WELSH HEALTH CIRCULARS. Status RAG/ Schedule / A. Completion Work in. Completed. Expected Date of. Progress Work. R-behind.

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1 WELSH HEALTH CIRCULARS WHC of in G - 001_17 The New Treatment Fund - Access to medicines recommended by the National Institute for Health and Care Excellence (NICE ) and the All-Wales Medicines Strategy Group (AWMSG). 20/04/2017 To note the new Directions which come into force from 26 April The Directions require all health boards to make medicines recommended by NICE and AWMSG available as soon as is reasonably practicable and certainly within two months of the published recommendation. Director of Primary and Community Care and Mental Health o o o New Treatment Fund now in place- collaborative work undertaken by Chief Pharmacists to develop intelligence and local systems. In Powys a Group is being established- draft TOR in place. The Medicines Management Team is engaged with the national work. Medical Director is directly supporting this work 002_17 Terms and Conditions of Services Community Dental Services (Wales) 20/01/2017 To note referral to this document in the application of terms and conditions for community dentists. Director force and OD January _17 HPV Vaccination for Men who have Sex with Men 13/01/2017 To note, and implement with effect from 1 April 2017, a new targeted human papillomavirus (HPV) immunisation programme that will be offered in sexual health clinics to men who have sex with men (MSM). Director of Public Health 1 April 2017 Circular cascaded in line with guidance (following initial discussion at Powys Vaccination Group, in vember 2016). Of more direct relevance to relevant PTHB commissioned services. Will be kept under review at Powys Immunisation Group through its routine arrangements (awaiting clarification for commissioned services). 004_17 Ordering Flu Vaccine for the 2017/18 Season 26/01/2017 To note and action advice on ordering supplies of influenza vaccine for the season. Director of Public Health Circular cascaded in line with guidance. Primary care elements delivered via GMS. Practices reminded regarding importance of further increasing uptake. Will be kept under review as part of the wider flu programme, through the Steering Group, in season. Page 1 of 14

2 of in G - 005_17 THE 2017 European Centre For Disease Control (ECDC) National Healthcare Associated Infection, Device Usage And Antimicrobial Usage Point Prevalence Survey 31/03/2017 All hospitals to participate in the 2017 point prevalence survey (PPS). As data will be collected using the new infection prevention & control case management system currently being rolled out across Wales (ICNet), it is essential that IT resource and solutions are in place and made readily available to facilitate data capture. In addition, availability of IP&C and ward pharmacy staff should be considered in advance of the survey. PTHB fully participated in the PPS. Results are awaited. 006_17 The Healthcare Travel Costs Scheme: Instructions and Guidance for Health Boards and NHS Trusts in Wales 23/03/2017 To implement the healthcare travel costs scheme guidance from 1 April Director of Primary & Community Care and Mental Health 1 April 2017 HTCS is set up to provide financial assistance to those patients who do not have a medical need for non-emergency patient transport, but who require assistance with their travel costs. Under the Scheme, patients on low incomes or receiving specific qualifying benefits or allowances are reimbursed in full, or in part, for costs incurred in travelling to receive NHS services provided in a hospital. Guidance followed across the rth and South Localities; it has been updated to include Universal Credit, but the core process appears the same; it is well established at each site; cashier and cashier office on each site, including community. Forms in use, entitlement checked, reasonableness logic applied, reimbursements made on the day, retrospectively and via the orange HC5 forms. 007_17 Ears, se and Throat Follow Up Guidelines 03/07/2017 For implementation to ensure that all follow ups are managed in accordance with the guidance Director of Primary & Community Care and Mental Health September 2017 The details of reimbursements claims are then all submitted to HQ Finance each month. Guidelines issued to localities. ENT group will ensure implementation in line with guidance and Commissioning Team will monitor external contracts. 008_17 NHS Wales Policy for the Repatriation of Patients 08/03/2017 To highlight the publication of the NHS Wales Policy for the Repatriation of Patients. Director of Primary & Community Care and Mental Health issued to Senior management Page 2 of 14

3 of in G - 009_17 010_17 Good Practice Guidance on the Provision of Mental Health Support for Asylum Seekers and Refugees Dispersed to Wales tification of Caldicott Guardian Guidance 23/02/2017 To note that Welsh Government has made available 40,000 to commission psychological trauma training for staff in both Adult and Child and Adolescent Mental Health Services in order to manage trauma in refugee and asylum seekers and to consider how provision of mental health services is provided to this cohort.. 21/04/2017 To note that the UK Caldicott Guardian Council (UKCGC) has recently issued A Manual for Caldicott Guardians as an aid to Caldicott Guardians in performing their role. Director of Primary & Community Care and Mental Health Medical Director 27 February 2017 Trauma specialists in place in our own service. Where complex trauma psychological support is required for patients, this service is either directly provided by the Powys service or commissioned on a bespoke basis. Powys CAMHS offers a service to asylum seekers though the agreed referral routes. The service has staff trained in therapies that address Trauma. The All Wales training for working with trauma specific to asylum seekers is being delivered again in the new year and staff from the service will attend to ensure that we have the appropriate skills in the team to address the issues. In relation to the other document and the reference to freedom from torture. These services are advertised as being available across the UK therefore referrals would be made as appropriate. However the training that we are due to attend on working with trauma specifically related to asylum seekers should provide staff with the relevant skills to reduce the requirement of referring to a national service. They would be available through to offer assistance should this be required. WHC For information The manual brings together information on: The role of the Caldicott Guardian Learning and development Relevant legislation Links to other help and guidance This will inform the ongoing work of the Caldicott Guardian 011_17 HCAI Reductions By March 2018: C.Difficile, S.Aureus Bacteraemias And E.Coli Bacteraemias 31/03/2017 Ensure joint working between primary care and secondary care and with social care partners to deliver the expected reduction in Healthcare associated infections (HCAIs) by end March March 2018 PTHB are not referenced within this WHC and no reduction has been set for PTHB at a national level. ICNET has gone live. 012_17 Local Government Elections 2017 Guidance 17/03/2017 Ensure guidance provided to NHS employees on their role and conduct during the forthcoming local election campaign is followed from the start of the pre-election period on 13 April up to and including polling day on 4 May. Board Secretary A Powys Announcement was issued 21 March 2017 Page 3 of 14

4 of in G - 013_17 Dispute Arbitration Process - Guidance for Disputed Debts (invoices and service agreements) within NHS Wales / /19 23/03/2017 To note and action revised guidance for disputed debts between Welsh NHS bodies and to note the change in timescales for service agreement disputes and invoice arbitrations. Director of Finance ing with Commissioning Unit to ensure that resolutions are sought and arbitration is viewed as the extreme exception. 014_17 Patient information on the Putting Things Right (PTR) arrangements 29/03/2017 To note and distribute the renewed Putting Things Right patient information leaflets. Ensure all out of date information is removed from circulation. To raise awareness of the renewed patient information with the public, staff and stakeholders. Leaflets received from Welsh Government and disseminated across PTHB. Posters only arrived from Welsh Government end of last week, to be distributed. Out of date information is currently being collected in. Powys announcement currently being drafted to indicate new leaflets, etc. Leaflets available on the internet for patients. The intranet is currently in the process of being updated. This action has been addressed 015_17 The implementation of an employer led model of Clinical Supervision for Midwives in Wales 01/04/17 To note the requirement to implement the new model for Clinical Supervision for Midwives in Wales An implementation and monitoring group has been set up by Welsh Government and will include a commissioned evaluation in 2017/18. further action. The new model is in place. 016_17 017_17 The Annual Quality Statement 2016/17 Changes to the shingles immunisation programme 30/03/17 To publish an Annual Quality Statement. This should form part of the organisation s annual reporting process 07/04/17 Delivery and monitoring of The Shingles Vacination Programme Director of Public Health 1 April July 2017 The AQS has been developed, the first draft went out for consultation and comments received by 8 May The second iteration has been drafted and sent to Committee and PEQS Committee 22 June 2017, with approval by Board planned 19 July Intended publication date no later than 31 July Communication team working with Q&S Unit re final formatting and design of document, including Welsh translation. The final draft AQS is on the agenda for Board Circular cascaded in line with guidance. Primary care elements delivered via GMS. Reviewed at Powys Vaccination Group on 13 June 2017 as part of routine arrangements. Supporting resources also cascaded to Powys general practices. Page 4 of 14

5 of in G - 018_17 Reduction in hospital food waste target from unserved meals to 5% 07/06/2017 Welsh Government requests that the target for food waste from unserved meals should be reduced from 10% to 5%. Director of Primary & Community Care and Mental Health Target to be met by June 2017 The performance of the NHS bodies to monitor food waste will be assessed by Welsh Government when the EFPMS report is formally submitted by NWSSP-SES in early autumn A ward based monitoring programme has been introduced which will allow improved communication to reduce waste. Levels are currently below 5%> Target being met PTHB has taken patient food waste monitoring a step further as we are not satisfied that the national approach gives us enough detailed data about food waste. We have developed an electronic in house food waste tool which deals with this issue whilst maintaining the ability to isolate the unserved meal element for national reporting purposes against the 5% target. The in-house developed audit tool is used on an unannounced basis monthly at each of our sites during the main meal service. 1. It measures firstly wasted portions from production in the kitchen i.e. made too much mashed potato, custard, cabbage etc. 2. It allows a cross check with meals ordered by ward staff with the number of patients requiring a meal on the ward. 3. It records the number of unserved portions of main meals (for national reporting purposes) as well as portions of the other menu items unserved. 4. Finally to completely close the loop, it measures menu portions left on the plate. It can be said that PTHB exceeds the requirements of the WHC with regards to monitoring the levels of patient s food waste to assist in meeting the 5% target. 019_17 Financial Returns Guidance 28/04/2017 The 2017/18 LHB and Trust monthly financial monitoring return guidance and associated submission templates for completion and submission by predetermined deadlines. Director of Finance and ongoing 020_17 General Election /04/2017 Guidance on the impact of the pre-election period on Local Health Boards and Trust activities from the start of the pre-election period on 22 April up to and including polling day on 8 June. Board Secretary A Powys Announcement was issued on 27 April 2017 Page 5 of 14

6 of in G - 021_17 National Enhanced Service Specification for the unscheduled vaccination of children and young people who have outstanding routine immunisation 10/05/2017 Implementation of the new National Enhanced Service Specification for the unscheduled vaccination of children and young people who have outstanding routine immunisations. Directed at GP practices delivering vaccination and immunisation services in Wales Director of Primary and Community Care and Mental Health For immediate implementation All Practices have received the specification and have signed up to its implementation 022_17 Change of vaccine for the routine primary infant immunisation 023_17 Re-focussing of the Designed to Smile child oral health improvement programme 12/05/2017 To implement the change to of vaccine to Infanrix hexa (DTaP/IPV/Hib/HepB) from both Pediacel and Infanrix-IPV+Hib (DTaP/IPV+Hib) for primary baby immunisations. This change means that as well as providing protection against diphtheria, tetanus, pertussis, polio and Hib, babies will also be given protection against hepatitis B virus. 16/06/2017 To follow the required actions to continue the effective delivery of D2S. CDS and D2S teams will Liaise with Welsh Oral Health Information Unit (WOHIU) to identify target settings. Focus primarily on children aged 0-5 years, although school based tooth bushing can continue up to and including year 2 children. Proactively engage with general dental practice teams to support practice delivery of evidence based prevention for children. Director of Public Health Director of Primary and Community care and Mental Health September 2017 Circular cascaded in line with guidance. Primary care elements delivered via GMS. Reviewed at Powys Vaccination Group on 13 June 2017 as part of routine arrangements. Changeover anticipated autumn te: the planned change involves the type of vaccine; there is no change to the immunisation schedule. te: May 2017 National Cover Report PTHB was second best performing health board for % uptake of all scheduled vaccines by children reaching their 4 th birthday in the specified time period. ing group set up. Plan in place to target 0-5 year olds. Powys never started FS programme. Have already engaged with GDS through D2S GDS/PDS contract several years ago. Need to set up programme to engage with other GDS. Training will be delivered by D2S team and wider CDS e.g. Dental Therapists/DCP s with OHE qualification. Already met with Health Visitors and actively working together. Pathway already in place and resources allocated. Screening as part of D2S stopped. RWS will be only OHE delivered to wide audience. Data collection already in place. D2S has process in place to link with WOHI unit. Target settings already done. Training ongoing with selective groups, eg student Health Visitors Page 6 of 14

7 of in G - 024_17 National Planned Care Programme Follow up priorities 025_17 Guidance on Cyber Security and Information Governance requirements relating to suppliers and the supply-chain closely with Health Visitors as part of the Healthy Child Wales Programme Provide consistent and evidence informed training to identify groups including student health visitors. Follow advice as provided in the updated How to Guide which supports teams to deliver the programme efficiently and safely. longer deliver fissure sealants as part of D2S. longer provide screening as part of their D2S work in schools. Provide data as required to support programme monitoring. CDS Clinical Directors will review D2S team capacity to deliver the refocused programme. 28/09/2017 The Planned Care Programme has been established to deliver sustainable services across scheduled care in Wales. The Programme is focusing upon five key specialities orthopaedics, ophthalmology, ENT, urology and dermatology. 04/07/2017 To be aware of all third parties holding, accessing or handling staff or patient identifiable data, and ensure that the appropriate level of assurance is evidenced and maintained on an ongoing basis. This is to be done in relation to both Director of Primary and Community Care and Mental Health Board Secretary and Director of Finance and IT October 2017 is being taken forward to establish a baseline against the issues and identify gaps in IG arrangements Under review and taking into account the circular. Legal are reviewing and we are expecting to publish revised T&Cs later in August. These revised T&Cs would take into account Cyber and GDPR amongst the change. Page 7 of 14

8 of in G - 026_17 Prescribing of coproxamol the data and the contract with the supplier. All controls are to be reviewed on a regular basis and updated to reflect new or amended legislation and the adoption of any revised best practice released by industry experts. There are a list of Cyber Security controls which should be used, depending on the assessed level of risk to systems/data. 16/06/2017 This circular requires that health boards identify all GP practices in their area and any clinical areas within secondary care, where there has been prescribing of coproxamol in the previous year. All prescriptions for coproxamol should be urgently reviewed with the intention of switching patients to alternative, safer treatments. Health board medical directors working with their Chief Pharmacists to put in place mechanisms Medical Director On the 8 th May the Medical Director wrote to all GP practices in Powys where a record of Coproxamol prescriptions had been recorded. Practices were reminded of the advice of the Committee on Safety of Medicines (2005) and subsequent further evidence of toxicity. Practitioners were advised of the importance of reviewing each case to advise patients on the potential risks and alternative treatments. 027_17 Clinical Musculoskeletal assessment Treatment Service (CMATS) 12/09/2017 The Welsh Orthopaedic Board has agreed an integrated (primary and secondary care) approach to providing an Musculoskeletal assessment service as a first point of contact for General practitioner and emergency department referrals for the assessment and treatment of Musculoskeletal related pain outlined. Director of Therapies and Health Science WHC Received September 2017 DoTHS Agreed October 2017 Scoping Meeting 28th vember 2017 Page 8 of 14

9 of in G - 028_17 NHS Wales Blood Health Plan 029_17 All Wales Guidelines for the Management of Devastating Brain Injury 28/09/17 To note the publication by the Welsh Blood Service of the NHS Wales Blood Health Plan ( the Plan ) that has been developed by staff across NHS organisations, supported by the Health Board/Trust Medical Directors, and coordinated by the Welsh Blood Service ( WBS ). 26/07/2017 This circular highlights the publication of the All Wales Guidelines for the Management of Devastating Brain Injury produced by the Welsh Intensive Care Society (WICS). The health board should, where appropriate, work with clinical colleagues to ensure guidelines are taken into consideration. Medical Director This will be considered at the Transfusion Committee For Powys this will only be relevant in Commissioned Services In the current LTA documentation (2017/18) there are references to national guidance and legislation etc. which Providers must follow. These clauses are included in both English and Welsh LTA documentation 2017/18. These are:- Clause Compliance with National & Local (Provider & Commissioner) Policies and Guidance :- The provider shall:- Comply with all relevant statutory and regulatory requirements relating to the National Health Service (including any re-enactment or amendment thereof) together with duties under common law and other obligations to be observed and performed in connection with the provision of services for patients as part of this Agreement; Medical Director 1 October 2017 Comply with the provisions of nationally mandated guidance on treatment and access to NHS secondary care for any conditions which are likely to be related to the services covered by the LTA e.g. Priority Treatment and Healthcare for Veterans; Support and deliver the key objectives, principles and targets of the Commissioner (PTHB) set by the Welsh Government in national strategies, circulars and best practice guidance documents that are relevant to the delivery of patient services covered by the Agreement; Under the Disputes Section there is a clause Clause 7.2 Where any conflicts are identified between the requirements of this LTA, and any national directives and circulars, the requirements of the latter shall take precedence. There are other references to WHC guidance in the LTA documentation but these are specific to certain requirements e.g. NICE guidance, National Data sets. Circular will need to be reviewed in more detail in order to determine whether there is any additional action required for English Providers. Page 9 of 14

10 of in G - 030_17 t yet issued 031_17 The National Influenza Immunisation Programme /06/2017 To implement the changes incorporated in the influenza programme in Wales. Director of Public Health For action and ongoing through October 2017 to April 2018 Already picked up as part of forward planning for 2017/18 season. A series of wash up reviews of the 2016/17 season have been completed and are influencing 2017/18 planning. Some central changes have been made to national targets Will be monitored through the Powys Influenza Steering Group routine arrangements 032_17 Implementation of Pre- Exposure Prophylaxis in Wales 033_17 List of Welsh Health Circulars - 1 October May /07/2017 To ensure arrangements are in place for sexual health services in Wales to offer Pre-Exposure Prophylaxis (PrEP) for the prevention of HIV to be made available to individuals for whom it is clinically appropriate 07/07/2017 List of Welsh Health Circulars covering the period 1 October 2016 to 31 May Director of Primary & Community Care and Mental Health Board Secretary For immediate implementation We currently have no sexual health clinics in Powys through which we would provide this service. It is not something that would be provided through GP services. The identified groups would have to access PrEP through out of county sexual health services. Reimbursement to these services comes through Public Health Wales not the health board of patient residence. Check made to ensure all WHCs are recorded and actioned. 034_17 Policy on the Management of Point of Care Testing (POCT). What, When and How? 12/07/2017 To provide an update of Guidance on Point of Care Testing for immediate implementation For immediate implementation Action already commenced. Representatives of the Quality & Safety Unit met with the Director of the Wales External Quality Assessment Scheme (WEQAS) in March, following which the Quality & Safety Manager is now a member of the All Wales POCT Group. Additionally, the Quality & Safety Manager has been provided external quality assessment training via WEQAS to support an EQA programme across the health board. The first meeting of the POCT subgroup is being arranged; this subgroup will report into the Diagnostics Board. This will provide structure, oversight, set out governance arrangements and develop a work programme for the current planned and initiated work streams across the health board; these include the Directed Enhanced Service: Oral Anticoagulation with Warfarin, D-Dimer, CRP and Blood Glucose Monitoring. A draft POCT policy is in place and being finalised prior to consultation and approval. This sets out the need to follow best practice in all aspects of the procedures undertaken, adhere to uniform standards across all PTHB sites, including the community, comply with all national standards and demonstrate compliance. Page 10 of 14

11 of in G - 035_17 Guidance on n-medical Prescribing in Wales 036_17 Guide to Consent for Examination or Treatment Revised Guidance 12/07/17 To note that guidance on n-medical Prescribing in Wales has been updated in line with the The National Health Service (Therapeutic Radiographer Independent Prescriber and Dietitian Supplementary Prescriber) (Miscellaneous Amendments) (Wales) Regulations 2016 regulations which came into force on 9 January The guidance provides information and advice to promote good practice for non-medical prescribing in Wales. It replaces n-medical Prescribing in Wales Guidance 2015 and all previous guidance. 24/07/2017 To provide an update on Guidance for Consent for Examination and Treatment Medical Director For immediate implementation The National Prescribing centre (2010) recognises that the practice of NMP affords wider and faster access to medicines for patients, through the more flexible use of workforce skills. Extending the practice of Nurses, Pharmacist and Therapists to include NMP has been an approach aimed at improving continuity of care and patient experience, whilst at the same time increasing autonomy for practitioners. These benefits were referenced in the review on n-medical Prescribing in NHS Wales (2017). Quarterly Continuous Professional Development (CPD) events are developed and facilitated by the Medicines Management Nurse to support the NMP. NMP s are required to maintain a portfolio of their CPD as prescribers. It is the responsibility of the individual to keep up to date in their field of practice and any changes in local or national policy. The NMP s developmental needs must also be included in personal development plans and evidenced through the appraisal process and subsequent reviews. The Medicines Management unit supports the development, registration and prescribing practice of appropriately trained and registered n-medical Prescribers employed by PTHB. The PTHB n-medical Prescribing policy has been reviewed and together with the recently developed NMP guidelines have been approved The Medicines Management unit holds and actively maintains a register for NMP s. With the above in place, PTHB is compliant with the recommendations from the National review. National work has been undertaken on the consent process Revised WG Guidance to Consent for Examination or Treatment was issued in July Revised NHS Wales Model Policy and consent forms are being produced by the National Consent Group. These documents will be taken through the Medical Directors Group for approval. This will then be reviewed for adoption as the Powys policy. is being undertaken to identify the training provision that will be required to support the increased focus on shared decision making and co-production. Welsh Risk Pool is seeking tenders for an e learning package. 037_17 NHS Wales Peer Review Framework 24/07/2017 This framework guidance should now be used to ensure peer reviews are carried out consistently and pragmatically, and produce measureable benefits Medical Director For immediate implementation There are well-established case review processes in Midwifery led care which form a strong basis for the peer review process The national framework describes governance arrangements which include a role for the NHS Wales Health Collaborative Team to manage an all Wales programme. Clarity is being sought from Welsh Government by the Chair of the MD Peer network to determine the expectation for action within Health Boards at this stage. 038_17 BCG Vaccine Supply and Ordering in Wales 27/07/2017 To note and implement new arrangements for the BCG vaccination programme as the result of improved vaccine availability. Director of Public Health Circular cascaded in line with guidance (procurement issue) Reviewed at Powys Vaccination Group as part of its routine arrangements. Receipt and circulation confirmed at PVG Discussed at the immunisation training provided for Powys primary care staff by PTHB Immunisation Coordinator Page 11 of 14

12 of in G - 039_17 Introduction of the hexavalent ( 6 in 1 ) vaccine including hepatitis B into the routine immunisation schedule for babies born on or after 1 August _17 National Dermatology Implementation plan 09/08/17 To action replacement vaccination. As notified in WHC 2017/22, in late September/early October, Infanrix hexa (DTaP/IPV/Hib/HepB) will replace both Pediacel and Infanrix/IPV+Hib (DTaP/IPV+Hib) for routine childhood immunisations at 8, 12 and 16 weeks of age for children born on or after 1 August /09/2017 The purpose of the National Dermatology Implementation Plan is to improve patient experience and deliver sustainable services. The plan builds on a series of developments in Wales to provide a balanced service change for implementation by health boards across Wales. Director of Public Health Director of Primary & Community Care and Mental Health September 2017 Circular cascaded in line with guidance. Reviewed at Powys Vaccination Group as part of its routine arrangements. Receipt and circulation confirmed at PVG Discussed at the immunisation training provided for Powys primary care staff by PTHB Immunisation Coordinator 6:1 vaccine now being used for all babies born on or after 01 August 2017, replacing the 5:1 at 8, 12, and 16 weeks Will be kept under review by the Powys Vaccination Group A Dermatology Planned Care Board has been established and will review the recommendations for such, with specific emphasis on the level, range, location and volume of service that can be delivered locally within Powys on the basis of primary care practitioners and support for secondary care specialists 041_17 Armed Forces Covenant - Healthcare Priority for Veterans 042_17 Addressing the impact of NHS Wales Medical and Dental Agency and Locum deployment in Wales 05/09/ 2017 To raise awareness among GPs, consultants, allied health professionals and administrative staff, when making referrals for diagnosis or treatment, or arranging waiting lists, of the Armed Forces Covenant regarding a commitment to provide priority treatment for veterans suffering from health conditions directly related to their Service. 23/10/17 To comply with the arrangements for a programme of coherent and coordinated system wide action across the NHS in Wales aiming to drive down agency and locum deployment and expenditure whilst maintaining the delivery of a safe and sustainable service across Wales. Director of Public Health Director of force and OD For immediate action Effective from 13 vember 2017 Circular circulated to relevant PTHB officers for information and action (commissioning; mental health; public health) Will be circulated to primary care under cover of a specific and tailored PTHB letter, which is currently being prepared Will also be discussed at next meeting of Powys Allied and Ex-forces Forum Response sent to WG on 3 rd vember 2017 Page 12 of 14

13 of in G - 043_17 Managing babies born on the threshold of survival 20/09/17 To set out and follow a clear position in respect of the management of premature babies on the threshold of survival meeting the requirements of this guidance. Director of Nursing For immediate action Midwives would undertake basic life support and transfer by ambulance EMRTS. They can t make a decision not to resuscitate. The EMRTS medic may decide to stop resuscitation but most would probably continue as gestation assessment can be really difficult and we know that sometimes a day either way can make a difference in how babies do. So basically we ve kept it simple for the out of hospital, our last such case hit 12 this year. 044_17 Guidance for the care of children and young people with continence problems 045_17 t yet issued 15/09/17 This circular provides guidance for health boards in respect of the provision of continence containment products for children and young people. For immediate action This draws attention to the discriminatory wording of the previous continence guidance which supported a limit of 4 products a day for children or young people who are incontinent. It was felt that a custom and practice approach was being used to prescribe products and that children for whom toilet training was not achievable were being denied a full and robust assessment of their continence needs. This new guidance supports an assessment pathway which is locally agreed to ensure that support for toilet skill development is commenced early i.e. professionals do not wait for a child to show signs of continence, and also that robust assessments take place to identify issues which may be preventing or delaying a child to achieve continence. A range of continence products must be considered with the child s dignity in mind. This is all included in the work undertaken for the Bevan project and it would be pertinent to ensure that our pathway is agreed and signed off as soon as possible. 046_17 Amendment to the Human Medicines Regulations 2012 Supply and Use of Adrenaline Auto Injectors in Schools 02/10/2017 To note the introduction of the exemption allowing schools to obtain, hold and use adrenaline autoinjectors in the emergency treatment of anaphylactic reactions. Director of Primary &Community Care and Mental Health The guidance was published on 25 th October. Guidance has been forwarded to School Nurses, and also Community Pharmacies have been alerted to the potential that they will receive requisitions for the Adrenaline Auto Injectors from schools. 047_17 NHS Planning Framework 2018/21 11/10/17 Local health boards are directed by WG to produce the plans that are required to be produced in the attached NHS Planning Framework 2018/21. Director of Planning and Performance 31 January _17 Attaining the WHO targets for eliminating hepatitis (B and C) as a significant threat to public health 17/10/17 Measures to be put in place to: 1. Reduce and ultimately prevent ongoing transmission of hepatitis C (HCV) within Wales; 2. Identify individuals who are currently infected with HCV including those who have acquired HCV Director of Public Health For immediate action The primary at risk group for HCV infection are injecting drug users and procedures are already in place in Powys to identify and treat injecting drug users as part of existing substance misuse services. The contents of this WHC will be discussed at the next Powys Substance Misuse Area Planning Board in December to agree what further actions are required to support attainment of the WHO target of a 90% reduction in incidence and 65% reduction in mortality due to hepatitis by Page 13 of 14

14 of in G - 049_17 Nurse Staffing Levels (Wales) Act 2016 Statutory guidance outside the UK and are now resident in Wales; 3. Test and treat individuals currently infected with HCV who are actively engaged in behaviours likely to lead to further transmission. 02/11/17 Receipt of the final published version of the Nurse Staffing Levels Act (Wales) Statutory Guidance which provides explanations of the key terms used in sections 25B and 25C, such as nurse staffing level and professional judgement. to support workforce planning and deployment ahead of the second duty coming into force in April. 1 April 2018 Page 14 of 14