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 Board Meeting 27 September 2017 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 11

2 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. Arrangements commenced and progressing. The Start for PPS in PTHB week commencing 12 June 30 June Training to compete the PPS arranged for Wednesday 7 June pm. This will be provided by Dr Wendy Harrison and involve pharmacists and nurses including mental health nurses for the four wards (Crug, Clywedog, Felindre and Tawe). We will be completing the PPS on the 9 community hospital sites. Each hospital will require one day for this work to be carried out, hence 9 days over the three week period. (see below) We will start with the larger community hospitals, also noting that we will need to include mental health. The order will be: o Ystradgynlais Hospital o Llandrindod Wells o Welshpool o Brecon o Bronllys o Knighton o Llanidloes o Machynlleth o Newtown A pharmacist and nurse will work alongside each other on the same day at each site. The new senior IP&C nurse will be in her second week of induction into the HB and she will be on site to work alongside the ward manager (or other allocated person). A schedule of the visits is currently being developed for the 3 week period. ICNet and an App will be available for use. PPS continues, with no issues, and concludes the end of June. National report expected in September 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. 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 Guidelines issued to localities. ENT group will ensure implementation in line with guidance and Commissioning Team will monitor external contracts. Page 2 of 11

3 in G - 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 009_17 Good Practice Guidance on the Provision of Mental Health Support for Asylum Seekers and Refugees Dispersed to Wales 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.. Director of Primary & Community Care and Mental Health 27 February 2017 Trauma specialists in place in our own service but the action noted was for All Wales rather than Powys specific response which we would have access too. We are not aware of progress against All Wales action. 010_17 tification of Caldicott Guardian Guidance 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. Medical Director 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 and no reduction has been set for PTHB at a national level. However, within PTHB we have set a target of reducing HCAIs across the health board, but in light of the validation work in March & April 17 which identified an increased number of C Diff and staph aureus Bacteraemia (MRSA and MSSA) the reduction trajectory needs to be revisited and updated. We will also need to progress work this year strengthening efforts to tackle E.coli bacteraemias. At this point in time we do not collect this data, but through ICNet we will be able to understand what our current position is. ICNet go live date will be before the 12 June 17. Page 3 of 11

4 in G - 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 _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 the 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 The Annual Quality Statement 2016/17 30/03/17 To publish an Annual Quality Statement. This should form part of the organisation s annual reporting process 31 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 Page 4 of 11

5 in G - 017_17 Changes to the shingles immunisation programme 07/04/17 Delivery and monitoring of The Shingles Vacination Programme Director of Public Health 1 April 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. Supporting resources also cascaded to Powys general practices. 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%> 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 Being submitted as required. 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 _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 Page 5 of 11

6 in G - 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. 4 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. closely with Health Visitors as part of the Healthy Child Wales Programme Provide consistent and evidence informed training to identified groups including student health visitors. Follow advice as provided in the 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 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 eg 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 11

7 in G - 024_17 t yet issued 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. Directors will review D2S team capacity to deliver the refocused programme. 025_17 Guidance on Cyber Security and Information Governance requirements relating to suppliers and the supply-chain 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 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. Board Secretary and Director of Finance and IT 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 11

8 in G - 026_17 Prescribing of coproxamol 027_17 t yet issued 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. 028_17 t yet issued Page 8 of 11

9 in G - 029_17 All Wales Guidelines for the Management of Devastating Brain Injury 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. For Powys this will 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 guidance in the LTA documentation but these are specific to certain requirements e.g. NICE guidance, National Data sets. 030_17 t yet issued 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 11

10 in G - 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 s 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 035_17 t yet issued Page 10 of 11

11 in G - 036_17 Guide to Consent for Examination or Treatment Revised Guidance 24/07/2017 To provide an update on Guidance for Consent for Examination and Treatment Medical Director For immediate implementation 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 Page 11 of 11