25 January 2017 STRATEGIC CHANGE UPDATE REPORT Director of Planning and Performance

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1 Agenda item: 3.3 Subject : Approved and Presented by: Prepared by: Other Committees and meetings considered at: Considered by Executive Committee on: Date of Meeting: 25 January 2017 STRATEGIC CHANGE UPDATE REPORT Director of Planning and Performance Director of Planning and Performance Finance, Planning and Performance Committee on 12 January Items contained within this report were discussed by the Executive Team in the Strategic Planning sessions. PURPOSE: This paper provides an update to the Board on Strategic Changes. Approval/ Decision Discussion Information Page 1 of 11

2 THE PAPER IS ALIGNED TO THE DELIVERY OF THE FOLLOWING STRATEGIC OBJECTIVE(S) AND HEALTH AND CARE STANDARD(S): Strategic Objectives: Health and Care Standards: This report supports strategic objectives 3, 4, 8, 9, Governance and accountability framework 6. Participating in Quality Improvement Activities 7. Safe and Clinically Effective Care SUMMARY: 1. Strategic Change The following key decisions have been taken since the last update to the Board: (a) Aneurin Bevan University Health Board Specialist Critical Care Centre (SCCC) Welsh Government approved capital funding for the Specialist and Critical Care Centre (Llanfrechfa) in November Work is ongoing to confirm construction timescales and associated service change and commissioning of the new facility. At present completion is projected in (b) Future Fit Programme Shropshire, Telford and Wrekin A Preferred Option was agreed by the Future Fit Programme Board but was not approved by Shropshire, Telford and Wrekin Clinical Commissioning Groups and the decision to begin formal consultation has been deferred. A Programme Board meeting has been scheduled for mid January to agree next steps and to confirm proposals and timetable for formal consultation. (c) Mid Wales Healthcare Collaborative (MWHC) The MWHC has confirmed it will continue in its current format for a further 12 months from March The members have agreed a set of priorities for this period and they will be co-reflected in the constituent Health Board s organisational IMTPs. (d) North Powys Adult Mental Health Fan Gorau engagement. Fan Gorau Unit in Newtown has been temporarily closed to inpatient admissions since 13 June 2016 due to the inability to safely staff the Page 2 of 11

3 unit to meet the needs of the patients on a 24/7 basis. The temporary closure was supported by Powys CHC. Public engagement will be conducted during February and March 2017 to consider the future of Fan Gorau and the broader adult dementia service in North Powys, the outcome of the engagement will be considered in April The following section provides an update of the current position of a number of the key strategic change schemes around our borders. Managing Care across the Five Health Economies PTHB is in a unique position in Wales in managing care over the five main health systems that span its borders. Each of these systems link into their own wider health economies. In addition to managing care pathways which span multiple health economies, PTHB has a lead role in assuring that the interests of Powys residents are considered in any planning processes and programmes of change and transformation in these external NHS services. The scale and complexity of effectively engaging and influencing the complex and multiple strategic change agendas. The below map highlights current Strategic Change schemes Mid-Wales Collaborative Welshpool Machynlleth Newtown Llanidloes = Community Hospital = Health & Social Care Centre Knighton MWWHSC ARCH Builth Wells Brecon Llandrindod Wells Bronllys SW ACA Ystradgynlais South Wales Programme ACA s Velindre Page 3 of 11

4 During the past twelve months a significant planning change is the establishment of the Service Transformation Programme (STP) process within NHS England Health economies. Below are highlights of some of the key change programmes that are likely to impact on PTHB during the next months: Future Fit Programme Telford and Wrekin and Shropshire The Future Fit programme has developed over the past three years culminating in an option appraisal and a preferred option for the arrangement of hospital services between the Shrewsbury and Telford hospitals sites run by Shrewsbury and Telford NHS Trust (SaTH). The programme board of NHS Future Fit met on 30 November to formally decide on a recommendation to health commissioners on the future shape of hospital services serving the people of Shropshire, Telford & Wrekin and Mid Wales. The programme board is made up of clinicians and leaders from across health and social care and patient representatives and PTHB is an active member. Based on clinical and non-clinical evidence collected over the past three years, the programme board made a recommendation to health leaders that a public consultation is undertaken to gather public views on the future of hospital services on the following preferred option: Princess Royal Hospital (Telford) Urgent Care (24/7) The majority of day case surgery Planned orthopaedic surgery Outpatients Diagnostics Midwifery led unit Royal Shrewsbury Hospital Emergency and critical care Urgent care (24/7) Complex surgery Outpatients and diagnostics Women and childrens centre. A joint meeting between Telford and Wrekin CCG and Shropshire CCG took place on 12 December 2016, with PTHB representation in attendance, and the CCGs did not agree that public consultation should begin. The lack of an agreed way forward is a risk to current service sustainability and a meeting Page 4 of 11

5 of the Future Fit Programme Board will take place on 18 January to agree next steps. Clinical Futures (SCCC) Aneurin Bevan University Health Board Welsh Government approved the capital funding to construct the Specialist and Critical Care Centre (SCCC) in Aneurin Bevan University Health Board (ABUHB) in November This is a key step forward in delivering the Clinical Futures programme within ABUHB. ABUHB is a key service provider for the South East Powys population and PTHB are represented on the Programme Board for the scheme. Key requirements of the approval of the SCCC are that ABHB - develop a detailed Clinical Strategy describing how the SCCC will work with existing hospital, primary care and community networks within and beyond the Health Board area; - how the SCCC will work regionally; - a detailed implementation/transition plan for these arrangements. Therefore, PTHB welcomes the announcement but also notes the need to develop detailed engagement with the population of South and South East Powys in collaboration with ABUHB with regard to the development of the service model for the SCCC and its relationship to other ABUHB hospitals, in particular Neville Hall in Abergavenny. In addition agreement has been reached to establish a tri-health Board discussion with Cwm Taf University Health Board on a population/catchment area basis. Herefordshire and Worcestershire Sustainability Transformation Plan Wye Valley NHS Trust is a key service provider for residents of South and South East Powys. In late 2016 PTHB were informed that the Trust would form part of a Foundation Group with South Warwickshire NHS Trust as part of its recovery from special measures. The potential longer term strategic direction for this provider requires careful consideration. There are potential changes to this (now growing) health economy through the Sustainability and Transformation Planning (STP) process which could result in changes to the current pattern of service provision. The STP footprint covers Herefordshire and Worcestershire and the implications of the new Foundation Group with South Warwickshire NHS Trust will need to be considered by the Health Board. Page 5 of 11

6 Major Trauma South Wales Collaborative The development of a Major Trauma Centre (MTC) and supporting network of acute and rehabilitation services will provide services for residents of South Powys. The scope of the MTC proposals includes Hywel Dda University Health Board in its entirety and therefore includes services at Bronglais General Hospital also. The process of progressing the Major Trauma business case is ongoing. Consideration of the capital and revenue implications of whether the MTC is established in either Swansea or Cardiff is being developed by the Collaborative as a Strategic Outline Case. It is anticipated this will be presented to Health Boards in 2017 for decision. Provider Health Boards will be considering where and how many Major Trauma Units will be located to support the Major Trauma Centre. Whilst PTHB will develop a view on the location of the MTC via the agreed South Wales Collaborative engagement process a key issue for our population is the location of supporting Major Trauma Units and rehabilitation locations and models. The Health Board have been working with Hywel Dda University Health Board and the Collaborative to consider and develop models for rural major trauma and rehabilitation and will be further refining these in 2017/18. Engagement of the Major Trauma Centre development has taken place previously as part of the South Wales Programme. Further engagement is scheduled with residents of effected areas in early/mid 2017 to improve awareness of the need and benefit to develop a Major Trauma service for South Wales and South Powys. Mid Wales Healthcare Collaborative (MWHC) The MWHC has confirmed it will continue in its current format for a further 12 months from March The members have agreed a set of priorities for this period and they will be co-reflected in the constituent Health Board s organisational IMTPs. Key priority areas of work include: Joint workforce model for Mid Wales Unscheduled Care Clinical Strategy for Bronglais General Hospital Telehealth Strategy and Funding Palliative Care and End of Life Community Focused Dental service Access and Transport Roll out of Virtual Ward concept Mental Health local crisis/recovery beds in Aberystwyth Page 6 of 11

7 Green Prescribing and Community Resilience Other Strategic Change Programmes There are a number of other programmes in providers where Powys residents receive services. Key decisions in relation to current and future service provision will require consideration, engagement and possible consultation with Powys residents. PTHB are working closely with ARCH, Velindre NHS Trust and WAST. 2. North Powys Adult Mental Health Fan Gorau engagement Fan Gorau transferred from the management responsibility of Betsi Cadwalader University Health Board to Powys Teaching Health Board in December 2015, as part of the Mental Health repatriation programme. Upon transfer there were staffing deficits and despite recruitment efforts these challenges continue, within nursing and the wider multidisciplinary team. Fan Gorau unit has been temporarily closed to inpatient admissions since 13 June 2016 due to the inability to safely staff the unit to meet the needs of the patients on a 24/7 basis. This has been supported by Powys CHC under urgent service change conditions. The aim was to reopen the unit with a revised workforce model following a period of recruitment. New workforce models were agreed but despite a number of attempts it has not been possible to recruit any suitable registered staff to run the unit. A number of alternative service strategies have been employed during the period of closure e.g. Dementia at Home Treatment Team and alternative inpatient facilities. This proposal outlines the proposed public engagement to be conducted in February and March 2017 to consider the future of Fan Gorau and the broader adult dementia service in North Powys. The engagement will consider the effectiveness and experience of these services from a PTHB, patient and carer perspective. The outcome of the engagement will be considered in April 2017 and depending on the nature of engagement a decision will be reached by Powys CHC on whether a further period of formal Consultation is required. Recruitment The full nursing establishment is 7.53 Registered (RMHN) Nurses. There are currently 2 RMHN Band 5 vacancies within the team (26.6% of the workforce). The level of deficit made it impossible to cover all operational shifts with one RMHN on duty. Page 7 of 11

8 Prior to temporary closure, the unit had drawn extensively on agency RMHN staff to cover shifts (especially nights, in the absence of bank staff). Using Agency staff as the only registrant is deemed unsafe. Recruitment activity has taken place as follows for the following band 5 RMHN posts (seeking to fill 2 FTE RMHN vacancies) on eleven occasions throughout 2015/16 and 2016/17 without success. This was despite an extensive recruitment campaign, social media campaign and adverts in all local newspapers. Alternative service(s) The following services have been developed as a result of the Fan Gorau temporary closure to replicate and improve the service offered to patients who would have previously been inpatients in the unit. 1. Dementia Home Treatment service (DHTT) Following the temporary closure of Fan Gorau, the staffing team have been deployed into the community to deliver a Dementia Home Treatment Service that provides intensive support to patients in their own homes, nursing /residential homes and community hospitals. The service operates between 07:30 20:30 seven days a week in order to reduce the need for admissions and support people in their own homes. Where patients have required treatment (or detention under the Mental Health Act), new admissions have been accommodated within Powys based wards or at Redwoods (through the LTA). Two Crisis beds were also commissioned at Crosfield House Nursing Home, Rhayader for people who require an alternative to admission. As usage of these crisis beds was not as high as anticipated at the time of the temporary closure of Fan Gorau and this has now been reduced to one bed. On discharge from the DHTT, all Patients (and their Carers) receive a Patient Satisfaction questionnaire. On the whole, patient and carer feedback is very positive of the care patients have received and a digital story of one patients experience has been recorded. In the period June to December 2016, the DHTT has assessed 70 individuals and supported 53 patients. Of these patients, only 5 individuals have required a hospital admission during the period of their assessment and treatment by the DHTT. Page 8 of 11

9 2. Inpatient beds a. Nursing Home beds Two beds were initially commissioned at Crosfield House nursing home in Rhayader. This was reduced to 1 bed once actual demand for bed usage was determined. The DTHH worked with patients in these commissioned beds both during their stay and upon discharge. Crosfield House was initially selected to provide this crisis care, as at the time of commissioning there was a very limited number of providers who had both capacity and a suitably skilled workforce to safely provide crisis care for patients. The commissioning arrangements for this provision are kept under review. b. Alternative hospital provision Where patients have required treatment (or detention under the Mental Health Act), new admissions have been accommodated as close to home as possible, based on individual needs (within Llandrindod, Brecon or Ystradgynlais or at Redwoods in Shrewsbury). Engagement plan 1. Timetable Engagement will commence on 6th February 2017 and conclude on 24 th March Thus meeting the requirements for engagement and consultation as outlined by the Welsh Government and Community Health Council Consultation and Engagement requirements. The outcome of engagement will then be considered and shared with the Powys CHC Services Planning Committee. The committee will be asked to consider whether further engagement is required and/or formal consultation. A formal decision would need to be reached at the Community Health Council Full Council in May If formal Consultation is required this would follow and run for a period of 12 weeks. This approach has been agreed (verbally) with the Acting Chief Officer of Powys CHC and will need to be clarified at the next Services Planning Meeting due to be held Tuesday 17 th January Page 9 of 11

10 2. Approach and meetings The majority of the engagement will be conducted through existing meeting arrangements as follows: 1. Patient forums (x3) 2. Newtown Patient Group 3. PAVO supported mental health groups 4. North Powys GP cluster 5. Mental Health Partnership Board It is anticipated that two additional focussed sessions will be set up also with a wide invite list to support engagement with those who are unable to attend any previous commitments. There would be one in North East and one in North West Powys. Presentations will be offered to: 1. Regional Partnership Board 2. Montgomeryshire (Elected Members) Committee 3. Staff side partnership forum 4. Joint Partnership Board 3. Materials The following materials to be developed to support engagement: 1. Presentation of key issues 2. Dementia Home Treatment service video 3. Webpage 4. Questionnaire paper and electronic RECOMMENDATION(S): The Board is asked to NOTE the report. NEXT STEPS: Regular updates from the Director of Planning and Performance will be provided at Finance, Planning and Performance Committee meetings. Page 10 of 11

11 Impact Assessments Equality Act 2010: Quality and Safety: Welsh Language (Wales) Measure 2011: Financial Implications: Legal Implications: Well-being of Future Generations (Wales)Act 2015: Impact of proposed model(s) will be impact assessed as part of the process. Q&S standards will be assessed as part of process. Will be assessed as part of process. Will be assessed as part of process. Will be assessed as part of process. Will be assessed as part of process. Page 11 of 11