION OF PATIENTS TO MENTAL

HEALTH FACILITIES IN WALES, 2010-2011 The group considered this information which included comparisons on the use of the Mental Health Act 1983 by each of the Health Boards within Wales. The relatively high number of formal and informal admissions within ABMU Health Board could be explained, in part, by the provision of Medium and Low Secure Services within the Mental Health Directorate. Formal admissions under the Mental Health Act 1983 are reviewed at Mental Health Review Tribunals and processes are reviewed by Healthcare Inspectorate Wales during their frequent visits to Health Boards across Wales. During 2010/11 there were 383 formal and 2,713 informal admissions to hospital beds within the ABMU Health Board area.

v) WELSH GOVERNMENT REPORT – PATIENTS IN MENTAL HEALTH HOSPITALS

AND UNITS IN WALES, AS AT 31ST MARCH 2011 Since 2001, the number of patients resident in hospitals and units for people with a mental illness had fallen by 19% to 1,764. People with a learning disability are now more likely to be cared for in the community rather than being in hospital. The number of patients resident in hospitals and units for people with a learning disability in Wales has declined by 64%, in the period since 2001, to 118. In terms of the Mental Health Act 1983, the percentage of patients detained has risen since 2001 from 20% to 34%, with higher increases being seen for males subject to detention. 52% of female patients and 34% of males were being treated by doctors who specialised in old age psychiatry.

vi)THE DEVELOPMENT OF CAMHS WITHIN ABMU HEALTH BOARD

Dr Hassan had attended the meeting to talk about the provision of CAMHS within the ABMU Health Board community. Principal partners included Social Services, Education and local Paediatric Departments. The inpatient service was based in the new Ty Llidiard facility, with only one of the two wards currently being commissioned. Information regarding detained patients would in future be included within the Mental Health Act activity quarterly reports. Prison in-reach services are provided to the Young Offenders Institution in HMP Parc and support is also provided to the Hillside Social Services Unit in Neath.

Concern was expressed by the group around the issue that whilst CAMHS would be responsible for all patients up to the age of 18 from 1st April 2012, there may remain a requirement to admit some adolescents into adult mental health assessment wards within the Health Board. Whilst the number of adolescents admitted to Ward F within the Mental Health Unit in Neath Port Talbot Hospital had reduced, concern was expressed about the future need to provide this service for CAMHS post 1st April 2012. Concerns was also expressed about the current effectiveness of transition arrangements between CAMHS and Adult Mental Health Services within the Health Board. The group were keen for access issues into CAMHS to be clearly agreed for Primary and Secondary Care partners. The group sought clarification on the governance arrangements which were managed by the Cwm Taf Local Health Board as the host of the CAMHS network.


vii)MENTAL HEALTH (WALES) MEASURE 2010 The group considered the Partnership Implementation Plan which had been developed by the Partnership Group established to co-ordinate the implementation of the Mental Health (Wales) Measure 2010. This multi-agency project group had a broad-range of membership from both the Statutory and Non-Statutory Sector. With regard to the Primary Mental Health Service (Part 1), a Welsh Government consultation event was planned to take place on 16th November 2011 to consider the draft regulations at 10am in the Welsh Government Building ECM2, Neath Port Talbot. A second event starting at 2pm at the same venue would focus on the draft Code of Practice for Care and Treatment Planning (Part 2) and Re-Access to Secondary Mental Health Services (Part 3). Good progress was being made on the development of an expanded Advocacy Service for both formal and informal patients (Part 4). An appointment had been made to the Part 1 Project Manager position which had received Welsh Government funding support. Correspondence was expected shortly from the Welsh Government identifying the resources to be allocated in support of the Primary Mental Healthcare Service.

viii) ‘CHANGING MENTAL HEALTH SERVICES FOR THE BETTER’ DISCUSSION

DOCUMENT The group were updated on the programme of consultation events in the period to the 9th December 2011. A large number of events had taken place with a broad-range of partners. A public engagement event had taken place in each locality and there was a sense that the engagement process had been very positive. There was general support for the proposals with requests for further work to be undertaken on the transport implications of any service change for patients and carers together with further information on the proposed Triage System.

The group looked forward to the development of the proposed service strategy following consideration of comments received on the discussion document.

ix)UNSCHEDULED CARE – MENTAL HEALTH DIRECTORATE ACTION PLAN

The group were updated on the development of a single integrated model for adult acute assessment services across the Health Board. This integrated way of working had been in operation within the Neath Port Talbot service for a number of months and had resulted in a reduced reliance on inpatient beds. The Mental Health Directorate were working through a reconfiguration of inpatient capacity in Neath Port Talbot and Cefn Coed Hospitals with the change being effective from 6th February 2012. Resources released from a small reduction in bed numbers would be used to improve staffing within the Home Treatment Team and remaining wards.

x) HEALTH INSPECTORATE WALES VISITS TO MENTAL HEALTH AND LEARNING

DISABILITIES FACILITIES

Cefn-yr-Afon Rehabilitation Unit – 16th July 2011 The Healthcare Inspectorate Wales report following the above visit had yet to be received at the time of the meeting.

3. RECOMMENDATIONS The Health Board is asked to note:

− The ongoing work of the Cefn Coed Hospital Service Improvement Steering Group. − Progress on the development of a local Mental Health and Criminal Justice Planning

Team for the South Wales Police area. − The Mental Health Act activity in the period 1st July – 30th September 2011.


− The information from Welsh Government on admission of patients into Mental Health

and learning disability units. − Concerns about the development of CAMHS within the Health Board. − Progress on the Mental Health (Wales) Measure 2010. − Progress on the ‘Changing Mental Health Services for the Better’ consultation

process. − Progress on the Mental Health Directorate’s plans to modernise unscheduled care

services.

1

REPORT PREPARED BY: Steve Combe, Board Secretary REPORT SPONSORED BY: Steve Combe, Board Secretary


AGENDA ITEM: 4 (g)

KEY ISSUES – HEALTH PROFESSIONAL FORUM (HPF)

1 PURPOSE

To update the Board on issues considered at the Health Professional Forum at its meeting on 15th December 2011.


the Health Professional Forum it has been agreed that a summary report on key deliberations of the Forum at its most recent meetings be provided to the Board. The full minutes of the Forum meeting will be considered at its next meeting and are available on request from the Board Secretary.

3 KEY ISSUES FROM THE MEETING HELD ON 15 DECEMBER 2011

The Health Professional Forum met on Thursday, 15th December 2011 and discussed the following issues:

(i) MEMBERSHIP

The Forum had not received nominations from hospital Consultants (2 vacancies) and confirmed that it was important for the Forum to elect a Chair and Vice-Chair and to develop a work programme. As a result Dr Alan Stephenson was nominated as Chair and Judith Vincent as Vice Chair.

TOGETHER FOR HEALTH

The Forum had a detailed discussion on Together for Health and the role of the Forum in considering plans at an early stage. It also discussed the potential link of Together for Health with other Welsh Government strategic documents and it was agreed that further research be undertaken regarding this. Due to the key role of Public Health in taking this forward, it was agreed that the Director or Public Health be invited to future meetings of the Forum and that this item be a standing Item on the agenda.

(ii) NATIONAL JOINT PROFESSIONAL ADVISORY COMMITTEE The Forum discussed its links to the National Joint Professional Advisory Committee and operated through the Welsh Government and the indication from the Welsh Government that the Forum had a role in overseeing the implementation of manifesto commitments.

(iii) DEVELOPMENT PROGRAMME / WORK PROGRAMME The Committee discussed the need for a Development Programme for the

Forum in order that it became fully functional as soon as possible and a need to develop a Work Programme for future meetings which would be closely linked to the timescales related to Together for Health.

2

A Time Out for the Forum will be arranged in early 2012.

4 RECOMMENDATION The Board is asked to:

- note the foregoing - confirm the nomination of Dr Alan Stephenson as Chair of the Health

Professional Forum and Judith Vincent as Vice-Chair. These appointments will be subject to Ministerial approval.

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Appendix 4 (h)

MINUTES OF THE JOINT COMMITTEE MEETING

HELD 29 NOVEMBER 2011

AT LARGE BOARDROOM, BLOCK A, MAMHILAD HOUSE, MAMHILAD PARK ESTATE, PONTYPOOL

Present: Professor Mike Harmer Chair Dr Cerilan Rogers Director of Specialised and

Tertiary Services, WHSSC Dr Geoffrey Carroll Medical Director, WHSSC Mr Stuart Davies Director of Finance and

Information, WHSSC Mr David Jenkins Independent Member Professor Simon Smail Associate Member/Chair of

Quality and Patient Safety & Sub Committee

Dr Andrew Goodall CEO Aneurin Bevan LHB Mrs Allison Williams CEO Cwm Taf LHB Mr Simon Dean CEO Velindre NHS Trust Mr Andrew Cottom CEO Powys Teaching LHB Professor John Williams Associate Member/Chair of

Renal Network Board

In Attendance: Mrs Lisa Cooper Corporate Services

Manager, WHSSC Miss Pam Wenger Committee Secretary,

WHSSC Mr Dan Phillips Director of Planning and

Performance, WHSSC

Page 2 of 19

Mr Rob Tovey Director of Performance, Powys Teaching LHB

Mr Mark Dickinson Director of Operations & Services, Public Health Wales

Mr Tim Woodhead Welsh Ambulance Services Trust

Mr Eifion Williams Director of Finance, ABMU LHB

Mr Paul Hollard Director of Planning, C&V ULHB

Mr Ian Langfield Specialist Planner, WHSSC Mrs Sara Thomas Specialist Registrar, Public

Health Wales Present Via Video Conference Link: Ms Karen Miles Director of Finance, Hywel

Dda LHB

ActionPRELIMINARY MATTERS

WHSSC11/ 39

Welcome and Introductions The Chair WELCOMED all to the Joint Committee meeting.

WHSSC11/ 40

Apologies for Absence: Mr Elwyn Price-Morris, CEO Welsh Ambulance Trust, Mr Bob Hudson, CEO, Public Health Wales, Mr Trevor Purt, CEO Hywel Dda LHB, Mrs Jan Williams, CEO Cardiff & Vale ULHB, Mr Paul Roberts CEO, ABMU LHB, Mrs Mary Burrows CEO BCU LHB, Mr John Hill Tout, Independent Member/Chair of Audit Committee and Dr Lyndon Miles Independent Member.

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WHSSC11/ 41

Declarations of Interest There were no Declarations of Interest.

WHSSC11/ 42

Minutes of the meeting held on 27 September 2011 The minutes of the last meeting were agreed as a true and accurate record.

WHSSC11/ 43

Action log Members NOTED the progress on the actions from the last meeting.

WHSSC11/ 44

Matters arising There were no matters arising.

WHSSC11/ 45

Chair’s Report The Chair provided an overview of his report and advised members that he had recently met with the Chair of the Audit Committee and its Independent Members to discuss the way forward to improve the sign off of the annual accounting process and the level of assurance given to the Audit Committee by the Auditors to facilitate that process. The Chair updated the Members that he has been invited to be the Co-Chair of the National Clinical Forum. The Chair advised Members that urgent action had been taken on a number of issues that were agreed at the September 2011 Joint Committee Meeting. The Chair also confirmed that urgent action was taken to approve the Financial Control Procedure which took account of the

Page 4 of 19

changes to the All Wales Specialised Services Individual Patient Funding Request Panel. Members present RESOLVED to:

• NOTE the contents of the report; and • RATIFY the urgent actions taken by

the Chair.

WHSSC11/ 46

To receive a report from the Director of Specialised and Tertiary Services Members RECEIVED an update report from Dr Cerilan Rogers, Director of Specialised and Tertiary Services on progress against key issues since the last meeting of the Joint Committee. In particular Members NOTED the updates in relation to the Cardiac Services Reviewand Safe and Sustainable Review. Dr CerilaRogers confirmed that a letter was issued tMembers from the Chair of the JoinCommittee of PCTs (JCPCT) for the Safe anSustainable review of paediatric congenitacardiac services. Members present RESOLVED to:

• NOTE the contents of the report.

SERVICE PLANNING

WHSSC11/ 47

To receive a report on the development process for the Annual Plan for Specialised Services For 2012/13 Members RECEIVED a report from Mr Daniel Phillips, Director of Planning outlining the development process of the

Director of Planning

Page 5 of 19

Annual Plan for 2012/13. Mr Daniel Phillips stated that the report was developed to provide a transparent and robust process, building on the progress made from last year. Mr Daniel Phillips updated Members on the roles of the development groups to assist in this annual plan process, and in particular drew Members’ attention to the role of the Planning and Prioritisation Advisory Group. Mr Paul Hollard advised that he had recently written to Mr Daniel Phillips for clarification on the differences between service pressures and changes in services and that a forum to discuss these would be helpful. Members discussed in detail the development process, in particular relation to timelines and that the timescale may need to be reviewed. Mr Daniel Phillips highlighted to members that a report will be provided to the July 2012 Joint Committee meeting to update on service developments and/or pressures identified since November 2011, as proposed in the paper. Mr Daniel Phillips advised Members that the Joint Committee Workshop in January 2012 would consider the Annual Plan schemes for review. Professor Mike Harmer reminded Members that the Committee was not quorate and that he would write separately to Members

Page 6 of 19

following the meeting. Members present RESOLVED to :

• SUPPORT the development process for the Annual Plan development plan for Specialised Services for the period 2012/13.

GOVERNANCE

WHSSC11/ 48

To receive a report on the Annual Review of the Governance and Accountability Framework Members RECEIVED a report on the Governance and Accountability Framework for the Welsh Health Specialised Committee following the Annual Review. Miss Pamela Wenger confirmed that the Audit Committee had reviewed the documentation at the meeting of the Audit Committee in October 2011. Members NOTED that the Hosting Agreement would be reviewed when it was clear what the impact would be on WHSSC. Miss Pamela Wenger confirmed that the Welsh Renal Clinical Network would review their governance arrangements and once the review was completed would be presented to the Joint Committee for consideration. Members present RESOLVED to:

• NOTE the contents of this report; and • RATIFY the Governance and

Accountability Framework.

Committee Secretary

Page 7 of 19

WHSSC11/ 49

To receive a report on the Transfer of Policies on the New Template.

Members RECEIVED a report from Mr Daniel Phillips, Director of Planning, outlining the progress in the development of the revised template for planning policies. Mr Daniel Phillips confirmed that further work to complete the transition of the policies and it was anticipated that the Chair will taken urgent action once the process is completed. Mr Daniel Phillips explained to Members that following the review of all specialised services policies, five policies have been withdrawn. Mr David Jenkins asked for clarification of the reasons that the policies were withdrawn and Mr Daniel Phillips confirmed that three were withdrawn as the service was no longer in WHSSC remit and the other policies were covered by separate arrangements such as Service Level Agreements.

Members present RESOLVED to:

• NOTE the progress achieved to date in transferring planning policies onto the new template; and


Page 8 of 19

• RATIFY the withdrawal of the following policies:

o Management of Atrial Fibrillation by percutaneous Radiofrequency Ablation;

o Hepatitis C Treatment Combination Therapy with Pegylated Interferon and Ribavirin;

o Intravenous Immunoglobin for patients with Neurological conditions (withdrawn previously)

o Anaemia Management with ESA in chronic Kidney disease;

o Antibody Incompatible Renal Transplant.

WHSSC11/ 50

To receive a report on The Eating Disorder Policy

Members RECEIVED a report from Mr Daniel Phillips on the Eating Disorder Policy. Mr Daniel Phillips outlined the key issues and advised that there had been a significant revision of the policy for the delivery of Tier 4 Specialised Eating Disorder Services.

Mr Daniel Phillips explained to Members that the clinical decision making process for access to Eating Disorder Services has changed and will now take into account the role of the All Wales Specialist Disorders Network, alongside the clinical gatekeeping process.

Mr Daniel Phillips advised Members that


Page 9 of 19

this will improve coordination between the Welsh Eating Disorders Services and the Tier 4 inpatient services in England.


• NOTE the contents of the policy; and • APPROVE the revised policy for Tier

4 specialised eating disorder services. To receive a report on The Health Technologies Policy

Dr Geoffrey Carroll, Medical Director presented the report and draft policy on New Health Technologies. Dr Carroll explained the purpose of the report and policy was to clarify the process of decisions to support the introduction of new technologies and improve consistency for applications in the absence of NICE/AWMSG guidance Mr Simon Dean suggested that he felt that there appeared to be a lack of ambition in the draft policy and that the way that the policy was written would suggest that nothing new would be approved without going through a process. Dr Geoffrey Carroll advised that in the absence of the Technology Assessment Framework process the draft policy is intended to provide a systematic and strategic approach to New Health Technologies. Dr Cerilan Rogers confirmed that as part of the planning of specialised services policy positions are developed. Mr Eifion Williams asked for clarification on

Page 10 of 19

how this policy will affect the Annual Planning process for this year. Mr Stuart Davies confirmed that in future years this can be built into the planning process but for this year this would not be possible due to the current timing of approving this policy. Dr Cerilan Rogers reminded the Joint Committee this policy was crucial as an increasing number of individual patient funding requests relate to New Health Technologies. Members discussed the Policy in some detail and recognised that this needed to be strengthened in order to avoid any problems further down the line. Members present agreed to RATIFY the policy subject to minor amendments in relation to the wording of the Policy. Members present RESOLVED to :

• NOTE the contents of the report; and • APPROVE the New Health

Technologies Policy subject to minor amendments.

Medical Director

NEURO SCIENCES & COMPLEX CONDITIONS WHSSC11/ 51

To receive a report on the All Wales Posture and Mobility Service Partnership Board Members RECEIVED a report from Mr Daniel Phillips on the All Wales Posture and

Page 11 of 19

Mobility Service Partnership Board Mr Daniel Phillips updated Members on the All Wales Posture and Mobility Partnership Board and the implementation of the Posture and Mobility Service Review. Mr Daniel Phillips advised that good progress was being made in relation to the delivery of the Welsh Government’s waiting times standards by the ongoing improvement programmes. Mr Daniel Phillips advised Members that there have been extensive discussions during Partnership Board meetings regarding payment of honoraria in recognition of the contribution of service users and asked Members for comments in relation to this. Members discussed this in detail and recognised the valuable contribution that Service Users make, however, agreed that it was important that there was equity across NHS Wales and therefore agreed that as currently only out of pocket expenses should be paid. Members discussed in some detail and recognised if there were to be any change in policy this should be from Welsh Government to ensure consistency across NHS Wales. Members present RESOLVED to:

• NOTE the on-going implementation of the Posture and Mobility Service Review and progress achieved to date through the DSU/NLIAH supported service improvement programme;

• NOTE the issues raised in relation to meeting the Welsh Government’s

Page 12 of 19

expectation regarding waiting times, in particular, for children, and how this is being addressed; and

• CONFIRMED that current practice within NHS Wales is to reimburse out of pocket expenses only will apply.

WELSH CLINICAL RENAL NETWORK WHSSC11/ 52

To receive a report on the Dialysis unit in Merthyr Tydfil Members RECEIVED a verbal report from Professor John Williams on the Dialysis Unit at Merthyr Tydfil Professor John Williams advised Members of the issues surrounding the dialysis unit in Prince Charles Hospital, Merthyr Tydfil and advised Members that the there are 60 patients currently receiving treatment at this site, and there are serious issues around restricted space and the age of the building. Professor John Williams outlined the proposal by the Welsh Clinical Renal Network to undertake a competitive tender process to provide a permanent 30 station chronic dialysis unit within a three-mile radius of the Prince Charles Hospital. Mrs Allison Williams confirmed that it was important to retain a local service for patient and co-locating the Unit on Prince Charles Hospital site in the timescale is unlikely. Mrs Allison Williams asked that serious consideration is given to co-locating the Unit within the Merthyr Health Park.

Page 13 of 19

Professor John Williams advised Members that this move is also expected to help maintain the current good relationship with the patients and also the staff employed by Cardiff & Vale ULHB who will continue to support the Welsh Clinical Renal Network. Members confirmed their support for the replacement of the Renal Unit at Merthyr Tydfil. Miss P Wenger confirmed that the tender process could proceed subject to full ratification from the Joint Committee. Members present RESOLVED to:

• NOTE the contents of the report; • AGREE to the extension of the

current service contract up to June 2012 as recommended; and

• AGREE to proceed to competitive tender for a permanent 30 station chronic dialysis unit within a three- mile radius of the Prince Charles Hospital with a Facility, Service, Equip and Supply contract.

Mr Simon Dean, Mrs Alison Williams, Dr Andrew Goodall, Mr Paul Hollard and Mr Andrew Cottom left the Meeting.

WHSSC11/ 53

To receive a report from the Sub Committees Integrated Governance Committee The Chair provided an update on the Integrated Governance Committee and Members RECEIVED the minutes of the meeting held on 27 September 2011.

GOVERNANCE

Page 14 of 19


• NOTE the contents of this report; and

• RECEIVE the unconfirmed minutes of the Integrated Governance Committee held on 27th September 2011.

Audit Committee Ms Pamela Wenger presented the report on behalf of Mr John Hill-Tout. Members RECEIVED the report from the Audit Committee and RECEIVED the minutes of the meeting held on 27 October 2011. Members present RESOLVED to:

• NOTE the contents of the report; and

• RECEIVED the unconfirmed minutes of the meeting held on 27th October 2011.

Quality and Patient Safety Committee Members RECEIVED an overview on key issues from Professor Simon Smail, and RECEIVED the minutes of the meeting held on 6th October 2011. Professor Smail informed Members that at the last meeting, Members received an overview of the development of quality standards for WHSSC. Members present RESOLVED to:


• RECEIVED the unconfirmed minutes of the meeting held on 6th October

Page 15 of 19

2011.

Welsh Renal Clinical Network Members RECEIVED an update report from Professor John Williams and RECEIVED the minutes of the meeting held on 6th July 2011. Members RECEIVED an update on the key activities of the Welsh Clinical Renal Network in particular relation to the Financial performance of month 6 report and Dialysis Transport. Members were asked to NOTE the progress made as outlined in Annex (ii) of the Financial performance and the good progress made with Dialysis Transport Service. Professor John Williams provided an update against the Dialysis Units expansion and Members NOTED the progress. Members present RESOLVED to:

• NOTE the summary position of the WRCN activities;

• NOTE the positive developments including new national ESA contract, Home Therapies expansion and user engagement on the dialysis transport charter;

• NOTE the delays in the dialysis expansion programme due to capital planning funding and strategic / political implications; and

• RECEIVE the confirmed minutes of the meeting held on 6th July 2011; and

Page 16 of 19

• NOTE the position of the dialysis unit expansion programme.

FINANCE AND INFORMATION WHSSC11/ 54

To receive a report on the Financial Position Members RECEIVED the report from Mr Stuart Davies, Director of Finance summarising the performance of WHSSC services for the seven months ending 31st October 2011. Mr Stuart Davies confirmed that there is a deterioration of the financial impact under the agreed risk sharing mechanism. Mr Eifion Williams & Mr Tim Woodhead left the meeting. Mr Stuart Davies explained to Members the key areas of adverse movement on the financial position and highlighted the to new financial commitments. Mr Stuart Davies advised that the completion of the Cardiac Review, in particular the increase in Cardiology Services, and also English Services that provide expensive treatment with low volume of patients, are causing the significant movement, with Great Ormond Street NHS Trust given as an example as one of the key English providers contributing to the adverse variances. Ms Karen Miles requested assistance from Mr Stuart Davies and Mr Daniel Phillips in relation to savings made as a result of

Director of Finance/

Page 17 of 19

the Cardiac Review and the implications to Hwyel Dda HB. Members present RESOLVED to:

• NOTE the contents of the report.


CANCER WHSSC11/ 55

To receive a report on the Implementation of the Children’s Cancer Standards Members RECEIVED a report from Mr Stuart Davies on the National Delivery Plan for the Implementation of Children’s Cancer Standards. Mr Stuart Davies summarised the progress made to date and confirmed that reasonable progress had been made with a further update to be available at the next Joint Committee Meeting in January 2012. Members present RESOLVED to:

• NOTE the National Delivery Plan and progress to date.

Director of

Finance

WOMEN & CHILDREN WHSSC11/ 56

To receive a report on the Neonatal Network Members RECEIVED a report from Dr Mark Drayton summarising the progress and developments made within the Wales Neonatal Network. Dr Mark Drayton presented the paper to

Page 18 of 19

Members and outlined to Members the progress made during the last 12 months following the establishment of the Neonatal Network. Dr Mark Drayton made particular reference to the Neonatal Transport activity and the improvements made for the movement of critically ill babies around Wales. Dr Mark Drayton updated Members on new IT information systems, such as the cot locator, stating that this is working very well to assist in the location of cots across Wales. Dr Mark Drayton updated Members that further training and staffing for Nurses has recently been reviewed and therecommendations made have been approved recently as outlined in the paper. Dr Mark Drayton updated Members that positive progress had been made on the All Wales Neonatal Standards. Dr Mark Drayton advised Members of the very good progress made and the impressive co-operation displayed across the Network in taking forward actions outlined by the Welsh Government inquiry. Members present RESOLVED to:


• RECEIVE the confirmed minutes of

Page 19 of 19

Signed …………………………………………………… (Chair)

Date ……………………………………………………

the meeting 20th July 2011

OTHER MATTERS WHSSC11/ Any other business 57

The Chair advised Members to take particualr note to the Schedule of meetings arranged for 2012.

WHSSC11/ Date of next meeting 58

The date of the next meeting was confirmed as 31st January 2012.

1

REPORT PREPARED BY: Dorothy Edwards, Joint Locality Director, Bridgend REPORT SPONSORED BY: Alex Howells, Director of Primary, Community and Mental Health Services

HEALTH BOARD January 2012

AGENDA ITEM: 4 (i)

KEY ISSUES – BRIDGEND CARE PARTNERSHIP

1 PURPOSE To update the Board on issues considered at the Bridgend Care Partnership on 15th December 2011.


the Bridgend Care Partnership a summary report on key issues arising from its recent meeting are being reported to the Board.

3 KEY ISSUES FROM THE MEETING HELD ON 15th DECEMBER 2011. [i] Terms of Reference

The Bridgend Care Partnership discussed draft terms of reference. A number of amendments were proposed and revised terms of reference will be agreed at the next meeting and reported to the Board thereafter. It was agreed that the Chair would rotate on an annual basis between the Leader of Bridgend County Borough Council and the Chair of ABMU Health Board. During 2012, the Leader will chair the Partnership.

[ii] Overview of Progress The Partnership noted that some progress had been made in taking forward the integration of health and social care within Bridgend. The programme was split into six work streams covering the following areas:

• Establishment of joint community teams working at a community network level

• An integrated community resource team providing services across Bridgend

• Integrating arrangements for securing and providing long term care • A combined public health team bringing together expertise from the

Council, Health Board and Public Health Wales to focus on agreed key issues

• Developing a single point of access for services, working with the ABM wide communications hub

• Ensuring the interface between hospital and community services worked effectively.

2

[iii] Integrating Management Arrangements The Care Partnership agreed to work towards a fully integrated management structure. This would be progressed in two key phases from January 2012.

[iv] Financial Governance

It was agreed to establish a financial governance workstream to map out opportunities for pooling resources, within an agreed governance framework that ensured that the statutory obligations of both bodies continued to be met.

[v] Information Sharing

It was agreed to develop the necessary protocols to enable information to be shared safely and effectively to benefit the citizens of Bridgend, within the overall framework of the Wales Accord for the Sharing of Personal Information [WASPI].

[vi] Specific Service Developments

A number of specific service issues were discussed. These included the recent engagement on ‘Changing Mental Health Services for the Better’, and specific plans in respect of residential care provision within Bridgend.

[vii] Regional Collaboration

Recent discussions that promote regional collaboration between local authorities and ABMU Health Board were noted.

[viii] Working with Leisure Services

A statement of intent in continuing the collaborative approaches between the health service and leisure services was agreed.

4 RECOMMENDATION The Board is asked to note the foregoing.

1

REPORT PREPARED BY: Wendy Penrhyn-Jones, Head of Corporate Administration REPORT SPONSORED BY: Gaynor Richards, Non officer Member


AGENDA ITEM: 4 (j)

KEY ISSUES – WELSH LANGUAGE STEERING GROUP

1 PURPOSE

To provide the Health Board with an overview of key issues considered by the ABM University Health Board’s Welsh Language Steering Group in terms of compliance with the commitments within the Welsh Language Scheme and plans for improvement.

2 INTRODUCTION Each year the Health Board submits a monitoring report to the WLB based on

its assessment of compliance against the commitments within its Welsh Language Scheme. Following receipt of feedback from the WLB steps are taken to address the areas for improvement and such actions are being monitored through the Welsh Language Steering Group which is chaired by Gaynor Richards, Non Officer Member.

3 KEY ISSUES FROM THE MEETING HELD ON 8th SEPTEMBER AND 8TH DECEMBER 2011

• Actions arising from the Welsh Language Monitoring Report

2010/11 The Group received a report on the WLB’s Recommendations for Action which had recently been received. Their conclusions found that the report content provided useful information which highlights a number of opportunities to develop and improve the Health Board's bilingual provision. It acknowledged progress was evident and also that it provided constructive comments in support of the ongoing work. The WLB noted that the report provided an update on the recommendations made for the previous year and that progress had been made. It was agreed that feedback would be submitted by Group Members as to how the actions could best be taken forward. Bearing in mind many of the areas for action mirror the objectives set out within the draft Equality & Diversity Strategic Plan it was agreed that this work could be incorporated and this would be taken forward via the Equality & Diversity Manager and the Welsh Language Officer. The Health Board is aiming to further improve the level of data available for the 2011/12 monitoring report and learn lessons from other Health Boards in terms of the best way of delivering the commitments in the Welsh Language Scheme.

• Welsh Language Task/Indicator Action Plan

The Group received a report on each of the items in the Action Plan setting out the current position in terms of compliance.

2

• Thematic Review of Speech & Language Therapy Services

The Group received a report confirming that the WLB’s findings from the above Thematic Review had been received and shared with Speech & Language Therapy Services who were charged with feeding back how they were taking the recommendations forward.

• Welsh Language Translator An oral report was received from the newly appointed Welsh Language Translator who was mainly engaged in translating the Health Board’s website.

• Welsh Language Resources The Group received a report on the various Welsh Language Resources available to staff via the Intranet website to assist them in providing a bilingual service.

• Appointment of Welsh Language Commissioner (WLC) The Group received a report regarding the appointment of the WLC due to take up post in April 2012 and that eventually Welsh Language Schemes would be replaced by Welsh Language Standards and a Tribunal system.

RECOMMENDATION

The Board is asked to note the foregoing.

REPORT PREPARED BY: Rosemary Fletcher, Head of Primary Care & Planning (Swansea) Catherine Roberts, Head of Primary Care & Planning (Bridgend) Samantha Moss, Interim Head of Primary Care (Neath Port Talbot) REPORT SPONSORED BY: Alexandra Howells, Director of Primary, Community and Mental Health Services


Agenda No: 4 (ii)

PRIMARY CARE CHANGES TO INDEPENDENT CONTRACTOR LISTS

Purpose To advise the Board of the changes to the principal and supplementary lists for independent contractors for October and November 2011. Changes to Independent Contractor Services Lists The changes to the principal and supplementary lists for independent contractors are attached at Appendix 1. The process used to include new performers in the LHB Lists is managed on behalf of every LHB in Wales by the Contractor Services Division of the NHS Wales Shared Services Partnership. Changes to the list as reported have been undertaken in accordance with regulations and the processes employed for the management of the Medical, Dental, Ophthalmic and Supplementary Ophthalmic Lists. Recommendation The Board is asked to note the changes to the independent contractor service lists for October and November 2011.

ABERTAWE BRO MORGANNWG HEALTH BOARD

AMENDMENTS TO THE MEDICAL AND DENTAL PERFORMERS, PHARMACEUTICAL AND OPHTHALMIC LISTS

October / November 2011 MEDICAL Bridgend Non Principal to Salaried 3.10.11 Dr Sophie Louisa Morag Nelson Oak Tree Salaried to Contractor Partner 1.11.11 Dr Matthew Peach Riversdale Retainer to Salaried 1.11.11 Dr Sarah Pellard Riversdale Non Principal (Swansea) to Retainer 2.11.11 Dr Elizabeth Jane Evans Contractor to Non Partner 31.10.11 Dr Robert J Hadley Riversdale Non Principal to Cwm Taf Health Board 29.11.11Dr Alistair Buchanan Non Principal Resignation to AB Health Board 17.11.11 Dr Anna Louise Gaskell Non Principal Resignation 7.1.11 Dr Pavan Gutta Swansea Non Principal to Contractor Partner 1.10.11 Dr Iestyn Glynog Davies Clydach Primary Care Centre New Registrar 3.8.11 Dr Christian Michael Jury Ty’r Felin 3.8.11 Dr Emma Louise Wrighton Fforestfach Medical Practice Registrar to Non Principal 4.10.11 Dr Sharifah Lailatul Aida Syed Abdullah Non Principal Removal 5.10.11 Dr Hasidah Abdul Hamid

Contractor Partner to Non Principal 1.10.11 Dr Naveed Akram Strawberry Place Non Principal Resignation 22.11.11 Dr Feroz Gaibie Non Principal to Salaried 1.11.11 Dr Laura Newington St Thomas Surgery New Contractor Partner from Cardiff 10.11.11 Dr Pramila Ramkumar Tawe Neath Port Talbot Non Principal Resignation to Cwm Taf 20.2.11 Dr James Michael Bolt 30.10.2011 Dr Aled Huw Davies Contractor Partner Resignation 31.10.11 Dr John I Hickey Afan Valley Group Practice Non Principal to Contractor Partner 1.10.11 Dr Mohammad Asghar Javid Cwmafan Health Centre Salaried Resignation to AB HA 13.11.11 Dr Aparna Shridhar Amin (Salaried in Cymer) Non Principal Resignation 22.11.11 Dr Richard C S Garland Non Principal to Contractor Partner (Hywel Dda) Dr Naheed Khan Tumble Dental Neath Port Talbot Inclusions 13.10.2011 Helen Griffiths Denticare, 66 Forfe Rd 3.8.10 Nishitha Cugati Cwmdulais Dental Centre Lucy Green, Port Talbot Resource Centre Tristan Ardley Port Talbot Resource Centre Kathryn Hudson Dental Teaching Unit, Port Talbot Istirza Khuram Dental Teaching Unit

Bridgend Resignation 14.11.11 Rania Obeid Swansea Inclusions 3.8.11 Rebecca Williams Chapel St Dental Practice Justin Underwood Waterfront Dental Practice Vishal Sachania 91 Walter Rd Ella Franklin Pentrepoeth Dental Surgery Claire Colquitt 36 High St Clydach Lisa Hinton Kee Dental Surgery Laura Davies Eastgate Dental Syed Alam St Teilo Dental Centre Rogerio Monteiro Denticare, 12 Goetre Fawr Rd 17.11.11 William Herdman Waunarlwydd Dental Practice OPHTHALMIC Swansea Inclusion 17.10.11 Samera Anna Dean Locum 24.10.11 Anand Patel Vision Express Swansea Lyndsay Judith Hewitt Specsavers Kingsway 7.11.11 Rebecca Lloyd Specsavers Morriston Bridgend Inclusion 9.11.11 Shireen Al-Mokhtar Specsavers Bridgend Resignation 24.11.11 Lesley Wakefield Specsavers Bridgend Neath Port Talbot No Amendments PHARMACEUTICAL Bridgend No Amendments Neath Port Talbot No Amendments Swansea No Amendments

Affixing of the Common Seal 1

Health Board 3rd November 2011

REPORT PREPARED & SPONSORED BY: Steve Combe, Board Secretary

HEALTH BOARD

26th January 2012

AGENDA ITEM: 4 (iii)

AFFIXING OF THE COMMON SEAL 1. PURPOSE

To report on documents to which the Common Seal has been affixed since the last meeting of the Health Board.

2. INTRODUCTION

In line with Standing Orders a routine report on documents to which the Common Seal has been affixed is required.

3. REGISTER OF SEALINGS

Attached at Appendix 1 are details taken from the Seal Register. All documents have been signed by the Chairman, or Vice Chairman, and an Executive Director/Board Secretary, in line with the requirements of Standing Orders.

4. RECOMMENDATION The Board is asked to note the foregoing.

Affixing of the Common Seal 2

Health Board 3rd November 2011

Appendix 1

REGISTER OF SEALINGS

Register No

Date Signed

Name of Document

823 24.10.11 Refurbishment of CDU, Morriston Hospital

824 24.10.11 Neonatal Refurbishment, Singleton Hospital

825 24.10.11 Multi-Faith Centre, Morriston Hospital

826 24.10.11 Main Theatres Refurbishment, Morriston Hospital

827 24.10.11 Theatre 5 Refurbishment, Morriston Hospital

828 24.10.11 Coelbren GP Branch Surgery

829 24.10.11 Transfer & Drainage Easement, Pencoed Primary Care Centre

830 14.10.11 Grazing Agreement, Cefn Coed Hospital

831 30.11.11 Singleton Hospital Ward 4, Refurbishment

832 30.11.11 Medical Genetics, Singleton Hospital

833 30.11.11 Medical Genetics, Singleton Hospital

834 30.11.11 Multi-Faith Centre

835 30.11.11 Proposed New Adult Mental Health Facility, Garngoch Hospital

836 19.12.11 CMHT move to Maesteg Hospital

837 19.12.11 Proposed Decant of Neonatal Service, Singleton Hospital

838 22.12.11 Diversion of a Sewer at Coelbren Surgery

839 22.12.11 Grant of Easement relating to Sewers at Coelbren Surgery

____________________________________________________________________________________________________________ Ministerial Letters 1

Health Board

REPORT PREPARED BY: Wendy Penrhyn-Jones, Head of Corporate Administration REPORT SPONSORED BY: Steve Combe, Board Secretary


AGENDA ITEM: 4 (IV)

MINISTERIAL LETTERS ISSUED

Number Title Date of Letter

005/11 Health Board Revenue Allocation 2012/13 19.12.11

Recommendation The Board is asked to note the report.

1

REPORT PREPARED & SPONSORED BY: Paul Stauber, Director of Planning


AGENDA ITEM: 4(v)

CHAIRMAN’S ACTIONS Purpose This paper is to inform the Board of those occasions since the last meeting when Chairman’s Action was sought and approved for urgent matters in accordance with Clause 2.1.1 of Section B of Standing Orders and to seek ratification of such approvals. – Extension to A & E Department at Morriston Hospital

In July 2011 approval was given up to the value of £500,000 to proceed with the enabling phase of the project whilst a Business Justification Case was developed and submitted to the Welsh Assembly Government for funding support. The approved enabling phase and further works to extend and refurbish the A & E Department were subsequently awarded to Interserve Project Services who were selected from the local construction framework. As it was then necessary to extend the approval level from £500,000 - £1m in order to erect pre-ordered steel for the new canopy and progress planned extensions to the front and rear of the Emergency Department and Chairman’s Action was sought to ensure that the momentum of upgrading works was not lost and that possible disruption to essential services was avoided. – Sale of Land at Cefn Coed Hospital

A land disposal strategy has been formalised to sell off parcels of land that become available at Cefn Coed Hospital as a consequence of delivering Reshaping Mental Health Services. Following a tender exercise a recommendation was made that a contract for the disposal and sale of an initial land parcel was progressed and a request was made under Chairman’s Action so that this could be promptly progressed. – Development of an IVF Centre at Neath Port Talbot Hospital

This scheme is to provide a new IVF suite of rooms including laboratories and treatment rooms plus supporting ancillary accommodation. The contractor’s assessment was that this scheme valued at £739,162 (excluding VAT) and deeming this value for money, approval was sought via Chairman’s Action to undertake this work. In accordance with the Health Board’s Standing Orders – Reservation and Delegation of LHB Functions 2.1.1, the Chairman and two Non-Officer Members were asked to consider the requests and subsequently undertook Chairman’s Action which the Board is now asked to ratify. Recommendation The Board is requested to ratify Chairman’s Action as detailed in the above report.

REPORT SPONSORED BY - NHS Wales Board Papers Jan... · REPORT SPONSORED BY: Win Griffiths, Chairman ... St David’s Hall, ... Director of Nursing Met with Paul Roberts, ...

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