HYWEL DDA LOCAL HEALTH BOARD ANNUAL REPORT AND ACCOUNTS 2011/2012

Transcription

1 HYWEL DDA LOCAL HEALTH BOARD ANNUAL REPORT AND ACCOUNTS 2011/2012

2 Welcome to Hywel Dda Local Health Board s Annual Report and Accounts for 2011/12. It has been a year full of innovation, engagement, challenges and celebration so it is important for us to first recognise and thank all our hardworking staff and volunteers for their ongoing commitment. It is a challenging time for the NHS and your hard work and dedication to providing the best care and support for patients remains constant and at the heart of everything we do. We are both extremely proud to be able to champion the ongoing excellence of Hywel Dda staff to the rest of Wales and the health board will work hard to meet its challenges to ensure you can continue to provide the care our community deserves in the years ahead. We are pleased to report that 2011/12 saw a number of firsts take place within Hywel Dda. In December, the Health Minister received the country s first health and social care co-design framework, recognising the contribution of the third sector in the delivery of services to support patients and carers and redefining how the health board works with the third sector. In June, Siarad Iechyd/Talking Health the first NHS public membership scheme in Wales was launched. To date, members have participated in events, readers panels, interest groups, surveys and volunteering and have contributed to many projects and initiatives, such as improving signage at Withybush Hospital. Most significantly, in December, we became the first health board in Wales to launch a comprehensive engagement period with the public on how services may be delivered in the future. It was extremely invaluable to be able to share the work done with senior clinicians and wider staff as to how we could deliver services across Carmarthenshire, Ceredigion, and Pembrokeshire. We feel as Hywel Dda health Board we have benefited from the listening and engagement exercise. We have reflected on the concerns and considered carefully alternative proposals for change. In August 2012, we launched our formal public consultation, due to end in October and we encourage all of the community to be involved in this process. Throughout our engagement we have championed how the NHS must change if it is to meet the challenges of the future, such as recruitment and retention in increasingly specialised medical fields, an increasingly older population and more people developing long term conditions such as diabetes and asthma. Our priority is to provide the safest and highest quality, sustainable and accessible care and using all our resources as effectively as possible that everyone can be proud of. Chris Martin, Chair Trevor Purt, Chief Executive 2

3 Hywel Dda Health Board Annual Report and Accounts 2011/12 1Introduction to Hywel Dda Health Board Who we are Hywel Dda Health Board is the provider of all healthcare services for Carmarthenshire, Ceredigion and Pembrokeshire. The health board was formed on 1 October 2009 following a reorganisation of NHS Wales, merging the Hywel Dda NHS Trust, Pembrokeshire Local Health Board, Ceredigion Local Health Board and Carmarthenshire Local Health Board. At the heart of local health, the health board is committed to improving the health and general wellbeing of its community. The organisation provides acute, primary, community, mental health and learning disabilities services via general and community hospitals, health centres, GPs, dentists, pharmacists and optometrists and other sites for around 375,000 people across Carmarthenshire, Ceredigion, Pembrokeshire and bordering counties. Our Mission Statement and Values We will provide care closer to home We will focus on quality, safety and improving outcomes We will ensure we have a flexible, skilled and motivated workforce We will invest in prevention We will eliminate waste, duplication and ensure value for money Our Vision We want to prevent the causes of ill health in our population and deliver the highest quality of healthcare for the people of Hywel Dda. This will mean providing the right care, in the right place, at the right time - every time. Adding Life to Years and Years to Life Our vision is to deliver a world class health care system of the highest quality with improved outcomes for the people of Hywel Dda. Across the health board area we need to: Improve the health and wellbeing for all Move from a sickness service to a wellness service Deliver quality healthcare in the most appropriate setting 3

4 have high quality, safe and sustainable hospital services that meet the needs of our population be recognised as Wales leading integrated rural health and social care system Our vision is to provide 80% of NHS services locally, through primary, community and social care teams working together from community resource centres. Our Services We bring together community, primary and secondary care services for around 375,000 people across our three counties and beyond. The health services we refer to throughout this document are primary care services (our GPs, dentists, pharmacists and optometrists); community services (often provided by our community team of nurses and therapists); secondary care services (in-hospital care) and specialised services (provided in specialist/tertiary centres). Primary care services are delivered by: 55 GP practices (main sites) 51 dental practices 100 community pharmacies 52 optometry premises Our community and secondary care services are currently delivered through: Four hospitals; Bronglais Hospital in Aberystwyth, Glangwili Hospital in Carmarthen, Prince Philip Hospital in Llanelli and Withybush Hospital in Haverfordwest Eight community hospitals Eleven health centres There are numerous locations and settings across our three counties from which mental health, learning disabilities and related services are provided. Specialised and tertiary services those highly specialised treatments such as neuro-surgery and cardio-thoracic surgery - are planned by the Welsh Health Specialised Services Committee (WHSSC); a joint committee of all seven health boards in Wales. Engaging with our public We are a person centred organisation and recognised the importance of giving our public, our staff and our stakeholders the chance to influence our thinking at an early stage. We aim to: Keep people well-informed about health services and policies 4

5 Hywel Dda Health Board Annual Report and Accounts 2011/12 Listen and respond to people s views and concerns through established ongoing engagement mechanisms Engage people in decisions about changes to services and policies Improve accessibility and accountability to local people Build trust Throughout 2011/12 the health board used a variety of methods to engage and involve patients, service users and the general public, including, but not limited to: Training clinical and non-clinical staff to take and learn from patient stories and experiences of health services (see page 37) The launch of Siarad Iechyd/Talking Health in June 2011, an involvement and engagement scheme open to all staff, stakeholders and the general public. Members are invited to get involved in various activities including focus groups, surveys and receive regular communication from the health board (see page 6) Informing the health board-wide committee looking at the provision of non-emergency patient transport as part of each county s Citizens Panels (see page 38) Your Health, Your Future Since 2010, we have been listening and engaging with our clinicians and stakeholders to find out what we need to do locally to meet these challenges and ensure we can provide safe, sustainable services of a high quality. From December 2011 to the end of April this year, we tried hard to engage with our local people, staff and stakeholders to be clear on what services we currently have and what we need to put in place for the future. This level of engagement was unprecedented in Wales. This exercise resulted in: Over 10,000 hits on the health board s online resource centre Thousands of documents ed, downloaded, sent to key stakeholders and made available in community locations Over a 1,000 people visiting one of 13 Meet the Health Board events Six staff roadshows, attended by over 650 staff Meetings with the full Council of each local authority Meetings with county consortiums of town and community councils Meetings with hospital campaign groups Events in Powys and Gwynydd supported by the health board Feedback from the listening and engagement exercise was independently collated by Opinion Research Services (ORS), including qualitative data gathered from direct conversations, focus groups and letters from individuals. The report provided the health board a significant depth and breadth of feedback from staff, partners, patients and local population and is available to download on the health board s website. 5

6 Hywel Dda Health Board began the formal consultation period on 6 August 2012 and in view of the timing of the launch, and to ensure everyone has he time to consider these options and comment on the, the health board has made the decision that there will be a 12 week consultation period ending on 29 October Siarad Iechyd/Talking Health Listening to and taking action on the views of staff, patients and general public is vital if we are to develop and deliver high quality health services to meet the needs of local people. The launch of the health board s membership and engagement scheme Siarad Iechyd/Talking Health in June 2011 marked a significant step forward in providing a platform for local people to engage directly with the health board. Open to all who use health board services or living in Carmarthenshire, Ceredigion and Pembrokeshire, members receive regular newsletters and updates and are invited to take part in events, readers panels, interest groups, surveys and volunteering. There are also a number of health benefits and incentives that members receive to help them improve their health. Sign up today by visiting or call Working in Partnership If the health board is to deliver world class quality care, we need to continue the significant partnership work that has taken place throughout 2011/12 to design the best services that give easier access to services and care delivered closer to home. Local service boards The health board is an active member of the Carmarthenshire, Ceredigion and Pembrokeshire Local Service Boards (LSBs). Local service boards are where the leaders of local public and third sector organisations come together to ensure public services are effective and citizen focused. LSBs: Improve the quality of life and joined-up service delivery for citizens in their areas Provide the leadership to ensure that difficult issues across public services are confidently managed not avoided or ignored Stimulate integration, co-ordination and co-operation between local, regional and national public sector organisations Set an example of innovative, citizen-focused leadership at the heart of the local partnership and delivery system 6

7 Hywel Dda Health Board Annual Report and Accounts 2011/12 Ensure an effective whole system response to the needs of citizens by pooling resources "Unblock blockages" by removing bureaucracy or other obstacles Memorandums of Understanding Memorandums of Understanding have been signed between Hywel Dda Health Board and Aberystwyth University, and with the University of Wales Trinity Saint David. The agreements will build on existing collaboration in areas such as research, continuing professional development and provision of shared services. A Chair of Rural Behavioural Science and Wellbeing the first in Wales - will also be jointly appointed to be an ambassador for rural health services across the Hywel Dda Health Board community. The Chair will act as a research and policy lead in four main areas; rural economics and social marketing; improved access to services; greater service integration; and community cohesion and engagement. It is intended that further partnerships with other public or voluntary bodies can also be explored, each bringing their own unique strengths to the project. Health Board Members Hywel Dda Health Board meets six times a year, on alternate months. Meetings of the Health Board are held in public across the three counties. Directors during 2011/12 Job Title Name Committees Detail Chairman Chris Martin Remuneration Committee (Chair), Litigation Committee (Chair), Strategy & Planning Sub-Committee (Chair) Vice Chair Sian-Marie James Mental Health Power of Discharge Committee (Chair), Audit Committee, Quality & Safety Committee Charitable Funds Committee Board Champion for Mental Health From October 2011 Chief Executive Trevor Purt Health Board and Key Committees 7

8 Medical Director Dr Simon Mahon (Joint) Dr Sue Fish (Joint) Executive Directors Health Board and Key Committees Director of Planning, Performance & Delivery Tony Chambers Health Board and Key Committees Director of Nursing & Midwifery Caroline Oakley Health Board and Key Committees Director of Primary, Community & Mental Health Services Karen Howell Health Board and Key Committees From July 2011 Director of Therapies & Health Science Kathryn Davies Health Board and Key Committees Director of Finance and Economic Reform Karen Miles Health Board and Key Committees Director of Workforce and Organisational Development Acting Director of Public Health Janet Wilkinson Dr Lyn Harris Health Board and Key Committees Health Board and Key Committees Independent Members (representing the community and specialist fields on the Health Board) Eifion Griffiths Audit Committee (Chair), Remuneration & Terms of Service Committee (Vice- Chair), Quality & Safety Committee, Mental Health Power of Discharge Committee Board Champion for Estates& Design Sustainable Development Security 8

9 Hywel Dda Health Board Annual Report and Accounts 2011/12 Management Julie James Melanie Jasper Jane Jeffs David Powell (from 01/12/2011) Margaret Rees-Hughes Neil Sandford Charitable Funds Committee (Vice Chair), Integrated Governance Committee, Mental Health Power of Discharge Committee Quality & Safety Committee (Vice Chair), Mental Health Power of Discharge Committee Quality & Safety Committee, Charitable Funds Committee (Chair), Mental Health Power of Discharge Committee Integrated Governance Committee, Audit Committee, Mental Health Power of Discharge Committee Quality & Safety Committee (Chair), Audit Committee, Charitable Funds Committee, Mental Health Power of Discharge Committee Remuneration & Terms of Service Committee, Integrated Governance Committee, Quality & Safety Committee, Mental Health Power of Discharge Committee Board Champion for Third Sector HR IM lead for Partnership Directorate Board Champion for Complaints, Public & Patient Involvement, Armed Forces & Veterans, and Children & Young Peoples' Services Board Champion for IT Systems & Services Information Governance & IT Security Patient Information & Records National Strategy & Systems, via NWIS Board Champion for Welsh Language, and Cleaning, Hygiene & Infection Management Board Champion for Violence & Aggression 9

10 Don Thomas Cllr. David Wildman Integrated Governance Committee (Chair), Audit Committee (Vice-Chair), Remuneration & Terms of Service Committee, Mental Health Power of Discharge Committee, Charitable Funds Committee Integrated Governance Committee (Vice-Chair), Audit Committee, Mental Health Power of Discharge Committee Board Champion for Older People Delayed Transfers of Care Dignity & Respect The following directors, who are formally associate directors, also attend board meetings, but do not have voting rights: Job Title Name Committees Comment Director of Corporate Services Christopher Wright Health Board and Key Committees Director of Strategic Partnerships Director of Clinical Services Sarah Veck Dr Philip Kloer Health Board and Key Committees Health Board and Key Committees From October 2011 The following directors and independent members left their position in 2011/2012: Job Title Name Comment Vice Chair Janet Hawes Until September 2011 Director of Primary Care, Community & Mental Health Bernardine Rees OBE Until May 2011 Independent Member Tim Irish Until November

11 Hywel Dda Health Board Annual Report and Accounts 2011/12 2Delivering a wellbeing service Our Ten Pledges In May 2011, the health board launched its business plan that clearly states what we want to achieve and how we will achieve it across a range of health issues at every stage of life. It allows us to create a modern, more efficient healthcare service that will meet the challenges of the future, shifting care closer to people s homes and supporting self-care to help individuals live independent lives. To support our vision, ten pledges have been made to help local people lead healthier lives, to enjoy a better quality of life and to live longer. In 3 years time, we will: Help 12,000 people to lose weight Help 5,000 people to stop smoking or prevent from starting Help prevent or stop 7,500 people drinking to excess In 5 years time, we will: Help prevent 200 people a year from developing heart disease Ensure, wherever possible, that no-one with a known long term condition is admitted to unexpectedly to hospital with that condition Reduce the number of people dying from cancer by 100 a year Help prevent 125 people a year from suffering a stroke Double the number of mothers breastfeeding their babies from birth up to 6 months of age In 10 years time, we will: Increase life expectancy by 3 years in the areas with the lowest life expectancy and improve quality of life for all Promoting our Ten Pledges A multi-agency Healthy Living Partnership Information Group (HeLPInG) was established by the health board to co-ordinate local, regional and all-wales campaigns with a focus on the ten pledges. The group s membership includes Hywel Dda Health Board, Public Health Wales and Carmarthenshire, Ceredigion and Pembrokeshire County Councils. 11

12 Key successes to date include: An innovative online Healthy Living Countdown Calendar, hosted by the health board in December that provided healthy living tips and signposting to further information. Aimed to stimulate people to make healthy New Year resolutions, the calendar also aimed to develop a supportive environment for people to make small changes to their lives to benefit their wellbeing. Healthy Wednesday, an ongoing campaign to encourage people to engage in healthy activities every Wednesday - a 'nudge' towards healthier living which cascades to other days of the week. Monthly campaigns developed inline with the multi-agency campaign calendar. Each campaign incorporates a specifically designed character named Hywel, press releases, social media messages, radio interview/s and features placed in staff newsletters, shared across the five organisations working towards the same messages and aims. Ten Pledge Progress The Director of Public Health Annual Report is a source of further information about the health of the Hywel Dda population. To mark the starting position of Hywel Dda, we feel it is important to include information available in this year s report relating to 2010/11. Smoking Cessation In 2010/11, 2,360 smokers contacted Stop Smoking Wales across Hywel Dda for support to quit, of which 1,097 participated in a six-week behavioural support programme. 69% reported having quit smoking at four-week follow up of which 47% of participants were validated by carbon monoxide testing. These figures do not include smokers helped through the local community pharmacy (Level 2) scheme, in GP practices who provide their own local support or within the health board s two hospitals that employ in-house smoking cessation support. Smokebugs prevention 2,235 children in the Hywel Dda area were members of Smokebugs during 2010/11. Smokebugs is a Welsh Government initiative to encourage children aged between 8-11 years old to not experiment with smoking. Helping pregnant smokers to quit Hywel Dda Health Board and Stop Smoking Wales are working together to provide a new and improved system that ensures all pregnant women who smoke are automatically referred to Stop Smoking Wales, unless they wish to opt out, as a routine part of their antenatal care. 12

13 Hywel Dda Health Board Annual Report and Accounts 2011/12 Stop Smoking Wales has also trained 34 midwives across Carmarthenshire, Ceredigion and Pembrokeshire to equip them with the skills to discuss smoking with pregnant women and their partners, explain the benefits of quitting in pregnancy, and encourage and motivate women to quit. Smoke free sites To protect non-smokers Hywel Dda Health Board has put in place a smoke free policy, as required by Welsh Government in recognition of its responsibility to promote public health to all its employees, patients and visitors. Hywel Dda is committed to guaranteeing the right of everyone to breathe smoke free air on all its sites. Diabetes The ambition of the health board over the next three years is to dramatically increase the quality and consistency of primary care to reduce the number of people with diabetes needing to visit hospital for treatment. To support the improved initial diagnosis and then ongoing treatment of people with diabetes, the health board introduced a new enhanced service in April 2012 to encourage practices to care for more patients within the community. Phase 1 will provide patient care closer to home while Phase 2 will actively search for at risk diabetics and pre-diabetics. The health board aims to improve detection and improve patient education and self management, improving care of diabetics and reversing, or slowing the onset of full blown diabetes. Hypertension The early identification and effective management of hypertension plays a key role in the prevention of cardiovascular disease. We must ensure that patients are provided with opportunities to assess their need and consider available interventions. Chronic Obstructive Pulmonary Disease (COPD) COPD remains a leading cause of disability, emergency hospital admission, readmission and mortality. It also contributes to the life expectancy gap between the least and most affluent and contributes significantly to sickness absence. A number of indicators of successful impact to improve care have been identified: Patients are diagnosed and treated at an earlier stage of disease Treatments in primary care, especially prescribing, are appropriate and cost effective 13

14 Referrals to specialists are more appropriate, timely and focused, especially for those patients with complex or resistant disease GP audits of their diagnostic accuracy rates Pulmonary Rehabilitation Pulmonary rehabilitation programmes have been used more widely this year by the health board to support those with more severe respiratory problems. Pulmonary rehabilitation is an evidence based programme of exercise training and education which aims to prevent physical deconditioning and empowers people with lung disease to self-manage their condition. Carmarthenshire already has a successful model in place and this continues. The first pulmonary rehabilitation course in Pembrokeshire took place in partnership with Pembrokeshire Local Authority and courses continue to run across Pembrokeshire. Ceredigion also commenced a successful programme and plans are in place to run more across the county to ensure they are accessible to the local population. There has been extensive research showing that the programme improves health related quality of life, increases exercise tolerance and reduces symptoms in people with chronic lung disease. It has been reported to reduce hospital readmission rates for patients with COPD from 33% to 7%. So far 85% of participants have made clinically significant improvements in terms of exercise tolerance and quality of life comparing very favourably with reported national response rates. Participants are supported to continue their exercise and lifestyle changes once they have completed the programme by National Exercise Referral Scheme instructors working within the leisure centre, later moving on to self management of their condition with confidence. EPP Cymru We have further developed our Educational Programme for Patients (EPP) this year, supporting people to manage their own conditions. As part of this development we have started an online programme targeting those people who are either housebound or are at work and are unable to attend in person. We are also extending this service to include a Self management for life programme specifically for people with respiratory conditions which will be delivered locally by health professionals and lay tutors. We currently have 14 trained tutors. It is anticipated that people living with chromic lung conditions will participate with the following benefits: Improvement in self management Improved health 14

15 Hywel Dda Health Board Annual Report and Accounts 2011/12 Improved quality of life Reduced likelihood of exacerbation Appropriate use of services, e.g. reduced need to attend A&E, GP appointments and avoidance of emergency hospital admission Epilepsy, ME and Chronic Fatigue Syndrome We have worked with action groups for epilepsy, ME and chronic fatigue syndrome to improve access to services for people with these conditions. Cancer Screening There are four population based screening programmes that are run across Wales: breast screening, bowel screening, cervical screening and newborn hearing screening. These aim to reduce the number of deaths from breast and bowel cancer, reduce the number of women developing and suffering the consequences of cervical cancer and detect babies with significant hearing loss early. In 2010/11: For breast screening, Hywel Dda is doing as well as the rest of Wales, but has not met the target uptake of 80%. For cervical screening Hywel Dda there is inequity between the three counties, and has not met the 80% target. For bowel cancer Hywel Dda are doing better than the Wales average, but still we do not meet the 60% uptake target. Hywel Dda has excellent coverage for newborn hearing screening at 99.4%. The HeLPInG group has strong Public Health Wales representation and will continue to actively support the screening message to the public. 15

16 3Care Closer to Home At Hywel Dda, we know that patients want to receive the care they need as close to home as possible. We want to provide 80% of all NHS care and treatment in the local community with only the most acutely ill needing hospital admission. We have to change to become more of a wellness service working to keep people healthy or cared for outside of hospital. To achieve this we need to continue to make a significant investment in primary and community care facilities, whilst ensuring our hospitals meet the needs of patients who require a higher level of in-hospital care. Investing in our Primary Care Facilities There has been significant additional investment made by both the health board and the Welsh Government in order to develop primary care facilities fit for new services and modern ways of working. Carmarthenshire Andrew Street, Llanelli The relocation of this surgery within the town centre s Boots store provides much larger, purpose designed accommodation and allows for expansion of services in the future. Llandybie development Work has been undertaken to establish a Health and Wellbeing Centre in the village. Funding has been made available to proceed. Pembrokeshire Barlow House Surgery and Robert Street Surgery This joint development will create a modern, purpose-designed and integrated primary care resource centre providing high quality patient care for the residents of Milford Haven. Ceredigion Meddygfa Padarn Surgery The new Meddygfa Padarn Surgery in Aberystwyth opened in March 2012, replacing the former premises on North Parade. The new facility offers an enhanced range of GP services and additional services will be located on the same site adjacent to the health facility; these include a renal dialysis unit, a pharmacy and a student wellness centre and crèche for Aberystwyth University. 16

17 Hywel Dda Health Board Annual Report and Accounts 2011/12 Community resource centres We are proposing to build new Community Resource Centres in Aberaeron, Carmarthen, Cross Hands, Crymych and Whitland, progress the Cardigan Hospital development and develop a new health and social care facility in Tregaron (Cylch Caron) with partners as part of a five year programme that will see 40million invested in primary and community care facilities. These centres are a major part of our plans to improve primary and community care and there is potential for some to be based in community hospitals. The centres will be used for a wide range of services, including tests, outpatient appointments, physiotherapy and mental health appointments. As skills and facilities develop, they can also be used for procedures, such as blood transfusions or intravenous antibiotics all of which result in providing care closer to home and taking the strain off hospitals. In some cases, the centres will be the home for GPs, and other relevant health and social care teams building a joined up approach to healthcare. The services in each centre may be different, depending on the health and care needs of the local population. Other primary care estates developments Scheme Carmarthenshire Meddygfa Tywi Overview of development Extension to provide additional treatment room & multi-purpose meeting/staff room Status Improvement grant application has been approved by the Assembly Government What next Work commenced in January 2012 Adfer Medical Practice Pembrokeshire Winch Lane Surgery To include an additional treatment room and 4 consulting rooms Extension to the Surgery to provide additional consulting rooms, meeting room & library Revenue application has been approved by the Assembly Government Improvement Grant application has been approved by the Welsh Government Additional accommodation opened February 2012 Work commenced March 2012, with a six month construction period 17

18 Saundersfoot Surgery Fishguard Health Care Centre Expansion of the current premises to provide additional space for consulting rooms, staff/meeting room, etc Provision of new GMS treatment room, improved staff facilities and improved DDA access Improvement Grant application is in the process of being developed. Options for refurbishing and increasing the amount of space for the GP practice have been agreed with the Practice Formal application completed in spring 2012 for submission to the Welsh Government Works completed in March 2012 Improving our Community Services Throughout 2011/12 we have continued to invest in community services and developed new ways of providing services traditionally provided in a hospital setting. Residential convalescence beds The convalescence beds service includes 12 beds at Llys y Bryn in Llanelli and eight beds at Maes Llewellyn in Newcastle Emlyn, and provides a residential convalescence model with rehabilitation support. The service allows older people a period of convalescence (gradual recovery of health and strength after illness) in a care home setting, with the aim being to enable older people to maintain their independence and gain confidence to return home. Since June 2010, 132 people have used the service with 77% returning home from Maes Llewellyn and 60% from Llys y Bryn with the support of either the enablement service or through an existing, increased or new domiciliary care package. Phlebotomy in the community A pilot phlebotomy service began in Asda supermarket in Llanelli in January The clinic is run through Wellbeing Regeneration Ltd and provides blood tests to patients who previously would previously have had to visit Prince Philip Hospital for their test. Locality networks Considerable work has commenced in line with Setting the Direction, the Primary and Community Services Strategic Delivery Programme, to ensure that locality networks are sufficiently resourced. 18

19 Hywel Dda Health Board Annual Report and Accounts 2011/12 Each locality has health and social care teams at differing stages of development and integration as well as community nursing services and specialist services, such as palliative care teams and Community Mental Health Teams. Each community resource team is bespoke to its locality. Community Virtual Wards We are transforming the way we support people with chronic diseases by developing virtual wards in each of the seven localities. These are groups of people identified from the GP s list who have higher healthcare needs and whose risk of health deterioration could be avoided if the right support was available much earlier. This will potentially avoid the need for a hospital admission or readmission. Patients will receive care in the comfort and convenience of their own home from skilled professionals and support staff. The wards will be operated by highly trained staff using cutting edge technology, such as telehealth monitoring, which allows us to keep a close eye on signs and symptoms. This important information can be sent to a trained nurse who will then be alerted to any deterioration in the patient s health. This will reduce the number of people who end up in hospital by supporting them at home and by better managing their conditions. Over time this will result in us needing less hospital beds as people are cared for at home. This initiative has been successfully piloted in a number of areas across the health board. Improving Access to GP Services There are currently 55 GP practices providing essential primary care services to their registered population. They also provide a range of enhanced services, such as some minor injury and surgical procedures, vaccinations and immunisations and services for patients with chronic diseases. 80% of patients have reported they found it either very easy or fairly easy to get through to their surgery on the phone. Access to GP services remains a key Welsh Government commitment and the health board has focussed on securing improved quality and access to GP services during core hours and extended hours and will continue to develop this throughout Successes and developments include: Hywel Dda has the largest percentage of practices in Wales opened for 100% of contracted hours or more 15 GP practices offering extended hours, either early morning or evenings A focus on patients who did not attend for their booked appointments has been initiated with further work planned for

20 Ongoing discussions are being held with six GP practices that use 0844 telephone numbers. Although this does not disadvantage landline customers it may increase costs for mobile users Half day closing is reducing with only one practice in Ceredigion, one in Pembrokeshire and five in Carmarthenshire All practices have access to the use of Language Line translation services. Polish and Chinese are the most requested languages The health board continues to improve services for hard of hearing patients through links with the RNID, specialist social workers and support workers for the deaf across all three counties alongside the development of a strategy for physical disabled and sensory impairment The Primary Care Team works in collaboration to develop an appropriate action plan to deal with access problems Quality and outcomes framework (QOF) QOF is an annual incentive programme that rewards GP practices for high quality services. The QOF process provides a wide range of comparative data that can be used to identify opportunities for service improvement. There is a rotational practice visit process undertaken by the Primary Care Team and Assistant Medical Directors to ensure continued improvement against and beyond QOF targets and that achievement claimed for is evidenced. QOF is viewed as the minimum standard expected. Dental Services There are 51 dental practices across the Hywel Dda healthcare area and significant improvements have been made in the provision of NHS dental care over recent years. Provision The new Dental Contract came in April 2006, at this time services were provided for approximately 26% of the population. This has now increased to 48%. Unregistered patient database In Pembrokeshire in 2003, an Unregistered Patient Database was established with over 58,000 patients registering their details. By February 2012 only 55 patients were waiting allocation to an NHS dentist. This is possible due to concerted efforts made in 2011, during which 9,246 patients were allocated. It is anticipated that the database can cease operation and Pembrokeshire patients will be able to register with a dentist in the same way as those living in Carmarthenshire and Ceredigion. 20

21 Hywel Dda Health Board Annual Report and Accounts 2011/12 Emergencies outside core hours The health board has been running its current weekend emergency dental service for the last six years in Carmarthenshire, and the last eighteen months within Pembrokeshire and Ceredigion. Patients who require an emergency appointment are advised to contact NHS Direct who will triage the patient, provide clinical advice and offer an emergency appointment if necessary. Uptake of service: 82% in Carmarthenshire 31% in Ceredigion 67% in Pembrokeshire Community dental service The community dental service (CDS) provides dental care for patients from vulnerable client groups who cannot access mainstream general dentistry across the three counties. The CDS provides a treatment service from clinics across Hywel Dda and on a domiciliary basis at patients homes and residential and nursing homes. CDS staff also provide support to consultant-led outreach services and provide screening, epidemiological and sedation services. Orthodontics Orthodontic treatment is available free-of-charge on the NHS for those under 18 years of age who have a clear clinical need for treatment. The Orthodontic Referral Management Centre (ORMC) receives and processes all primary care orthodontic referrals. During the period December 2010 to December 2011 the ORMC received 2,276 referrals. Urgent and complex planned care Abertawe Bro Morgannwg University (ABMU) Health Board is commissioned to provide emergency dental, cancers and complex maxillo facial procedures for the three counties. This service is provided from Morriston Hospital. Optometry Hywel Dda currently has 51 opticians across the three counties. A large number of these are involved in the Welsh eye care initiatives and are registered to provide Welsh Eye Health Examinations (WEHE) as well as participate in the primary eye care acute referral scheme (PEARS). Glaucoma referral refinement 2011/12 has seen significant success of glaucoma referral refinement and the health board is committed to further explore the possibility of using trained, accredited optometrists to provide extended examinations for the patient in their own practice and meaning that only appropriate referrals are seen in a hospital setting. 21

22 The results of this scheme in Carmarthenshire showed a reduction of over 50% of false positive referrals into the hospital eye system (HES) with a significant saving to the NHS of approximately 117 per patient. Recent re-evaluation and redesign has established this service as the gold standard for detection, diagnosis and treatment. A bid has been made to the Welsh Government to purchase equipment that will allow our primary care optometrists to provide an improved service to both the patient and HES. The glaucoma referral refinement scheme has now been rolled out to Pembrokeshire and we await the agreement and participation of the ophthalmologists in Ceredigion before it is rolled out. Unscheduled care Due to the successful relationship between our accredited optometrists and the local ophthalmologists we have recently been able to look at ways in which our primary care optometrists may be able to help in assessing patients seen in our rapid access eye clinics within the hospital eye service. These clinics are designed for emergency access for patients with acute problems, which need to be seen immediately. Unfortunately, as a recent audit has shown, many of the patients seen within these clinics are not emergencies and could be dealt with in primary care. Referrals are now triaged by nurses over the telephone at the source of referral, and where appropriate, patients are being directed to one of the primary care WECI accredited optometrists close to the patient s home. Community Pharmacies Hywel Dda has 100 community pharmacies offering a range of local services. They are able to provide a number of enhanced services such as an appointment with a pharmacist to focus on how patients use their medicines. We are fortunate in having pharmacies which are open seven days a week and for longer hours than offered in general practice. This means that there is real benefit in developing the services that community pharmacy can offer in order to improve overall access to primary healthcare. Primary and Community Care Working Together The Welsh Government s Setting the Direction and Transforming Care delivery programmes clearly outline the need for more integrated working across primary and community care. 22

23 Hywel Dda Health Board Annual Report and Accounts 2011/12 Progress to date includes: Development of seven GP lead posts for each locality with the responsibility for liaising with the community resource teams and engaging in forward planning based on the needs of the population The pilot of community virtual wards Implementation of diabetes care based on research and best practice Development of lifestyle advisor roles in Carmarthenshire working within GP practices providing advice and up to six sessions of support for people at risk of developing chronic diseases continues and evaluation in progress. Currently looking to adapt the service for Ceredigion and Pembrokeshire Working with acute medicine services to develop outreach, joint clinics and advanced access to hot clinics for chronic diseases, falls clinics, etc to deliver more services closer to home Working with the HR education department to develop a chronic disease education programme for staff working in the community Epilepsy education and training programmes introduced to enhance the knowledge and skills of generalist practitioners Specialist pain practitioners now provide clinics and deliver more interventions in the community Recruiting more volunteers for EPP Cymru to increase capacity On-going implementation of the self care strategy A Co-designed Future: The Third Sector Role in Health and Social Care Hywel Dda Health Board delivered the Wales first health and social care co-design framework to the Minister for Health and Social Services in December 2011 which we believe will help deliver world class services. A Co-designed Future: The Third Sector Role in Health and Social Care in Hywel Dda recognises the contribution of the third sector in the delivery of services to support patients and carers. The third sector is comprised of voluntary organisations, community groups, charities, faith-based organisations, social enterprises and many more and plays a key role in preventing ill health. The sector helps to provide services closer to where people live; involving people in planning and providing care, and delivering responsive services and support, particularly to the most vulnerable. However, previously the services provided by the sector may not have received the recognition they deserved, and it was clear to all that arrangements between the sector and the health board needed to be simplified. 23

24 As a result, the health board is now redefining the way it works and the report marks a new strategic direction for its joint work with the third sector in supporting health, social care and wellbeing. A Co-designed Future: The Third Sector Role in Health and Social Care in Hywel Dda is available to download from Hywel Dda Health Board s website Carers It is estimated that one in 10 people in Wales is a carer. The health board recognises and values the role of carers within our communities, supporting those who need help because of old age, physical or learning disability or ill health, including mental ill health. With an ageing population, the health board area will need more care from friends and family in the future. This is an issue that will touch everyone s life at some point. Investors in Carers Hywel Dda s Investors in Carers (IiC) scheme is an accredited award for GP practices across the three counties. The award scheme encourages GP practices to actively identify and support carers in their practice. The Investors in Carers scheme has been developed in partnership by Ceredigion Social Services, Hywel Dda Health Board, supported by the Ceredigion Carers Support Service with the British Red Cross. Out of 55 GP practices across Carmarthenshire, Ceredigion and Pembrokeshire 45 have been assessed for or awarded the Bronze Investors in Carers award and three in Ceredigion have a silver award. The practices have received the Carers Scheme award for successfully demonstrating they have processes in place to effectively identify carers and provide appropriate information and signposting to further support. The scheme complements the work that is ongoing within the health board to include training on carers issues within the professional development programme for GPs and other health professionals. 24

25 Hywel Dda Health Board Annual Report and Accounts 2011/12 4Investing in our future Whilst we continue to invest in care closer to home, we will ensure that when patients do have to go in to hospital, they will get the highest quality care, in the best facilities. Carmarthenshire 24/7 stroke treatment across Carmarthenshire In May 2011, thrombolysis intervention became available to suitable stoke victims 24 hours a day, seven days a week at both Prince Philip Hospital and Glangwili General Hospital. This potentially life saving treatment is now available at all four acute hospital sites. Rheumatology day unit at Prince Philip Hospital A new rheumatology day unit opened at Prince Philip Hospital in October The new unit provides care for rheumatology patients who require intravenous (IV, through a needle) drugs to manage their condition. Previously patients could only receive this treatment at Singleton Hospital or The Princess of Wales Hospital in Bridgend. The spacious unit provides a safe and comfortable environment for at least four patients a day, with access to TV, radio and magazines to help pass the time. Critical care unit at Glangwili Hospital The new 18 bed critical care unit was commissioned in August This project represents a circa 9m investment in providing state of the art services. Sterilisation and decontamination unit at Prince Philip Hospital Prince Philip Hospital s sterilisation and decontamination unit (HSDU) and the endoscope decontamination unit (EDU) combined in October 2011 to become a centre of decontamination excellence following the instalment of a revolutionary 500,000 new system. The state of the art centralised HSDU and EDU became only the second endoscopy unit in Wales to achieve this efficient way of working. 25

26 The extra space within the endoscopy unit is now available to increase privacy and dignity for patients, in line with Joint Advisory group (JAG) standards for endoscope decontamination recommendations. Acute clinical decisions unit at Glangwili Hospital The acute clinical decisions unit ACDU project was commissioned August This facility will provide a new 34 place clinical decisions unit which will provide a range of facilities including single bed rooms, multi bed wards and ambulatory areas (capital value - 8.8m). Engineering infrastructure upgrade Completion of a further three phases of the Engineering Infrastructure Upgrade at Prince Philip and Glangwili Hospitals (capital value 1.8m). Ceredigion Front of house development, Bronglais Hospital This investment marks the health board s largest capital project. Construction work on the new build element of this project is now well under way, scheduled for commissioning in February The refurbishment elements of the project will continue up to November 2015 (capital value - 38m). The facility has been designed to meet the current and future needs of Ceredigion and its surrounding areas and includes: A new emergency department, clinical decisions unit, and GP out of hours service, speeding up access to treatment and reducing inappropriate hospital admissions Purpose-built day surgery unit, incorporating two day case theatres New short-stay surgical ward New maternity unit, including relocating antenatal and paediatric clinics Refurbishment of existing accommodation to relocate pathology services to establish an integrated blood sciences department to improve turnaround times and Refurbishment of the main theatre suite The enabling works to facilitate the main development were completed in January Construction work on the new build has now commenced and will continue over four and half years and is due to be completed in late Bronglais ward refurbishment Following an 18 month refurbishment programme at Bronglais Hospital, two wards reopened and were renamed by staff. A new day case ward has been called Tirion meaning gentle in Welsh. The ward provides an admission and discharge area, which has relieved pressure on staff on other wards, as well a minor procedures room and the pre-assessment service. 26

27 Hywel Dda Health Board Annual Report and Accounts 2011/12 The refurbished orthopaedics and general surgery ward is now named Ceredig which means kindness in Welsh. JAG accreditation for Bronglais endoscopy unit In February 2012, Bronglais Hospital s endoscopy unit became the first in Wales to be awarded JAG Accreditation. JAG Accreditation is achieved through a peer review visit process that assesses all aspects of an endoscopy service, including clinical quality, quality of the patient experience and workforce issues. In Wales, Bronglais Hospital is the first Unit to have achieved this status. The report stated: The unit should be congratulated on high standards of leadership, teamwork, safety and facilities. There is a highly experienced and obviously caring and committed staff workforce. This is a patient centred service. It has outstanding waiting list management and booking systems which other units could learn from. Energy centre development at Bronglais The replacement of the main boilers and central heating plant was completed in February This new facility is delivering substantial energy and carbon efficiencies (capital value - 2.8m). Pembrokeshire Renal dialysis unit The Welsh Government has announced a 7.5million funding for a 21 station Renal Dialysis Unit to replace the temporary six bed unit. The new unit will deliver vital renal services for the patients of West Wales, providing environmental and patient focussed designs required of modern renal unit. Research and Development The past year has seen the introduction of a national R&D office who work closely with the local office in considering new studies being run within the health board. The health board has also developed its own portfolio of research projects from a variety of specialist areas such as physiotherapy, ENT, diabetes and respiratory medicine. A major development has been the creation of a Health Board Clinical Research Unit based at Prince Philip Hospital which will improve the research facilities available in the health board to a very high level. The department and researchers within the health board continue to work in conjunction with and foster relationships with commercial and noncommercial researchers, other NHS institutions and academic partners. 27