Hywel Dda University Health Board. Annual Report and Accounts 2016/2017

Transcription

1 Hywel Dda University Health Board Annual Report and Accounts 2016/2017 1

2 What Will This Annual Report Tell You? Our Annual Report is part of a suite of documents that tell you about our organisation, the care we provide and what we do to plan, deliver and improve healthcare for you, in order to meet changing demands and future challenges. It provides information about our performance, what we have achieved in 2016/17 and how we will improve next year. It also explains how important it is to work with you and listen to you to deliver better services that meet your needs and are provided as close to you as possible. Our priorities are shaped by our Integrated Medium Term Plan which sets out our objectives and plans until You can read this and find out more about us at Our Annual Report for 2016/17 includes: Our Performance Report which details how we have performed against our targets and actions planned to maintain or improve our performance. Our Accountability Report which details our key accountability requirements under the Companies Act 2006 and The Large and Medium-sized Companies and Groups (Accounts and Reports) Regulations 2008; including our Annual Governance Statement (AGS) which provides information about how we manage and control our resources and risks, and comply with governance arrangements. Our summarised Financial Statements which detail how we have spent our money and met our obligations under The National Health Service Finance (Wales) Act Our Annual Quality Statement Published at the same time as the Annual Report, our Annual Quality Statement (AQS) provides details on actions we have taken to improve the quality of our services and is available here: Our Public Health Annual Report Our Public Health Annual Report 2016/17 provides further detail on the actions we have taken to improve the health and wellbeing of our local communities and is available here: If you require any of these publications in printed or alternative formats and/or languages please contact us using the details below. How to Contact Us Hywel Dda University Health Board, Ystwyth Building, Hafan Derwen, St David s Park, Jobswell Road, Carmarthen, SA31 3BB. Telephone: Website: /@BIHywelDda Facebook: Hywel Dda University Local Health Board. Hywel Dda University Health Board is the operational name of Hywel Dda University Local Health Board. 2

3 Contents Chapter 1: Welcome from the Chair and Chief Executive...4 About Us...6 Key Achievements and Developments...8 Improving Patient Care and Services...13 Improving Health and Wellbeing...20 Involving Local People, Partners and Communities...22 Valuing Our Staff...27 Investing in Our Estates and Services...29 Chapter 2: Performance Report...39 Performance Outcomes...41 Performance Analysis...46 Sustainability Report...75 Chapter 3: Accountability Report...81 Chapter 4: Our Annual Accounts

4 Chapter 1: Welcome from our Chair and Chief Executive This year has been the continuation of a journey of improvement for Hywel Dda University Health Board. Our destination is to become a population health organisation focused on keeping people well, developing more services in local communities and ensuring we run high quality, safe and efficient hospitals. Our road map is our ten strategic objectives set out last year in our Integrated Medium Term Plan. These remain at the core of what we do and drive all our improvement work at a time when the NHS across the UK faces significant challenges with staffing levels, growing and ageing populations and tight budgets. In 2016/17, we saw our organisation continue the process of turnaround. We have seen consistent and sustained improvement in many areas including diagnostics, cancer care and stroke services which are now some of the best in Wales. In the challenging area of unscheduled care, our four hour hospital waiting times can compare with the best in Wales and all our hospitals have been at lower levels of escalation, despite a 5% rise in emergency department attendance. We ended 2016/17 having improved or sustained performance in 44 of 68 indicators. We also recognise that in 24 of our indicators, our performance did not improve and this is the next stage of our journey. This annual report showcases many of our new developments, innovations and awardwinning successes, including many firsts in Wales. In 2016/17, we invested 17.8m in improving our hospital and community services. We strengthened clinical leadership across all our services, began work on co-producing our organisation s first clinical strategy and initiated a transformation programme. These will form the central elements in our first three year Integrated Medium Term Plan which we hope will be approved by Welsh Government in 2018/19. Of course, we still have our challenges. This year we wanted to decrease our overspend. We enjoyed some success in stabilising our workforce, attracting new nurses, doctors and medical staff from across the UK and overseas, and working with our universities to employ newly-qualified staff. This helped to halt the rise in locum, agency and overtime costs but it was not sufficient to turn our deficit around. So this remains a key priority in the coming year as we seek to achieve financial balance without increasing our deficit and whilst still maintaining our performance improvements, delivering 32m of savings and making investment choices based on quality, safety, productivity, prudency and service innovation. No journey can be successfully completed without people who know the way. The drivers and the navigators on our road to improvement are, of course, our workforce. Our staff always do their very best to provide the highest standard of care and to support them this year we launched our new organisational values, introduced more staff benefits and invested further in medical education and training. Our NHS staff survey results show that more staff than ever before are happy with the standard of care we provide and would recommend Hywel Dda as a place to work. We also achieved both gold and platinum accreditation in the Corporate Health Standard, the national quality mark for health and wellbeing in the workplace. The quality of our staff is evidenced in this annual report by the numerous national awards and recognition for innovative new services, teams and individual employees. For this dedication, in difficult times, we thank each and every member of our workforce. 4

5 This year, thanks to the hard work of our staff, we have provided more primary and community services closer to home. We saw another increase in GP appointments, more services available at GPs through multi-practitioner teams and more treatments in local pharmacies, with our pharmacy Triage and Treat service another first in Wales shortlisted for a national award. We also saw further increases in teleheath services with patients in some of our most rural areas benefiting from on-their-doorstep access to expert consultants in specialist hospitals hundreds of miles away. We also approved the development of a walk-in service in Tenby Hospital following a successful pilot. We have set out a model to transform our adult mental health services in discussion with staff, service users and partners which we will consult on later this year, secured 2m for improvements to adult mental health inpatient units, improved assessment facilities at Prince Philip Hospital and recruited more staff to improve access to therapies and clinics. Our public health team also greatly expanded in-hospital and community stop smoking services, including the first telehealth quitting service in Wales, as well as focusing on new exercise and obesity services. We also could not continue on our road to improvement without our partners and the people and communities we serve. This year, we started our Sgwrs Iach Let s Talk Health Big Conversation events and held over 100 community engagement events across Hywel Dda. We now have more than 1,000 members in Siarad Iechyd/Talking Health. We recruited 138 new health volunteers and increased the number of bronze and silver Investors in Carers awards with our GP surgeries, pharmacies and health settings. We will continue these important conversations with our patients, staff, partners and stakeholders as we seek to formulate our Transforming Clinical Services strategy in the year ahead. All of these developments are important steps on our journey towards securing a sustainable future for local services that meets our ambition to make a real difference for the health of our population. We want you to come on that journey with us and, when we arrive, we will know that we have achieved this together. Mrs Bernardine Rees OBE Chair Hywel Dda University Health Board Mr Steve Moore Chief Executive Hywel Dda University Health Board 5

6 About Us Hywel Dda University Health Board (UHB) is the planner and provider of NHS healthcare services for people in Carmarthenshire, Ceredigion, Pembrokeshire and its bordering counties. Our 9,871 members of staff provide primary, community, in-hospital, mental health and learning disabilities services for around 384,000 people across a quarter of the landmass of Wales. We do this in partnership with our three local authorities and public, private and third sector colleagues, including our volunteers, through: Four main hospitals: Bronglais in Aberystwyth, Glangwili in Carmarthen, Prince Philip in Llanelli and Withybush in Haverfordwest. Seven community hospitals: Amman Valley and Llandovery in Carmarthenshire; Tregaron, Aberaeron and Cardigan in Ceredigion; and Tenby and South Pembrokeshire Hospital Health and Social Care Resource Centre in Pembrokeshire. 53 general practices, 46 dental practices (including 1 orthodontic), 99 community pharmacies, 51 general ophthalmic practices (43 providing Eye Health Examination Wales and 34 low vision services) and 11 health centres. Numerous locations providing mental health and learning disabilities services. Highly specialised and tertiary services commissioned for us by the Welsh Health Specialised Services Committee, a joint committee representing seven health boards across Wales. Our vision is to deliver a world class healthcare system of the highest quality with improved outcomes. Our mission the difference we intend to make for people is: We will prevent ill health and intervene in the early years. This is crucial to our long term mission to provide the best healthcare to our population. We will be proactive in our support for local people, particularly those living with health issues and the carers who support them. If you think you have a health problem, rapid diagnosis will be in place so that you can get the treatment you need, if you need it, or move on with your daily life. We will be an efficient organisation that does not expect you to travel unduly or wait unreasonably; is consistent, safe and high quality; and with a culture of transparency and learning when things go wrong. To do this, we have set ourselves 10 strategic objectives, as follows: 6

7 How Will We Do This? The NHS Wales Planning Framework 2017/20 sets out the Welsh Government s expectation for the delivery of an Integrated Medium Term Plan (IMTP) for 2017/18 to 2019/20 which describes our strategic vision, objectives and plans for the next three years. Last year, we set 10 strategic objectives listed above. These remain the same this year because the needs assessments upon which they are based have not changed. Strategic objectives 1 to 8 are what local people need now and over the next ten years. Strategic objectives 9 and 10 focus on our financial position, national performance targets and the quality and safety of our services. Our financial strategy sets out the steps needed to balance our finances so that we end the year with the same deficit as last year whilst maintaining the improvements we have already made and making further improvements in performance, quality and safety. We also require 32m of savings. However, our strategy is not about service cuts. It is about making the very most of our resources to meet the needs of our population. This will mean doing a smaller number of large projects well, stabilising our workforce to reduce variable pay, developing our clinical leadership and the organisation s first clinical strategy, implementing our turnaround and transformation programmes and making better use of our existing partnerships and collaborations. 7

8 Given the need to develop our clinical services strategy, it has been agreed with Welsh Government that, for 2017/18, we will develop an annual plan setting out our actions to improve quality, delivery, workforce and finance. This will also show progress made last year in our key performance areas and how we will move forward to develop a full Integrated Medium Term Plan in 2018/19. Key Achievements and Developments New Haematology and Oncology Day Unit at Withybush Hospital In 2016/17, a new Pembrokeshire Haematology and Oncology Day Unit opened at Withybush Hospital with the support of local charitable fundraisers, staff and partners. The new unit is a modern, purpose-built facility tailored for patients at different stages of cancer. It has a larger patient treatment area, an isolation facility, a counselling/quiet room, a drug preparation room, a multi-disciplinary room with video-conferencing to reduce travel, increased consulting rooms, a reception and additional waiting areas. It has been designed by staff, patients, healthcare professionals, hospital managers, stakeholders and key fundraisers, including Adam s Bucketful of Hope, Withybush Hospital Cancer Day Unit Appeal and Pembrokeshire Cancer Support. Over 670,000 was raised by fundraisers, with 926,000 funded by discretionary capital. Fundraising continues for the Ward 10 project which is also progressing well. New Puffin PACU Opens at Withybush Hospital This year, a new Paediatric Ambulatory Care Unit (PACU) opened in Withybush Hospital, sited closer to the hospital's Emergency and Urgent Care Centre. The new unit is called Puffin PACU, a name chosen by local school children, service users, visitors and the public. The unit is located nearer to services frequently used by children, including radiology and community children's services, to enable closer working between paediatric specialists, emergency teams and support services and to facilitate ongoing developments in children s care, such as shared training and new roles. Over 1.2m for Glangwili Hospital Business Case Development In 2016/17, 1.209m in funding was approved to develop a full business case for the second phase of improvements to maternity and neonatal services at Glangwili Hospital. This will make Glangwili more accessible to patients and improve the Special Care Baby Unit (SCBU), labour ward and maternity theatres. We are working on the business case with patients, staff, stakeholders and the public, and planning a third phase to improve accommodation for antenatal and postnatal, paediatrics and gynaecology services. The Phase 2 business case will be submitted to Welsh Government in the Autumn Health Secretary Opens New Step-Down Ward at Bronglais Hospital This year, we opened a new step-down ward at Bronglais Hospital. The new unit, based in the former Afallon Ward, has improved patient flow and reduced delays in the discharge of medically fit and stable patients who require reablement. It also allows us to review care for patients with complex needs and those in need of further assessment for safe discharge. The 12 bedded Y Banwy Unit is staffed by a multi-disciplinary team focused on discharge planning and optimising patient ability in an area designed to meet their needs. It provides a high nursing, low medical care environment, as close to home as possible, to enable patients to regain their independence. Patients have single side rooms, which free up acute medical and surgical beds, with nursing stations at each end of the unit. Advice, treatment and care is decided in partnership with patients, their families and carers, and tailored to meet individual needs, before discharge or transfer to community services. 8

9 New Physician Associates Welcomed to Bronglais General Hospital In 2016/17, Bronglais Hospital became the first in Wales to provide a training programme for Physician Associates who support doctors in diagnosis and management of patients. In partnership with Birmingham University, Bronglais has taken Physician Associates in psychiatry, general medicine and surgery, paediatrics, maternity, gynaecology and accident and emergency. Working with Powys Teaching Health Board and the Mid Wales Healthcare Collaborative, we also have placements in GP surgeries after qualification. Physician Associates are trained in medical histories, examinations, test results and diagnosing under doctor supervision which will positively contribute to clinical services. Prince Philip Hospital Has New Best Performing Clinical Units This year, two new cutting-edge clinical units at Prince Philip Hospital were opened by the Cabinet Secretary for Health, Wellbeing and Sport, Vaughan Gething, and are already among the best-performing in the UK. The Acute Medical Assessment and Minor Injuries Units are part of the Welsh Government funded 1.4m Front of House project and, since opening, have achieved impressive performance results in waiting times, discharge rates and patient satisfaction. This new unscheduled care services model separates acute medical assessment from minor injury and out-of-hours GP services. The Minor Injuries Unit is run by GPs and emergency nurse practitioners, and patients walk in for a range of minor treatments. There is direct admission for the sickest patients to the Acute Medical Assessment Unit. The two units form a model of clinical care which optimises patient flow at the hospital. Since opening, four hour emergency care delivery has improved, meaning patients do not wait so long. The number of acute medical admissions discharged in less than 24 hours has increased, meaning patients who do not need hospital care are discharged home. The hospital has also recruited staff, reducing reliance on locums. Prince Philip Hospital s Frailty Team Leading the Way In 2016/17, Prince Philip Hospital led the way in caring for frail patients by creating a dedicated team of frailty support workers, believed to be the first of its kind in Wales. The Frailty Support Worker initiative is funded by Welsh Government s Intermediate Care Fund and jointly run by Carmarthenshire Integrated Services Board. It aims to improve care provision between health and social services for frail patients and strengthen the resilience of unscheduled care services. Focusing on hydration, nutrition and rehabilitation, the team provides a patient-centred approach to reduce the time patients stay in hospital. More flexible roles allow staff to feed, mobilise and rehabilitate patients in line with their needs, ensuring individual care, reducing hospital stays and improving the bed situation. Assessments show that this support improved patients functions and staff morale. Cardigan Integrated Care Centre This year, the full business case for a new integrated care centre in Cardigan was submitted to Welsh Government for consideration. The new centre will provide a modern, fit-for-purpose healthcare service for local people closer to home and in the community. A wide range of health and social care services will be delivered by our UHB, GPs, the third sector, local authority and our partners. The benefits include: Improving how health and social care services work together and communicate Increasing the range of clinics provided Increasing the numbers of people attending outpatient clinics Potential for an increase in seven day service provision 9

10 Increased diagnostic services including pre-operative assessments Improved outcomes for patients Progress on 8.1m Cylch Caron Community Resource Centre In 2016/17, we purchased the site for the new 8.1m Cylch Caron Integrated Resource Centre in Tregaron with 727,000 of Welsh Government funding. The Mid Wales Housing Association has been appointed to design and deliver the project. This development brings together health, housing and social services under one roof, closer to home and will replace Tregaron Community Hospital, Bryntirion Residential Home and GP surgery. It will have a GP surgery, community pharmacy, outpatient clinics, community nurses, long-term nursing care and day care. There will be 34 flats for people who need help to remain in their homes and six health and social care places for people who do not need hospital care but need support to return home. Detailed plans and a full business case will be submitted to Welsh Government. Our other partners are Ceredigion Public Service Board and Ceredigion County Council. Award-Winning Staff and Services Corporate Health Standard Platinum and Gold Level This year, we achieved both gold and platinum accreditation for the Corporate Health Standard following a rigorous assessment process. This is the national quality mark for health and wellbeing in the workplace, recognising good practice and workplaces which target key preventable ill health issues. We were the first NHS Wales organisation to gain the platinum accreditation in 2013 and, as part of the revalidation process, also completed a full evaluation against the gold criteria in February This was a two day evaluation where external assessors spoke to various leads and visited both acute and community sites to talk to our staff and gather evidence of good health and wellbeing practice, employee engagement and senior leadership commitment. The assessors highlighted improvements in our organisational values, communication and sense of wellbeing among staff. In March 2017, we were re-assessed against the platinum standard which assesses our community engagement, capital build work, facilities, procurement, transport, employment and skills initiatives. The report highlighted many of our excellent initiatives. Glangwili Specialist Wins Top Award from Wales Deanery In 2016/17, a top doctor at Glangwili Hospital was honoured by the Wales Deanery at the BEST awards for clinical service innovation hosted by the British Medical Association. Dr Madhuri Kodliwadmath, Associate Specialist in Obstetrics and Gynaecology, was rewarded for her excellence in clinical service. The annual BEST/BSAS awards are part of the BMA/BMJ Clinical Teacher of the Year Awards run by Cardiff and Swansea Medical Schools and the Wales Deanery. They form part of the Supervising the Route to Excellence programme which ensures excellence in medical training by supporting high quality educational clinical supervisors and trainers across Wales. The four winners also received a medical education bursary worth 3,000. Bronglais Best in Wales in Emergency Laparotomy Audit for Second Year This year, for the second time, Bronglais was named as the top hospital in Wales for quality care provided for patients undergoing emergency laparotomy. 10

11 The National Emergency Laparotomy Audit report also shows that, for the second time, Bronglais is the only hospital in Wales to be highly rated for specialist post-operative assessments in patients over the age of 70 years. Across Wales and England, this was seen in fewer than 10% of older patients. Bronglais met this standard for at least 80% of patients. The audit improves quality by providing comparative data from all providers. Bronglais Has Welsh Radiographer of the Year In 2016/17, a Bronglais Hospital sonographer won the Wales Radiographer of the Year award from the Society of Radiographers at a Houses of Parliament ceremony. Marie Hatfield was nominated by her colleagues for continually inspiring them with her enthusiasm and diligence and successfully juggling excellent service delivery with the health and wellbeing of her staff. This national award acknowledges the unique contribution her service has made in diagnosing and treating patients and providing technical expertise coupled with compassion. Pembrokeshire s Midwives Shortlisted for National Midwifery Award This year, the midwife-led unit team at Withybush Hospital gained recognition in the EuroKing Better Births Award at the Royal College of Midwives Midwifery Awards. The team, who have delivered midwife-led care at the hospital since 2014, were one of four teams shortlisted for the award out of 200 applicants. This was for their work to ensure their service met one or more of the Royal College s Better Births Initiative aims which focus on three themes of high quality maternity care, namely: Facilitating normal births for the majority and normality for all women Increasing access to midwifery-led continuity of carer Raising awareness to reduce maternal and newborn health inequalities Hywel Dda Becomes First JAG Accredited Health Board in the Country In 2016/17, Prince Philip Hospital s Endoscopy Unit s accreditation from the Joint Advisory Group (JAG) on GI Endoscopy made Hywel Dda the first fully JAG accredited health board in Wales. JAG accreditation means that the endoscopy service has met strict criteria known as the Global Rating Scale (GRS) Standards. To meet these high standards, Prince Philip Hospital s Endoscopy Unit had to provide evidence that they deliver high-quality, safe and appropriate endoscopy services. This achievement means all four hospitals within Hywel Dda Bronglais, Glangwili, Prince Philip and Withybush are now JAG accredited. Innovative Pharmacy Triage and Treat Service Shortlisted for National Award This year, our community pharmacy Triage and Treat service, the first of its kind in the UK, was shortlisted in the primary care innovation category at the prestigious Health Service Journal Awards. Developed to reduce A&E attendance for low level injuries, 16 community pharmacies now provide this service across Hywel Dda, advising on minor health conditions and injuries. This service has benefits for residents, visitors and the NHS by providing quick and local care, saving money and resources. Partners include the community pharmacy teams, GPs, Hywel Dda Community Health Council and the Welsh Ambulance Service NHS Trust. Health Mentor Awards Highlights Local Excellence In 2016/17, local healthcare workers were awarded several accolades at Swansea University s Mentorship Awards. This mentoring programme develops professions and promotes nursing and midwifery excellence. The winners included: 11

12 Prince Philip Hospital s theatre team who won the Exceptionally Innovative Learning Environment Award; Withybush Hospital s Outpatients Department who won the Team Mentorship Award; Sian Phillips from the Midwife Led Unit at Withybush Hospital who won the Outstanding Involvement in Midwifery Mentorship Practice category; Kelly Conlon, from Bryngofal Ward at Prince Philip Hospital, who won an award for Going the Extra Mile as a Mentor ; and Stephanie Samuel, from Ty r Nant in Llanelli, who won an award for her Outstanding Contribution to Support Learning in Practice. Two student nurses from Glangwili Hospital also received recognition from Swansea University. Melissa Rees won Student of the Year Outstanding Achievement Award and Samantha Barratt was runner-up for the award. Team Success at the RCN Nurse of the Year Awards 2016 This year, our nursing team had three winners and two runners-up in the Royal College of Nursing Wales Nurse of Year Awards which reward nurses who demonstrate excellent practice, passion and distinction in care, leadership, service and innovation. Royal College of Nursing (RCN) Award for Pressure Damage Reduction Tissue Viability Clinical Nurse Specialist, Jane James, won the Clinical Nurse Specialist Award. She has led the tissue viability team in its nurse-led service for 10 years. Jane is a founder member and former vice-chair and chair of the All-Wales Tissue Viability group and has played a key role in standardising practice across Wales by helping to develop a national pressure damage investigation tool and working to embed this into practice. She led on the development of a dressing formulary within our UHB and contributed to work to introduce a non-prescription delivery of dressings via shared services. As a result, there has been a reduction in the number of reported pressure ulcers. RCN Award for Stroke Success Senior Sister at Bronglais Hospital s Ystwyth Ward, Linzi Shone, won the Registered Nurse (Adult) Award for fostering a positive staff learning environment. Linzi supports stroke research trials on the ward, encouraging staff to attend research meetings. Her excellence is illustrated in the ward s success in a recent international, nurse-led interventional study in which it was recognised as one of the best performing stroke units in the UK. Linzi has led on research and transformational practice, contributing to the advancement of nursing and healthcare in the UK, and developed innovative staff roles to free up nurses to focus on patient care. RCN Award-Winning School Nurse Rucksack School Nurse, Jacqueline Jones, won the Community Nursing Award for her work in the Carmarthenshire School Nursing Team with 12 secondary schools, two special schools, two private schools and 105 primary schools. She developed a simple and unique way to encourage children to talk openly about their health and wellbeing by using familiar items to start conversations. Dubbed The School Nurse Rucksack, it is carried by the school nurse to identify them to pupils. This work is evidence based, has been evaluated at a national level and can be transferred across a range of health and social care settings. RCN Award-Winning Therapeutic Day Service Clinical Lead, Margaret Meleady, was runner-up in the Mental Health and Learning Disabilities Award. She developed the Therapeutic Day Service which provides a range of 12

13 psychological interventions and therapies across numerous sites, including intensive support for people with mental health problems and alternatives to inpatient care. Margaret used service user views to create a service which provides meaningful interventions seven days a week and provides training and consultation to other mental health teams. She has also shared her expertise by presenting extensively on this subject. RCN Award for Clinical Research Senior Clinical Trials Nurse, Sarah Jones, and Research Nurse, Dr Helen Trench, were runners-up in the Research in Nursing category for engaging nurses in research. Their work includes stroke research and involves other hospital disciplines. They have made a significant contribution to the creation of a research culture in a rural environment and achieved collaborative working on an early stroke management study, which has further engaged multidisciplinary teams in research-based activity in every day practice. Improving Patient Care and Services Primary and Community: More Care Closer To Home More GP Appointments Between March and May 2016, Hywel Dda UHB and GPs undertook a rapid improvement programme to improve access to appointments and opening hours. There was an increase in practices opening for all core hours from 22% to 43% and an increase in those opening for 95% of core hours from 48% to 68%. Half day closures also dropped from 6% to 2%. The range of appointment times compares well to other health boards, with more appointments before 8.30am and after 5.30pm and 6pm. Source : GP Access in Wales 2016, WG

14 Source : GP Access in Wales 2016, WG New Community Pharmacy Common Ailments Service This year, a new service to encourage patients to visit their local community pharmacy for free treatment and advice was launched in a first wave of pharmacies in south Pembrokeshire. The Community Pharmacy Common Ailments Service allows patients to seek advice or treatment from a community pharmacist, rather than a GP, for a defined list of ailments. The pharmacist will, after a short consultation, give advice on 26 common ailments and, for most, also supply medication from an agreed formulary at no cost to the patient. If necessary, the pharmacist will refer the patient to their GP. This service will free up GP appointments for patients with more complex conditions. Initially, 60 pharmacies out of 99 in Hywel Dda that met the requirements were invited to participate and, since February 2017, the service has been introduced in fourteen pharmacies in Pembroke, Pembroke Dock, Neyland, Goodwick, Fishguard, St Davids, Newport, Crymych, Trimsaran, Burry Port, Kidwelly and Pontyates. It will be made available at pharmacies across Hywel Dda in a phased roll-out with a planned completion date of July New Palliative Care Medication Service In 2016/17, a new service to help community health staff access medication for palliative care patients was launched across Hywel Dda. Nine community pharmacies have agreed to hold specific drug stocks so that community nursing teams can access them more easily. The Palliative Care Medication Service will operate during normal opening hours and a prescription will still be needed. The new arrangement means that health workers now have better access to medication in urgent and end-of-life situations, reducing the time taken to find a prescribing pharmacy and delays for people who need the drugs. New Health Professionals at the Heart of GP Surgery This year, we improved patient access to care at a rural GP surgery in Carmarthenshire. Advanced practitioner nurses and health professionals, including pharmacists, physiotherapists and paramedics, were centred at Minafon GP Surgery in Kidwelly to support patient access at a time of decreasing GP availability both locally and nationally. The new team, combined with innovations such as telephone triage for patients who do not need to see a GP, are having positive results: 14

15 Three GPs provide care in the surgery and at a satellite surgery at Derwendeg, Trimsaran every day. These GPs meet all local need with capacity each day for unscheduled appointments and no need to turn patients away. Advanced nurses provide on the day appointments for patients as well as long term conditions management. A dedicated advanced musculoskeletal physiotherapist supports the management of painful joints, ligaments, tendons and muscle problems. Practice-based pharmacists assist with house calls and patients with an urgent need without needing to see a GP. A review of anticoagulant prescribing resulted in medication changes that mean less risk of stroke and admission to hospitals for patients. A review of medication and prescribing has resulted in 1,600 less items issued, reducing unnecessary medication being taken by patients. A pilot project to share asthma patient information between GPs and community pharmacy has recruited 20 participants and is receiving good patient feedback. A Community Health Council patient feedback survey is showing positive responses in the main from local patients. Future plans include bringing social care and mental health even closer to the surgery and the rollout of the model to other rural GP surgeries in the area. Tenby Unscheduled Care Walk-In Service Given the Green Light In 2016/17, following a successful 10 day pilot, we approved a year round walk-in nurse-led service at Tenby Hospital to provide a range of minor illness and injury treatments by advanced nurse practitioners. During the pilot, 180 patients were seen. Care was provided to 142 patients, 31 were referred to a GP or practice nurse, two were referred to secondary care, three needed further investigation and two did not wait for treatment. Only a small number of visitors attended and common ailments included infections, inflammation or pain management. The Tenby Walk-In Service Implementation Group will oversee implementation and includes representatives from South East Pembrokeshire Community Health Network and Hywel Dda Community Health Council. We intend to open the service in the summer. South Pembrokeshire Hospital, Health and Social Care Resource Centre This year, a joint review with Pembrokeshire County Council continued into services at South Pembrokeshire Hospital, Health and Social Care Resource Centre to consider if changes are required to ensure services meet patient needs. These include: Day care and rehabilitation and reablement for adults including therapies Inpatient services including 35 health and five social beds Support services including administration, estates, hotel services and transport Accommodation space for staff and provision for visiting services The project group has representation from doctors, therapists, medicines management, health and social care, finance, workforce, staff and unions, estates, third sector, Hywel Dda Community Health Council and Friends of South Pembrokeshire Hospital. Both organisations are also talking to staff, patients, partners and stakeholders. Electronic Diagnostic and Triage Dermatology Service Piloted in North Ceredigion In 2016/17, patients in north Ceredigion took part in a community-based teledermatology pilot which allowed them to be treated by consultants over 100 miles away in Cardiff. 15

16 Working with the Mid Wales Healthcare Collaborative, the six month dermatology trial enabled patients to be seen by experts without having to travel outside their community. Patients attended one of seven GP practices equipped with telehealth cameras across Mid Wales. The images are sent to consultant dermatologists in Cardiff for treatment advice and GPs are informed of diagnosis. Patients needing further consultation are referred to Glangwili Hospital or a GP dermatology clinic in Borth Surgery. This service improves access to quality healthcare, reduces travel and waiting times for specialist opinion, improves prioritisation of urgent suspected cancers and ensures patients are seen sooner and by the most appropriate clinician. The scheme also educates GPs in managing patients with dermatological problems, reducing the number of referrals. It is currently used in Cardiff and Birmingham and, if successful, will be further extended across the mid Wales and Hywel Dda UHB area. Wales s First Recovery Programme for Head and Neck Cancer Patients This year, Wales s first head and neck cancer recovery programme was set up for patients and their families in Hywel Dda. Over three free sessions, the Holistic Acute Recovery Programme (HARP) gives patients recovering from head and neck cancer treatment access to advice, guidance and support on a range of subjects from diet to oral hygiene, relaxation to counselling, plus welfare services. Clinical Nurse Specialists Anwen Butten and Karen Howarth set up HARP after recognising that additional support and self-management after treatment could aid recovery. HARP will be rolled out across Hywel Dda via the use of telemedicine and is also delivered by the Old Mill Foundation, Macmillan and Tenovus. Innovative Occupational Therapy Service Celebrated in National Report In 2016/17, the introduction of an occupational therapist to the Argyle Medical Group team in Pembroke Dock was featured in a national report celebrating the value of innovative occupational therapy services. The report entitled Reducing the Pressure on Hospitals: A Report on the Value of Occupational Therapy in Wales illustrates how shifting occupational therapy to A&E, primary care and the community can play a vital role in reducing hospital admissions in Wales. GP-based occupational therapists provide proactive care for frail and older patients in the community by responding quickly in the first 24 hours, liaising with appropriate services and pointing to support services to help them stay at home safely. Since its introduction, repeat surgery visits, hospital admissions and re-admissions have reduced and use of community and third sector services has increased. The trial has been so successful that two further occupational therapists will now join the practice. Amman Gwendreath Locality Frailty Care Home Service This year, a new service was launched to provide proactive care and support, and improve the provision of quality care for vulnerable patients in Amman Gwendraeth. Between 28 February and 31 October 2016, 133 reviews were undertaken and 78 Do Not Attempt CPRs completed to provide guidance to healthcare professionals on action to take in the event of a sudden death. Every patient had a review with recommendations to stop or reduce medications sent to their GP practice. Questionnaires were issued to patients, families, care homes and GP practices and feedback shows that there is a high family and patient satisfaction rate, improved relationships with care homes and anecdotal evidence of avoided admissions. Positive feedback included 87% strongly agreeing that they had been 16

17 engaged in the future care of their family member and 79% strongly agreeing that their relatives benefited from the review meetings that took place. Transformation of the Chronic Pain Service In 2016/17, we improved services for patients suffering from chronic pain in Hywel Dda. After a 12 month service review by patients, clinicians and therapists, a new model was introduced involving a specialist pain multi-disciplinary team including physiotherapists, nurses, medical consultants and clinical psychologists. Patients are triaged and referred to either a medical or a chronic pain assessment clinic. They receive advice on how to manage pain or are referred to a clinician or therapist for treatment. The service focuses on self-management of pain and new treatments such as 12 week pain management programmes, self-help sessions, psychological support, physiotherapy, consultation and advice about medicines and traditional interventions. Increase in Patient Participation Groups This year, we increased the number of primary care patient participation groups to seven with the level of interest in local practices growing. Activities held include supporting the launch of the Community Pharmacy Common Ailments Programme, an open afternoon, a patient questionnaire and a practice newsletter. A patient participation network continues to support group development and provides opportunities to share best practice. These open group discussions help to develop a better understanding between primary care and the people they support, and are an essential part of improving services. Proactive Care Events In March 2016, we held our first Proactive Care event bringing together healthcare professionals, managers and patients to talk about what proactive care means for certain patients. It was attended by over 100 people. The main themes were communication and signposting so people know what help is available to support proactive care. In November 2016, the second event promoted the services available for people to support themselves and introduced new models of care and workforce. This was attended by nearly 100 people. In May 2017, the next event will focus on working together. Llanelli Locality Cluster Pharmacist This year, Llanelli s cluster pharmacist, Jennifer Richards, carried out medication reviews in Llanelli and Burry Port care homes. To date, four care homes have been visited resulting in 106 medications being stopped as unnecessary, 661 clinical changes and interventions and over 42 GP appointments saved. This ensures patients are on the appropriate medication for their needs, reduces the risk of hospital admission and supports care home staff and service delivery sustainability within general practice. Advanced Care Planning with Paul Sartori Foundation In 2016/17, the north Pembrokeshire locality funded the Paul Sartori Foundation to employ 1.2 WTE registered nurses as advance care planning facilitators. This project aims to reduce hospital admissions from home and care homes, improve patient satisfaction and involvement in decision making and reduce stress, depression and anxiety in bereaved families. Between October 2015 and September 2016, the Paul Sartori Foundation received 101 referrals and over 600 contacts. GPs referred 29% and combined self and family referrals were 45%. Other referrers were CNS, social workers, therapists and hospital doctors. The team participated in awareness raising events at care homes, assisted living housing schemes and community groups. Over 500 health and social care professionals and 300 people attended educational sessions. 17

18 A review of GP records shows that between March 2015 and March 2017, the number of patients with an advanced care planner in place increased by 219%, from 74 to 162, with many more conversations yet to be completed and recorded. This project has also seen the integration of services such as referrals to GPs, district nurse teams, clinical nurse specialists, food banks, third sector projects and provision of patient information including advice on body, tissue and organ donation, will-making and social care, and carer assessment referrals. Oral Health Promotion This year, the community dental service oral health promotion team concentrated on three evidence-based projects: the Designed 2 Smile programme; improving oral health in care homes; and modernising mouth care training for health workers. Designed 2 Smile focused on its tooth brushing and fluoride varnish programmes. Since its introduction, there has been a 12% decrease in dental decay nationally. The care home work focused on mouth care risk assessments and developing care plans for people in care homes. At this pilot stage, the team are supporting a number of care homes and staff to ensure each resident has an oral health risk assessment and individual care plan within seven days of being admitted. The team has also developed links to trainers delivering mouth care training to ward, school and student nurses, healthcare support workers, health visitors and drug and alcohol teams. Praise for Prince Philip Hospital s New Contact Centre Since its launch in October 2015, our new centralised contact centre at Prince Philip Hospital, responsible for arranging and agreeing all outpatient appointments, has dealt with almost a quarter of a million calls. The 15 staff organise outpatient appointments as soon as possible, particularly for people suspected to have life-threatening conditions such as cancer. The single dedicated telephone number allows service users across Hywel Dda to arrange appointments with ease, ensuring all outpatient clinic sessions are fully utilised. Patients can also request a free call back to avoid having to wait in a queue on the phone. By December 2016, the centre had received over 241,382 calls and made over 8,200 calls. 101,956 calls have been answered in less than two minutes and 77,425 in less than 60 seconds. The centre helps us to achieve our referral to treatment time targets. The new telephone system is bilingual and Welsh-speaking patients can be directed to bilingual call handlers to use their language of their choice, as almost 50% are fluent Welsh speakers. Future plans include text and facilities to arrange appointments. Development of Transport Services This year, the central transport unit continued to develop transport and travel improvement schemes for Hywel Dda, as follows: An additional dedicated discharge vehicle for Glangwili Hospital Improved discharge transport procedures for Glangwili and Prince Philip hospitals Implementation of a pool car scheme resulting in 90,000 miles travelled by fuel efficient vehicles, reducing carbon emissions and transport costs The unit is working closely with the emergency ambulance services commissioner to develop new arrangements for non-emergency patient transport to further improve quality. Car park improvements have been developed for Glangwili, Prince Philip and Bronglais hospitals, increasing disabled parking spaces. The schemes include: 18

19 An additional 65 car park spaces at Glangwili Hospital Designated parking at Bronglais Hospital to ensure sufficient provision for patients Improving Bronglais Hospital s staff park and ride service to reduce parking on site Staff charges in visitor car parks at Glangwili Hospital to prioritise patients/visitors Reduction in allocated consultant parking spaces at Glangwili Hospital Macmillan Wales Opens Two New Cancer Support Centres In 2016/17, cancer patients in Ceredigion and Carmarthen benefited from two new Macmillan Cancer Information and Support Centres in Bronglais and Glangwili hospitals. The new services are part of a 3.3m investment over the last five years to support posts and projects, plus 500,000 specifically for information and support services. There are now designated Macmillan centres and coordinators in all four hospitals in Hywel Dda. The centres provide face-to-face, telephone support and information for cancer patients throughout diagnosis, treatment and recovery. This includes leaflets on cancer types, financial, emotional and physical support and advice for patients, families, carers and healthcare workers. They point patients to other services such as welfare benefits, support networks, cancer communities, physical activity groups and counselling services. The centres are funded by Macmillan Cancer Support in partnership with our UHB. Health and Care Standards: Fundamentals of Care This year, we continued work to improve performance against the Fundamentals of Care in the Health and Care Standards. The 2016 audit of care provision across our services concluded that, for most areas under scrutiny, we achieved the target. There is still work to do in some aspects of patient care and next year, we will continue improvement work on pressure sore prevention, eating and drinking, foot care, oral hygiene and continence care. We will also carry out focused work on rest, sleep and health promotion. Patient feedback shows that we mostly get things right. It tells us where we provide excellent standards and, if we do not, where to focus efforts to improve care. Staff feedback shows an increase in staff feeling valued, treated with dignity and respect and having a sense of belonging. Feedback on our organisational values, launched in July 2016, shows an increase in staff who feel that we put patients at the heart of everything we do. Almost 80% of respondents felt that we work together to be the best that we can and strive to deliver excellent services. Next year, we will work to ensure that those caring for you are at the forefront of what we do to improve the quality of care you receive. Transforming Mental Health Services The Transforming Mental Health Programme is led by a multi-stakeholder group comprising health professionals, service users, carers, voluntary sector, local government and Hywel Dda Community Health Council working together over two years to consider how to meet the mental health needs of our population. Our vision is for a modern, community-based service available 24 hours a day with no waiting lists and more care at home and in the community from health, social care and the third sector. In 2016/17, we spoke to staff, service users and partners about how to provide better, more accessible services across Hywel Dda. Following an evaluation of comments, options for future adult mental health services were developed through co-production with service users, carers, staff and other stakeholders. From 19 initial options, a new model has been proposed which incorporates three key components which the UHB wants to consult on: a single point of access, regional assessment, treatment units and 24/7 community mental health centres in each county. This model, which also includes several additional areas 19

20 which are open to influence by staff, patients, carers and other stakeholders, will go to public consultation following approval by our Board. 2m for Improvements to Adult Mental Health Inpatient Units This year, a successful Welsh Government bid secured 2,064,000 in capital funding to improve the environment and safety of our five adult mental health inpatient and intensive care units. This work will significantly upgrade current facilities. Refurbishment of Assessment Suite In 2016/17, improvements to a Llanelli mental health facility were completed in order to enhance the assessment experience. The new suite on Bryngofal Ward at Prince Philip Hospital provides a discreet area to protect dignity and confidentiality during a mental health assessment and will complement similar facilities across the area. Additional Funding for Financial Year This year, additional funding of more than 383,000 was received to recruit additional staff to improve access to psychological therapies on inpatient units and increase clinics to reduce waiting times for memory assessments. Third sector working has been strengthened to support this and a number of joint initiatives are being progressed. First Anniversary for Welsh-Italian Mental Health Twinning In 2016/17, we celebrated the anniversary of the first Mental Health International Twinning Agreement in Wales. Health professionals from mid and west Wales welcomed colleagues from Trieste in Italy on a staff exchange programme. Trieste is recognised by the World Health Organisation as a centre of excellence for mental health services and this twinning provides opportunities for sharing good practice, learning from each other's services and solving challenges together. The exchange will inform our new adult mental healthcare model and provide opportunities for formal training and staff placement. Completion of United4Heath This year, we completed our work as part of the pan-european United4Health research project assessing the large scale implementation of telehealth devices. We were involved in two chronic disease areas, Type 2 Diabetes and Chronic Obstructive Pulmonary Disease. Final results are being analysed so that lessons can be understood. This will: Provide funding to support telehealth deployment as part of care closer to home Enable us to learn about how to embed it into care pathways and service delivery Help to rebalance the care system using clinical expertise in all care settings Support the evaluation of service redesign Help inform key work streams and collaborations such as the Mid Wales Health Care Collaborative Improving Health and Wellbeing Tobacco Control In 2016/17, we expanded the existing in-hospital smoking cessation service within Carmarthenshire hospitals to include Withybush and Bronglais hospitals. The iquit pharmacy level three smoking cessation scheme saw a 50% increase in service provision compared to last year. We also implemented a smoking in pregnancy improvement programme, which will train midwives in offering advice, promote the use of carbon monoxide monitors and introduces an opt-out referral pathway for pregnant women who smoke. 20

21 Hywel Dda Leads the Way in Wales to Keep Hospitals Smoke Free This year, we were the first health board in Wales to launch a public announcement system discouraging smokers outside hospitals. The new Push the Button scheme aims to curb smoking across our four hospital sites. The system enables onlookers to anonymously push a red button which triggers an audio message reminding smokers that this is a smoke free site and asking them to extinguish their cigarette. Children at Wolfscastle School recorded the bilingual message with advice from smoking cessation service staff, scheme staff and senior managers. Immunisations and Vaccinations Historically low influenza vaccination uptake amongst target groups in Ceredigion has led to the development of a research project to understand and challenge the reasons behind vaccine hesitancy and assist in the creation of bespoke communication approaches. The introduction of these new communication and engagement approaches should improve uptake rates in the forthcoming season. A pilot project to vaccinate patients against influenza in secondary care settings was developed in Withybush Hospital in February and March Due to the complexities of governance arrangements, this pilot has a standard operating procedure and supporting documentation but has not yet provided active vaccination of patients. However, it has been decided to continue this approach for the coming year. In 2017/18, additional investment will be available to develop a team of community immunisers to support delivery of childhood and adult vaccinations through more assertive outreach to eligible groups and individuals. This new model of service delivery will positively impact upon uptake rates. Overweight and Obesity In 2016/17, we focused on supporting maternal and early years health professionals to promote healthy weight in service users. This was underpinned by insight work to get a better understanding of issues and barriers faced by health professionals in raising and addressing issues around being overweight or obese with service users. As a result of this, we have delivered and evaluated a Brief Advice and Eating for 1: Healthy for 2 training programme for midwives aimed at increasing competency, skills, knowledge and confidence to promote behaviour change in pregnant women and their families. This is supported by a short film about healthy weight in pregnancy made available via social media. We have also helped school health nursing staff by purchasing resources to promote healthy weight in school age children and their families Health Experts Launch New Scheme to Support Mums-to-Be to Exercise This year, health experts in Carmarthenshire launched a new scheme to support mums-tobe to take up exercise. Baby Let s Move is an exercise programme designed to help women have an active and healthy pregnancy. It enables midwives to offer referrals to antenatal and post natal exercise classes, with basic nutrition advice, to all women with a body mass index of more than 30. The scheme is operational in nine leisure centres in Hywel Dda and has received 247 referrals during the first nine months. It includes an initial consultation, health assessment, leisure centre tour and plan for success. Participants then attend two sessions a week for 16 weeks. This investment allows us to work with local authorities to deliver the programme 21

22 for expectant mothers whose weight may adversely affect them and to train midwives to support pregnant mothers to maintain a healthy weight. Lifestyle Advocates: Promoting Health in Practice In 2016/17, the public health and primary care teams continued delivery of the Lifestyle Advocates: Promoting Health in Practice, following a positive evaluation last year. The aim is to improve population health by embedding a healthy lifestyle and prevention ethos in primary care settings. Participating GPs and pharmacies nominated additional advocates. 60 advocates completed the 15 hour development programme, including level 2 brief intervention training, enabling them to become skilled advocates for promoting healthier living, wellbeing and prevention in personal environments, discussing health-promoting life changes and linking with local support groups and services. As well as supporting patients to live healthier lives, these staff also reported changes to their own health behaviour. A celebratory event was held to mark the success of the project and advocates were presented with certificates to recognise their participation. Smokers Trial First Telehealth Quitting Service in Wales This year, smokers in Aberystwyth piloted the first ever remote stop smoking service in Wales. We worked with Stop Smoking Wales and Church Practice in Aberystwyth to trial a telehealth smoking cessation service aimed at helping local smokers kick the habit. Evidence shows that smokers are more likely to quit for good using a support service. Stop smoking services in rural Ceredigion face challenges in delivering services and the telehealth format makes it easier for smokers to access free, professional and convenient support. Quitters attended the surgery one morning each week to speak one-to-one with a video conference advisor and undertake intensive behavioural support equal to face-to-face consultations but closer to home. The new service is believed to be as effective as services offered in person, with support given by experienced stop smoking advisors. The remote service was identified by the Mid Wales Health Care Collaborative and ran for 14 weeks. It could be rolled out across rural Wales in the future. Other free options include the iquit pharmacy and iquit+ hospital services for inpatients and outpatients. Involving Local People, Partners and Communities Continuous Engagement We have a statutory duty to continuously engage and consult around changes to health services. In 2016/17, we continued to engage with staff, patients, carers, stakeholders and citizens in different ways. We invited people from across Hywel Dda to our Sgwrs Iach - Let s Talk Health Big Conversation events. Together with Hywel Dda Community Health Council, we held workshops to ask your views on what wellbeing means for you and your community and to help with future planning. Themes included the Wellbeing of Future Generations Act to ensure public service providers tackle challenges together and give current and future generations a good quality of life by thinking about the long term impacts of decisions made now. We delivered over 100 engagement events with patients, service users, individuals, stakeholders and local communities. Discussion topics included the Pembrokeshire Haematology and Oncology Day Unit, the Cardigan Integrated Care Project, testing our strategic objectives and the experience of outpatient services. Updates and future Sgwrs Iach Let s Talk Health meeting dates are available online at 22

23 Co-Production Co-production focuses on working with our stakeholders, local people, staff, statutory agencies, Hywel Dda Community Health Council, the third sector and others at every step when reviewing, planning, designing and evaluating services. This approach is underpinned by an ethos of openness, honesty, clear communication, a commitment to equality and diversity, and the Welsh Language. The Transforming Mental Health Services programme has adopted a co-production approach to designing future services and has undertaken extensive engagement to inform the formal consultation process. We will continue with this approach in the coming year as we develop our overarching plans for transforming our healthcare and support services in and outside of hospital. Siarad Iechyd/Talking Health The Siarad Iechyd /Talking Health involvement and engagement scheme continues to provide members with up-to-date information and opportunities to shape health services. We have over 1,000 members and are keen to recruit more. For further information, or to join us, please visit telephone or write to Freepost Hywel Dda Health Board. Success for Health Volunteers Our Volunteering for Health service aims to improve patient healthcare experiences. Our volunteers act as patient friends on wards, as meet and greeters at hospital receptions, on children and maternity wards, in A&E, intensive care, stroke rehabilitation and pharmacy and as diabetes education meet and greeters and administration volunteers. This year, we developed additional roles on the Chemotherapy Day Unit (now the Pembrokeshire Haematology & Oncology Day Unit) in Withybush Hospital and the shop trolley service in Prince Philip Hospital. We recruited 138 volunteers, of which we employed three, five went to university to study medicine, 12 to study nursing, one to study midwifery, seven to study other courses and eight moved on to other employment. We also worked with the third sector to recruit volunteers for the MacMillan Cancer Information Service and continued work with hospital radio stations. If you are interested in volunteering, please contact: Volunteering for Health Service, Hywel Dda University Health Board, 1 Penlan Road, Carmarthenshire, SA16 OBB. Support for Carers In 2016/17, we placed special noticeboards in all our hospitals for staff and carers. These display posters and leaflets relevant to carers. They also signpost carers to the county Carers Information and Support Services which support carers and point to further help including referrals to a carers needs assessment with social services. We are also developing intranet pages to help staff who are themselves carers. Investors in Carers Scheme The Investors in Carers initiative is designed to help health and social care settings, such as GP practices, pharmacies, hospital wards and outpatient departments, improve carer awareness and enhance the support they give carers. It is delivered with local authorities in Carmarthenshire, Ceredigion and Pembrokeshire and third sector organisations. This year, new bronze level awards went to St Non Ward; Bro Cerwyn in Haverfordwest; Boots Pharmacy in Fishguard; Cardigan Hospital s Outpatients and Minor Injuries Department; Ceredigion Community Mental Health Team (CMHT); Cea Bryn CMHT at Prince Philip Hospital; Boots Pharmacy in Whitland. Bronze revalidations were awarded to Tenby Surgery; Charles Street Surgery in Neyland; Robert Street Surgery in Milford Haven; Amman Valley Surgery; Coalbrook Surgery in Ponyberem; Penygroes Surgery in Llanelli; 23

24 Llanilar Surgery in Aberystwyth; Padarn Surgery in Aberystwyth; and Newcastle Emlyn Surgery. A silver level award went to Margaret Street Surgery in Ammanford. The Investors In Carers scheme has now been developed for other settings that work with carers. This includes secondary schools for young carers, libraries and community projects and social services departments in local authorities. In addition, the Workways+ Community Project in Pembrokeshire was successful in 2016/17. Withybush Hospital Wards Rewarded For Using Welsh In 2016/17, Wards 11 and 12 at Withybush Hospital were recognised at the Pembrokeshire Shwmae Awards for promoting Welsh on their wards. Patients on these wards suffer from dementia or stroke so it is important that they receive care in their language of choice. Ward staff used magnets to identify Welsh speaking patients, enabling them to provide an active offer. They also held a St David s Day event to introduce new overseas doctors to Welsh culture by providing a Welsh taster session. Withybush Hospital chaplain Geoffrey Eynon and Play Specialist Dawn Thomas were also shortlisted in the awards for their work and dedication to the Welsh language. New Welsh Language Resources This year, we produced a video to emphasise the importance of Welsh language in healthcare. The video stars two-year-old Ioan Downes, born six weeks premature, whose first language is Welsh. It will be shown to new staff at induction and at Welsh language awareness sessions to highlight the importance of language of choice. In addition, new Welsh language stickers and certificates were produced for children visiting hospital or their GP. These resources will be provided to children s and primary care services. There are three types of stickers, a Ti n Seren! You re a Star! certificate and a colouring activity based on Captain Get Well (or Captain G for short), who also features in a child-friendly video aimed at preparing children for a visit to hospital. Health Board and Coffee Giant Open Bilingual Coffee shops at Welsh Hospitals In 2016/17, working in partnership with Medirest, part of Compass Group UK and Ireland, we have created Costa s first bilingual coffee shops at Welsh hospitals. Costa outlets in Withybush, Glangwili and Prince Philip hospitals, plus a Deli Marche in Bronglais, display opening hours and menu boards in both languages and have Welsh speaking staff with identification lanyards. These are the first Costa retail units in Wales to create a bilingual environment. Equality, Diversity and Human Rights We recognise that people s individual experience of equality varies. We believe that people should not be disadvantaged because of their age, disability, religion/belief, gender, race, sexual orientation, gender reassignment status, by being married or in a civil partnership, being pregnant or raising a family. Our aim is to be accessible and inclusive for all. This year, we enhanced our work towards delivering patient-centred care and providing more inclusive environments for both staff and service users. Examples are outlined in our Equality and Diversity Annual Report 2017: Our report covering April 2016 to March 2017 will be published by 31 March Following extensive joint multi-agency public engagement across Dyfed Powys, we published our strategic equality objectives for , which can be found here: 24

25 We have increased engagement with our communities, including LGB&T, young people, women and children, people with mental health issues, learning disabilities and sensory loss in order to better tailor service delivery and clinical areas to meet particular needs. Key highlights include the development of in-house sensory loss friendly awards, driving equitable service delivery within inclusive environments and improving our ranking by 59 places on the Stonewall Workplace Equality Index which measures performance on welcoming and inclusive working environments. We use appropriate equality/diversity centred patient stories to identify areas for improvement and to celebrate best practice, aligning with our organisation s values. Increasing collaboration with partner organisations, engagement with staff and service users and expert advice from specialist organisations continue to inform the provision of equitable services for all. Our Strategic Partnerships To develop joint services, we play our role in key strategic partnerships and collaborations to support the involvement of local communities: Public Service Boards (PSBs), part of the Wellbeing of Future Generations (Wales) Act 2015, in Carmarthenshire, Ceredigion and Pembrokeshire. These aim to sustainably improve economic, cultural, social and environmental wellbeing for local people. Having undertaken assessments of local wellbeing over the past year, the coming year will involve developing develop a wellbeing plan that aligns with the objectives of each PSB as well as our own UHB wellbeing objectives. The University Partnership Board comprising us, Aberystwyth and Swansea Universities and the University of Wales Trinity St David. Our three year agreement aims to improve the health and wellbeing of local people by working together and pooling resources and ideas in areas of mutual benefit to achieve the highest possible standards of care, innovation, education and training. The Mid Wales Healthcare Collaborative was formed to implement the 12 recommendations of the Mid Wales Healthcare Study and to deliver high quality and sustainable services for people in Mid Wales. It comprises us, Betsi Cadwaladr University Health Board, Powys Teaching Health Board and the Welsh Ambulance Services NHS Trust. Established by the Mid Wales Healthcare Collaborative, Rural Health and Care Wales (previously the Centre for Excellence in Rural Health and Social Care) is a focal point for the development and collation of high quality research into rural health and wellbeing; improving the training, recruitment and retention of professional workforces in rural communities and being an exemplar in rural health and wellbeing on an international stage. The West Wales Regional Partnership Board was set up to implement the Social Services and Wellbeing (Wales) Act Its membership is us, Carmarthenshire, Ceredigion and Pembrokeshire County Councils and includes third sector care providers, carers and people with care needs. The Mid and West Wales Health and Social Care Collaborative has strategic responsibility for delivering health and social care integration across the region including older people s services, modernising learning disability services, regional complex needs and transition service and regional adult safeguarding. The NHS Wales Health Collaborative, hosted by Public Health Wales, aims to improve joint working between NHS Wales bodies, NHS Wales and its stakeholders and manage defined clinical networks operating across NHS Wales. Its governance group is the NHS Wales Collaborative Leadership Forum comprising the Chairs and Chief Executives from all NHS Wales organisations. A Regional Collaboration for Health (ARCH) is health, education and science working together to improve the health, wealth, skills and wellbeing of the people of 25

26 south west Wales. It is a partnership between us, Abertawe Bro Morgannwg University Health Board and Swansea University covering six local authority areas and working with social care, voluntary and other public bodies. It aims to improve healthcare through research, innovation and skills across the region. Hywel Dda Community Health Council through our Executive team and the Community Health Council Strategy and Planning Committee. Hywel Dda Health Charities Hywel Dda Health Charities is a registered charity which supports patients, staff and services across our UHB. It makes a difference to thousands of patients across Hywel Dda and beyond each year. The continued generosity of patients, families and local communities enables us to direct our charitable donations to support a wide range of services and activities, above what the NHS can provide, for the benefit of our patients. Our Income The total income in 2016/17 was 1,444,367. *Note: The figures quoted are subject to audit by Wales Audit Office in Sept/Oct 2017 Our Expenditure Hywel Dda Health Charities is a grant-making body, providing grants to our UHB as a contribution to the cost of healthcare and adding value to what the NHS provides. Our charitable donations provide invaluable support on patient focused expenditure. This year, expenditure on charitable activities was 944,203 supporting a wide range of charitable and health related activities. 26

27 *Note: The figures quoted are subject to audit by Wales Audit Office in Sept/Oct 2017 Full details of the charity s activities are available in the Hywel Dda Health Charities Annual Report and Accounts 2016/17 which is available here: Valuing Our Staff Our Organisational Values In July 2016, we launched our organisational values, developed with staff, to shape the future delivery of services. Staff fed back on personal attributes that are important to them to help form a list of nine values which are: dignity, respect and fairness; integrity, openness and honesty; and caring, kindness and compassion. Our organisational values are: working together to be the best we can be; striving to develop and deliver excellent services; and putting people at the heart of everything we do. Following the launch, drop-in sessions were held to communicate the values. We have a dedicated intranet page and social media feed which recognises staff for demonstrating our values and behaviours. The values have been incorporated into the Chair s staff recognition scheme and our organisational development team is helping to embed the values across Hywel Dda. To symbolise the values, a logo has been developed which depicts a DNA strand within a heart holding the nine values. The values will also play a big part in measuring and improving staff and patient experience. Hywel Dda Sign Up To RCM Staff Wellbeing Charter This year, we become the latest health board in Wales to sign up to the Royal College of Midwives Caring for You health and wellbeing charter. This campaign aims to improve health, safety and wellbeing for midwives and maternity workers so that they can provide the highest quality maternity care for women and their families. It was launched as a 27

28 response to over-worked midwives in Wales and across the UK. The charter includes commitments to ensuring adequate rest breaks, staying properly hydrated during shifts and fostering a positive working environment. NHS Wales Staff Survey Results In 2016/17, we took part in the NHS Wales staff survey to listen to what staff had to tell us about how they felt about working for Hywel Dda and the care we provide. Key staff findings include: 67% say that if a friend or relative needed treatment, they would be happy with the standard of care provided by the organisation, compared to 49% in % say that the care of patients/service users is the organisation s top priority, compared to 52% in % say that they would recommend Hywel Dda as a place to work, compared to 46% in % say that they are able to provide Welsh services in the preferred language of service users, up from 58% in 2013, and 18% higher than overall NHS Wales score. 69% say that the team they work in understands how to obtain support to meet language needs of service users, up from 61% previously. These results show significant improvements since the last survey in 2013 and we are now developing an action plan to take forward identified areas for improvement. Staff Benefits and Rewards We offer a range of benefits and rewards for all staff. These include salary sacrifice schemes to purchase home technology, lease cars, bicycles, leave and childcare vouchers. This year, we launched Hywel Dda Benefits 4U which offers a range of online offers and discounts, plus a Vectis Card for use in local and UK stores. Staff also benefited from free promotional and work perk samples and we are currently looking at using volunteers to continue this successful staff reward initiative. Staff Wellbeing Services In 2016/17, we continued to support our staff through comprehensive occupational health and staff psychological wellbeing services. A range of support services and resources are provided to both individuals and managers including an innovative new wellbeing development programme called You Matter and work with managers on building a culture of wellbeing and resilience. Chair s Staff Recognition Scheme In 2016, we launched our new staff recognition scheme. Monthly award certificates are presented by our Chair to say thank you to staff and teams who have been nominated by others for their outstanding and exemplary service. This year, our Chair s monthly staff recognition scheme awarded 45 certificates to valued employees and teams. Medical Education and Training We are a local education provider. We need appropriately trained staff to deliver high quality healthcare for local people and training and education is a central element of our function and clinical governance strategy. Our employees are also individuals with aspirations and personal development needs to provide optimum performance. We aim to: Create an educational environment that nurtures and develops future doctors Deliver quality training standards by harmonising service and training to maximise educational opportunities within the clinical setting 28

29 Develop a culture of educators, supporting and developing doctors as trainers Support the continual professional development of all doctors and dentists Our achievements in 2016/17 include: Developing our clinical skills and simulation training capacity across all sites A commendation for Psychiatry, Medicine in Prince Philip Hospital and at Foundation Year 2 level in Glangwili Hospital has been received from the Wales Deanery for achieving above outlier results in the General Medical Council National Survey on a number of areas relating to best practice in medical education. The continuation of the clinical fellows programme at Withybush Hospital Providing observation programmes for over 100 sixth form school pupils applying for medical school Piloting careers workshops for year 9 school pupils, introducing a future as a doctor Successful placements of Physician Associates students in Bronglais Hospital from Birmingham University Library and Knowledge Services The Library and Knowledge Service provides a multi-disciplinary service function supporting patient care, education, research and lifelong learning. This year, they: Successfully moved to a new library management system along with NHS Wales and Cardiff University Undertook a comprehensive and systematic literature search on telemedicine at Bronglais Hospital for the Mid Wales Healthcare Collaborative Updated the nursing collection with funding from the nursing directorate Investing In Our Estates and Services Hywel Dda University Health Board continued to invest in its estate and total capital investment in 2016/17 was 17.8 million. Key investments from Welsh Government central funding in 2016/17 included: Commencement of work to refurbish existing Theatres together with the provision of a new Fire Evacuation Lift for Theatres/ICU at BGH which will complete in 2017/18 (full capital value 5.32m) Installation of replacement X-ray Room at PPH ( 1.1 million). Provision of additional patient bed capacity at GGH and BGH (630k) Investment in IT to improve a range of areas including Server Capacity, Backup, Storage and Network expansion projects ( 2 million). Funding to provide local wet AMD clinic facilities in Pembrokeshire (30k) Investment in Pharmacy services across the Health Board across a range of areas including the replacement of Pharmacy Robots at GGH and PPH with an upgrade to the existing Robot at WGH, extension work to the air tube system on all four acute sites to link Pharmacy to key patient areas and the provision of 20 automated dispensing units at ward level across the acute sites ( 1.7 million). The key elements of the expenditure from our Discretionary Capital Programme are set out in the table below: 29

30 Carmarthenshire GGH Replacement Transport Incubator 57,300 GGH Replacement Obstetrics Theatre Table. 47,000 GGH Replacement Ultrasounds x 2 174,200 GGH Replacement Theatre Patient Monitors 483,000 GGH Replacement Maternity Delivery Beds 66,000 PPH Replacement Catering Trolleys 77,800 GGH Phase 1 Upgrade of Ward Block Waste Drainage project 300,000 PPH Creation of a Medical Equipment Library GGH Phase 1 Upgrade works to Outpatients circulation areas. 52,000 PPH Upgrade to Gas Boilers and Roofs to Junior Doctor 40,000 Accommodation Blocks GGH Additional Car Parking Spaces Ceredigion Replacement ventilators Repl Transport Incubator Replacement Ultrasound Replacement Instrument Sterilizer Replacement Cystoscopes Pembrokeshire 106, , ,000 57, ,000 45,000 92,300 Replacement Ultrasound Replacement Colonoscope Replacement Theatre Patient Monitors Refurbishment works to relocate Medical Day Unit Refurbishment works linked to PHODU project. Mental Health Upgrade works to Patient Bedrooms in Bryngolau Ward PPH Upgrade works in Patient Bedrooms in Cwm Seren Facility Carmarthen 66,200 41, ,000 89, ,000 65,000 85,000 Major Projects Completed 2016/17 Bronglais Hospital Front of House ( 43.3m) Construction works on the refurbishment element of this project continues with the completion of refurbishment works to the Outpatients Department. The scheme is now entering the final phase with the refurbishment of the Main Theatres and construction of an additional fire evacuation lift (proposed picture below) to improve means of escape from the Main Theatres and ITU on the floor below. These works are scheduled for completion within the 2017/18 financial year. 30

31 Future Projects Cardigan Integrated Care Centre, Cardigan A Full Business Case has been developed and submitted to Welsh Government for scrutiny in April Construction works are anticipated to start on site in 2017/18. Women and Children (Phase 2), Glangwili Hospital. Funding of 1.2 million has recently been approved by Welsh Government to proceed to Full Business Case stage for the redevelopment of Womens & Childrens Services at the site. The expected submission date for the FBC is in the Autumn 2017 with construction works subject to the Welsh Government approval process commencing in early Total Value of scheme is circa million). 31

32 Endoscopy, Prince Phillip Hospital A review of Endoscopy Services across the Health Board as part of JAG Accreditation has identified a requirement for improved facilities at Prince Philip Hospital. Welsh Government has agreed to a Capital funding bid via the normal business case processes. The scheme requirements are currently being scoped with a Health Care Planning Team. Cardiac Catheter Scheme, Glangwili Hospital A scheme is currently being developed to upgrade Cardiac services at the site to provide new Cardiac Catheter Labs and Pacing Suite via the Welsh Government Business Justification Case process. Aseptic Suite The Health Board is currently undertaking a feasibility option appraisal to determine the most suitable location for a new Aseptic Suite. Once completed it is a bid to Welsh Government will be made for Capital Funding. Withybush Hospital Wards 9 and 10 The Health Board is currently developing a Business Case for the refurbishment of Ward 10 to form a Specialist Palliative Care, Haematology and Oncology Ward comprising 18 inpatient beds and a Discharge Lounge. To enable this work it is also proposed to redevelop Ward 9 to allow the Ward 10 project to progress and to provide an additional 14 beds on \Ward 9 thus creating a decant facility and capacity to mitigate future winter pressures. The Business Case is in the final stages of development will be presented to WG later in the year with the intention of obtaining funding in the region of 3.4 million. Energy Efficiency Phase 2 Following the success of the Phase 1 Energy Performance Contract, the HB has developing plans to further exploit energy efficiency opportunities to achieve circa 180k of energy savings and circa 600 tonnes of carbon reduction per annum. The business case submission to Welsh Government is approved in principle pending funding availability. Discretionary/Capital Projects Refurbishment and Alteration Schemes: Phase 1 Drainage Infrastructure upgrade at Glangwili General Hospital Proposed 24no Car Park Facility at Glangwili General Hospital Medical Gas Compliance Works at Glangwili General Hospital & Prince Philip Hospital Air Tube Installation Health Board Wide External Envelope Improvement Works at Residential/Office Blocks at Prince Philip Hospital Cardiac Cath/Radiology Facility at Prince Phillip Hospital Cardiac Recovery Area at Prince Phillip Hospital Fire Code Improvement Work at Prince Philip Hospital & Glangwili General Hospital Proposed Pharmacy Robotic Enablement Works at Prince Philip Hospital & Glangwili General Hospital Proposed Community Diabetic Centre at Block 13, Prince Philip Hospital Proposed Refurbishment & Alteration Works at Ward 5 Chemotherapy Day Unit at Withybush General Hospital Proposed Dental Room Facility at Withybush General Hospital Medical Day Unit Facility at Withybush General Hospital Proposed Refurbishment & Alteration Works at Bro Myrddin, Johnstown Ward 14 Enablement & Refurbishment Works Childrens Ward at Withybush General Hospital 32

33 Proposed Points of Ligature Improvement Works Health Board Wide Charitable Funded Schemes: Llandovery Wet Room Facility New Car Park Facility & External Improvement Works at Amman Valley Hospital Welsh Government Funded Schemes: Acute Medical Assessment Unit (AMAU) Prince Philip Hospital The Acute Medical Assessment Unit (AMAU) which is part of the health board s 1.4m Front of House Project at Prince Philip officially opened on 6 April A new Minor Injuries Unit (MIU) has also opened for patients via the old A&E entrance at the front of the hospital. The new AMAU features two resus bays, a fast positive stroke bed, assessment area / reception and lobby, and a six-bed monitored step-down area. It also sports a new ambulance entrance with a canopy and an AMAU reception area. Health Board Estate Performance Property Performance Key Facts Current backlog within the estate is 60.8 million (high & significant backlog totals 42 million); 58% of our estate is over 32 years old; Average running cost for FM services is circa 158 /m 2 per annum; The Estate Hywel Dda UHB s estate continues to evolve and adapt to the changes in health care requirements ensuring that the Health Board keeps pace with the changing face of current health care needs. As it stands the current estate covers circa 52 Hectares across the counties of Pembrokeshire, Ceredigion and Carmarthenshire, this equates to a land mass of approximately a quarter of Wales. Health care services at present are provided via 57 freehold and leasehold properties with a total gross internal floor area equivalent to 188,043m 2. 33

34 Estate Acquisitions & Disposals To ensure the evolution of the Hywel Dda UHB estate continues to adapt and evolve to meet current health care requirement a proactive approach has been adopted to develop the estate accordingly. The on-going identification of surplus premises for disposal and the acquisition of suitable premises either through capital purchases and or external lease arrangements have resulted in the disposal/acquisition of the following accommodation in 2016/17: Disposals 2016/17 Leasehold Disposals: 7a Great Darkgate Street Aberystwyth Derwen Gardens, Newcastle Emlyn Freehold Disposals: Carmel & Pentargon, St David s, Carmarthen These disposals have produced Capital Receipts totalling circa 260k and a reduction in rental charges of circa 12.5k for the 2016/17 period. An additional capital receipt in the region of circa 190k is also anticipated with the disposal of the Bryntirion CPU which is currently for sale on the open market. Acquisitions 2016/17 Leasehold Acquisitions: Building 24 Stradey Park Ind. Park, Llangennech School of Nurses office accommodation Felinfoel Community Resource Centre Primary Care offices Ty Myddfai, Johnstown, Carmarthen Psychotherapy treatment centre Felinfach Joint Equipment Store Community Services Awel Deg, Llandysul Mental Health LD/Social Care joint service Freehold Acquisitions: Pembrokeshire County Council Offices, Minaeron, Aberaeron Purchase to develop an integrated care facility servicing the Aberaeron area and enable the disposal of the current Aberaeron Hospital site. Estate Performance Indicators Estates Performance is measured against the All Wales average on six national performance indicators, as reported via the Estates, Facilities and Performance Measurement System. Overall HDUHB is closely aligned to the All Wales average position, although as noted previously energy performance and Fire Safety remains a challenge, as noted in the table below: 34

35 Estate Operating Costs Comprehensive and accurate information is vital for an organisation to monitor and manage the performance of its estate. Cleaning, Catering and Energy Management represent the most significant spends in running the estate. The overall facilities average premise running cost across the estate translates to 158/m 2 in 2016/17 ( 151/m 2 in 2015/16, 153m 2 in 2014/15, 156m 2 in 2013/14) although costs per location will vary depending on occupancy and activity. Operational Facilities Management and Compliance Work continues to enhance the working partnership between soft and hard Facilities Management teams to continue to improve the patient experience by: - Continuing our efforts to ensure the built environment is fit for purpose; Continually improving the standards of cleanliness monitoring and scoring across the Health Board in line with the national Standards for cleaning in NHS Wales; The service continues to develop a number of initiatives to support nursing teams to deliver an improved patient experience. The Credits for cleaning (C4C) software is continually utilised to establish scores for the stakeholders. The new technology that has been introduced across the Heath Board (Mini I-Pad's) capture the data to enable in depth statistics on cleaning, nurse cleaning and estates to be produced. These are discussed and scrutinised in various forums throughout the Health Board. There is an improvement trend evident from this exercise and the system provides accurate and timely information regarding the cleanliness of the environments in all in patient areas. The facilities managers continue to be represented on the national framework group for C4C and are also part of the group looking at the National Standards of cleanliness for Wales. This will ensure the Health Board continues to work to best practice guidelines. The integration of operational staff on both hard and soft FM functions has further developed and is proving to be successful in enhancing the standard of ward cleanliness. The facilities teams work closely with the senior ward staff to ensure access is granted at the most suitable time for the wards. Rapid response teams continue to ensure bed turnaround is kept to a minimum to assist in ensuring patient flow is maintained. In addition the Microfibre cleaning technology continues to be utilised to enhance the cleanliness of the built environment and has continues to be standardized across all sites. 35

36 Specialist Services - Catering Food Hygiene Inspections/FSA Ratings The most recent round of Food Hygiene inspections have been undertaken by the Department of Environmental Health (EHO) in accordance with the revised Food Standards Agency Food Hygiene Rating Scheme. All of the UHB s premises, with the exception of Prince Philip Hospital who received a score of four, have been awarded the highest possible score rating of five. All Wales Menu Framework (AWMF) Compliance in relation to the AWMF has continued to progress incrementally with three out of the four acute hospital sites being fully compliant with the in-house patient menus. There is a necessity to invest resources at Withybush General Hospital in order to achieve compliance and it is anticipated that this will be achieved and improve efficiency following the pending restructuring of catering services at Bronglais and Withybush General Hospitals. Catering Services Strategic Outline Case (SOC) The UHB currently produces in excess of 23,000 patient meals per week or 1.2 million patient meals per annum UHB wide at an average cost of 3.86 per meal. In addition, it provides catering services for staff and visitors generating in excess of 1.1million per annum and is currently carrying a subsidy of 315 k for non-patient catering services (EFPMS 2015/16). Catering services are responsible for meeting the diverse needs of patients, staff and visitors while meeting a range of national standards/guidance and directives in relation to the impact this catering has on health and well being. Additional work was commissioned to extend the scope of the original August 2016 Strategic Outline Case (SOC) for future UHB catering services in order to capture key qualitative information. This includes a review of evidence in relation to the wider clinical and economic impact of catering services in consideration of national policy and direction. From this extended piece of work, it is anticipated that the SOC will be re-evaluated to ensure that it is future proofed to sustainably meet the increasingly complex nutritional needs of patients and respond to changes in patient demographic, particularly an increasing frail, elderly patient population Operationally catering services continue to work towards the All Wales Nutrition and Catering Standards for Food and Fluid Provision for Hospital Inpatients and the All Wales Menu Framework (AWMF), the latter underpinning ongoing improvement in catering across NHS Wales while supporting best value. Despite our varied systems, overall patient experience and quality of meals in Hywel Dda is highly rated. Local evidence shows patient satisfaction is higher with conventional catering, increasing with meals plated at ward level and where the AWMF is fully implemented. Conversely, patient rated quality of meals at Prince Philip, following the change from in-house CPU cook-chill to bought-in cook-freeze meals, noticeably declined. Patients on the Hafan Derwen site receiving externally provided cook freeze meals report a low level of satisfaction (Hywel Dda All Wales Catering Survey). Food Wastage Significant improvements have been made in terms of capturing, monitoring and reporting wastage levels particularly in relation to unserved meals, although more work is necessary to achieve the new Welsh Government target of <5% which has recently been announced. These reports are currently being received for scrutiny at Menu Planning Group and at the County Nutrition Groups. Service Developments and Service Initiatives The closure of the Central Production Unit (CPU) at Bryntirion saw a major change in the provision of patient meals at Prince Philip Hospital with the introduction of bought-in cook frozen meals from 36

37 Cwm Taf Health Board. This service change was necessary due to the significant concerns in relation to the building infrastructure which left no option but to move off the site. Laundry Services The Central Laundry Service based at Glangwili General Hospital is currently participating in a Welsh Government initiated review of all Laundry Production Units in Wales. This review has been commissioned to identify gaps in compliance and to determine the optimum number and configuration of production laundries for future provision across the principality. Health, Safety and Security Health, safety and security management responsibilities continue to sit with the Deputy Chief Executive and Director of Operations with line management arrangements under the Director of Estates, Facilities and Capital Management. In 2016, an existing Health and Safety Manager was appointed to the role of Head of Health, Safety and Security to oversee the functions of the department. Health and Safety and Emergency Planning Sub Committee The above quarterly Sub-Committee continues to formally provide assurance to the Health Board in terms of its compliance with health, safety and security management. This Committee reports to the Business Planning & Performance Assurance Committee, a Sub Committee of the Board. The purpose is to provide assurance for the health, safety, welfare and security of all employees and of those who may be affected by work-related activities, such as patients, members of the public, volunteer s and contractors. The Health, Safety and Security Team continue to review and update the Health and Safety Priority Action Plan. This document highlights a number of key health, safety, security and compliance risks and sets out how each area is being managed. It is also used to highlight emerging threats to the organisation s health and safety governance arrangements. The following significant topics were discussed in the period: Laboratory environmental and compliance concerns. Training for the Health Board members on new sentencing guidelines for health and safety offences. Mandatory training requirements for operational Estates staff. Medical gas and water safety action plans. Fire safety training attendance. The management of potentially violent patients in the acute sector. Training for specific staff to respond to personal attacks and safely restrain where necessary. Case management and our Prevent strategy. Security Case Management Violence and aggression towards staff is a concern for the Health Board with incidents increasing year on year. This year has been no exception. Employees are supported by the Security and Case Manager and Health and Safety Managers when incidents do occur. This has also resulted in the team providing assistance when having to speak directly to aggressive patients or family members who have assaulted our staff. The challenge to provide an effective response to these incidents has been recognised and a request for additional administrative support and Case manager are being considered. Collaboration 37

38 and improved partnership working with Dyfed Powys Police has taken place during the year and this will be continued throughout 2017 with plans to hold governance site meetings being established. The aims of the meetings are to reduce demand on our services and Police attendance. Of note this year is the placement of Police Community Support Officers at each of our acute sites working closely with staff on site to provide a reassuring presence to all. Accommodation and IT links have been provided to assist the officers and encourage their presence on site. Plans are also in place and being developed across the Health Boards acute sites for 24hr Police monitored CCTV provision linked into to local authority CCTV which will provide further reassurance in terms of missing patients and incident reporting Prevent Strategy In relation to the Governments strategy on Counter Terrorism the Health and Safety Team continue to represent the Health Board at Local Authority CONTEST and Channel Panel meetings. Mental Health staff together with Learning Disabilities and Safeguarding takes an active role in ensuring the Health Board discharges its duties effectively. The method of referrals is now imbedded in established safeguarding mechanisms. The Security Manager has also taken up further responsibility for the Operational response for Prevent and also sits on the Regional CONTEST Board and All Wales NHS PREVENT Coordinators Group. Recent Terrorist activities with links to this area and our Services have highlighted the need for increased awareness and compliance with this duty. We continue to raise awareness via Management Passport Training and our internet page currently there are plans to make this more prominent. We are further assisting in developing Prevent Awareness workshop based training with our partners in the three counties. 38

39 Hywel Dda University Health Board Performance Report 2016/

40 Chapter 2: Our Performance Report Performance Overview The NHS Finance (Wales) Act 2014 requires us to prepare a plan which sets out our strategy for complying with the three year financial duty to breakeven. Our Integrated Medium Term Plan (IMTP) was unable to evidence financial balance and should therefore be considered in terms of the strategic direction it signalled and as an interim position only. Further work has continued locally and with Welsh Government to bridge the financial gap and develop the local Clinical Services Strategy to ensure sustainable high quality services. In the absence of an approved IMTP and as advised by Welsh Government,, the University Health Board worked to a Board approved 1 year Operational Plan concentrating on delivery against the NHS Outcomes Framework. The Plan signalled a significant and profound change of emphasis for the University Health Board. This shift was based on our desire to be recognised as a Population Health Organisation not simply the provider of health services. We must shift our focus decisively towards the promotion of good health, prevention of illness, systematic disease management and holistic care coordination. We must also ensure that we are efficient in the way we use taxpayers money and as a minimum deliver on the targets set for us by Welsh Government. Our start point has been to take a careful look at what the future holds for our local population over the coming 10 years. We believe this time frame enables us to put the necessary building blocks in place now to address the challenges we can be sure are coming. These challenges are not unique to Hywel Dda an ageing population, increasingly coping with multiple long term physical and mental health problems; the existence of a growing range of factors which will drive future health needs such as smoking, drinking, diabetes, respiratory and cardiovascular disease, and obesity; and the continuing rise in people being diagnosed with and surviving cancer. Ten Strategic Objectives have therefore been established. Strategic objectives 1 to 8 have been expressed in terms of the ambition we have set ourselves a measurable set of targets against which we can monitor our progress. Underpinning these measures is a specific delivery plan bringing together, for the first time, all of our work across clusters, the Integrated Care Fund, national delivery plans, Together for Health plans and our local Population Health Programme work streams. Strategic Objectives 9 and 10 differ from the others in that their focus is on addressing our underlying financial position, delivering on national performance targets, addressing the fragility of many of our key services and bringing to life that part of our vision which seeks to ensure our services are efficient and effective and that we do not ask patients to travel unnecessarily or wait unduly. We also remain committed to our mission - the difference we intend to make as an organisation in the delivery of services: Prevention and early years intervention is the key to our long term mission to provide the best health care to our population We will be proactive in our support for our local population, particularly those living with health issues, and carers who support them If you think you have a health problem, rapid diagnosis will be in place so that you can get the treatment you need, if you need it or move on with your day-to-day life 40

41 We will be an efficient organisation that does not expect you to travel unduly or wait unreasonably; is consistent, safe and of high quality, and, has a culture of transparency and learning when things go wrong A key contextual change from September 2016 was the introduction of targeted intervention by Welsh Government. The main focus in relation to the performance agenda were demand and capacity planning and to improve data analysis to support planning and delivery. This process led to even greater scrutiny of the University Health Board performance delivery in 2016/17. The University Health Board saw significant investment to target performance improvement and the significant impact of that investment on 36 week waits can be seen in the year end performance position. Performance Outcomes The NHS Wales Delivery Framework contributes towards the goals of the Public Health Outcomes Framework for Wales and aims to ensure that the health and wellbeing of people living in Wales is improved as part of the Well-being of Future Generations (Wales) Act The framework provides an annual view of the impact health services are having on improving population outcomes and is supported by a delivery framework. The NHS Wales Delivery Framework seven domains are listed below. Detailed performance reports are reported routinely to every Board meeting and are also available on the Board s website. 41

42 The following table demonstrates that 2016/17 performance overall has improved. Of the 68 measures the Health Board has improved performance in 42 measures and held a sustained position across two. During this reporting period, all 7 domains, apart from Staying Healthy, have demonstrated an upward trend compared to 4 domains showing improvement in the previous year. Within the Staying Healthy domain, we have not achieved the required uptake of influenza vaccinations but there are proposals in place to increase uptake rates with an emphasis on the potential for vaccinating patients in secondary care. In both admissions and readmissions for the basket of 8 chronic conditions the Health Board witnessed a declining trend since November 2016 however the service aims to improve performance going forward following investment and the implementation of caseload reviews. There is an improvement witnessed for residents making a smoking quit attempt. There is a declining trend in the percentage of children who received their scheduled vaccinations at four years olds but with improved workforce, data reporting and recording, the service aims to increase the number of children vaccinated going forward. There is a marginal decrease of patients who have had their blood pressure reading completed within the last 12 months compared to the previous year. For the Safe Care domain, there was an increase in the number of Clostridium difficile infections whilst the numbers decreased of Staphylococcus aureus blood stream infections. 42

43 In order to improve, the Health Board is reinforcing health promotion and infection prevention in the Community and Primary Care. The target has been met for the three antibacterial items measured and non-steroidal antiinflammatory drug (NSAID) target. Hywel Dda University Health Board (UHB) has witnessed a declining trend in the percentage of GP practices submitting their yellow cards. The UHB monitors Patient Safety Alerts and Notices as and when required. There are some months where no alerts are due for compliance which impacts on being able to demonstrate an improved performance. The number of Serious Incidents assured within the agreed timescale has shown a declining trend. However, development work has been undertaken on the UHB s Datix system to ensure better tracking and overall management of Serious Incidents across the board. Across the year, there has only been one never event which is an improvement. Within Dignified Care, performance has improved for short notice procedure postponements. The percentage of people with dementia (over 65) who are diagnosed has improved. However, there has been a marginal decline in the % of GP practices that have completed Mental Health DES in Dementia care training. Within Effective Care, both Mental Health and Non Mental Health Delayed Transfer Of Care rates have shown an improvement over the 12 month period. The UHB has achieved continuous improvement in all of the key mortality measures over the last 12 months, showing a reduction in the overall Crude Hospital Mortality rate for patients less than 75 years of age. Clinical coding of consultant episodes has been a challenge due to vacancies. However, performance has improved. Two of the four Clinical Research Measures have demonstrated an improvement whilst the number of patients recruited into commercially sponsored studies has remained static. Within the Individual Care Domain, there is an improvement in the rate of Welsh residents calling the Wales Dementia Helpline but a reduction in the number of Mental Health calls to C.A.L.L and DAN. Both Mental Health metrics have seen an improvement trend over the past 12 months. The UHB has consistently ensured that there are arrangements in place to ensure advocacy is available to all qualifying patients and has achieved 100% since March Whilst not achieving all the required targets that sit within the Timely Care domain, there have been successes. There is an annual improvement in the two GP practice measures. There is an improvement in the number of practices set up to use My Health Online (MHOL) but deterioration in the number of practices offering appointment bookings. Patients treated by an NHS dentist have shown an improving trend over the past 24 months. At the end of March 2017, there were a number of patients who were not treated within the Welsh Government s 36 week target. The majority of these patients were in Orthopaedic. However, a trend improvement is witnessed. The number of patients seen within the 26 week target has also improved. The total patients delayed waiting for a follow appointment has shown an improvement trend over the 12 month period. The UHB met the eight week diagnostic target. 43

44 The UHB s performance against the Welsh Government stroke quality improvement measures has shown an improving trend for three of the four measures. A stroke delivery plan is now in place which details actions required to deliver further improvements. Red call ambulance performance has shown an improvement trend across the year. Whilst not achieving the ambulance handover and A&E targets, the UHB has developed an unscheduled care programme to review all aspects of the emergency care pathway from primary care and ambulance arrivals through to discharge. The Non-Urgent Suspected Cancer performance remains below target whist the Urgent Suspected Cancer has demonstrated an improvement. Breaches are predominantly due to delays for specialist tertiary centre treatments. Both Mental Health LPMHSS measures noted have shown an improvement trend over the 12 month period. Within the Workforce and Sickness domain, there has been a decline in performance for new outpatient Did Not Attend (DNA) rates and an improvement in the Follow-up DNA rates. The % of inhaled Corticosteroids prescribed in primary care has demonstrated an improvement. Although the number of do not do breaches are predominantly fewer than ten a month, there has been a trend reduction witnessed in Ophthalmology and Urology. Between 2015 and 2016, performance has declined marginally for staff undertaking performance appraisals who agreed it helped them improve how they did their job. The overall staff engagement score has shown an upward trend. Sickness has improved across the year, as has the percentage of staff that would be happy with the care our UHB can provide if a friend or relative needed treatment. Our Delivery against Finance and Workforce Plans The deficit of m at year end reflects another challenging financial year. The plan set out at the beginning of the year (in the 2016/17 Draft Interim Integrated Medium Term Plan (IMTP) forecast a year end deficit of 38.3m. This was heavily dependent on tackling the significant increase in high cost variable pay seen in recent years. Whilst there were schemes in place to address this, the delay in recruitment compared with planning assumptions and the challenge in controlling variable pay proving impossible, the year end forecast was restated in November to m. The UHB was informed that the revised target was also subject to risk and dependent on receipt of waiting times and winter pressure funding from Welsh Government (WG) with 6.31m being received. The actual deficit of m was slightly less than anticipated due to the costs for new treatment fund drugs, for which all Health Boards received additional WG allocations, not materialising in full. As this was the final year of the first IMTP starting in 2014/15, the Annual Accounts were qualified as the UHB did not meet the statutory requirement to achieve break even against its Revenue Resource Limit over the three year period 2014/15 to 2016/17. The financial target of 38.3m set at the beginning of the year was immediately under pressure due to the difficulties encountered in reducing the high cost variable pay. There was a significant rise in high cost agency and premium cost locum seen between 2014/15 and the end of 2015/16. This had been exacerbated by the medical staffing pressures in Withybush General Hospital that required alternative solutions to be put in place so that 44

45 other hospitals in Hywel Dda needed to open medical bed capacity in order to receive acute medical patients from Pembrokeshire, where capacity reduced. The UHB successfully kept the four front doors open all year but the knock on effect of these pressures lasted far longer than anticipated and beyond when services returned to their normal configuration. The plan set at the beginning of the year did not allow for this level of spend to continue during 2016/17 and, whilst the rate of growth was capped, there was no reduction in the monthly spend. Disappointingly, the average monthly spend on variable pay (including agency, bank, locum and overtime) increased from 3.26m in 2015/16 to 4.76m in 2016/17 totalling 57m for the year. The plans put in train before the start of the 2016/17 financial year meant that the UHB had offered over 170 nursing posts to overseas staff together with appointing newly qualified nurses and normal recruitment levels. Unfortunately, the lead in time for the overseas nurses, particularly associated with the ability to demonstrate competent language skills, far exceeded the planning target. At year end, only seven of the initially planned 170 had taken up post. The focus on increasing the use of on-contract agencies and reducing, ideally eliminating, the use of non registered nurse agency by bank recruitment also took longer than anticipated. Good progress was made to switch from the most expensive agencies but even the on-contract agencies charged Hywel Dda a rural premium. Significant numbers of non-registered nurses were recruited, especially during the latter part of the year, meaning that spend in that area has now begun to reduce. Medical recruitment continued to be challenging as the UHB tried to recruit to specialties where there are national shortages and looked at alternatives to the traditional routes taken e.g. by developing links with overseas universities and promoting Hywel Dda as an employer of choice. The issues encountered with managing variable pay severely hampered the UHB s ability to deliver savings. In the end, through the use of reserves and alternative funding streams together with savings plans, a total of 20m was delivered against a target of 29.4m. For 2017/18, the plans are again heavily dependent on tackling workforce challenges but, learning from previous years, the following actions have been put in train focusing on the main areas of Medical, Nursing and Other. Medical: a medical recruitment plan has been developed; a process to ensure managers ensure rest breaks for agency workers are taken has been introduced; a review of all agencies has been undertaken to ensure we are maximising the use of those that are VAT efficient; a review has commenced of all engagements with agencies to ensure appropriate rates are being charged dependent on the type of shift being undertaken; conversion of Agency workers to NHS employment is happening where possible; exit strategies for existing high cost agency workers are being put in place. Nursing: a nursing recruitment plan has been developed based upon recruitment performance during 2016/17 and newly qualified nurses have already been offered posts for September 2017; from 1 st April 2017, new rates of pay for agency workers were implemented but, due to difficulties experienced during April with some agency nurses refusing to work for the revised rates, a slight increase was agreed to include some support for travel and accommodation. The final rate agreed was still a reduction on the previous rates. Allied Health Professionals (AHP): from March 2017, the UHB introduced a new process for all AHP/Scientific agency bookings meaning this is now a VAT efficient process. 45

46 Workforce, although significant, is not the only challenge and the UHB is introducing a turnaround process to help with overall savings delivery. Learning from others, the detailed process for delivery is based on identifying turnaround themes and breaking these down into component parts or turnaround projects. Projects will be managed in accordance with a 60-day improvement cycle which will provide a planned, organised and structured way in which to develop clarity around an issue and arrive at an agreement on outcome measures. Much of the capital investment in year was directed at supporting Information Management and Technology and Medical and Other Equipment with less being spent on individual major projects. The projected deficit for 2017/18 is 58.9m. This represents a stabilisation position after accounting for loss of non recurring income. For 2017/18, WG have requested the UHB produce an Annual Plan with a view to being in a position to have an approvable IMTP in place for 2018/19 to 2020/21. As was the case in 2016/17, we have not reflected the 7.475m 2014/15 deficit, m 2015/16 deficit and m repayment, pending agreement with WG. The 2017/18 draft Annual Plan was agreed by the Public Board on 30 th March Our Performance Analysis Staying Healthy Domain Uptake of National Influenza Vaccine % uptake of the national influenza for the following groups: Staying Healthy Over 65 years of age Under 65 years of age in at risk groups Target 2014/ /16 % Trend Pregnant women Healthcare workers How are we doing? Overall, we have the lowest uptake rates by UHB in Wales. This is despite an additional 639 vaccinations given in Primary Care this season, as opposed to the equivalent date last year, which reflects the change in numbers of the population eligible for this intervention. Cultural barriers to influenza vaccination uptake remain in large parts of the population and challenging and overcoming these barriers remains a long term process. These barriers extend to a sizeable proportion of the Hywel Dda workforce who are resistant to accepting the offer of a vaccination. 46

47 How will we deliver? A range of actions are being undertaken to boost vaccination levels for both patients and staff within Acute, Primary Care, Community and the Voluntary sector. When will we deliver? A Situation, Background, Assessment and Recommendation report (SBAR) was presented to the UHB s Executive Team in early January 2017 with proposals to increase uptake rates and an emphasis on the potential for vaccinating patients in secondary care settings. Additional improvement actions continued across the remainder of the influenza vaccination season until 31 st March Chronic Conditions Staying Healthy Target Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-1 Jan-17 Trend Rate of emergency hospital admissions within a year for a basket of 8 chronic conditions per 100,000 of the population Rate of emergency hospital readmissions within a year for a basket of 8 chronic conditions per 100,000 of the population Reduce over 12 month Trend How are we doing? Both chronic condition measures have shown an improving trend up to November However, during the winter months, performance declined when admissions increased resulting in the 12 month reduction trend not being met. How will we deliver? The focus within the UHB of the Frailty programme and the Dementia programme will result in a positive impact to reduce admissions and readmissions for the basket of eight Chronic Conditions. The preventative agenda of the community resource teams in focussing on proactive case findings, in conjunction with the Primary Care disease registered patients, will improve performance. Work is underway to review the caseloads of the Community Specialist Nurses. Work is also underway with Welsh Ambulance Service Trust to review frequent callers and to develop management plans. The development of a Primary Care led Stay Well plan pilot in the 2Ts (Taf/Tywi) Locality in Carmarthenshire is also proving to be successful in managing patients in their own homes. 47

48 When will we deliver? The service aims to improve performance going forward following investment and the implementation of caseload reviews. Smoking Cessation Services Staying Healthy Target 2015/16 (Q1- Q3) 2016/17 (Q1- Q3) Trend % % of estimated LHB smoking population treated by NHS smoking cessation services % of smokers treated by NHS smoking cessation services who are CO-validated as successful How are we doing? We have improved our performance compared to last year for both measures. Uptake of Childhood Scheduled Vaccinations Staying Healthy % of children who received their scheduled vaccinations at age 4 Target Q1 (2016/17) Q2 (2016/17) % Q3 (2016/17) Q4 (2016/17) Trend How are we doing? We are below the target for this measure. How will we deliver? We have successfully appointed two Band 5 Community Nurse Immunisers to work with our vulnerable population and support existing immunisation clinics within the UHB, subject to assessment of need etc. We have appointed a Support Manager to the Children s Public Health Nursing Team who will support the Immunisation Coordinator with business cases for trying different models of immunisation delivery within all sectors of the population, starting with childhood immunisation. Within the Childhood Immunisation group, a task group will look at the data reporting, data recording and other data related issues, to cleanse the data to truly reflect the vaccination status of our population. When will we deliver? We would expect that a number of children will be vaccinated and that future Coverage Of Vaccination Evaluation Rapidly (COVER) reports would reflect this. 48

49 Hypertension Patients Staying Healthy Target Trend % of hypertension patients with last blood pressure reading in the last 12 months was <= 150/90 mmhg Annual improvement % How are we doing? The percentage of patients receiving a blood pressure check has dropped. This is set within the context of the absolute number of tests rising by 265 from 49,345 in 2015/16 to 49,610 in 2016/17. Practices are therefore working harder and delivering more care but showing a deteriorating position due to the aging population. How will we deliver? HYP006 is an active indictor in the Quality and Outcomes Framework for When will we deliver? We aim to improve by the end of the 2017/18 financial year. However, this will be set within the context of demographic change and sustainability challenges for GP Practices. Safe Care Domain Healthcare Acquired Infections: Clostridium difficile and Staphylococcus aureus Safe Care Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Trend Number of cases of C Difficile per 100,000 of the population Number of cases of S.Aureus Bacterae mia per 100,000 of the population How are we doing? Performance for Clostridium difficile infection has declined over the 12 months whilst Staphylococcus aureus blood stream infections have improved. How will we deliver? In addition to identifying the avoidable infections that arise in hospital, we are also reinforcing health promotion and infection prevention in the Community and Primary Care. The root cause of Clostridium difficile infection is antibiotic usage thus our focus is 49

50 implementing the Antimicrobial Delivery Plan for Wales to eliminate inappropriate antibiotic use. When will we deliver? The infection reduction expectation for the UHBs in Wales has now been revised with a retained focus on Clostridium difficile and Staphylococcus aureus and the new reduction expectation for Escherichia coli (E. coli). Fluoroquinolone, Cephalosporin, Co-amoxiclav Safe Care Fluoroquinolone items as a % of total antibacterial items prescribed Cephalosporin items as a % of total antibacterial items prescribed Co-amoxiclav items as a % of total antibacterial items prescribed Target Maintain performance levels within the lower quartile or show a reduction towards the quartile below Q1 (2016/17) Q2 (2016/17) % Q3 (2016/17) Q4 (2016/17) Trend How are we doing? The target has been met for the three antibacterial items measured. NSAID (Nonsteroidal Anti-inflammatory) Safe Care Target Q1 (2016/17) Q2 (2016/17) Q3 (2016/17) Q4 (2016/17) Trend NSAID average daily quantity per 1,000 STAR-PUs Maintain performance levels within the lower quartile or show a reduction towards the quartile below 17,14 1,723 1,615 1,589 How are we doing? The target has been met for this measure. 50

51 Submission of Yellow Cards Safe Care % GP practices >= national target for submission of yellow cards that monitor the safety of medicines. Target Annual improvement 2015/ /17 Trend % How are we doing? Although the provisional figure suggests 16.7%, All Wales Therapeutics and Toxicology Centre (AWTTC) have informed UHBs that there are issues with yellow card data received from the Medicines and Healthcare Products Regulatory Agency (MHRA) for Quarter /17. This is currently being investigated and we anticipate that corrected data will be available at the beginning of July How will we deliver? Educational sessions on yellow card reporting have been delivered via the UHBs GP Prescribing Leads forums. The Medicines Management team are reviewing yellow card reporting data and are providing GP practices with information on their practice. Prescribers are advised to review adverse drug reaction in order to identify those that are suitable to report via the yellow card system. GP Practices are being advised how to report electronically via their GP systems rather than using historic paper based systems. When will we deliver? Continually drive to encourage GP practices to review adverse reactions and to report those that are appropriate via the yellow card system in order to improve reporting rate. Patient Safety Solutions Safe Care Target Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Trend Number of Patient Safety Solutions Wales Alerts that were not assured within the agreed timescales Number of Patient Safety Solutions Wales Notices that were not assured within the agreed timescales NA NA *Where a blank appears in the table above this means that no alerts or notices were due for assurance in the given month. How are we doing? The service monitors Patient Safety Alerts and Notices as and when required. There are some months where no alerts are due for compliance which impacts on being able to demonstrate an improved performance. In addition, due to the small number of alerts 51

52 issued, the trend information and same period/end of financial year comparison is not available. Non compliant Patient Safety Alerts and Notices are regularly reported to the Quality Safety Experience and Assurance Committee (QSEAC). Serious Incidents and Never Events Safe Care Target Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Trend Of the Serious Incidents due for assurance within the month, % which were assured in the agreed timescale Number of new Never Events % How are we doing? There has been a significant increase in the number of Serious Incidents that require reporting to Welsh Government in recent years. In response to this, development work has been undertaken on the UHB s Datix system to ensure better tracking and overall management of Serious Incidents across the UHB. For the current financial year, the Assurance Safety and Improvement Team are undertaking a review of the process focussing on determining whether there is: 100% compliance with reporting all serious incidents to Welsh Government; Whether all incidents are reported within an agreed time-frame i.e. within 24 hours of the incident occurring; Whether the incident is investigated and closed within 60 working days. How will we deliver? Following the recent appointment of a dedicated resource to track all Serious Incidents processed by the UHB via the Datix system, it is anticipated this will have a positive impact on the UHB s compliance with Serious Incident reporting to Welsh Government. Weekly reports are also due to be submitted to the executive teams for performance purposes addressing all of the above. The UHB will continue to remain in contact with Welsh Government addressing any concerns immediately. When will we deliver? Training is underway and processes are still being firmed up. Having a dedicated resource and better utilisation of the Datix system can only improve the UHB s overall management of Serious Incidents for 2017/18 compared to previous years. 52

53 Dignified Care Domain Postponed Admitted Procedures Dignified Care Target % procedures postponed on >1 occasion, 12 month had reduction procedure trend <=14 days/earliest convenience Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 % Oct How are we doing? During the 2016/17 financial year, the UHB has improved in performance in comparison to 2015/16. How will we deliver? The UHB is committed to further improve by addressing the longstanding and complex issues that impact on the successful delivery of timely care to our patients. The planned care directorate aims to continually reduce cancelled operations and deliver further improvement to ensure patients waiting for elective surgery receive the best possible experience and outcomes. The Welsh Audit Office report on theatre utilisation recognises the need for corporate leadership to push forward a strategic work plan for theatres. The Theatre Improvement Group has been established in order to provide a framework for this to happen. When will we deliver? By improving systems and communications, the group is committed to improving the quality and safety of the service that is provided to patients with the aim of making a significant and material impact in cancellation numbers during 2017/18. The Theatre Improvement Plan has set the following targets to be reached by the end of the financial year: 1. 20% reduction in cancellation on the day of surgery due to patient being unfit for the procedure 2. 50% reduction in cancellations on the day / day before due to appointment being inconvenient 3. 50% reduction in administration errors leading to cancellation 4. Year on year improvements for cancellation due to lack of ward beds 5. Year on year improvements for cancellations due to unavailability of clinical staff 6. Reduce the number of patient inappropriate appointments to ensure an improved patient experience. Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Trend % of People Diagnosed with Dementia Dignified Care % of people with dementia, aged >=65 years, who are diagnosed 53 Target Annual improvement 2014/ /16 Trend %

54 How are we doing? The annual improvement target has been met. Direct Enhanced Services (DES) in Dementia Care Dignified Care % GP practice teams that have completed Mental Health DES in dementia care or other directed training Target Annual improvement 2014/ /16 Trend % How are we doing? There has been a marginal decline in performance when comparing 2014/15 to 2015/16. How will we deliver? Mental Health DES continues to be commissioned by Hywel Dda and has been amended to include three new training topics for When will we deliver? We aim to improve by the end of the 2017/18 financial year. Effective Care Domain Delayed Transfers of Care: Non- Mental Health Effective Care Target Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Trend DTOC per 10,000 Local Authority population - non mental health (aged 75+) - rolling 12 month period Reduce over 12 month trend How are we doing? Non-mental health delayed transfers of care have shown an improvement trend over the 12 month period. 54

55 Delayed Transfers of Care: Mental Health Effective Care Target Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Trend Rate of mental health delayed transfers of care per 10,000 of Local Authority population (all ages) Reduce over 12 month trend How are we doing? Mental health delayed transfers of care performance has improved over the year. How will we deliver? There has been significant focus on improving and ensuring a timely discharge for patients across the service. The impact has been seen throughout the year. There is significant regularly scrutiny by the service on all patients recorded as having a delayed transfer of care and this has recently been extended to other patients showing as having a long length of stay. When will we deliver? Further improvement targets have been agreed with the service for 2017/18 which aim to see the rolling 12 month rate of delayed transfers of care per 10,000 population reduce to 3.4 by the end of the year. Crude Mortality Effective Care Target Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Trend Crude hospital mortality rate (< 75 years of age) 12 month reduction trend % How are we doing? Over the last 12 months, the UHB has focused on the key targets in the table above following the recommendations made by Professor Stephen Palmer who concluded that a number of measures need to be brought together to achieve a comprehensive view and that Risk Adjusted Mortality Index as a single measure was not particularly useful or accurate. His report recommended that to obtain a more accurate view of quality and safety of services, a range of indicators need to be considered. Following Dr Palmers recommendations, the UHB monitored the following clinical indicators: 55

56 % of deaths within 30 days of emergency admission for a heart attack for patients aged 35 to 74 % of deaths within 30 days of emergency admission for a stroke % of deaths within 30 days of emergency admission for a hip fracture (age 65+) The UHB has achieved continuous improvement in all of the key measures over the last 12 months, showing a reduction in the overall Crude Hospital Mortality rate for patients less than 75 years of age. How we will deliver Over the next 12 months, the UHB will continue to focus on the delivery of these key targets. Additionally, with the current mortality reviews being maintained, we will continue to aim for improved performance. When will we deliver? The UHB is currently meeting the target. Clinical Coding Effective Care Target Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Trend % episodes clinically coded within one month post episode end date % How are we doing? The UHB has seen the trend for the new target improve consistently over the year. Performance for March 2017 is showing 65.6% but this is due to an error in submitting the data. The actual performance should have been 97.6% which is above the 95% target. How will we deliver? Achieving the 95% target is going to be a continual challenge through 2017/2018. There is a balancing act with regards to achieving the target but also not letting the backlog of coding build up. If we concentrated predominantly on the latest month, the increased backlog would then mean any data analysis, corporate reporting and finance data would not necessarily be as up to date and accurate as it should be. When will we deliver? There are plans in place to continue working towards achieving the target on a monthly basis during 2017/2018 although there will be a decrease in performance for the first three months due to the coding of the 2016/2017 backlog of which 98% need to be coded by the end of June

57 Clinical Research Effective Care Number of Health & Care Research Wales Clinical Research Portfolio Studies Number of commercially sponsored studies Number of patients recruited into Health and Care Research Wales Clinical Research Portfolio Studies Number of patients recruited into commercially sponsored studies. Target Annual Improvement Q1-Q3 2015/16 Q1-Q3 2016/17 Trend , How are we doing? The UHB is on target to reach the required increase in the number of portfolio research studies open in 2016/17 and are set to exceed the target for number of participants recruited into studies. The UHB is unlikely to meet the annual target to increase the number of commercially sponsored studies by five or to increase the number of participants recruited into commercially sponsored studies by five. During 2016/17, there have been major changes in the structure and organisation of the NHS Research and Development research delivery infrastructure in Wales. In some organisations, this has included Transfer of Undertakings (Protection of Employment) Regulations TUPE of staff and all organisations have seen an adjustment of research delivery staff funding, previously population based, towards an activity based funding model. In Hywel Dda, this has meant that there were vacancies early in the year that were put on hold due to uncertainty over future funding. Our commercial research nurse has also been on maternity leave this year and this has affected set up and recruitment in commercially sponsored studies. How will we deliver? Because of the increase in activity for non-commercial research studies, Hywel Dda has seen an increase in activity based funding for 2017/18. This funding will be used to increase research delivery staff across the UHB in order to support the clinical research targets, including an extra research nurse based in Glangwili General Hospital and an extra research nurse to support commercial research development in Prince Phillip Hospital. We are also working hard to bring more commercial studies into Hywel Dda and plan to use income from these studies to support further posts. We are still experiencing long term issues with provision of space for research across the UHB. We have also recently appointed to a new post of Grant and Innovation Manager. Part of the role of this new post is to work with clinicians and other collaborators to increase the number of successful research grant applications into Hywel Dda, leading to increased study activity and funding. There are a number of successful grant applications that have recently been awarded. 57

58 When will we deliver? In Hywel Dda, we have seen a year on year increase in the number of clinical research portfolio studies and the number of patients recruited into these portfolio studies. The target for improvement is 10% each year. In 2016/17, we are likely to have had a 20% increase in patients recruited and therefore the target for next year (10% more than this year) will be more difficult to achieve. We are monitoring and trying to boost commercial clinical trial activity with more staff and three new trials are imminent or in set-up. With extra staff recruited to support commercially sponsored research studies, we anticipate that we will be able to increase the number of studies and participants recruited into commercial studies. We are also actively seeking commercially sponsored studies that could be supported in our District General Hospitals where there is no dedicated clinical research facility. Individual Care Domain Helplines Individual Care Target Q1 16/17 (Apr Jun) Q2 16/17 (Jul - Sep) Q3 16/17 (Oct - Dec) Q4 16/17 (Jan - Mar) Trend Rate of Welsh resident calls to the mental health C.A.L.L helpline per 100,000 of HB pop Rate of Welsh resident calls to the Wales Dementia helpline per 100,000 pop (aged 40+) Rate of Welsh resident calls to the DAN 24/7 helpline per 100,000 HB pop 4 Quarter Improvement Trend

59 How are we doing? Although there has been an improved performance in the rate of Welsh resident calls to the Wales Dementia helpline, there has been a reduction trend in the rate of calls to the Community Advice and Listening Line (C.A.LL) and Drug and Alcohol (DAN) helplines. Mental Health Individual Care Target Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 % Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Trend % of LHB residents (all ages) to have a valid CTP completed at the end of each month 12 % of LHB residents sent their outcome assessment report 10 working days after assessment Individual Care % of hospitals with arrangements to ensure advocacy available to qualifying patients Month Trend Annual Trend months ending March months ending March 2017 % Trend How are we doing? Two of the Mental Health (Wales) measures have shown an improvement trend over the 12 month period. The advocacy arrangement metric remained static at 100%. How will we deliver? The directorate will continue to closely monitor Care and Treatment Plans (CTPs) and outcome assessments through the Mental Health Scrutiny structures. The Directorate reviews the advocacy figures recorded on a monthly basis to identify those areas where performance is low. The service managers, together with ward managers, will scrutinise every breach that has occurred and address non-compliance with the individual staff responsible at the time of admission to help increase staff awareness and improve compliance. 59

60 When will we deliver? The Directorate aims to continually improve during 2017/18. Timely Care Domain GP Practices Timely Care % GP practices offering appointments between 17:00 and 18:30 on 5 days a week % GP practices open during daily core hours or within 1 hour of the daily core hours Target Annual improvement Annual improvement % Trend How are we doing? The annual improvement target has been met for both measures. My Health Online Timely Care Of the practices set up to use MHOL, % who are offering appointment bookings Of the practices set up to use MHOL, % who are offering repeat prescriptions Target Annual improvement Annual improvement Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Trend % How are we doing? There is an improvement in the number of practices set up to use My Health Online but deterioration in the number of practices offering appointment bookings. 60

61 How will we deliver? The Primary Care Team continue to liaise with all GP practices regarding implementing the prescribing module and identifying ways to implement the appointment module for appropriate clinics. When will we deliver? We aim to improve by the end of the 2017/18 financial year. Dentists Timely Care Patients treated by an NHS dentist in the last 24 months as % of population Mar-16 Jun-16 Sep-16 Dec-16 Target Trend % Improve How are we doing? Patients treated by an NHS dentist have shown an improving trend over the 24 month period. Referral to Treatment Timely Care % of patients waiting less than 26 weeks for treatment all specialties Number of referral to treatment 36 week breaches all specialties Target Apr-16 May-16 Jun-16 Jul-16 Aug Sep-16 % 12 month improve trend 0 4,652 4,798 4,788 5,002 5,192 4,852 4,809 4,730 5,040 4,827 4,059 2,666 How are we doing? Both referrals to treatment measures have shown an improvement trend over the 12 month period. How will we deliver? In order to meet the planned profile, the operational team, in collaboration with clinical colleagues, used various methods of validation to ensure the waiting list was clean and patients were seen and treated in turn. These methods included: Virtual validation where internal validators and clinicians reviewed stage two and three patients and made office-based decisions regarding investigations. Patients were contacted by letter when no further treatment was required and pathways were subsequently closed. This also removed the lengthy wait for a follow up appointment Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Trend

62 Patients were contacted, either by letter or telephone, to ascertain if they wished to remain on the waiting list The operational teams consisting of service managers and the internal validation team undertook a review of the overall Patient Tracking List (PTL) on each new data file which was run every other day. This ensured the directorate achieved a clearer position to schedule and prioritise patients in the 36 week and over cohort Weekly Watchtower meetings prioritised the work of both the validation team and the service management team as improvements were seen across stages and the priorities shifted. The service aims to add therapy breaches to the live Patient Tracking List (PTL) on a weekly basis so that the teams have a transparent view of the validation required to reduce the waits as required. Longer term objectives for the operational team include accurate representation at the National Planned Care Programme meetings and appropriate sub/collaborative groups across the UHB, together with the involvement of the transformation team. All potential 36 week and over breaches continue to be validated, providing assurance that longer waits on the PTL are accurate and still waiting for treatment. Services continue to work on improvement projects, interventions and changes to facilitate a further reduction in breach numbers. The operational team have engaged the newly established transformation team to assist and support in a number of improvement initiatives. These are outlined as follows: A review of all outpatient clinic templates including number of slots and variation between clinicians. This will ensure clinic sessions are maximised and there is uniformity across the service Identification of referral criteria for top three clinical conditions within services Monitor impact of referral criteria for top three clinical conditions Establish access to specialist advice for top three clinical conditions In addition, there continues to be: Referral to treatment awareness and training is in progress with secretaries on all sites All stages of the Patient Tracking List were monitored on a daily basis by the Scheduled Care General Manager and relevant Service Delivery Managers. When will we deliver? During 2017/18, the service aims to maintain the 2016/17 end of year position as closely as possible. Diagnostic Waits Timely Care Target Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 No-16 Dec-16 Jan-17 Feb-17 Mar-17 Trend Number of patients waiting less than 8 weeks for specific diagnostics

63 How are we doing? The number of patients waiting less than 8 weeks for diagnostics has shown a significant improvement in 2016/17. How will we deliver? Each area maintained their position by following their current plans, outlined as follows: Radiology continued to use overtime, an agency locum and bank working Cardiology heads of service continually monitor diagnostic lists closely. The department is supported by locum Echo-Cardiographers that are in the process of being recruited on a substantive basis In Urodynamics, the department is continuing to offer respective tests at different sites until staffing levels are replaced In Endoscopy, service managers and waiting list teams continually monitor patient lists to resolve potential breaches When will we deliver? The target was met in the last 6 months of the financial year. Delayed Follow-Up Appointments Timely Care Target Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 No-16 Dec-16 Jan-17 Feb-17 Mar-17 Trend Total patients waiting for a follow up appointment delayed past target date booked & not booked Reduce 12 month trend 29,686 28,576 28,418 29,306 29,434 29,932 29,506 30,612 31,728 29,318 25,089 25,225 How are we doing? The total patients delayed waiting for a follow up appointment has shown an improvement trend over the 12 month period. How will we deliver? The Outpatient Programme is utilising a Programme Management Office approach, setting up robust governance and accountability structures and key deliverables for this work which is being tracked and managed under this framework. This has now been established and includes a programme initiation document with key performance indicators which are monitored and linked with efficiency value realised. Weekly meetings have now been established with the service delivery managers, service managers and senior nurse managers to support the outpatient work. This work is now being supported by an enhanced Service Improvement and Transformation team. When will we deliver? During 2017/18, the Outpatient Transformation group will continue with an action focused agenda with high level objectives to achieve the needed improvements. 63

64 Stroke Timely Care Target Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Trend % compliance with stroke quality improvement measures: Direct admission to Acute Stroke Unit (<4 hrs) % compliance with stroke quality improvement measures: CT Scan (<12 hrs) % compliance with stroke quality improvement measures: Assessed by a Stroke Consultant (<24 hrs) % compliance with stroke quality improvement measures: Thrombolysis door to needle <=45 mins 58.5 SSNAP UK average 93.5 SSNAP UK average 81.9 SSNAP UK average 12 month improvement trend % How are we doing? Three of the four stroke measures have shown an improvement trend over the 12 month period and are performing above the Sentinel Stroke National Audit Programme (SSNAP) UK average. The other stroke measure has shown a slight downward trend over the 12 month period. Assessed by stroke consultant within 24 hours has shown a variable performance over the period. Some of this variation can be attributed to a lack of seven day working and the patterns of when stroke patients present. The thrombolysis door to needle times within 45 minutes has shown a slight downwards trend during the period but across the year a 12 month improvement trend is witnessed. Although this measure is affected by the relatively small numbers of patients, further work is required to improve performance in this area. 64

65 How will we deliver? The stroke plan has been developed which identifies the investments required to meet the standards recommended by the Royal College of Physicians for clinical nurse specialist and therapies staffing. In parallel with the stroke plan, cost neutral improvement plans are being developed from weekly and monthly site performance review meetings and the monthly Stroke Steering Group meeting. 4 hour target Although the UHB performance is in excess of the SSNAP UK average, further work is planned to improve the communications between departments and to reduce delays in the handover of patients on all sites across the UHB. 12 hour target The UHB performance of undertaking Computerised Tomography (CT) scanning within 12 hours is also in excess of the SSNAP UK average but the UHB is now aiming to consistently achieve this level of performance on a monthly basis through continued focus on communications and a review of the current pathways on each site. 24 hour target The review of patients by stroke consultants within 24 hours is limited by the lack of seven day working and is dependent upon when stroke patients present. Local work will look to maximise the review of stroke patients during the working week. Further work is being discussed at a regional level with the Regional Collaboration for Health (ARCH) programme and the development of a regional Hyper Acute Stroke Unit. Thrombolysis Although the numbers of patient s thrombolysed is small, further work is now underway to review the thrombolysis pathways on all sites. Particular attention is being made to improve education and communication for out-of-hours staff who may have limited exposure to thrombolysis compared to stroke specialist staff. When will we deliver? The stroke plan has been submitted and work is now underway to determine the priorities for investment. In parallel, cost neutral improvement work is being undertaken and improvement trajectories have been developed based upon a focused review of performance and the development of improvement actions. As additional investment is realised through the stroke plan, the improvement trajectories will be adjusted to incorporate this. 4 hour waits in A&E Timely Care %of new patients to spend no longer than 4 hours in A&E Target Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 % Trend 65

66 How are we doing? Demand for emergency services has risen during 2016/17. Four hour A&E performance has improved throughout the year and Prince Philip Hospital has consistently delivered above the target. However despite improvements the measure has not achieved the required standard. How will we deliver? The Unscheduled Care Programme, chaired by the Director of Operations, oversees a plan of work delivered by Acute, Community, Mental Health, Primary Care and Welsh Ambulance Service Trust colleagues. Its focus is the improvement of the whole unscheduled care system and will look at key areas with clear actions and timescales, and aim to improve patient flow across the acute hospital sites. When will we deliver? In 2017/18, we aim to consistently and as a minimum ensure at least 85% of patients wait less than 4 hours with aspirations to significantly improve this. Ambulance Red Calls Timely Care % of emergency responses to red calls arriving within (up to and including) 8 minutes Target Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 % How are we doing? Since October 2015, when the new clinical response model was introduced, performance has shown an improvement trend and the target is being met in 2016/17 with only one month falling just short (February 2017). Ambulance Handovers 1 Hour Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Trend Timely Care Target Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Trend Number of Ambulance handovers over 1 hour How are we doing? Ambulance handover delays over one hour have shown a declining trend over the 12 month period and improved on the previous year. 66

67 How will we deliver? The Unscheduled Care Programme, chaired by the Director of Operations, oversees a plan of work delivered by Acute, Community, Mental Health, Primary Care & Welsh Ambulance Service Trust colleagues focuses on improving the whole unscheduled care system which aims to deliver improved patient flow across the acute hospital sites. A key aspect to ensuring timely ambulance offload is sufficient bed availability by time of day so that A&E does not become blocked with patients waiting for inpatient beds. This is dependent on the discharge pathway from hospital and ensuring patients have clear discharge plans and appropriate community support. At Prince Philip Hospital, Medical patients are seen in an Adult Medical Assessment Unit and this has resulted in a reduction in ambulance delays and patient flow has improved, through timely assessment and treatment of patients. When will we deliver? As a minimum, we aim to achieve 12 handover delays at Withybush General Hospital and 3 at Prince Philip Hospital by the end of 2017/18 and reduce our numbers significantly at Glangwili General Hospital to 47 and Bronglais General Hospital to 14. Our aim is to continue to see a reduction in ambulance handover delays over 1 hour through 2017/18 reducing steadily through the year to no more than 76 per month by March hour waits in A&E Timely Care Target Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Trend Number of patients spending 12 hours or more in A&E How are we doing? Demand for emergency services has risen during 2016/ hour A&E performance has been maintained. However, despite improvements, this measure has not achieved the required standard. How will we deliver? The Unscheduled Care Programme, chaired by the Director of Operations, oversees a plan of work delivered by Acute, Community, Mental Health, Primary Care and Welsh Ambulance Service Trust colleagues. Its focus is the improvement of the whole unscheduled care system and will look at key areas with clear actions and timescales and aim to improve patient flow across the acute hospital sites. When will we deliver? Our aim is to significantly reduce the number of patients waiting more than 12 hours during this financial year. This will be dependent upon delivering the unscheduled care plan. 67

68 Cancer Waiting Times Timely Care Non Urgent Suspected Cancer:% patients referred via the non urgent cancer route seen within 31 days Urgent Suspected Cancer:% patients referred via the urgent cancer route seen within 62 days Target Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 % Oct Non-Urgent Suspected Cancer How are we doing? Performance in respect of the Welsh Government non-urgent suspected cancer shows a declining trend. However, the target was met on five occasions over the 12 month period. Where performance fell below target levels, this was predominantly due to delays for specialist tertiary centre treatments. Where treatments are available locally within Hywel Dda, the UHB has consistently demonstrated its ability to deliver treatments within 31 days of an agreement of treatment plans with patients. Urgent Suspected Cancer How are we doing? Performance in respect of the Welsh Government urgent suspected cancer shows an improving trend in performance for 2016/17. However, the target is not being met. How will we deliver? The UHB continues to pursue a range of actions across several cancer tumour sites which are designed to support further improvements in the timeliness of diagnostic and treatment pathways, as well as working closely with the tertiary cancer centre partners to improve access to very specialist treatments not available locally within the UHB. When will we deliver? We are aiming to continue to meet the targets in 2017/18. Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Trend 68

69 LPMHSS (Local Primary Mental Health Support Services) Timely Care Target Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 % Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Trend % of assessments by the LPMHSS undertaken within 28 days from the date of referral % of therapeutic interventions started within 28 days following assessment by LPMHSS How are we doing? Performance has shown an improvement in both measures over the12 month period. How will we deliver? Demand for Primary Care level Mental Health interventions remains high and is increasing year on year. Work is underway to strengthen the model of the Local Primary Care Mental Health Support Service. Psychology education courses are being commissioned out to be run by the third sector and this will both improve access to these interventions and increase capacity for the registered practitioners to deliver assessments and 1-1 interventions. When will we deliver? The directorate aims to continually improve during 2017/18. Our Staff and Resources Domain New and Follow-Up Outpatient Did Not Attend (DNA) Rates Our Staff and Resources Target Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Trend New outpatient DNA rates for selected specialties Follow-up DNA rates for selected specialties 12 month reduction 12 month reduction

70 How are we doing? We have not met the 12 month reduction target for new outpatient DNA rates but the target has been achieved for follow-up DNA rates. How will we deliver? The UHB s Outpatient Transformation Programme plan is to reduce DNA rates across identified specialties. The aim is to reduce DNA rates within the identified specialties which have a greater DNA rate over 5% by 50%. A working group has been established which are progressing key actions to impact on the reduction of DNAs. This includes: An improved access policy Patient acknowledgement, invitation and confirmation letters co-designed with the public and aligning with the new access policy Improved text reminder service Implementation of a no follow up process for diagnostic results until formally reviewed DNA policy enforced and monitored by scrutiny of the data An increased use of virtual clinics, contacting patients via various methods to convey information and clinic appointments Weekly meetings with service delivery managers and senior nurse managers to review and facilitate the improvement When will we deliver? The aim is to improve our performance in 2017/18. Inhaled Corticosteroids Our Staff and Resources % of inhaled corticosteroids prescribed in primary care that are low strength Target Maintain performance level within upper quartile or show an increase towards the quartile above Q1 2016/17 Q2 2016/17 % Q3 2016/17 Q4 2016/17 Trend How are we doing? An increasing trend is seen with this indicator with movement towards the national target. How will we deliver? Review of the Hywel Dda respiratory guidance is currently taking place. Prescribers are advised to review high dose inhaled corticosteroids and step down in appropriate patients. When will we deliver? Continually drive review of high dose inhaled corticosteroids to maintain an upward trend. 70

71 Do Not Do Procedures Our Staff and Resources Target Feb-16 Mar-16 Apr-16 May-16 Jun-16 July-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Trend Number of ENT procedures that do not comply with NICE Do Not Do guidance for procedure of limited effectiveness (as agreed by the Planned Care Board) Number of ophthalmology procedures that do not comply with NICE Do Not Do guidance for procedure of limited effectiveness (as agreed by the Planned Care Board) Number of orthopaedics procedures that do not comply with NICE Do Not Do guidance for procedure of limited effectiveness (as agreed by the Planned Care Board) Number of urology procedures that do not comply with NICE Do Not Do guidance for procedure of limited effectiveness (as agreed by the Planned Care Board)

72 How are we doing? The UHB has improved performance and met its 12 month reduction target in ophthalmology and urology. Ear Nose and Throat (ENT) and orthopaedics have not met the 12 month reduction target. Staff Appraisals Our Staff and Resources % of staff who undertook a performance appraisal (PADR) who agreed it helped them improve how they did their job Target Improvement target Trend % How are we doing? In relation to the staff survey results, we improved on 133 of the 145 comparable questions. This particular question was the only one in the section on PADR where a slight decrease was seen. While this is the case, 76% of staff agreed that the appraisal/review helped them agree clear objectives for their work and 61% felt that the appraisal left them feeling their work was valued by the organisation which was an improvement of 5% on the 2013 survey. How will we deliver? We are revising our PADR documentation to strengthen the link with core objectives and improve the link between PADR and work improvement. PADR has high profile within the UHB and we are striving to improve the quality of the discussions through development programmes and specific PADR training. When will we deliver? We are monitoring through our pulse surveys and will be able to give a like-for-like comparison at the next NHS staff survey. Staff Engagement Our Staff and Resources Overall staff engagement score Target Improvement target Trend % How are we doing? The improvement target has been met for this measure. 72

73 Staff Sickness Our Staff and Resources Target Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 % Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Trend % staff sickness absence 12 month reduction trend How are we doing? The 12 month reduction target has been met for this measure. Staff Our Staff and Resources % staff who would be happy with the care by their organisation if a friend/relative needed treatment Target Improvement target Trend % How are we doing? The improvement target has been met for this measure. Hywel Dda University Health Board received a progress report in January 2017 to provide assurance of the work which had been on-going with Public Service Board (PSB) partners to develop well-being assessments. The UHB subsequently received and endorsed the PSB well-being assessments at its meeting on 30 th March 2017 and, during the same meeting, approved the publication of its well-being statement and objectives. The wellbeing objectives were also reflected within the UHB s Annual Plan 2017/18. Link to the Well-being Statement and Objectives 2017/18: final-draft-mar-2017-large-format.pdf Long-Term Expenditure Trend The UHB has a requirement to report on long term expenditure trends and detailed below is the expenditure incurred over the last five years from 2012/13 to 2016/17 within the main programme areas of: Hospital and community health services Primary health care services Healthcare from other providers 73

74 The expenditure trends of the UHB over its main programme areas from 2012/13 to 2016/17 are as follows: Programme Area Primary Health Care Services Healthcare from Other Providers Hospital and Community Health Services 2012/ s 2013/ s 2014/ s 2015/ s 2016/ s 167, , , , , , , , , , , , , , ,923 Where the UHB undertakes activities that are not funded directly by the Welsh Government, the UHB receives income to cover its costs which will offset the expenditure reported under the programme areas above. When charging for this activity, the UHB has complied with the cost allocation and charging requirements as set out in HM Treasury guidance. The miscellaneous income received for the last five years is as follows: 2012/ s 2013/ s 2014/ s 2015/ s 2016/ s Miscellaneous Income 58,127 56,107 53,436 51,698 52,934 Well-Being of Future Generations (Wales) Act 2015: Well-Being Statement The Wellbeing of Future Generations (Wales) Act 2015 establishes both individual and statutory responsibilities for the UHB. On a collective basis, the UHB must work as a statutory partner on Public Services Boards (PSBs). PSBs are aligned to each local authority area in Wales and bring together a collection of public bodies and other partner organisations working together to improve the economic, social, environmental and cultural wellbeing of our area. Our UHB worked with each PSB to support the publication of a Well-being Assessment setting out the state of economic, social, environmental and cultural wellbeing in its area. In 2017/18, each PSB will publish a Well-being Plan setting out local well-being objectives and the steps the PSB partners will take to meet them. Like all of the individual public bodies named in the Act, the UHB must follow the sustainable development principle - meeting the needs of the present without compromising 74

75 the ability of future generations to meet their own needs. Hywel Dda University Health Board fulfilled its individual responsibilities by publishing a Well-being Statement and Objectives on 30 th March The Well-being Objectives were also reflected within the UHB s Annual Plan 2017/18. The Board has agreed there is strong alignment of the Strategic Objectives set out in our Annual Plan submitted to Welsh Government and their contribution to maximising the delivery of the principles of the Act and the seven national Well-being Goals for Wales. During 2017/18, the UHB has defined its Well-being Objectives as: Improve population health through prevention and early intervention Support people to live active, happy and healthy lives Improve efficiency and quality of services through collaboration with people, communities and partners Ensure a sustainable, skilled and flexible workforce to meet the changing needs of the modern NHS Further information about our Well-being Statement and Objectives can be found at the following link: Our Sustainability Report Sustainable Development (SD) is a central organising principle of the Welsh Government. Although not directly applicable to devolved governments, the Welsh Government request public bodies in Wales who report under the FReM to produce a Sustainability Report. Accordingly, this section of our annual report covers the environmental performance of the organisation, written in line with public sector requirements set out in the FReM and supplementary HMT Guidance Sustainability Reporting in the Public Sector. Description of Organisation Hywel Dda University Health Board has an estate covering circa 52 hectares containing 57 freehold and leasehold premises totalling circa 188,043m2. This includes four acute hospitals, seven community hospitals and administration, health centre and clinic, mental health and accommodation facilities. Environmental Management Governance Board assurance on environmental and sustainability performance is provided via the Business Planning and Performance Assurance Committee, with work coordinated by the Estates, Capital and IM&T sub committee. Action is delivered in line with the international environmental management standard ISO A monitoring system is in place to gather the data required for sustainability reporting. This system is audited annually by the NHS Wales Shared Services Partnership Audit and Assurance Services and periodically as part of external ISO audits. Summary of Performance A focus on good practice has enabled improvements in key areas of sustainability. Year 2 of our Energy Performance Contract (EPC) delivered reductions of 634,701 plus VAT and 4,567 tco 2 (based on 2010/11 baseline). The introduction of fuel efficient pool cars for staff journeys has also supported our drive to reduce CO 2 emissions. The project is being expanded in 2017/18. In line with the Environment (Wales) Act, expanding food waste collections and the commencement of projects seeking to increase and improve recycling facilities has seen our recycling rate increase 5% to 38%. 75

76 Continual improvement in this area is coordinated through our Environmental Management System (EMS), on which work is well underway to achieve the new 2015 version of the ISO standard. Greenhouse Gas Emissions Improvements in national renewable energy generation and the use of our own Combined Heat and Power (CHP) units resulted in a 5% reduction of CO 2 e emissions from electricity use. Emissions associated with oil, gas and business mileage have increased however and overall our CO 2 e emissions increased by 1.9% in 2016/17. Greenhouse Gas Emissions Non Financial Indicators (1000 tco 2 e) Total Gross Emissions Gross Emissions Scope 1 from Gas and Oil Gross Emissions Scope 2 & 3 from electricity and business mileage Related Energy Consumption (million KWh) Electricity: Non 20.17* 14.42* Renewable Electricity: Renewable Gas 51.9* 62.14* LPG Oil Biomass Financial Indicators Expenditure on Energy CRC License Expenditure Expenditure on official business travel 4,896,655* 4,088,359* 4,157, , , ,578** 2,848,813 2,751,059 3,038,985 *these figures include estimated data for a small number of sites use DEFRA Greenhouse Gas Emissions for Company Reporting calculations for carbon emissions for 2016 **estimate pending submission of annual CRC report Following last years significant reduction in spend due to the new Energy Performance Contract (EPC), this year has seen a 1.7% increase linked to the usual 3% creep in energy consumption at our sites. This is a national trend and relates to the day to day equipment and technology we use to run our services. 76

77 Year 2 of our 10 year EPC successfully delivered 55,470 savings over and above the contracted savings. This helped counteract the impact of increasing oil costs. Year 1 of the Health Boards pool car scheme has been a success with 99,900 miles travelled by 238 registered users in low emission vehicles, supporting CO 2 reduction across our grey fleet. Use of park and ride scheme has also improved this year, a lower emission travel option which also relieves pressure on hospital parking. Our long running cycle to work scheme continues to be popular with staff and 56 signed up this year. Overall our business mileage and associated expenditure has increased and this provides a focused for 2017/18 on alternatives to single occupancy car journeys. Waste Management Total waste disposal rose by circa 9% this year. This reflects service delivery such as the ophthalmology unit at Withybush Hospital and a change in waste practices e.g. moving away from using macerators for food waste. The biggest change was seen in improved recycling figures as our Environment Team, guided by the Environment Act, focused on extending food waste collection schemes (a move away from using macerators) and increasing source segregated recycling. Our continually improving recycling rate is now at 38%. Clinical waste sent for heat treatment (orange bags) remained steady however domestic waste, hygiene waste and waste sent for incineration (sharps containers) increased by 2.5%, 9% and 7.5% respectively. Reducing waste production is a challenge the Health Board will seek to address in 2017/18 by continuing the roll out of recycling facilities, raising awareness of correct waste segregation and focusing on resource efficiency. Overall, expenditure has increased by 8% largely due to new food waste collections but also the annual rate increase on collection services. 77

78 Non Financial Indicators (tonnes) Waste Total Waste ,155 2,345 Landfill (Black Bag) Reused/Recycled Composted* Landfill (Hygiene Bag) Alternative Treatment (Clinical) Incinerated with energy recovery** Incinerated without energy recovery Financial Indicators Total Disposal Cost 668, , ,677 Landfill (Black Bag) 145, , ,562 Reused/Recycled 61,739 63,209 71,259 Composted* 1,073 4,433 15,223 Landfill (Hygiene Bag) Alternative Treatment (Clinical) Incinerated with energy recovery** Incinerated without energy recovery *includes Anaerobic Digestion **provides steam to a nearby facility 104, , , , , , , , , Use of Resources Water consumption has increased in year reflecting activity on site but also a range of infrastructure and compliance issues such as identified water leaks and necessary flushing of systems. Rates increase year on year also and this is particularly pertinent for sewage charges linked to Welsh Water infrastructure improvements. 78

79 Finite Resource Consumption Non Financial Indicators (m 3 ) Water Consumptio n (Office)* Water Consumptio n (Non - Office)*** Supplied 228, , ,591 Abstracted 0 11,178 22,593 Per FTE** Supplied 31,311 29,436 30,216 Abstracted Financial Indicators Water Supply Costs (Office)* 313, , ,183 Sewerage Costs (Office)* 329, , ,321 Water Supply Costs (Non - Office)*** 30,301 26,174 26,918 Sewerage (Non -Office)*** 31,937 32,064 33,872 *All estate with the exception of the main laundry at Glangwili and the Bryntirion Central Production Unit ** WTE Staff at 31 st March *** Main laundry at Glangwili and the Bryntirion Central Production Unit only Environmental Management System (EMS) - Implementation Hywel Dda University Health Board continues to be externally audited and maintains compliance with the requirements of the international standard for Environmental Management Systems, ISO The EMS has been in use since 2012 and the Environment Team is now working towards updating the system to reflect the newer 2015 version of the standard. 79

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81 Hywel Dda University Health Board Accountability Report 2016/

82 Chapter 3: Our Accountability Report Corporate Governance Report Annual Governance Statement Scope of Responsibility The Board is accountable for Governance, Risk Management and Internal Control. As Chief Executive Officer (CEO) of the Board, I have responsibility for maintaining appropriate governance structures and procedures as well as a sound system of internal control that supports the achievement of the organisation's policies, aims and objectives, whilst safeguarding the public funds and the organisation's assets for which I am personally responsible. These are carried out in accordance with the responsibilities assigned by the Accountable Officer of NHS Wales. The Hywel Dda University Health Board (the UHB) recognises that governance is at the heart of public services and underpins how resources are managed, how decisions are made, how services are delivered and the impact they have, now and in the future. Governance infuses how organisations are led and needs to be robust, proportionate and dynamic, and avoid being over bureaucratic. Effective governance involves sufficient consideration of arrangements for oversight and strikes the right balance between autonomy and intervention and clarity around how governance arrangements operate in practice, contribute to increased transparency and public accountability. At Hywel Dda, we strive to achieve a consistent and shared understanding of, and commitment to, standards of ethics and conduct to be observed by all those involved in public service delivery this is the essence of Hywel Dda. In my closing observations included in the Annual Governance Statement for the 2015/2016 financial year, I commented that it was becoming evident that there would be fresh challenges for the Board during 2016/2017. This has undoubtedly been the case and this Annual Governance Statement for the current year covers a period of unprecedented challenges for the Hywel Dda University Health Board (the UHB). The UHB was already subject to Welsh Government Enhanced Monitoring under the NHS Wales Escalation Framework arrangements and in October 2016, this was escalated to Targeted Intervention in recognition of the fact that we have been facing a number of long standing challenges that require more a more strategic solution. The change in our escalation status with Welsh Government is both a reminder of these challenges and, I strongly believe, part of the process to finally resolve them. For us in Hywel Dda, the status of targeted intervention means that we are receiving support from the Welsh Government to help us develop an approved three year business plan (Integrated Medium Term Plan) and return to a sound financial footing. The UHB has welcomed this support and is looking forward to working in partnership with the Welsh Government to provide a more concentrated and strengthened approach to putting the organisation on a sound financial footing, with an approved Integrated Medium Term Plan. We have unique challenges in Hywel Dda, providing healthcare to a large geographical area, mainly rural but with urban pockets and with significant workforce challenges. During the year the UHB has been working very hard to make improvements, not just by ensuring prudent use of our finances but also in improving our workforce position, in tandem with being wholly committed to making improvements to the services provided to patients where they are most needed. I am therefore pleased to be able to report that our performance across a number of Tier 1 targets in 2016/2017 has held or improved on the previous year. 82

83 Progress has been made during the year to better understand the scale of the financial issue and to stabilise the position as much as possible and there is now a commitment from the UHB and the Welsh government to work together to tackle this. The Board is confident that with the additional support, we have an opportunity to provide the organisation and the patients we serve with the assurance that we have a sustainable plan and financial position for the future. In all of this, our staff continue to rise to the challenge, consistently providing patient centred care and working with the Board on improvements and innovation and for this we are hugely grateful to them. We have a rich and diverse team that make up our Hywel Dda family with our professions represented by staff from here in Britain, the European Union and across the world and all make a lasting contribution to the delivery of our services and their efforts are sincerely appreciated. In support of governance principles, one of the key pieces of work progressed during 2016/2017 was the implementation of our Values and Behaviours Framework which was approved by the Board in July Designed by Staff for Staff, we launched our organisational values which will shape the future delivery of services across the UHB. As an organisation I feel it is important that we have a set of behaviours that we are all aligned to and will benefit from. These values represent how we do things and the behaviours expected of those working for the UHB. As illustrated above, the personal values are: Dignity, Respect and Fairness, Integrity, Openness and Honesty; Caring, Kindness and Compassion. In addition to the personal values, there are three statements that represent the organisation values: working together to be the best we can be; striving to develop and deliver excellent services; putting people at the heart of what we do. These values are also integral to the essence of Hywel Dda. The Board is responsible for maintaining appropriate governance arrangements to ensure that it is operating effectively and delivering safe, high quality care. It also recognises the need to govern the organisation effectively and in doing so build public and stakeholder confidence. In the course of the previous year the Board reviewed and restructured the way it was organised. Those changes brought more focus to vital areas such as quality and performance, devolved responsibility to leadership teams and increased clinical involvement in all that we do. Within this context and building on the foundations that were previously set, the Board has been considering this year on how it can ensure that it has the strongest possible focus at Executive level, this also reflecting one of the issues highlighted in the escalation to targeted intervention and in previous Wales Audit Office Structured Assessment reports. As it was felt that the organisation must build its capacity and capability to ensure appropriate and manageable focus in key areas to support the 83

84 Board s positive intentions, it was clear that a review of Executive portfolios was necessary to ensure balance and appropriateness. The structure of the Executive Team has therefore been strengthened during the year, ensuring we have the capacity to address the challenging agenda ahead. It also ensures due regard to the regulatory requirements set out in the Local Health Boards (Constitution, Membership and Procedures) (Wales) Regulations All Board members share corporate responsibility for formulating strategy, ensuring accountability, monitoring performance and shaping culture, together with ensuring that the Board operates as effectively as possible. The Board, which comprises individuals from a range of backgrounds, disciplines and areas of expertise, has during the year provided leadership and direction, ensuring that sound governance arrangements are in place. Taking the above principles into account, the principal role of the Board during the year has been to exercise leadership, direction and control as shown in the following figure: Formulate Strategy Setting the strategic direction within overall WG NHS policies; Compelling organisational vision; Quality & patient safety at core; Longer term view (3 5 years); Financially sustainable; Workforce needs identified; Whole system approach; Clear outcomes and milestones. Understanding of external context and landscapes The Board has a comprehensive understanding of statutory, accountability and organisational context within which it has to operate. Core Roles Ensure Accountability Rigorous and constructive challenge; Clear responsibilities & accountabilities for staff; Triangulating information sources; Recognising good performance; Seeking assurance that the systems of control are robust and reliable; Assurance and reassurance where problems & concerns are evident. Board Leadership (Embedding the Seven Principles of Public Life) Accurate and timely information and intelligence Ensure that Performance Information is reliable to enable effective scrutiny & challenge. Enabling Factors Shape Culture Commitment to openness, transparency & candour; Takes the lead in establishing and promoting values and standards of conduct for the organisation & its staff; Outward looking; Visible. Constructive engagement with internal and external stakeholders Effective Board engagement regarding planning & performance & is responsive to identified needs. The Board has an open culture with its meetings held in public and meeting papers, as well as those of its committees, are available on the UHB s website. The Board has a strong and independent non-executive element and no individual or group dominates its decision making process. The Board considers that each of its non-executive members is independent of management and free from any business or other relationship which could materially interfere with the exercise of their independent judgement. There is a clear division of responsibility in that the roles of the Chair and CEO are separate. 84

85 Board and Committee Membership The Board has been constituted to comply with the Local Health Boards (Constitution, Membership and Procedures) (Wales) Regulations In addition to responsibilities and accountabilities set out in terms and conditions of appointment, Board members also fulfil a number of Champion roles where they act as ambassadors for these matters. Board and Committee Membership and Champion roles during were as follows and reflect a number of changes during the year due to the departure of both Independent and Executive Board Members: NAME POSITION AREA OF EXPERTISE REPRESENTATION ROLE BOARD COMMITTEE MEMBERSHIP/ ATTENDANCE ATTENDANCE AT MEETINGS 2016/2017 CHAMPION ROLES Bernardine Rees Chair (Chair) Board (Chair) Remuneration & Terms of Service Committee 7/7 5/6 Carers Sian- Marie James (until ) Vice Chair Mental Health Primary Care & Community Services (Vice Chair) Board Quality & Safety Experience Assurance Committee (Chair) Mental Health Legislation Assurance Committee Charitable Funds Committee Audit & Risk Assurance Committee University Partnership Board (Chair) Primary Care Applications Committee Business Planning Performance Assurance Committee 3/3 2/2 1/1 0/1 3/5 2/2 2/2 1/2 Judith Hardisty (from ) Interim Vice Chair Mental Health Primary Care & Community Services Vice Chair) Board Quality & Safety Experience Assurance Committee (Chair) Mental Health Legislation Assurance Committee Audit & Risk Assurance Committee University Partnership Board (Chair) Primary Care Applications Committee Business Planning & Performance Assurance Committee 2/2 3/3 2/2 N/A 2/3 3/3 3/3 Judith Hardisty (from ) Vice Chair Mental Health Primary Care & Community Services (Vice Chair) Board Quality & Safety Experience Assurance Committee (Chair) Mental Health Legislation Assurance 2/2 0/1 1/1 85

86 NAME Julie James Mike Ponton John Gammon Don Thomas POSITION Independent Member Independent Member Independent Member Independent Member AREA OF EXPERTISE REPRESENTATION ROLE Third Sector Community University Finance 86 BOARD COMMITTEE MEMBERSHIP/ ATTENDANCE Committee Audit & Risk Assurance Committee (Chair) Primary Care Applications Committee Business Planning & Performance Assurance Committee Board Quality Safety & Experience Assurance Committee Audit & Risk Assurance Committee Charitable Funds Committee Remuneration & Terms of Service Committee Primary Care Applications Committee Business Planning & Performance Assurance Committee Board (Chair) Business Planning & Performance Assurance Committee Audit & Risk Assurance Committee Quality Safety & Experience Assurance Committee Remuneration & Terms of Service Committee Primary Care Applications Committee Board Quality Safety & Experience Assurance Committee (Chair) University Partnership Board Mental Health Legislation Assurance Committee Business Planning & Performance Assurance Committee Board Audit & Risk Assurance Committee Remuneration & Terms of Service Committee ATTENDANCE AT MEETINGS 2016/2017 N/A 1/1 1/1 7/7 6/6 9/13 3/5 5/6 5/6 5/6 5/7 6/6 7/13 5/6 5/6 3/6 6/7 5/6 3/4 3/4 1/5 6/7 13/13 6/6 CHAMPION ROLES Concerns Children & Young People s Services Armed Forces & Veterans Judith Independent Board 3/3 Emergency

87 NAME Hardisty (until ) David Powell Margaret Rees-Hughes Simon Hancock POSITION Member Independent Member Independent Member Independent Member Adam Morgan Independent Member Paula Martyn Associate Member AREA OF EXPERTISE REPRESENTATION ROLE Information, Communications & technology Community Local Authority Trade Union (Chair) Stakeholder Reference Group 87 BOARD COMMITTEE MEMBERSHIP/ ATTENDANCE Business Planning & Performance Assurance Committee Quality, Safety & Experience Assurance Committee University Partnership Board Board Audit & Risk Assurance Committee Business Planning & Performance Assurance Committee Charitable Funds Committee Primary Care Applications Committee Board Mental Health Legislation Assurance Committee Audit & Risk Assurance Committee Business Planning & Performance Assurance Committee (Chair) Quality Safety & Experience Assurance Committee Charitable Funds Committee Board Charitable Funds Committee Business Planning & Performance Assurance Committee Audit & Risk Assurance Committee University Partnership Board Board Charitable Funds Committee Quality Safety & Experience Assurance Committee Mental Health Legislation Assurance Committee ATTENDANCE AT MEETINGS 2016/2017 2/2 1/2 N/A 7/7 11/13 6/6 5/5 5/6 6/7 4/4 10/13 6/6 5/6 3/5 4/7 5/5 4/6 9/13 1/4 5/7 5/5 4/6 4/4 Board 4/7 N/A Jake Morgan Associate Director of Social Board 3/7 N/A CHAMPION ROLES Planning Cleaning Hygiene & Infection Management Welsh Language Unscheduled Care Older People Equalities & Diversity related legislation

88 NAME POSITION AREA OF EXPERTISE REPRESENTATION ROLE BOARD COMMITTEE MEMBERSHIP/ ATTENDANCE ATTENDANCE AT MEETINGS 2016/2017 CHAMPION ROLES Member Services Phil Parry (until 30/06/2016) Associate Member Chair (Healthcare Professionals Forum) Board 0/2 N/A Steve Moore Chief Executive Officer Board 7/7 Time to Change Wales Mental Health Joe Teape Deputy Chief Executive Officer/ Director of Operations Board Mental Health Legislation Assurance Committee Audit & Risk Assurance Committee Quality Safety & Experience Assurance Committee Business Planning & Performance Assurance Committee 7/7 1/4 10/13 5/6 6/6 Delayed Transfers of Care Sustainable Development Security Karen Miles (until ) Director of Finance, Planning & Performance Board Business Planning & Performance Assurance Committee NHS Wales Shared Services Partnership Charitable Funds Committee Quality Safety & Experience Assurance Committee Audit & Risk Assurance Committee 5/5 4/4 2/2 4/4 5/5 10/10 N/A Karen Miles (from ) Director of Planning, Performance & Commissioning Board Business Planning & Performance Assurance Committee Quality Safety & Experience Assurance Committee 2/2 2/2 Stephen Forster (from ) Interim Director of Finance Board Business Planning & Performance Assurance Committee NHS Wales Shared Services Partnership Charitable Funds Committee Quality Safety & Experience Assurance Committee Audit & Risk Assurance Committee 2/2 1/1 1/1 0/1 2/3 88

89 NAME POSITION AREA OF EXPERTISE REPRESENTATION ROLE BOARD COMMITTEE MEMBERSHIP/ ATTENDANCE ATTENDANCE AT MEETINGS 2016/2017 CHAMPION ROLES Charitable Funds Committee Caroline Oakley (until ) Director of Nursing, Quality & Patient Experience Board University Partnership Board Business Planning & Performance Assurance Committee Quality Safety & Experience Assurance Committee 2/2 0/1 2/2 2/2 Children & Young People s Services Violence & Aggression Mandy Davies (from ) Interim Director of Nursing, Quality & Patient Experience Board University Partnership Board Business Planning & Performance Assurance Committee Quality Safety & Experience Assurance Committee 5/5 1/3 4/4 5/5 Children & Young People s Services Violence & Aggression Kathryn Davies (until ) Director of Commissioning, Primary Care, Therapies & Health Scientists Board University Partnership Board Quality Safety & Experience Assurance Committee Business Planning & Performance Assurance Committee Primary Care Applications Committee Welsh Health Specialised Services Committee Emergency Ambulance Services Committee N/A 1/1 0/1 0/1 Jill Paterson (from ) Interim Director of Commissioning, Primary Care, Therapies & Health Scientists Board University Partnership Board Quality Safety & Experience Assurance Committee Business Planning & Performance Assurance Committee Primary Care Applications Committee Welsh Health Specialised Services Committee Emergency Ambulance Services Committee 7/7 3/3 5/5 5/6 6/6 3/3 2/2 Lisa Gostling Director of Workforce & Board University Partnership 7/7 N/A 89

90 NAME POSITION AREA OF EXPERTISE REPRESENTATION ROLE BOARD COMMITTEE MEMBERSHIP/ ATTENDANCE ATTENDANCE AT MEETINGS 2016/2017 CHAMPION ROLES Organisational Development Board Quality Safety & Experience Assurance Committee Business Planning & Performance Assurance Committee Staff Partnership Forum Remuneration & Terms of Service Committee 4/6 5/6 5/5 6/6 Teresa Owen (until ) Director of Public Health Board University Partnership Board Quality Safety & Experience Assurance Committee Business Planning & Performance Assurance Committee 5/5 4/5 4/5 Emergency Planning Public Health Consultants (shared) From ) Director of Public Health Representative Board Business Planning & Performance Assurance Committee 2/2 1/1 Sarah Jennings Director of Governance, Communication & Engagement Board University Partnership Board Quality Safety & Experience Assurance Committee Business Planning & Performance Assurance Committee Audit & Risk Assurance Committee Stakeholder Reference Group Charitable Funds Committee 5/7 4/4 6/6 5/6 8/13 1/3 5/5 Public Patient Involvement Joanne Wilson Board Secretary Board Audit & Risk Assurance Committee 7/7 13/13 N/A Phil Kloer Medical Director & Director of Clinical Strategy Board University Partnership Board Quality Safety & Experience Assurance Committee Business Planning & Performance Assurance Committee 6/7 3/4 6/6 6/6 Caldicott At a local level, Health Boards in Wales must agree Standing Orders for the regulation of proceedings and business. They are designed to translate the statutory requirements set 90

91 out in the LHB (Constitution, Membership and Procedures) (Wales) Regulations 2009 into day to day operating practice, and, together with the adoption of a scheme of matters reserved to the Board; a scheme of delegation to officers and others; and Standing Financial Instructions, they provide the regulatory framework for the business conduct of the University Health Board and define - its 'ways of working'. These documents, together with the range of corporate policies set by the Board make up the Governance Framework. The following table outlines dates of Board and Committee meetings held during 2016/2017, with all meetings being quorate: Meeting Dates of Meeting Board Audit & Risk Assurance Charitable Funds Quality, Safety & Experience Assurance Mental Health Legislation Assurance Business Planning Performance Assurance Primary Care Applications University Partnership Board (2 meetings) (2 meetings) (2 meetings) (Extraordinary) Remuneration & Terms of

92 Service The Board and its Committees The Committees of the Board, chaired by Independent Members, have key roles in relation to the Governance and Assurance Framework. On behalf of the Board they provide scrutiny, development discussions, assessment of current risks and performance monitoring in relation to a wide spectrum of the UHB s functions and its roles and responsibilities. Each of the main committees of the Board is supported by an underpinning sub-committee structure reflecting the remit of its roles and responsibilities. The committees have met regularly during the year with update reports outlining key risks and highlighting areas of development being provided to the Board to contribute to its assessment of assurance and provide scrutiny against the delivery of objectives. The committees as well as reporting to the Board, also work together on behalf of the Board to ensure where required that cross reporting and consideration takes place and assurance and advice is provided to the Board and the wider organisation. The Wales Audit Office (WAO) Structured Assessment 2016 acknowledged that the Board and its committees are generally operating effectively with evidence of on-going improvements to management and performance information and scrutiny of this information. The Board recognises that there are remaining opportunities to further strengthen operation of the committees and is committed to ensuring that this work continues. Our system of Governance and Accountability during the year is therefore demonstrated in the following diagram: 92

93 Advisory Groups Health Professionals Forum Staff Partnership Forum Stakeholder Reference Group HYWEL DDA UNIVERSITY HEALTH BOARD Joint Committees Welsh Health Specialised Services Committee NHS Wales Shared Services Partnership Emergency Ambulance Services Committee Public Service Boards Quality, Standards and Patient and Staff Safety Audit and Risk Assurance Committee Capital Estates & IM&T Sub Committee Mid & West Wales Health & Social Care Collaborative South Wales Health Collaborative Mid Wales Healthcare Collaborative Business Planning & Performance Assurance Committee South Wales Acute Care Alliance National Complex Care Board Area Planning Board (Substance Misuse) Information Governance Sub Committee Charitable Funds Committee CFC Sub Committees: Acute Services Pembrokeshire Ceredigion Carmarthenshire MH&LD Emergency Planning and Health and Safety Sub Group Local Resilience Forum Mental Health Legislation Assurance Committee Hospital Managers Powers of Discharge Executive Team Workforce & OD Sub Committee Improving Experience Sub Committee Strategic Safeguarding Sub Committee Effective Clinic Practice Sub Committee Quality, Safety & Experience Assurance Committee Quality Safety & Experience Sub Committees: Acute Primary & Community MH&LD Remuneration and Terms of Service Committee University Partnership Board Research Governance Sub Committee Key Lilac Statutory Blue Established by HB Orange only meets when applications to consider Red Groups with wider representation than HB Primary Care Applications Committee Corporate and Clinical Risk Management Types of Internal and External Assurance Community Health Councils, Older Persons Commissioner, Patient Groups Statutory Inspections (H&S Executive) Information Commissioner Welsh Language Commissioner Regulatory Bodies (WAO, Healthcare Inspectorate Wales, Welsh Risk Pool) Clinical Audit & Effectiveness Internal and External Audit 93